Discussion on How Doctors Should get Paid

[Awesome Sauceome]

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Found this rural primary care physician's blog. He has some interesting insight into the field. This man has seen it all. He has been practicing medicine for almost twice as long as most of us have been alive. He has seen all sorts of changes to the payment systems throughout the past 40-odd years and he has worked in many different medical environments. So I would imagine he really knows what works and what doesnt. He really gets to the meat around parts 4 and 5. Hopefully it can generate some thoughtful discussion.

Part 1
http://acountrydoctorwrites.wordpress.com/2014/04/02/how-should-doctors-get-paid-part-1/
Part 2
http://acountrydoctorwrites.wordpress.com/2014/04/13/how-should-doctors-get-paid-part-2/
Part 3
http://acountrydoctorwrites.wordpress.com/2014/04/26/how-should-doctors-get-paid-part-3/
Part 4
http://acountrydoctorwrites.wordpress.com/2014/05/01/how-should-doctors-get-paid-part-4/
Part 5
http://acountrydoctorwrites.wordpress.com/2014/05/04/how-should-doctors-get-paid-part-5/

 

[tripl3s3v3n]

Very interesting read. Thank you.

 

[Awesome Sauceome]

Very interesting read. Thank you.

Yea no problem, altogether they are kind of long which I think turns off a lot of people from reading them haha. But his system seems like it could actually work. Like as it stands now, docs are bailing out of insurance altogether and are going cash only which is bad for the system and bad for patients. What he is proposing is going with the setup that cash only uses (direct pay/concierge) but having medicare and private insurance companies pay for that type of practice. And he recognizes that this type of system would not work for procedural based specialties. I really respect this guy, he is a wise dude.

 

[tripl3s3v3n]

I think he makes a valid argument that would work really well in a primary care setting. I believe, however, there is a place for cash based practices. For example, I received my physical for medical school at one. (I live in a rural area and we have 3 month waits to see a PCP)

 

[Awesome Sauceome]

I think he makes a valid argument that would work really well in a primary care setting. I believe, however, there is a place for cash based practices. For example, I received my physical for medical school at one. (I live in a rural area and we have 3 month waits to see a PCP)

Yea I am thinking about doing this while I am in school (if I get in / crossing fingers). Like get some crazy high deductible ACA plan that is dirt cheap and then just go cash only. I just cant stomach paying that exorbitant amount of money for any schools trashy insurance plans.

 

[tripl3s3v3n]

Well I have good insurance, I just couldn't wait that amount of time. Fortunately I work directly for the ED physician group and receive the same insurance they give themselves.

 

[tripl3s3v3n]

Yea I am thinking about doing this while I am in school (if I get in / crossing fingers). Like get some crazy high deductible ACA plan that is dirt cheap and then just go cash only. I just cant stomach paying that exorbitant amount of money for any schools trashy insurance plans.

If you check the Osteopathic Medical Student forum there are some posts on this. I believe they are religious based healthcare plans from what I remember.

 

[verynice]

It seems like most PCPs I have shadowed have this assembly line type approach to patient care. I always thought that it was inconsiderate and used in order to make more money. From this article, I can see that this process is actually needed in order to make up for the lost time dealing with payers.

This also begs the question, why is it needed to spend so much time with payers in the first place? Prior authorizations are ridiculous right now. Having worked in a pharmacy, I can say that insurance is like an ethereal, profit-centered, presence that has a hold on the patients' lives. I agree that they are needed, because sometimes the provider just doesn't know their is a cheaper option, but putting a PA on someone's statin or ACE inhibitor is ridiculous. This makes for extremely long wait times from the time the medication was prescribed to the time that the patient receives the medication. All because the physician/PA/NP has to prove that the medication is "medically necessary." Of course it is necessary, it was prescribed wasn't it?!

 

[coolingglasses]

It seems like most PCPs I have shadowed have this assembly line type approach to patient care. I always thought that it was inconsiderate and used in order to make more money. From this article, I can see that this process is actually needed in order to make up for the lost time dealing with payers.

This also begs the question, why is it needed to spend so much time with payers in the first place? Prior authorizations are ridiculous right now. Having worked in a pharmacy, I can say that insurance is like an ethereal, profit-centered, presence that has a hold on the patients' lives. I agree that they are needed, because sometimes the provider just doesn't know their is a cheaper option, but putting a PA on someone's statin or ACE inhibitor is ridiculous. This makes for extremely long wait times from the time the medication was prescribed to the time that the patient receives the medication. All because the physician/PA/NP has to prove that the medication is "medically necessary." Of course it is necessary, it was prescribed wasn't it?!

Good grief. I have seen so much insurance meddling in just two weeks on a preceptorship. They're basically playing doctor.

It pisses me off.

 

[Awesome Sauceome]

It seems like most PCPs I have shadowed have this assembly line type approach to patient care. I always thought that it was inconsiderate and used in order to make more money. From this article, I can see that this process is actually needed in order to make up for the lost time dealing with payers.

This also begs the question, why is it needed to spend so much time with payers in the first place? Prior authorizations are ridiculous right now. Having worked in a pharmacy, I can say that insurance is like an ethereal, profit-centered, presence that has a hold on the patients' lives. I agree that they are needed, because sometimes the provider just doesn't know their is a cheaper option, but putting a PA on someone's statin or ACE inhibitor is ridiculous. This makes for extremely long wait times from the time the medication was prescribed to the time that the patient receives the medication. All because the physician/PA/NP has to prove that the medication is "medically necessary." Of course it is necessary, it was prescribed wasn't it?!

yea they really have to in order to "feed the beast." They don't keep seeing patients and their nurses and staff don't get paid. Its actually very sad...





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[deleted480308]

If you check the Osteopathic Medical Student forum there are some posts on this. I believe they are religious based healthcare plans from what I remember.

I do one for my family since we have no pre-existings....it's $370 for the whole family. http://samaritanministries.org/