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Jan 21, 2006
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Fewer Primary Care Doctors Take Medicare
- Anchorage Daily News, Rosemary Shinohara
February 19, 2007

After Henry Taylor's doctor moved to Homer, Taylor, who is 77, needed two things: an Anchorage physician to prescribe drugs for diabetes and other ailments, and relief for his aching back.

He didn't realize his lungs were quietly killing him. He didn't find out until it was too late because he is on Medicare, and doctor after doctor refused to see him.

There's a crisis in health care for Alaska's older residents: Few primary care doctors take new patients on Medicare, the federal insurance program for people 65 and older.

The crisis is not new, but evidence indicates it is worsening.

Alaska is short of primary care doctors in general. And many of them say they can afford to treat only limited numbers of Medicare patients, if any, because the rates are too low -- often less than half what a doctor normally charges.

"When you get close to 23 to 25 percent of your visits from Medicare patients, you're going bankrupt," said Dr. Bruce Kiessling of Primary Care Associates, the largest primary care group in the state. "We do not take new Medicare, not at all."

Primary Care keeps existing patients who age into Medicare.

Click here to read the complete article.
 

Faebinder

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Well Alaska is a stupid state anyway... All states base their license on the number of times you pass step 3... only Alaska puts a condition on the number of times step 2 is passed. How is that an issue you might ask? Studies show that you are more likely to end up practicing in the place that you do your residency...

So if you block people before they come to do residency.... guess what, they wont practice there. Why would a physician with a license in Oklahoma, decide to move to Alaska unless there is something good going on for him/her.

Bah.. enough rant.. Alaska = Dumb State. (Didn't they also want money to build a bridge to an island uninhabited last year?)
 

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Um, this may actually be a better example of why it is a bad idea to move to a small hamlet in the middle of nowhere when you are elderly and have significant morbidity than an actual problem with primary care. Alaska has like 500,000 people, and over 400,000 of them are in the Anchorage metro. If you leave Anchorage, you may have to go without amenities. I commented on this one over in the Topics in Healthcare forum (where it is double posted KentW), but I didn't really get the gist of this until I read it again here.

Good things about Homer, I've seen Oceanfront homes for sale here under $300,000. Bad things about Homer, one earthquake might put your oceanfront home into the ocean. Oh yeah, and apparently there are no doctors.
 
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The cost of living is also significantly higher in AK and HI, so it's not surprising that docs really can't make it with Medicare...although, with rural health clinic status, your medicare reimbursements are higher. I bet rural AK docs are still taking it.
 

jmsMD

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I wonder which state will be next.
 
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Um, this may actually be a better example of why it is a bad idea to move to a small hamlet in the middle of nowhere when you are elderly and have significant morbidity than an actual problem with primary care.

Perhaps, but you don't have to go to Alaska to have trouble finding a doctor who takes new Medicare patients. In my office, only one of the three docs is taking new Medicare...and that's only because he's the new guy, and needs the business.
 

Faebinder

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Perhaps, but you don't have to go to Alaska to have trouble finding a doctor who takes new Medicare patients. In my office, only one of the three docs is taking new Medicare...and that's only because he's the new guy, and needs the business.

Yup.. that's pretty much the case everywhere...

Taking medicare? Are you new in town doc, don't you know you are supposed to say NO to medicare?
 
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Yup.. that's pretty much the case everywhere...

Taking medicare? Are you new in town doc, don't you know you are supposed to say NO to medicare?

I'm closed to new Medicare now, but I have plenty already. I took over a retired doc's practice, so I started out rather top-heavy in Medicare from the onset.
 

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I very seriously doubt that I will take Medicare when I get out. The only way I will is if I end up in a location that really leaves me no other option.
 

Faebinder

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I plan to do exactly as Kent said... start with not being picky and over time become picky.... which means start 'taking some medicare' overtime transfer to 'not going to take any medicare'.
 

Miami_med

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Perhaps, but you don't have to go to Alaska to have trouble finding a doctor who takes new Medicare patients. In my office, only one of the three docs is taking new Medicare...and that's only because he's the new guy, and needs the business.

