Obamacare's effects on Psychiatry

[surftheiop]

There are numerous examples of professional/industry groups governing a profession/industry, often in partnership with the government.

This is especially common in finance- the Fed is a private organization with some gov oversight, working with government agencies such as the FDIC to oversee banks (among its other functions). Another example is the FASB (private) working with the SEC (gov).

And how did that work out for us?

But more seriously, you make a good point

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[jmadden]

I think the better question is whether these private/public agency designations are pure nomenclature. Nothing divides them

Its just a way to steal so its not "embezzlement" if you are employed by a company or "corruption" if you work for the public.

I mean what is it called when a privately employed individual steals from the public or when a public official who steals from a private company? Or is just employed the next year by the company at triple his former salary


Stop being some pigeons, ask what u are paying for and when u disagree stop paying it. They actually dont have the backing or capacity to enforce what they do.

International law forbids being imprisoned for violating contractual obligations which is all they have when u just say FU and dont pay. Irs imprisonment is few and for publicly favorable prosecutions, like 75 a year and in the millions owed

 

[jmadden]

When the IRS puts the few people they do in jail there is always another criminal element like theft, rackateering, or crimes with stiffer sentences but they take a plea so the IRS can clout

 

[Anasazi23]

I agree that it's unlikely, but it's a favorite Chicken Little argument around here, so I felt it must be addressed. Your point that it's a small slice of the pie is valid...for now. It's going to become a larger and larger slice as things move along, especially in psychiatry.

Obviously, the Commerce Clause has been used to pull some pretty questionable things over the years, and our current Supreme Court hasn't exactly been a friend to liberty...

Still, I find it difficult to conceive that the United States could ever get away with forcing it's citizens into unwilling employment. I, personally, would leave if it ever came to that. I have the same rights as anyone else to own my own business...that shouldn't change because I'm a doctor. If it ever did...see ya later.

It will happen. But not for a bit. They are already testing the waters with state licensure being dependent on acceptance of Medicare, for example.

This bill from 2010 in Mass, for example, tied licensure to acceptance of medicare. As we know, this model was the model base for Obamacare.

You can't add 3 million patients to the pot, and expect the same amount of doctors to take care of them for less reimbursement. It will collapse the system (thus leading to single payor, which is the eventuality. They know this though - it's not by accident by their own admission.

Don't get me started on the commerce clause.

 

[digitlnoize]

It will happen. But not for a bit. They are already testing the waters with state licensure being dependent on acceptance of Medicare, for example.

This bill from 2010 in Mass, for example, tied licensure to acceptance of medicare. As we know, this model was the model base for Obamacare.

You can't add 3 million patients to the pot, and expect the same amount of doctors to take care of them for less reimbursement. It will collapse the system (thus leading to single payor, which is the eventuality. They know this though - it's not by accident by their own admission.

Don't get me started on the commerce clause.

Yeah, but a state bill is legal...maybe...a federal bill forcing a citizen into government employment against their will...I can't see any way, commerce clause or not, that that could possibly be legal.

Either way, the day I can no longer operate my own business free in the USA, as a normal citizen would, is the day I pack up my couch and leave.

 

[islandCrazy]

Yeah, but a state bill is legal...maybe...a federal bill forcing a citizen into government employment against their will...I can't see any way, commerce clause or not, that that could possibly be legal.

Either way, the day I can no longer operate my own business free in the USA, as a normal citizen would, is the day I pack up my couch and leave.

Honest question with no sarcasm involved but I see this all the time and I really want to know where you would consider going?

 

[Frazier]

Honest question with no sarcasm involved but I see this all the time and I really want to know where you would consider going?

I hear Canada is nice this time of year.

 

[islandCrazy]

I hear Canada is nice this time of year.

As a Canadian citizen I must agree, the slopes should be great in a few weeks.

 

[OldPsychDoc]

Honest question with no sarcasm involved but I see this all the time and I really want to know where you would consider going?

Costa Rica?

 

[Chimed]

I hear Canada is nice this time of year.

I've heard that Canadian academic centers pay their child psychiatrists very well. Only been to Toronto, but I LOVE that city.

