CaliDr

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So this is not necessarily California specific...but CA is our market. I am sure others are eager to hear some responses based on different locations of everyone's practice.

Backstory: I practice in NorCal within a large group...I'm in the process of branching off to start my own private practice (launch Feb/Mar) in an in-demand area. Focus to be on Interventional Pain and some alternative treatment options (PRP, Bio Hormone, etc.).

So my business partner and I had a lengthy discussion about overall practice strategy and implementation of Obamacare going forward. We just so happened to be at dinner with friends and one of them was one of the 4 main consulting persons that is helping implement California's transition into Obamacare. We discussed at length the changes and it was, quite honestly, not the news we wanted to hear. He said that the overall plan is that there will be major consolidation among the big entities and the smaller private practices (and groups) - specialties included. The overall strategy is that there will be, over time, a move away from private into the "cog in the wheel" due to decrease in rates and need for consistent patient base (filtering through the bigger system) - This was not news to us, but the degree to which he was saying this is going to happen was quite disturbing - It was almost a "practices really have no idea what is coming their way" kind of message delivery. Keep in mind this was a consultant...not a government employee - he really had no agenda or bias, just stating the facts.

We were taken aback given this news plus the current, California specific, Kaiser institution competition. Can anyone provide any insight into what you are hearing in your area and if so, address how this might affect our private practice/your private practice given these supposed changes coming in the pipeline? We were obviously a little dissapointed to hear this and we are seriously trying to figure out if this is a good move without paying much more attention to forecasting these "planned" implementations by the state.

I know many of you are in the private and group setting, so I would be interested to hear what you all are hearing/planning for.
 

Doctodd

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Kaiser and other big groups lobby to Federal politicians.....you (and other small businesses) dont. End of story.
 

powermd

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So the strategy is to get everyone under the hospital umbrella, and then cue the thunder, rain, wind, etc… Not unexpected at this point. At some point in the future I can see going direct-pay based, making a lot less money, but working easier days. Remember, in the system of the future, it's going to be all about saying NO to patients. If patients wants the doctor to be on their side, they'll have to leave the system and pay for it directly.
 
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CaliDr

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Thank you for the responses so far. Doctodd and DRusso, I appreciate trying to be succinct in response but my intention was to generate more of a discussion and hope to see what the rest of the practicing docs on here are thinking. While I mention California, this was by no means a state specific conversation as the aforementioned consolidation looks to be planned nationwide. Lobbying, control, size of entity all help in negotiations, but only mean so much in a successful private practice (ability to adjust overhead costs, becoming more lean, increasing volume, etc.) - or head towards Powermds direct-pay/saying NO scenario. We are structuring about 30% of the practice to incorporate this direct-pay scenario just curious if anyone else is doing something with similar long-term strategy in mind or pushing through these changes and pivoting as you see fit down the line. Private practice was never for the faint of heart but it appears to be even less appealing with upcoming changes and cuts. Thanks again for your input.
 

hyperalgesia

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The govt has been trying to do this for decades. Like governments everywhere, it wants to consolidate industries and place them under central control. I think it will work for a while to a certain extent but ultimately fail.

The govt could also start building cars and use its leverage to "drive down the cost of carcare" by short changing parts manufaturers, etc. But I really think this kind of thing will collapse under its own bureaucratic weight in this country. Our govt will never fully control everything to the extent necessary to get the full benefits of a communist state. I think that's why that even as the govt tries to expand it's role in healthcare, Medicare is collapsing underneath it.
 

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I'm personally planning for a much harder go at it. I fully agree about saying "no" in 2014 and I wrote something for my waiting room stating just that. No longer will I treat, for example, a shoulder and a hip on the same day. The patient may request it and it may make it easier for them, but the answer is no. I'm going full lawyer mode, billing for every second of my time. No more trying to do what I would want done for me.
 
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olafa

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if your market area is in demand it probably wont matter what the larger hospital organization have because they can't keep up with the patients. In my area we have a good CCO that supports private practice and infact the biggest hospital in our area with pain dept just closed d/t to "restructuring" whatever that means...
Regardless of the changes I think there will still be a demand, cut that came our way hopeful can get renegotiated with lobbying efforts to some degree.
 

Ducttape

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I'm personally planning for a much harder go at it. I fully agree about saying "no" in 2014 and I wrote something for my waiting room stating just that. No longer will I treat, for example, a shoulder and a hip on the same day. The patient may request it and it may make it easier for them, but the answer is no. I'm going full lawyer mode, billing for every second of my time. No more trying to do what I would want done for me.
You have an " out".