Yeah,

I wasn't implying that it wasn't a problem everywhere, just that the example in the article wasn't a very good representation of the problem that they had in mind.
 

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I very seriously doubt that I will take Medicare when I get out. The only way I will is if I end up in a location that really leaves me no other option.

Hmmm....I know that some insurance reimbursements are even lower than Medicare (United Healthcare is one I remember in particular). May not be true anymore.

I just can't imagine not taking Medicare. Maybe that's because I've spent a lot of time in rural health clinics that are subsidized. Those docs are doing very well for themselves.

Also, who are you going to take care of, only people under 65? Okay...that makes a lot of sense, with baby boomers turning 65 right about now. Also, who gets sick??? Old people!!

Who's going to take care of these people??
 
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Take care of old people? Isn't it obvious... it's the ER... like just like take care of the homeless, drunks and drug seekers... My Chemical Romance calls them: broken, beaten and the damned and their Black Parade song.:D
 

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I'm going to do an OB fellowship so I can do sections and then tailor my practice to mostly OB and peds type stuff with some adult and geriatric type stuff interspersed along the way to keep it interesting. I don't particularly enjoy doing chronic care for people that are on tons of meds (and this is pretty much the medicaid population from what I have seen) so I intend to tailor my practice to avoid that type of care to a large extent. I know of another FM doc that has tailored his practice this way and pretty much sees only middle aged, relatively healthy women and their kids. It's a really cool practice in my opinion.
 

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I'm going to do an OB fellowship so I can do sections and then tailor my practice to mostly OB and peds type stuff with some adult and geriatric type stuff interspersed along the way to keep it interesting. I don't particularly enjoy doing chronic care for people that are on tons of meds (and this is pretty much the medicaid population from what I have seen) so I intend to tailor my practice to avoid that type of care to a large extent. I know of another FM doc that has tailored his practice this way and pretty much sees only middle aged, relatively healthy women and their kids. It's a really cool practice in my opinion.

Still, if you are an FP doing OB, you are likely going to be practicing in a rural or semi-rural area due to the inability to compete with OB/Gyns in the city...and I can tell you, there aren't a lot of privately insured folks in rural areas. I'd be very surprised to see many FPs with the kind of practice you describe being able to survive if they only take private insurance. But more power to you. Can't hurt to dream, can it?
 

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I'd be very surprised to see many FPs with the kind of practice you describe being able to survive if they only take private insurance. But more power to you. Can't hurt to dream, can it?

If I remember correctly, are'nt you a student? In which case, how would you know what is possible and what isn't? I and many doctors just don't take Medicare plain and simple. Heck, there are guys who don't take insurance period, cash only, thank you. FYI, when you negotiate rates with private insurance it usually goes like....115%-130% of Medicare rates. The only positive thing about Medicare is they pay VERY quickly.
 

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Actually, there is an FP with c-section training here in our CITY at our university hospital that happens to be a partner with the OB group that is part of the residency (yes, she helps instruct the OB residents on how to perform proper OB care). In addition, I know of at least two more FP's in our CITY that have c-section privileges at other hospitals here in our CITY, so I venture to say you don't entirely know about that of which you speak. I know FP's getting privileges for advanced procedures is regional, but I am in a region that seems happy to acknowledge that properly trained FP's are capable of providing high level services. There certainly doesn't seem to be a patient preference either way in our area, either. Of the FP's I know that are doing OB in our area, they are all pretty darn busy. The patients I have worked with on both the OB service and our OB patients in FP clinic are more concerned with having a doctor that they can relate to and that can perform the needed services adequately than some artificial letters or professional association. Maybe that's regional as well.

By the way, I grew up in one of the most rural areas of Kentucky so you don't have to tell me anything about the social situation in those rural areas. I bet I have way more experience and expertise on that subject than you.
 

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If I remember correctly, are'nt you a student? In which case, how would you know what is possible and what isn't? I and many doctors just don't take Medicare plain and simple. Heck, there are guys who don't take insurance period, cash only, thank you. FYI, when you negotiate rates with private insurance it usually goes like....115%-130% of Medicare rates. The only positive thing about Medicare is they pay VERY quickly.