 

[F0nzie]

Whether laws are passed to restrict physicians in the private sector makes little difference to me anymore. My entrepreneurial outlook for starting an innovative and modern private practice has almost completely fizzled over the last 4 years. I am also ambivalent about opting out of insurance to compete for a small market share. With decreasing reimbursements, ongoing price fixing by Medicare, and a stagnant economic recovery, it's just a matter of time before the private sector gets entirely consumed. We do not need a law passed for it to happen, it's happening!

Good news however: 1. Psych is less likely to experience reimbursement cuts. 2. Less call with larger entities.

 

[digitlnoize]

Honest question with no sarcasm involved but I see this all the time and I really want to know where you would consider going?

I'd prefer more temperate places...but Canada is on the list. Along with Australia, New Zealand (although I hear the pay sucks there, and the SPIDERS, OMG), and even the UK. Basically anywhere that speaks english and would still allow someone to open their own business. We're also working on our Italian citizenship (my wife has "jus sanguinis" rights b/c her grandfather was an italian citizen, so we can get ours, which means we'd be EU citizens and could probably set up shop anywhere in the EU.)

If this went through, I probably wouldn't have to go that far. I think the day the government can force a citizen into government employ is the day Montana, probably Texas, and a few other states secede. I'd prefer Texas, but I have a very good friend in Montana too...

I truly think, despite all the doom and gloom here, that this will never happen in the US. It won't come to that.

 

[islandCrazy]

I'd prefer more temperate places...but Canada is on the list. Along with Australia, New Zealand (although I hear the pay sucks there, and the SPIDERS, OMG), and even the UK. Basically anywhere that speaks english and would still allow someone to open their own business. We're also working on our Italian citizenship (my wife has "jus sanguinis" rights b/c her grandfather was an italian citizen, so we can get ours, which means we'd be EU citizens and could probably set up shop anywhere in the EU.)

If this went through, I probably wouldn't have to go that far. I think the day the government can force a citizen into government employ is the day Montana, probably Texas, and a few other states secede. I'd prefer Texas, but I have a very good friend in Montana too...

I truly think, despite all the doom and gloom here, that this will never happen in the US. It won't come to that.

Oh Canada.... If your running from a government "employment" you probably shouldn't run North.

 

[Lokhtar]

The government may try to take away tier 3 by tying licensure to accepting their insurance. This is unconstitutional though and won't stand. The government has no right to force anyone to be their employee. Slavery and indentured servitude were outlawed over a century ago. We have just as much right to life, liberty, and the pursuit of happiness as the next guy.

Many ways to skin a cat. The government controls the laws related to practice. It's not hard to make an argument that if you take $500k of medicare money to train as a psychiatrist, you have to accept government insurance, or you aren't eligible for medicare funding to train (good luck finding a residency then). Or they could say if you choose not to accept it later, you have to pay that money back with interest.

 

[digitlnoize]

Or we could just not fund residency with Medicare, and hospitals could hire new physicians as normal employees, just like they do for mid-levels, who, by the way, have less training, a license, and get paid more than us.

 

[DOC PENGUIN]

Or we could just not fund residency with Medicare, and hospitals could hire new physicians as normal employees, just like they do for mid-levels, who, by the way, have less training, a license, and get paid more than us.

any more ideas?

 

[Enkidu]

Or we could just not fund residency with Medicare, and hospitals could hire new physicians as normal employees, just like they do for mid-levels, who, by the way, have less training, a license, and get paid more than us.

That would decrease the number of residency spots and possibly result in massive physician shortages.

 

[Enkidu]

You can't add 3 million patients to the pot, and expect the same amount of doctors to take care of them for less reimbursement. It will collapse the system (thus leading to single payor, which is the eventuality. They know this though - it's not by accident by their own admission.

Don't get me started on the commerce clause.

How is the reimbursement going to be less? It seems like in psychiatry it would be more, because I bet a lot of your patients are uninsured.

 

[digitlnoize]

That would decrease the number of residency spots and possibly result in massive physician shortages.

Nope. Hospitals would just hire us the same way they hire other mid-level providers.

The idea that a PA with 2-3y experience is hired at a much higher salary, less supervision, and less work hours, than a physician with 4 years of medical school is absurd.

 

[notdeadyet]

The idea that a PA with 2-3y experience is hired at a much higher salary, less supervision, and less work hours, than a physician with 4 years of medical school is absurd.

It's just residency. Four years and then you will have far greater earning potential, more autonomy, and greater flexibility than the PAs.