Care core guidelines for interventional pain contain limitations.

One of the main. " limitations" is:
Additional interventional pain management procedures are planned at the same time .

Ergo tell patients "I can't do injections together any more - not allowed by your Medicare /Medicaid guidelines...."
 

clubdeac

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You have an " out".

Care core guidelines for interventional pain contain limitations.

One of the main. " limitations" is:
Additional interventional pain management procedures are planned at the same time .

Ergo tell patients "I can't do injections together any more - not allowed by your Medicare /Medicaid guidelines...."
Duct please explain this more. I'm getting very pissed right before going to bed! Not good.... ughhhhh
 

stim4u

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So this is not necessarily California specific...but CA is our market. I am sure others are eager to hear some responses based on different locations of everyone's practice.

Backstory: I practice in NorCal within a large group...I'm in the process of branching off to start my own private practice (launch Feb/Mar) in an in-demand area. Focus to be on Interventional Pain and some alternative treatment options (PRP, Bio Hormone, etc.).

So my business partner and I had a lengthy discussion about overall practice strategy and implementation of Obamacare going forward. We just so happened to be at dinner with friends and one of them was one of the 4 main consulting persons that is helping implement California's transition into Obamacare. We discussed at length the changes and it was, quite honestly, not the news we wanted to hear. He said that the overall plan is that there will be major consolidation among the big entities and the smaller private practices (and groups) - specialties included. The overall strategy is that there will be, over time, a move away from private into the "cog in the wheel" due to decrease in rates and need for consistent patient base (filtering through the bigger system) - This was not news to us, but the degree to which he was saying this is going to happen was quite disturbing - It was almost a "practices really have no idea what is coming their way" kind of message delivery. Keep in mind this was a consultant...not a government employee - he really had no agenda or bias, just stating the facts.

We were taken aback given this news plus the current, California specific, Kaiser institution competition. Can anyone provide any insight into what you are hearing in your area and if so, address how this might affect our private practice/your private practice given these supposed changes coming in the pipeline? We were obviously a little dissapointed to hear this and we are seriously trying to figure out if this is a good move without paying much more attention to forecasting these "planned" implementations by the state.

I know many of you are in the private and group setting, so I would be interested to hear what you all are hearing/planning for.
CAliDr: if you watched meet the press this weekend it was pretty much summed up. The two CEO physicians of Mayo and Cleveland essentially stated our 'cottage' medical industry will consolidate for 'quality of care' and 'efficiency' and 'modernization'. These are all bogus terms for socialized medicine that a hand full of our colleagues want, ie. Single payer system. Your only why to survive out side of this 'cog wheel' is to band with large ortho, spine, Nero groups, and have more power over a regional hospital. Alternatively, you need a high volume of WC, PI, and good commercial insurances (with good contracts). Most of the people on this board are employees and have no clue how to balance a practice and business. I would be very weary to get info from the majority of the forum members responses.....
Good luck. I personally will opt out of medicare by 2016, and have patients submit claims to medicare. I wont work for the socialized machine, and was lucky to make a good retirement fund under George W. Bush...
 

lonelobo

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CAliDr: if you watched meet the press this weekend it was pretty much summed up. The two CEO physicians of Mayo and Cleveland essentially stated our 'cottage' medical industry will consolidate for 'quality of care' and 'efficiency' and 'modernization'. These are all bogus terms for socialized medicine that a hand full of our colleagues want, ie. Single payer system. Your only why to survive out side of this 'cog wheel' is to band with large ortho, spine, Nero groups, and have more power over a regional hospital. Alternatively, you need a high volume of WC, PI, and good commercial insurances (with good contracts). Most of the people on this board are employees and have no clue how to balance a practice and business. I would be very weary to get info from the majority of the forum members responses.....
Good luck. I personally will opt out of medicare by 2016, and have patients submit claims to medicare. I wont work for the socialized machine, and was lucky to make a good retirement fund under George W. Bush...
why wait, why don't you opt out now since they have made large cuts on ESI's and CESI"s?
 

stim4u

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why wait, why don't you opt out now since they have made large cuts on ESI's and CESI"s?
because I have several thousands of medicare patients, and it takes time to dismiss them without pissing of PCP's. I rather have the media and the self-destruction of medicare be the reason. For example, no CESI procedure in my office for all medicare patients. Off the the surgical center for them. This sends a clear message to medicare patients, that their time is limited., and for me, I get a cut of the $700 for a ACS CESI. I still stay afloat in the end.