I am a student, but that doesn't mean I haven't had personal experience with a number of family medicine clinics. Since my first year, I've done summer preceptorships, spent afternoons in a family medicine clinic during my second year, and I've rotated with several private family physicians recently. I've always been interested in the business side, so I've taken an interest in it and asked questions. I've already said that many of my rotations have been in inner city or rural family medicine clinics, and that's probably why I've seen mostly practices that have a significant portion of medicare and medicaid patients.

I also still perhaps foolishly think that part (not all) of my responsibilty as a physician will be to take care of people. I'm not willing to suffer personally or have my business suffer, but I find it somehwat irresponsible that physicians are refusing to accept ANY medicare/medicaid patients (which increases the burden on those who do), when, as flawed and broken as it is, it's still the only safety net we have in this country for the uninsured or underinsured. I guess if you practice in an affluent area with very few older people or poor people, you can do this, and make more money. But like I said, pretty soon the MAJORITY of the US population will be over 65, and most of them have Medicare.

There are county indigent programs, but most of the folks needing this assistance are working people, skirting the edge of poverty, but making "too much" to qualify for public assistance from the county or city.

I understand the frustration, even as a mere student (but not for long...!), but I've also started and run a successful business, and I'm not as green as you might think.

There are ways to make the bottom line work without suffering financially, and still take medicare and medicaid. One of them is to work in a federally qualified or rural health clinic, which is what I plan to do. Reimbursement rates are higher than some insurance plans, and as you say, they are paid more quickly.
 

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I bet I have way more experience and expertise on that subject than you.

Let's keep it civil, shall we? My post was, and I'd appreciate the same in return. This is not a pi$$ing contest, but a discussion.

Thanks.
 
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Actually, there is an FP with c-section training here in our CITY at our university hospital that happens to be a partner with the OB group that is part of the residency (yes, she helps instruct the OB residents on how to perform proper OB care). In addition, I know of at least two more FP's in our CITY that have c-section privileges at other hospitals here in our CITY, so I venture to say you don't entirely know about that of which you speak. I know FP's getting privileges for advanced procedures is regional, but I am in a region that seems happy to acknowledge that properly trained FP's are capable of providing high level services. There certainly doesn't seem to be a patient preference either way in our area, either. Of the FP's I know that are doing OB in our area, they are all pretty darn busy. The patients I have worked with on both the OB service and our OB patients in FP clinic are more concerned with having a doctor that they can relate to and that can perform the needed services adequately than some artificial letters or professional association. Maybe that's regional as well.


I think either you misunderstood what I was saying or I didn't make it clear. I was referring to the successful FP-run OB practice with lots of pedi patients which refuses to take any Medicare or Medicaid as being something that is probably a rarity, not FPs doing OB in general. Also, a lot of kids--both urban and rural-- are on Medicaid or the state equivalent (in TX it's the CHIP program).

I can quote back to you quite a few successful FPs doing OB in my region, so I'm not arguing that. I want to do the same thing you do, so we're really on the same side here.

I've been arguing for FPs doing OB, and commenting on the regionality of it for quite a while here on SDN. I've done a lot of research about what is possible and how to make OB work in an FP practice, and in my area, it's unlikely I'd be able to make it without taking medicare or medicaid.
 

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FYI, when you negotiate rates with private insurance it usually goes like....115%-130% of Medicare rates. The only positive thing about Medicare is they pay VERY quickly.

Doesn't this negotiation take a significant amount of time? There was an article about this is the most recent AAFP news where one doc said she took an entire afternoon a week to resolve claims and only ended up with about three claims done at the end of the afternoon. So she hired someone to do it. I guess my point is that if I'm not having to pay someone full time to negotiate with insurance companies, or do it myself, I can see more patients and make up that 15-30% in that time, particularly in an RHC.
 
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I've done a lot of research about what is possible and how to make OB work in an FP practice, and in my area, it's unlikely I'd be able to make it without taking medicare or medicaid.

Medicare? I wasn't aware that there were that many people over the age of 65 delivering babies these days. ;)

Just kidding. Medicaid is another matter, of course. Most of the peds and OB folks that I know feel they "have to" accept Medicaid, too.
 