It's residency. We are paid less for those four years because we are still in training. PAs get out of the gate quicker because they have less training. This extra training is why we have far greater earning potential more autonomy, and greater flexibility. It's a marathon, not a sprint.

 

[Enkidu]

Nope. Hospitals would just hire us the same way they hire other mid-level providers.

The idea that a PA with 2-3y experience is hired at a much higher salary, less supervision, and less work hours, than a physician with 4 years of medical school is absurd.

No way - currently 'hiring' residents is induced by the government at ~500k per resident. If that inducement goes away, you think that programs will just hire the same number anyway?

 

[toothless rufus]

No way - currently 'hiring' residents is induced by the government at ~500k per resident. If that inducement goes away, you think that programs will just hire the same number anyway?

500K?! That seems high. I thought it was in the $150-200 range If its 500 then we should all get substantial raises.

 

[digitlnoize]

No way - currently 'hiring' residents is induced by the government at ~500k per resident. If that inducement goes away, you think that programs will just hire the same number anyway?

I'd hope so. Who else is going to see all those patients? It's simple math. If they have x number of patients to see, they need x number of providers.

I know we come out ahead in the end. That's still no reason why we should be penalized for that fact.

I know it is what it is, and I'm very happy with my personal residency, but overall, I think the system is broken and needs an overhaul. Osler is far from the god people make him out to be, and residency was his worst evil. I'm not denying that we need more training to be specialized physicians, but we could receive that training in much the same way PAs receive training in their subspecializations without all the trappings (and traps) of residency.

Also: why are they allowed to randomly switch fields and we aren't? Makes no sense people.

Sigh.

 

[QuesoAndFromage]

so I have a question regarding the mandatory Medicare aspect of the MA bill

If someone was practicing there and had to take Medicare, but would have preferred not to, could they schedule Medicare patients on specific days? This is assuming the physician was doing private practice.

I am only a MS2 who is very interested in psych (I am one of those people who got into medicine from the psych/neuro aspect, and some clinical experience I had last summer made me absolutely love the field even more) so I apologize for the ignorance I do have in running a practice. I know "Obamacare" is not forcing doctors to take Medicare at this time and being in CA the MA law does not matter for me

I know that medicine should be done for the "right" reasons, and that psych is definitely not a specialty for someone who JUST wants easy hours and decent enough pay (even my very limited experience made it perfectly clear though I did love it), but it is at least good to know how financial aspects of medicine are like, without it completely dictating what I go into

 

[Enkidu]

500K?! That seems high. I thought it was in the $150-200 range If its 500 then we should all get substantial raises.

I could be wrong about it being 500k, I'm just repeating a number that was claimed on another thread. It may well be in the 200 range. Regardless, that amount is certainly causing hospitals to take on more residents than they otherwise would - which of course is the reason it exists.

If taking away the Medicare funding didn't result in fewer spots then the government would probably become wise to that and stop paying - I suspect they may alter their funding anyway to encourage primary care over specialist slots.

 

[PikminOC]

Whether laws are passed to restrict physicians in the private sector makes little difference to me anymore. My entrepreneurial outlook for starting an innovative and modern private practice has almost completely fizzled over the last 4 years. I am also ambivalent about opting out of insurance to compete for a small market share. With decreasing reimbursements, ongoing price fixing by Medicare, and a stagnant economic recovery, it's just a matter of time before the private sector gets entirely consumed. We do not need a law passed for it to happen, it's happening!

Good news however: 1. Psych is less likely to experience reimbursement cuts. 2. Less call with larger entities.

I dont like taking less call with a bunch of patients I dont know and dont manage.

Why has your outlook fizzled? Have you tried something that failed? I am going to start a PP soon..cash only...

 

[toothless rufus]

so I have a question regarding the mandatory Medicare aspect of the MA bill

If someone was practicing there and had to take Medicare, but would have preferred not to, could they schedule Medicare patients on specific days? This is assuming the physician was doing private practice.

I am only a MS2 who is very interested in psych (I am one of those people who got into medicine from the psych/neuro aspect, and some clinical experience I had last summer made me absolutely love the field even more) so I apologize for the ignorance I do have in running a practice. I know "Obamacare" is not forcing doctors to take Medicare at this time and being in CA the MA law does not matter for me

I know that medicine should be done for the "right" reasons, and that psych is definitely not a specialty for someone who JUST wants easy hours and decent enough pay (even my very limited experience made it perfectly clear though I did love it), but it is at least good to know how financial aspects of medicine are like, without it completely dictating what I go into

Did the proposed law actually pass in MA or anywhere else!?! Gaaah!!!