Lono you don't have to worry about this because your are a hospital monkey, worker bee, remember??? keep on working for the machine, troll.
 

SSdoc33

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because I have several thousands of medicare patients, and it takes time to dismiss them without pissing of PCP's. I rather have the media and the self-destruction of medicare be the reason. For example, no CESI procedure in my office for all medicare patients. Off the the surgical center for them. This sends a clear message to medicare patients, that their time is limited., and for me, I get a cut of the $700 for a ACS CESI. I still stay afloat in the end.

Lono you don't have to worry about this because your are a hospital monkey, worker bee, remember??? keep on working for the machine, troll.
pretty sure he runs his own shop, "sport". just too classy to rub your nose in it. evidently you dont have that problem.
 

stim4u

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pretty sure he runs his own shop, "sport". just too classy to rub your nose in it. evidently you dont have that problem.
Socdoc you want to start another pissing fight? that's all you have to say? what about the Oregon health study, any feed back? Happy about your CESI professional fees, any solutions? You are just a loser antagonist like lonebel. both of you are so bored and disgruntled I can smell it.

Please teach me how to be 'class'y. Even better, provided me your disgruntled wife for a while, she can teach me all night. Loser.
 

SSdoc33

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Socdoc you want to start another pissing fight? that's all you have to say? what about the Oregon health study, any feed back? Happy about your CESI professional fees, any solutions? You are just a loser antagonist like lonebel. both of you are so bored and disgruntled I can smell it.

Please teach me how to be 'class'y. Even better, provided me your disgruntled wife for a while, she can teach me all night. Loser.
everyone on this board is laughing at YOU right now.

im not a fan of medicaid. i dont think it works well. im also not a fan of the drop in professional fees. i was just saying that there does need to be some way for the indigent to get health care. it seems like you are advocating to eliminate medicaid completely. no money, no health care? that seems a bit harsh, even for the most ardent capitalist.

my solution? VERY basic health care for everyone. most specialist care, costly meds, MRIs , no wait for joint replacements, etc and the patients will have pay out of pocket for this. eliminate private insurance completely. let the market sort out how much patietns will pay for an epidural. i dont mave much faith in washington, either, but i cant stand to see 30% of health care dollars going directly to CEOs of United and Aetna.
 

lonelobo

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because I have several thousands of medicare patients, and it takes time to dismiss them without pissing of PCP's. I rather have the media and the self-destruction of medicare be the reason. For example, no CESI procedure in my office for all medicare patients. Off the the surgical center for them. This sends a clear message to medicare patients, that their time is limited., and for me, I get a cut of the $700 for a ACS CESI. I still stay afloat in the end.

Lono you don't have to worry about this because your are a hospital monkey, worker bee, remember??? keep on working for the machine, troll.
FYI, I do own my own practice and have never worked for a hospital and if you wanted To have a D*ck measuring contest I am pretty sure My Practice would put yours to shame Financially, Ethically, and Morally
 

Ducttape

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Duct please explain this more. I'm getting very pissed right before going to bed! Not good.... ughhhhh
my local managed medicaid programs "follow" the CareCore National guidelines for procedures.

Each of the procedures has a different set of guidelines and different limitations attached to them. my understanding is that these "limit" what can be done at an appointment.


for example, 64483 (Lumbar Transforaminal Injection):
II. Acute radiculopathy for second and subsequent injection
E. Limitations (none may exist)
4. Additional interventional pain management procedures are planned at this visit except where the below apply:
a. Multiple pain generators have been clearly identified
b. Significant but incomplete response from medically necessary procedures aimed at these pain generators have been demonstrated
c. Scheduling is restricted by ongoing anti-coagulation therapy.

so my take on this is that, in order to do more than just a TF on a patient at a visit, i have to document that there are multiple pain generators that have been identified, that there has been some response fom previous procedures, or that i am doing something else because he is on anticoagulation. thats a lot of additional paperwork and details that have to get authorized, and i will not "jeopardize" the TF prior auth by asking for auth for anything else at that appointment.
 

emd123

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Duct please explain this more. I'm getting very pissed right before going to bed! Not good.... ughhhhh
They usually only pay 1/2 on the second anyways, so....sorry, "Gotta come back next week, for the knee Mrs Jones. Medicare's rules."
 

stim4u

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FYI, I do own my own practice and have never worked for a hospital and if you wanted To have a D*ck measuring contest I am pretty sure My Practice would put yours to shame Financially, Ethically, and Morally
keep dreaming liberals... the only one laughing is me.
you people are out in left field, there is no way you have successful practices. If you did, you wouldn't continue to make sophomoric comments on a daily basis on this forum. Go see patients, help people.
 
