A Physician’s New Reality: Patients A...
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“Don't trust the internet!”

Since: Jan 12

Location hidden

#102 Nov 26, 2012
Wait what wrote:
<quoted text>
The Barr Code
Georgia Court: Personal medical records are fair game for government snooping
http://blogs.ajc.com/bob-barr-blog/2010/07/23...
Not quite an open book. As I read it, a subpeona is still required. And this has not yet been taken to the federal Supreme Court for conflicts with FERPA.

“Ludibrium est onus genio”

Since: Dec 11

Planet Earth

#103 Nov 26, 2012
Simple. Don't accept insurance any more. Demand payment upfront, and tell the patient they have to seek reimbursement from their insurance provider.
VADoc

Warrenville, SC

#104 Nov 26, 2012
TonyD2 wrote:
Simple. Don't accept insurance any more. Demand payment upfront, and tell the patient they have to seek reimbursement from their insurance provider.
I did a short stint at an office that did this for Medicare. They were not Medicare providers but patients could see them and pay upfront and submit to Medicare for reimbursement. It's called not taking assignment under Medicare. They still saw a ton of patients because they were good. Patients loved them and kept coming back.

I think once Obamacare hits the only places that will accept assignment will be hospitals and large non profit clinics. Anyone who is in private practice won't be able to stay afloat at the reimbursement rate for Obamacare if it's like Medicaid and Medicare.

“Don't trust the internet!”

Since: Jan 12

Location hidden

#105 Nov 26, 2012
VADoc wrote:
<quoted text>
I did a short stint at an office that did this for Medicare. They were not Medicare providers but patients could see them and pay upfront and submit to Medicare for reimbursement. It's called not taking assignment under Medicare. They still saw a ton of patients because they were good. Patients loved them and kept coming back.
I think once Obamacare hits the only places that will accept assignment will be hospitals and large non profit clinics. Anyone who is in private practice won't be able to stay afloat at the reimbursement rate for Obamacare if it's like Medicaid and Medicare.
It's kind of a six of one, half dozen of the other kinda deal. By not accepting assignment, The physician is not bound by the payment structure of Medicare. What Medicare doesn't pay can be billed to patients. If you have enough patients with the ability to pay cash up front (and are willing to do their own Medicare submissions), you are OK. If you get into much patient billing, the risk of non-payment goes up, so the gain may be inconsequential.

I don't believe that Obamacare sets reimbursement rates. However, the reality is that insurers are all following in the government direction and have been for quite some time. The Medicare fee schedule (with local UCR adjustments) is typically the starting point in figuring what insurers will allow. And depending on the type of plan (HMO, PPO, traditional) everything is negotiated from there.

“Don't trust the internet!”

Since: Jan 12

Location hidden

#106 Nov 26, 2012
VADoc wrote:
<quoted text>
I did a short stint at an office that did this for Medicare. They were not Medicare providers but patients could see them and pay upfront and submit to Medicare for reimbursement. It's called not taking assignment under Medicare. They still saw a ton of patients because they were good. Patients loved them and kept coming back.
I think once Obamacare hits the only places that will accept assignment will be hospitals and large non profit clinics. Anyone who is in private practice won't be able to stay afloat at the reimbursement rate for Obamacare if it's like Medicaid and Medicare.
It has been my impression that "private practice" is going the way of the dinosaur. Simply not feasible. First step was to clump together in group practices, and even these are being swallowed up by the various hospital systems.

IMHO, this has been driven by a couple of things. One is "coverage" (growing up with a father who was a doctor I was accustomed to the notion of being "on call"), and another is billing. Again--growing up I could handle most of the details of office billing when I was in high school. Then my dad had to add someone just to handle the insurance billing (including Medicare and Medicaid), because of the complex coding systems. Since then we have added all kinds of negotiated fee schedules, approved panels and other complexities. Sharing this functions with a group--which allows for more highly specialized personnel--is more efficient.

Then there is the growing commercialization of medicine. Hospital systems who used to hire docs (or previous to that, to provide services to them) now prefer to own them.