 

[DOC PENGUIN]

Doctors aren't in hell in countries with single payer. And i admit that Single Payer is relatively successful in other countries. However, I think a much more market devised hybrid-esque solution is better than single payer. And the free market won't be revived fro some time (2050 at minimum with our growing government.)

A few things we can do is block grant or even give medicare and caid to the states. Every dollar put in is 60/40, why can't it be a totally state run program?

Why can't we let people buy insurance across state lines?

Why do we have to have mandates on our insurance?

Why can't we have more market reforms?

Britain's NHS was liberalized in 1989, so is canada's in 2005. Single payer is not as socialistic or government run as we like to think it is.

 

[toothless rufus]

Doctors aren't in hell in countries with single payer. And i admit that Single Payer is relatively successful in other countries. However, I think a much more market devised hybrid-esque solution is better than single payer. And the free market won't be revived fro some time (2050 at minimum with our growing government.)

A few things we can do is block grant or even give medicare and caid to the states. Every dollar put in is 60/40, why can't it be a totally state run program?

Why can't we let people buy insurance across state lines?

Why do we have to have mandates on our insurance?

Why can't we have more market reforms?

Britain's NHS was liberalized in 1989, so is canada's in 2005. Single payer is not as socialistic or government run as we like to think it is.

As long as physician's salaries are not reduced and match inflation they can do whatever the hell they want.

 

[Lokhtar]

As long as physician's salaries are not reduced and match inflation they can do whatever the hell they want.

There is literally no system in existence, or proposed, where that will be the case.

 

[toothless rufus]

There is literally no system in existence, or proposed, where that will be the case.

Well there should be. Bunch of #$%^ ninnies! Physician salaries are not the problem, and someone had better figure that out soon.

 

[QuesoAndFromage]

Did the proposed law actually pass in MA or anywhere else!?! Gaaah!!!

as far as I know, MA has that.

People brought up the potential for the mandatory Medicare aspect of the MA bill would also be used for "Obamacare", but I have no idea whether that idea has been officially brought up

The main aspect of the healthcare debate that I still find to be ridiculous is that the average person seems to think that the bulk of healthcare is spent on physician salary. I agree with some others that psych seems at the very least stable in reimbursement cuts though.

Does anyone know if there is still a potential to practice some psychotherapy if you took any insurance/Medicare without it taking a toll on your overall salary?

 

[F0nzie]

Why has your outlook fizzled? Have you tried something that failed? I am going to start a PP soon..cash only...

The advantages of cash practice are always glorified ie. "decrease administrative costs", "spend more time with the patient", "increase revenue", "deliver quality care". Clearly these buzzwords proclaim everyone is a winner which is why everyone wants to do it. However, it isn't a surprise to me that rarely anybody does it. The biggest and most important question is: where are you going to get these patients?

Since I do not have any real experience in starting up a cash practice and most of my knowledge is researched based and hypothetical, for all I know, patients will break down my office door like a stampede of suburban women at a gourmet cupcake shop. I can then set my own hours, work half as hard, and not have to deal with the politics and bureaucracy of organized medicine.

I believe that many factors are involved in starting up a successful cash practice and getting all the stars to align to meet your personal goals can be challenging. Here is some practical advice for those of you wanting to capitalize on this:

1. Location
-accessibility, parking, commute time
-number of practicing psychiatrists in the area ie. market saturation
-upper middle class to upper class median family income
-total population
-cultural (openness to mental health treatment and actively looking for it) NYC? LA?

2. Financial plan
-accounting, balance sheets, method of payment, payroll
-LLC,corp, partnership, group practice, or sole proprietor

3. Reducing overhead costs even further
-cheap and integrated EMR for e-rx, lab
-online scheduling
-google voice
-answering service
-online fax solutions
-web Design, PDF forms, online requests
-consider outsourcing your billing if you accept insurance

4. Referral sources/marketting
-building alliance with therapists, primary care physicians, schools (child psych)
-social media, internet (extremely low yield IMO)
-newspaper articles, email newsletters/fax

5. Uniqueness.
-after hours and weekends? (attractive but sets you up for liability)
-telephone? email? video conferencing (another malpractice trap without nursing supervision)
-on call availability? same day or next day appointments?
-added qualification? (academic, research, writing, tv, newspaper, other media)
-Your personality and professionalism (do people like you and will they refer you to others?). Establishment in the community.