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stim4u

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everyone on this board is laughing at YOU right now.

im not a fan of medicaid. i dont think it works well. im also not a fan of the drop in professional fees. i was just saying that there does need to be some way for the indigent to get health care. it seems like you are advocating to eliminate medicaid completely. no money, no health care? that seems a bit harsh, even for the most ardent capitalist.

my solution? VERY basic health care for everyone. most specialist care, costly meds, MRIs , no wait for joint replacements, etc and the patients will have pay out of pocket for this. eliminate private insurance completely. let the market sort out how much patietns will pay for an epidural. i dont mave much faith in washington, either, but i cant stand to see 30% of health care dollars going directly to CEOs of United and Aetna.
who is recommending elimination of Medicaid? you make outlandish and extreme assumptions, but I guess that is your persona.
Giving CEO cash is bad, adding dozens of taxes on the rich/middle class to support Medicaid is also bad. Obamacare is basically a dumping ground for Medicaid. The Oregon study I mentioned is one of the few studies, that shows Medicaid does NOT lower costs, ER visit, or even help with routine care. Show me a study to contradict this. You can't. SO you resorts to petty comments, antagonism, and so forth. That is the liberal montra. You want a fix, reform medicare/Medicaid first. The reimbursement needs to be stabilized for all specialities. There are patients getting kicked out of their Ob/GYN visits as we speak because of crappy Medicaid obamacare state exchanges (my wife felt bad for a patient dropped at an GYN visit). This reform you voted for screws everybody and does not fix a crappy useless and expensive Medicaid system. I would vote for a voucher system, let people decide what they want, make them more informed. Because clearly you and Obama are ****in clueless.....
 

hyperalgesia

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I met with an insurance contractor last week. No Medicaid for me thank you very much. I had an orthopod give me the stink eye about it, "You really have to take Medicaid here..." and really, the stink eye - like he was mad at me or something.

Most pain docs I know set up their practices accepting everything that walks in the door. They got busy extremely fast. Now they are busy, making okay money but they are completely miserable. Their waiting rooms smell like cigarettes. They have a high turnover of employees. That's just not my goal.
 
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nvrsumr

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my local managed medicaid programs "follow" the CareCore National guidelines for procedures.

Each of the procedures has a different set of guidelines and different limitations attached to them. my understanding is that these "limit" what can be done at an appointment.


for example, 64483 (Lumbar Transforaminal Injection):
II. Acute radiculopathy for second and subsequent injection
E. Limitations (none may exist)
4. Additional interventional pain management procedures are planned at this visit except where the below apply:
a. Multiple pain generators have been clearly identified
b. Significant but incomplete response from medically necessary procedures aimed at these pain generators have been demonstrated
c. Scheduling is restricted by ongoing anti-coagulation therapy.

so my take on this is that, in order to do more than just a TF on a patient at a visit, i have to document that there are multiple pain generators that have been identified, that there has been some response fom previous procedures, or that i am doing something else because he is on anticoagulation. thats a lot of additional paperwork and details that have to get authorized, and i will not "jeopardize" the TF prior auth by asking for auth for anything else at that appointment.

This confuses me a bit. Does this mean I cannot address knee arthritis and a radiculopathy in the same intial visit then schedule both an epidural and a knee injection? The medicaid patients that come thru my door all have multiple issues which I document with PE and imaging prior to treatment so I'm assuming I'm ok.
 

lonelobo

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keep dreaming liberals... the only one laughing is me.
you people are out in left field, there is no way you have successful practices. If you did, you wouldn't continue to make sophomoric comments on a daily basis on this forum. Go see patients, help people.
I know it hard to imagine that someone that does not subscribe to your point of view is successful, but it is is reality

We should be laughing because you are clearly a joke and the ultimate Narcissist.
 

Ligament

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i was just saying that there does need to be some way for the indigent to get health care. it seems like you are advocating to eliminate medicaid completely. no money, no health care? that seems a bit harsh, even for the most ardent capitalist.
I also advocate to eliminate medicaid completely. No money, NO healthcare. Exactly. Nothing harsh there, that is the real world.

I would support a law providing basic healthcare to poor children 18 and under. I would make this a voluntary tax to those who support it.

I'd also support a law making it a crime to reproduce while one is on welfare.

SSdoc33 if you want to pay for those who cannot, please feel free to do so. But I do not wish to pay for THEIR healthcare.