We never wanted government-run health care--too big, bureacratic, run by folks who don't have patient interests at heart. Now we have for-profit health care run by corporate bureacracies. Hard to see that it's much different. Or better.
VADoc

Warrenville, SC

#107 Nov 26, 2012
FKA Reader wrote:
<quoted text>
It has been my impression that "private practice" is going the way of the dinosaur. Simply not feasible. First step was to clump together in group practices, and even these are being swallowed up by the various hospital systems.
IMHO, this has been driven by a couple of things. One is "coverage" (growing up with a father who was a doctor I was accustomed to the notion of being "on call"), and another is billing. Again--growing up I could handle most of the details of office billing when I was in high school. Then my dad had to add someone just to handle the insurance billing (including Medicare and Medicaid), because of the complex coding systems. Since then we have added all kinds of negotiated fee schedules, approved panels and other complexities. Sharing this functions with a group--which allows for more highly specialized personnel--is more efficient.
Then there is the growing commercialization of medicine. Hospital systems who used to hire docs (or previous to that, to provide services to them) now prefer to own them.
We never wanted government-run health care--too big, bureacratic, run by folks who don't have patient interests at heart. Now we have for-profit health care run by corporate bureacracies. Hard to see that it's much different. Or better.
Both systems have their drawbacks, but the government system doesn't save the patient any money and doesn't provide better care. Right now because of that profit machine hospitals compete with other hospitals for your business. They hire cutting edge specialists, recruit the best, pay people for their skills, and do everything to provide patients with top notch care. It's because of competition this exists. If you remove the need for competition then hospitals will become like the health departments. Full of usually overworked, underpaid staff with long lines and limited services.

Medicaid gets the best of both worlds. The patients pay nothing for it and get to go where they want and see who they want to see. They get top notch care for free. That little dream world will come to an end soon. Mark my words states will slash Medicaid funds to pay for Obamacare. Medicaid patients will get to see how the real world lives. They will wait for care under covered providers. They may even have to pay something out of pocket for their care (oh the humanity!). The end result is the quality of care will drop.

Now you even admit that due to government instrusion that it's become no longer cost effective or possible for the private practice to survive. Do you think this was an accident? The government wants the money from insurance companies and want to dictate to providers what they will provide and how much they will be paid to provide it. So with Obamacare just like with Medicaid and Medicare, providers will have more regulations to abide by adding more costs and headaches to us all the while getting paid less for the services we provide. If I was in private practice I wouldn't accept Medicaid, Medicare, or Obamacare. I'd take private insurance and cash for services and accept non assignment Medicare.

“Don't trust the internet!”

Since: Jan 12

Location hidden

#108 Nov 26, 2012
VADoc wrote:
<quoted text>
Both systems have their drawbacks, but the government system doesn't save the patient any money and doesn't provide better care. Right now because of that profit machine hospitals compete with other hospitals for your business. They hire cutting edge specialists, recruit the best, pay people for their skills, and do everything to provide patients with top notch care. It's because of competition this exists. If you remove the need for competition then hospitals will become like the health departments. Full of usually overworked, underpaid staff with long lines and limited services.
Medicaid gets the best of both worlds. The patients pay nothing for it and get to go where they want and see who they want to see. They get top notch care for free. That little dream world will come to an end soon. Mark my words states will slash Medicaid funds to pay for Obamacare. Medicaid patients will get to see how the real world lives. They will wait for care under covered providers. They may even have to pay something out of pocket for their care (oh the humanity!). The end result is the quality of care will drop.
Now you even admit that due to government instrusion that it's become no longer cost effective or possible for the private practice to survive. Do you think this was an accident? The government wants the money from insurance companies and want to dictate to providers what they will provide and how much they will be paid to provide it. So with Obamacare just like with Medicaid and Medicare, providers will have more regulations to abide by adding more costs and headaches to us all the while getting paid less for the services we provide. If I was in private practice I wouldn't accept Medicaid, Medicare, or Obamacare. I'd take private insurance and cash for services and accept non assignment Medicare.
Not an accident--more a natural consequence of our patchwork system--government contracted services for some things, employer provided plans for others, out of pocket for others. And a lot of jockeying for profit.
Wait what

Columbus, OH

#111 Nov 26, 2012
FKA Reader wrote:
<quoted text>
How do you handle a patient being seen at a different site?
How did you track the paper records (previously) when they were checked out?
The variety of EMR systems does tend to fly in the face of WW's assertions (and notlocal's as well) that everything is running through the feds.
http://www.gpo.gov/fdsys/pkg/FR-2011-07-15/pd...
Wait what

Columbus, OH

#112 Nov 27, 2012
FKA Reader wrote:
<quoted text>
Not an accident--more a natural consequence of our patchwork system--government contracted services for some things, employer provided plans for others, out of pocket for others. And a lot of jockeying for profit.
Since the insurance company stakeholders are working with the HHS to develop health care reform, I'd say your 'jockeying for profit' term is right on the money. Literally.

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