Why do I think these factors are important? Because starting a cash practice is like being Jupiter's moon and hoping that an amateur star gazer will look through a telescope and notice you.

Additional uphill challenges on a Macro scale:
-most patients do not want to pay to see a doctor, especially if they are already paying to have insurance. If they do not have insurance then they can't afford to see you.
-most patients go through their insurance company first and tolerate the wait.
-the stigmatization of mental illness is more extreme in some parts of the country than others, reducing your demand as a concierge provider.
-big fish eat the small fish (group practice mergers, larger healthcare organizations, etc), further reducing demand in larger cities while shortages exist in rural areas where people cannot afford to pay out of pocket.

With all of this in mind, I do believe it is possible to have a successful cash private practice. The inner workings of the "machine" are highly complex and influenced by a lot of factors that are constantly changing. Tailoring your practice to meet your personal and financial goals will be by far the most difficult challenge you will face.

I shall find out in 2013 after I graduate from residency if this is a viable model and report back with my successes and shortcomings. I am currently in the process of setting everything up. If anything, it might just be nice to have a private practice on the side where I can at least meet overhead costs and claim some tax deductions.

 

[PikminOC]

heres the deal..
i dunno how its going to work out...
but I am DONE being managed by NURSE administrators
I am joining a group with therapists, one other psychiatrist, sw etc.
I will get one room and will give out a percentage so i dont pay if i have no patients, the resrouces are already there
i am going to start with all cash and see how it goes..
i will have a great deal of autonomy this way (vs being paid hourly, the ni have to take all teh insurances)
psychiatry is underserved..everywhere..esp where i am at..
lets see waht happens...
it will take a long time to build patients...
i can wait...
copays for us for med managemt are already high..i have seen patiens pay 65$ anyway..

 

[HeyThereJude]

The shortage is real and quite bad, and this clientele will pay top dollar for a GOOD psychiatrist (keep in mind that in addition to the shortage, there are a LOT of bad psychiatrists out there). Especially true for child.

The government may try to take away tier 3 by tying licensure to accepting their insurance. This is unconstitutional though and won't stand. The government has no right to force anyone to be their employee. Slavery and indentured servitude were outlawed over a century ago. We have just as much right to life, liberty, and the pursuit of happiness as the next guy.

I know there is a shortage of child psychs; but it seems that is mostly for low income populations. Could you still say there is a shortage of child psychs for the people willing to pay cash only?

I also wonder about typing licensure to medicare. I wonder if this was true, what this would mean for derm and plastics, where many of their money making procedures are cosmetic and elective?

 

[vistaril]

heres the deal..
i dunno how its going to work out...
but I am DONE being managed by NURSE administrators
I am joining a group with therapists, one other psychiatrist, sw etc.
I will get one room and will give out a percentage so i dont pay if i have no patients, the resrouces are already there
i am going to start with all cash and see how it goes..
i will have a great deal of autonomy this way (vs being paid hourly, the ni have to take all teh insurances)
psychiatry is underserved..everywhere..esp where i am at..
lets see waht happens...
it will take a long time to build patients...
i can wait...
copays for us for med managemt are already high..i have seen patiens pay 65$ anyway..

you've been writing for like several months(4?) that you have started your own pp.....are you still in planning stages? In what capacity are you seeing patients now?

 

[vistaril]

The advantages of cash practice are always glorified ie. "decrease administrative costs", "spend more time with the patient", "increase revenue", "deliver quality care". Clearly these buzzwords proclaim everyone is a winner which is why everyone wants to do it. However, it isn't a surprise to me that rarely anybody does it. The biggest and most important question is: where are you going to get these patients?

Since I do not have any real experience in starting up a cash practice and most of my knowledge is researched based and hypothetical, for all I know, patients will break down my office door like a stampede of suburban women at a gourmet cupcake shop. I can then set my own hours, work half as hard, and not have to deal with the politics and bureaucracy of organized medicine.