The fundamental disconnect with socialists and those living in the real world is that the socialist cannot imagine life without handouts of other peoples money.
 

lonelobo

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I also advocate to eliminate medicaid completely. No money, NO healthcare. Exactly. Nothing harsh there, that is the real world.

I would support a law providing basic healthcare to poor children 18 and under. I would make this a voluntary tax to those who support it.

I'd also support a law making it a crime to reproduce while one is on welfare.

SSdoc33 if you want to pay for those who cannot, please feel free to do so. But I do not wish to pay for THEIR healthcare.

The fundamental disconnect with socialists and those living in the real world is that the socialist cannot imagine life without handouts of other peoples money.
No this is not the real world, we are only industrialized country who doesn't have Healthcare for everyone.
Just got back from couple weeks in Australia and the two things I was asked about multiple times was U.S. healthcare and guns.

Everyone I spoke to was pleased with their system of healthcare( which was essentially medicare), and couldn't believe we don't have the same system here.
They have private insurance as well, but some rather affluent people I met don't bother with it as they feel they don't need it.
So I guess you would call them "Socialist"

They are also the wealthiest and happiest country on earth, maybe they know something we don't.
 
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docnyc

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No this is not the real world, we are only industrialized country who doesn't have Healthcare for everyone.
Just got back from couple weeks in Australia and the two things I was asked about multiple times was U.S. healthcare and guns.

Everyone I spoke to was pleased with their system of healthcare( which was essentially medicare), and couldn't believe we don't have the same system here.
They have private insurance as well, but some rather affluent people I met don't bother with it as they feel they don't need it.
So I guess you would call them "Socialist"

They are also the wealthiest and happiest country on earth, maybe they know something we don't.

I like to stay out of these political debates as they just become a shouting match. I am independent politically but am not happy about the squeeze on our profession.

A few points though.

About Australia....I have a very sweet retired doc who still maintains her Australian citizenship and lives in the US 8 months out of the year. She gets about a year of relief with RFA from me. Without fail she will try to squeeze this in before she makes her yearly trip to Australia. I am fine with her getting it in Australia, and I told her that she can try that if its cheaper for her. She gets medical care in Australia as well however she has told me that their national healthcare does not cover this procedure (I do not know the details on this, but either its not covered or its hard to find someone who does it under the national system). Her wait time for healthcare in general is also significantly longer. For checkups etc, she likes the national system, for specialized care she does not.

I have a partner in our practice who is a neurologist, who is from Australia. He chooses not to move back to Australia because
1) the cost of living is significantly higher than the US...he has a nicer house, nicer cars at a more affordable price here than it would cost in Australia,
2) He finds the US to be significiantly more economically friendly in acquiring wealth than Australia. Much harder to move up the wealth ladder in Australia
3) Docs in Australia dont make nearly as much money as we do. They are comfortable but they are by no means wealthy.

My points cannot generalize the situation just like yours cannot. I wouldnt go so far to say that Australia is the happiest country on earth.

And for what its worth...Australia's population is 23 million, Canada 34 million, USA............314 million. This is not an apples to apples comparison IMHO.
 

Tenesma

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"Socialism is great until you run out of other peoples money" I don't know where this came from (although attributed to Marg. Thatcher quite a bit).

Can't wait to leave Medicare - however, a bit pissed off that if you our of network w/ medicare you can't order imaging or prescribe medications - I mean you can order imaging, prescribe medications, but Medicare won't cover/pay for imaging/meds prescribed by an out of network doctor...
 

nvrsumr

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"Socialism is great until you run out of other peoples money" I don't know where this came from (although attributed to Marg. Thatcher quite a bit).

Can't wait to leave Medicare - however, a bit pissed off that if you our of network w/ medicare you can't order imaging or prescribe medications - I mean you can order imaging, prescribe medications, but Medicare won't cover/pay for imaging/meds prescribed by an out of network doctor...

This is going to kill concierge medicine.
 

lonelobo

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I like to stay out of these political debates as they just become a shouting match. I am independent politically but am not happy about the squeeze on our profession.

A few points though.

About Australia....I have a very sweet retired doc who still maintains her Australian citizenship and lives in the US 8 months out of the year. She gets about a year of relief with RFA from me. Without fail she will try to squeeze this in before she makes her yearly trip to Australia. I am fine with her getting it in Australia, and I told her that she can try that if its cheaper for her. She gets medical care in Australia as well however she has told me that their national healthcare does not cover this procedure (I do not know the details on this, but either its not covered or its hard to find someone who does it under the national system). Her wait time for healthcare in general is also significantly longer. For checkups etc, she likes the national system, for specialized care she does not.