I believe that many factors are involved in starting up a successful cash practice and getting all the stars to align to meet your personal goals can be challenging. Here is some practical advice for those of you wanting to capitalize on this:

1. Location
-accessibility, parking, commute time
-number of practicing psychiatrists in the area ie. market saturation
-upper middle class to upper class median family income
-total population
-cultural (openness to mental health treatment and actively looking for it) NYC? LA?

2. Financial plan
-accounting, balance sheets, method of payment, payroll
-LLC,corp, partnership, group practice, or sole proprietor

3. Reducing overhead costs even further
-cheap and integrated EMR for e-rx, lab
-online scheduling
-google voice
-answering service
-online fax solutions
-web Design, PDF forms, online requests
-consider outsourcing your billing if you accept insurance

4. Referral sources/marketting
-building alliance with therapists, primary care physicians, schools (child psych)
-social media, internet (extremely low yield IMO)
-newspaper articles, email newsletters/fax

5. Uniqueness.
-after hours and weekends? (attractive but sets you up for liability)
-telephone? email? video conferencing (another malpractice trap without nursing supervision)
-on call availability? same day or next day appointments?
-added qualification? (academic, research, writing, tv, newspaper, other media)
-Your personality and professionalism (do people like you and will they refer you to others?). Establishment in the community.

Why do I think these factors are important? Because starting a cash practice is like being Jupiter's moon and hoping that an amateur star gazer will look through a telescope and notice you.

Additional uphill challenges on a Macro scale:
-most patients do not want to pay to see a doctor, especially if they are already paying to have insurance. If they do not have insurance then they can't afford to see you.
-most patients go through their insurance company first and tolerate the wait.
-the stigmatization of mental illness is more extreme in some parts of the country than others, reducing your demand as a concierge provider.
-big fish eat the small fish (group practice mergers, larger healthcare organizations, etc), further reducing demand in larger cities while shortages exist in rural areas where people cannot afford to pay out of pocket.

With all of this in mind, I do believe it is possible to have a successful cash private practice. The inner workings of the "machine" are highly complex and influenced by a lot of factors that are constantly changing. Tailoring your practice to meet your personal and financial goals will be by far the most difficult challenge you will face.

I shall find out in 2013 after I graduate from residency if this is a viable model and report back with my successes and shortcomings. I am currently in the process of setting everything up. If anything, it might just be nice to have a private practice on the side where I can at least meet overhead costs and claim some tax deductions.

excellent post....I think the answer is that it is a viable model for *some* people in certain situations. And even then I think many of them make less money than if they just took a job on salary somewhere(especially when bennies are considered). But the perks of being completely autonomous outweigh those other things....

one point: if I were going to do cash pay pp, I would consider no EMR. Patients will like this.

 

[vistaril]

Well there should be. Bunch of #$%^ ninnies! Physician salaries are not the problem, and someone had better figure that out soon.

there are a *lot* of problems....more than 10. Of those, physician salaries are one.

 

[F0nzie]

if I were going to do cash pay pp, I would consider no EMR. Patients will like this.

Can you explain this further?

 

[vistaril]

Can you explain this further?

One guy I know who does cash pay tells me he believes his patient who are concerned about confidentiality are glad there is no electronic record out there. He believes patients believe paper charts in their providers office(with very vague/limited stuff in them) is safer from a confidentiality standpoint than having a electronic record somewhere.....

Plus, these patients who are going to be cash pay are going to be mostly therapy patients. You're not going to be ordering metabolic screening panels and Lithium levels on them(where an EMR and lab values and lab tests would be more useful)....You can easily make the case that for these type of patients, confidentiality issues aside, that paper charts are much easier/faster.

 

[F0nzie]

One guy I know who does cash pay tells me he believes his patient who are concerned about confidentiality are glad there is no electronic record out there. He believes patients believe paper charts in their providers office(with very vague/limited stuff in them) is safer from a confidentiality standpoint than having a electronic record somewhere.....

Plus, these patients who are going to be cash pay are going to be mostly therapy patients. You're not going to be ordering metabolic screening panels and Lithium levels on them(where an EMR and lab values and lab tests would be more useful)....You can easily make the case that for these type of patients, confidentiality issues aside, that paper charts are much easier/faster.

I hear what you're saying. In reality, this is only a problem when staff or other departments have access to the chart. If you are running the practice solo, you're the only person that has access to those records. The encryption technology we have these days is very sophisticated and hackers have better things to do than to crack your individual therapy sessions. To make the EMR less of an object of paranoia, take notes on a pad of paper and write your notes in the EMR after the session has ended.

As far as the utility of a free web-based EMR such as practice fusion, we're talking GOLD.

-access from any computer anywhere in the world (you like to travel?)
-e-prescribing. A few clicks and you can send off a rx to the pharmacy. (saving time calling the pharmacy or writing out the scripts). The exception is controlled substances.
-online scheduling. If you have tech savvy patients, that will save you from having to return a message to reschedule an appointment.
-quickly print out a superbill before the end of the session (this saves you from having to sending them out biweekly or monthly). Saves you time and postage.
-send/receive labs through the EMR

You will lose out on a lot by not getting an EMR.

 

[vistaril]

I hear what you're saying. In reality, this is only a problem when staff or other departments have access to the chart. If you are running the practice solo, you're the only person that has access to those records. The encryption technology we have these days is very sophisticated and hackers have better things to do than to crack your individual therapy sessions. To make the EMR less of an object of paranoia, take notes on a pad of paper and write your notes in the EMR after the session has ended.

As far as the utility of a free web-based EMR such as practice fusion, we're talking GOLD.

-access from any computer anywhere in the world (you like to travel?)
-e-prescribing. A few clicks and you can send off a rx to the pharmacy. (saving time calling the pharmacy or writing out the scripts). The exception is controlled substances.
-online scheduling. If you have tech savvy patients, that will save you from having to return a message to reschedule an appointment.
-quickly print out a superbill before the end of the session (this saves you from having to sending them out biweekly or monthly). Saves you time and postage.
-send/receive labs through the EMR

You will lose out on a lot by not getting an EMR.

so what's the catch with practice fusion? I hear how other people(mainly in other specialties) are buying these 25k emr's(with several thousand dollars/year) needed to maintain them......if practice fusion is free and so awesome, why do most people/practices use one that isn't free, isnt web based, and doesn't rely on commercials? When something seems too good to be true, it usually is.

 

[F0nzie]

so what's the catch with practice fusion? I hear how other people(mainly in other specialties) are buying these 25k emr's(with several thousand dollars/year) needed to maintain them......if practice fusion is free and so awesome, why do most people/practices use one that isn't free, isnt web based, and doesn't rely on commercials? When something seems too good to be true, it usually is.

I think you are underestimating the revenue that can be generated through advertising which is how practice fusion keeps their services free. If you are out-of-network and practicing by yourself, who cares if you do not have the best EMR with all the bells and whistles. You just need a simple and cheap solution for keeping a chart open to make your life easier.

 

[RaistlinMajere]

I've yet to meet a doc from Canada who complains nearly as much as docs here say they will complain if we emulate Canada's system. I actually met several at the conference I just got back from. They appeared to be well-fed, well-dressed, had some money to eat nice food at a conference, and also didn't have to deal with a lot of hassles that we need to deal with on an almost daily basis. None of them wanted to trade systems.

That's a totally unscientific sampling, but I'd actually welcome going to more of a Canadian single-payer type system. I don't like Obamacare because I don't think it goes far enough or solves the fundamental problem.

That is because the costs also are less. How much is it to buy a house in Canada? And what about the perks? How much time off are they getting. I would definitely retire into the business world if someone told me I was going to be making less than $100k. Not because I am money hungry but because I have a house, family, college, etc. Pay me what I am worth or I am gone.

 

[budda10000]

I would think Psych would be one of the few fields of medicine largely unaffected by the ACA or even a single payer system. It doesn't really revolve around procedures and is largely independent of the hospital/clinic system. It is also not "prestigious" deflecting competition from a lot of the narcissistic gunner types and creating a chronic under-supply of practitioners. You say that people are unwilling to pay doctors cash, but the public doesn't view psychiatrist as "doctors" per se, since they do not go to the hospital or clinic to see you. Additionally individual sessions are not obscenely expensive(like outpatient procedures), so there is less sticker shock. Psychiatry is more like dentistry in the way it is practiced and dentists have no problem finding cash patients(since dental insurance is largely useless). Furthermore Psychiatry is a UNSATURATED field with many more opportunities to diversify practice than dentistry.

 

[jakeislove]

Your small town practice may not be Interstate Commerce, but the health insurance policies that your patients rely on are. Unless you envision a barter-based economy (prozac for chickens?) this is the cold, hard reality.

Are those chickens fried?