I have a partner in our practice who is a neurologist, who is from Australia. He chooses not to move back to Australia because
1) the cost of living is significantly higher than the US...he has a nicer house, nicer cars at a more affordable price here than it would cost in Australia,
2) He finds the US to be significiantly more economically friendly in acquiring wealth than Australia. Much harder to move up the wealth ladder in Australia
3) Docs in Australia dont make nearly as much money as we do. They are comfortable but they are by no means wealthy.

My points cannot generalize the situation just like yours cannot. I wouldnt go so far to say that Australia is the happiest country on earth.

And for what its worth...Australia's population is 23 million, Canada 34 million, USA............314 million. This is not an apples to apples comparison IMHO.
Points well taken.

Anecdotally they did seem pretty darn happy when I was there... But some do rate them as the Happiest
http://www.huffingtonpost.com/2013/05/28/worlds-happiest-countries-2013-australia_n_3347347.html
 

hyperalgesia

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Medicaid is Medicare with a balanced budget. I like it politically because it is state based. It's not like the 'healthcare is a right' fantasy that is Medicare/Single Payer philosophy. But god help us when the states start to mandate Medicaid to keep our medical licensure.
 

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This is going to be a tricky year for private practice docs who take public insurance: we've got Obamacare, Meaningful Use 2, ICD-10, and the new improved HIPAA with bigger fines and more requirements. I fully expect to see a wave of pain docs moving back to Anesthesia as this all takes effect.
 

Ligament

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No this is not the real world, we are only industrialized country who doesn't have Healthcare for everyone.
Just got back from couple weeks in Australia and the two things I was asked about multiple times was U.S. healthcare and guns.

Everyone I spoke to was pleased with their system of healthcare( which was essentially medicare), and couldn't believe we don't have the same system here.
They have private insurance as well, but some rather affluent people I met don't bother with it as they feel they don't need it.
So I guess you would call them "Socialist"

They are also the wealthiest and happiest country on earth, maybe they know something we don't.
Yes, any system where the government provides healthcare for those who DO NOT PAY FOR IT is socialist, and is participating in taking YOUR money, to give to those with less or no money.

Nothing is free. I wish you socialists would understand that.
 
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bedrock

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Can't wait to leave Medicare - however, a bit pissed off that if you our of network w/ medicare you can't order imaging or prescribe medications - I mean you can order imaging, prescribe medications, but Medicare won't cover/pay for imaging/meds prescribed by an out of network doctor...
Did that start already? I thought they were proposing it for 2015? I agree that it will kill concierge medicine.
 

bedrock

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Everyone I spoke to was pleased with their system of healthcare( which was essentially medicare), and couldn't believe we don't have the same system here.
They have private insurance as well, but some rather affluent people I met don't bother with it as they feel they don't need it.
So I guess you would call them "Socialist"

They are also the wealthiest and happiest country on earth, maybe they know something we don't.
Australia is neither the wealthiest or happiest country. I doubt your sources, I'm sure the Aussie like to brag that their country is the best.......

You talk to people from countries with socialized medicine and they all say's it's great, except for the people who actually needed more than a PCP level of healthcare.

The people who actually needed major medical procedures/surgery and cutting edge treatments and were denied out of hand or told to wait for 10 months tell you a very different story. That's why those polls are useless, because a random sampling doesn't include a high percentage of over 55yr old people who really need their healthcare.
 

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I like to stay out of these political debates as they just become a shouting match. I am independent politically but am not happy about the squeeze on our profession.

A few points though.

About Australia....I have a very sweet retired doc who still maintains her Australian citizenship and lives in the US 8 months out of the year. She gets about a year of relief with RFA from me. Without fail she will try to squeeze this in before she makes her yearly trip to Australia. I am fine with her getting it in Australia, and I told her that she can try that if its cheaper for her. She gets medical care in Australia as well however she has told me that their national healthcare does not cover this procedure (I do not know the details on this, but either its not covered or its hard to find someone who does it under the national system). Her wait time for healthcare in general is also significantly longer. For checkups etc, she likes the national system, for specialized care she does not.

I have a partner in our practice who is a neurologist, who is from Australia. He chooses not to move back to Australia because
1) the cost of living is significantly higher than the US...he has a nicer house, nicer cars at a more affordable price here than it would cost in Australia,
2) He finds the US to be significiantly more economically friendly in acquiring wealth than Australia. Much harder to move up the wealth ladder in Australia
3) Docs in Australia dont make nearly as much money as we do. They are comfortable but they are by no means wealthy.

My points cannot generalize the situation just like yours cannot. I wouldnt go so far to say that Australia is the happiest country on earth.

And for what its worth...Australia's population is 23 million, Canada 34 million, USA............314 million. This is not an apples to apples comparison IMHO.
Best part about this is the 10 fold difference in populations. Nobody factors that in when making comparisons. For every one 1 medicaid patient some taxpayer over in Canada has to support, I have to support 10...and their babies, and their baby mommas, and their baby's momma's mommas....
 

hyperalgesia

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Best part about this is the 10 fold difference in populations. Nobody factors that in when making comparisons. For every one 1 medicaid patient some taxpayer over in Canada has to support, I have to support 10...and their babies, and their baby mommas, and their baby's momma's mommas....
I believe the correct term is "baby momma mommas". Or simply "ho".
 

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"Socialism is great until you run out of other peoples money" I don't know where this came from (although attributed to Marg. Thatcher quite a bit).

Can't wait to leave Medicare - however, a bit pissed off that if you our of network w/ medicare you can't order imaging or prescribe medications - I mean you can order imaging, prescribe medications, but Medicare won't cover/pay for imaging/meds prescribed by an out of network doctor...
Won't necessarily hurt the cash only pain doc who manages to make cash for interventions work. You can always ask the primary to order those things. If interventionalists exit the field en mass, there will be a lot less competition. It may be similar to dentistry, which many of us would love.
 

stim4u

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lonelobo the sad truth is that you are the outlier and don't even know it.... scary. And don't make baseless comments about my ethics and practice, I have survived in a region where there are 15 pain doctors in a 20 mile radius. Be happy that you are in the sticks, and don't have the daily competition that most of us deal with regularly.

As for Medicaid and medicare, it is correct, you cannot order imaging or medications if you opt out.
You could probably offset this by having one of your PA's/MD's as a participating Medicare provider.
Once most of us are forced out of medicare, due to the poor reimbursement and burdensome documentation, it will be up to the PCP to order these tests.

From reading the links above, this argument about Australia and Canada being the 'happiest places' are simplistic at best. THe sample size and
persons responding are not sick-health care-using patient's actually using these socialist health systems. From my direct discussions from patients from London (I have lots of business types) there is a two tier system. If you work for a big rich company in England you get concierge health plans with direct access to doctors (no wait times) and access to all treatments (ie. epidurals). If you do NOT have these concierge plans, you are subject the the NASPER rules, which are draconian in nature. Furthermore, the doctors in England are forced to see all patients, but triage the higher end insurance first. THeir incomes are essentially dependent on these high end plans. So the social system is even more aristocratic in nature, whereas in the USA the health care provided has been traditionally universal for all classes, at least in the ER and with specialists. Clearly, Medicaid clinics are resident training grounds, and a different story here.

everybody has a different spin on socialized health care, but I would submit if you want a major procedure you typically go to a high end London/Germany hospital or you come to America. NObody uses the traditional French/English system. Furthermore if you read the international editorials, England health system is going through a backlash as we speak, due to crappy geriatric care and and high death rates.....
 

lonelobo

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lonelobo the sad truth is that you are the outlier and don't even know it.... scary. And don't make baseless comments about my ethics and practice, I have survived in a region where there are 15 pain doctors in a 20 mile radius. Be happy that you are in the sticks, and don't have the daily competition that most of us deal with regularly.
s.....
kinda of like you did about "my practice"
 

lonelobo

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From reading the links above, this argument about Australia and Canada being the 'happiest places' are simplistic at best. THe sample size and
persons responding are not sick-health care-using patient's actually using these socialist health systems. From my direct discussions from patients from London (I have lots of business types) there is a two tier system. If you work for a big rich company in England you get concierge health plans with direct access to doctors (no wait times) and access to all treatments (ie. epidurals). If you do NOT have these concierge plans, you are subject the the NASPER rules, which are draconian in nature. Furthermore, the doctors in England are forced to see all patients, but triage the higher end insurance first. THeir incomes are essentially dependent on these high end plans. So the social system is even more aristocratic in nature, whereas in the USA the health care provided has been traditionally universal for all classes, at least in the ER and with specialists. ..
When did I say anything about England?
 
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lonelobo

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Yes, any system where the government provides healthcare for those who DO NOT PAY FOR IT is socialist, and is participating in taking YOUR money, to give to those with less or no money.

Nothing is free. I wish you socialists would understand that.
Like our Police, fire, EMS, schools
 

stim4u

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lonelobo the sad truth is that you are the outlier and don't even know it.... scary. And don't make baseless comments about my ethics and practice, I have survived in a region where there are 15 pain doctors in a 20 mile radius. Be happy that you are in the sticks, and don't have the daily competition that most of us deal with regularly.

As for Medicaid and medicare, it is correct, you cannot order imaging or medications if you opt out.
You could probably offset this by having one of your PA's/MD's as a participating Medicare provider.
Once most of us are forced out of medicare, due to the poor reimbursement and burdensome documentation, it will be up to the PCP to order these tests.

From reading the links above, this argument about Australia and Canada being the 'happiest places' are simplistic at best. THe sample size and
persons responding are not sick-health care-using patient's actually using these socialist health systems. From my direct discussions from patients from London (I have lots of business types) there is a two tier system. If you work for a big rich company in England you get concierge health plans with direct access to doctors (no wait times) and access to all treatments (ie. epidurals). If you do NOT have these concierge plans, you are subject the the NASPER rules, which are draconian in nature. Furthermore, the doctors in England are forced to see all patients, but triage the higher end insurance first. THeir incomes are essentially dependent on these high end plans. So the social system is even more aristocratic in nature, whereas in the USA the health care provided has been traditionally universal for all classes, at least in the ER and with specialists. Clearly, Medicaid clinics are resident training grounds, and a different story here.

everybody has a different spin on socialized health care, but I would submit if you want a major procedure you typically go to a high end London/Germany hospital or you come to America. NObody uses the traditional French/English system. Furthermore if you read the international editorials, England health system is going through a backlash as we speak, due to crappy geriatric care and and high death rates.....
correction for my statement above:
apparently you can opt out of MEDICARE and be an OUT of NETWORK 'referring physician' capable of MRI referrals and medications prescriptions. This is an option I was not aware of and informed by my biller, I was incorrect....
 

Tenesma

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lonelobo - interesting point about fire/police/schools.... where i live, most public service employees (cops/firefighters and teachers) can expect (at tax-payer expense) retirement after 20 years (for cops/firefighters) 25 years (for teachers) with the majority of them making >90-100k/year with COLA adjustments of 5% per year in their pension....

if my medical care is considered a similar service then 1) i want no further risk of malpractice litigation 2) i want to be able to retire after 25 years 3) i want a guaranteed pension w/ COLA adjustments...
 

hyperalgesia

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If a politician were to start pointing out the incredible disparity in funding between communities of fire and police departments, and how unfair it is, why not make a national fire department? Is it fair to let these "back woods, racist" communities decide which fires to put out and which crimes to solve when the federal government could do it in such an even-handed, efficient manner? My view is that these services, along with education and Medicaid are all best left at the state and community level. Because it's easy for a community to oust a Fire Chief or a Sheriff. Therefore there's more accountability. And one size does not fit all.
 

Louisville04

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lonelobo - interesting point about fire/police/schools.... where i live, most public service employees (cops/firefighters and teachers) can expect (at tax-payer expense) retirement after 20 years (for cops/firefighters) 25 years (for teachers) with the majority of them making >90-100k/year with COLA adjustments of 5% per year in their pension....

if my medical care is considered a similar service then 1) i want no further risk of malpractice litigation 2) i want to be able to retire after 25 years 3) i want a guaranteed pension w/ COLA adjustments...
Teachers, cops, firefighter making $90-100k in retirement pensions??? This will no longer be the case. Detroit is bankrupt and probably will default on their pension obligations. Illinois is cutting teacher pensions as well due to budget deficits.
 

Ducttape

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If a politician were to start pointing out the incredible disparity in funding between communities of fire and police departments, and how unfair it is, why not make a national fire department? Is it fair to let these "back woods, racist" communities decide which fires to put out and which crimes to solve when the federal government could do it in such an even-handed, efficient manner? My view is that these services, along with education and Medicaid are all best left at the state and community level. Because it's easy for a community to oust a Fire Chief or a Sheriff. Therefore there's more accountability. And one size does not fit all.
We tried this approach once, and the Confederates who supported this concept lost the war.

Some things need to be under federal control. We can argue which aspects (I don't think most ppl would argue against national defense, for example). Politicians use this to their own advantage too. Remember CRNAs and noctors requesting coverage for ESI and pain interventions last year? The final ruling - let the states decide. Yet affordable care act is essentially forced on all states ...