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Doesn't this negotiation take a significant amount of time? There was an article about this is the most recent AAFP news where one doc said she took an entire afternoon a week to resolve claims and only ended up with about three claims done at the end of the afternoon. So she hired someone to do it. I guess my point is that if I'm not having to pay someone full time to negotiate with insurance companies, or do it myself, I can see more patients and make up that 15-30% in that time, particularly in an RHC.

I'm pretty sure that the "negotiation" being referred to is on the front end, at the time a contract is signed. That's when you settle on a fee schedule. It's not something that takes place with each claim. That's a whole different process.
 

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I'm pretty sure that the "negotiation" being referred to is on the front end, at the time a contract is signed. That's when you settle on a fee schedule. It's not something that takes place with each claim. That's a whole different process.

Thanks for clarifying that, Kent.
 

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Medicare? I wasn't aware that there were that many people over the age of 65 delivering babies these days. ;)

Hey, there was a 55 year old in France somewhere who did it recently... (I'm shuddering inside)...and fertility technology is improving every day--heck, you could be having a baby at 65 one day for all we know!

I should have clarified that...because I will be hopefully seeing the older folks as well. Green as I am, I actually do understand the basic difference between Medicare and Medicaid. ;)
 

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Ive always thought that Medicare makes up a majority of a PCPs revenue...
 
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I have yet to say anything uncivil to you or anyone else.

It's a subtle distinction, but while there's nothing wrong with suggesting that you know what you're talking about, saying that somebody else doesn't know what they're talking about is a bit rude. It's always better to discuss the subject, not the participants.
 

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Perhaps, but you don't have to go to Alaska to have trouble finding a doctor who takes new Medicare patients. In my office, only one of the three docs is taking new Medicare...and that's only because he's the new guy, and needs the business.

Which means that the federal government wont feel the pinch about docs "not accepting medicare" which further means that the threat of doctors "refusing medicare" is basically nonexistant.

Its going to take massive populations of people who cant get any doctors at all within a wide radius before the govt will even consider altering reimbursement.
 

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BTW, the GAO recently did a huge nationwide study on claims that docs were refusing Medicare patients.

Their conclusion? Surprise, there was no statistically measurable differnece in access to primary care doctors for Medicare patients.

Meaning that all this talk about docs not taking Medicare patients is nothing more than inconsequential anecdotes and NOT any part of a larger trend.
 

Faebinder

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BTW, the GAO recently did a huge nationwide study on claims that docs were refusing Medicare patients.

Their conclusion? Surprise, there was no statistically measurable differnece in access to primary care doctors for Medicare patients.

Meaning that all this talk about docs not taking Medicare patients is nothing more than inconsequential anecdotes and NOT any part of a larger trend.

That's cause there will always be new graduates who come to the area and of course they gotta start having patients... when you are new and dont have an established number of patients, you will take anyone. After a couple of years they start fine tuning.
 

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Actually, there is an FP with c-section training here in our CITY at our university hospital that happens to be a partner with the OB group that is part of the residency (yes, she helps instruct the OB residents on how to perform proper OB care). In addition, I know of at least two more FP's in our CITY that have c-section privileges at other hospitals here in our CITY, so I venture to say you don't entirely know about that of which you speak. I know FP's getting privileges for advanced procedures is regional, but I am in a region that seems happy to acknowledge that properly trained FP's are capable of providing high level services. There certainly doesn't seem to be a patient preference either way in our area, either. Of the FP's I know that are doing OB in our area, they are all pretty darn busy. The patients I have worked with on both the OB service and our OB patients in FP clinic are more concerned with having a doctor that they can relate to and that can perform the needed services adequately than some artificial letters or professional association. Maybe that's regional as well.

By the way, I grew up in one of the most rural areas of Kentucky so you don't have to tell me anything about the social situation in those rural areas. I bet I have way more experience and expertise on that subject than you.

I know you are an MD and I am only an MD student to be, yet your post completely misses her point. She was discussing her thoughts on rural areas and you attacker her by bringing up the example of your CITY experience.
 

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I know you are an MD and I am only an MD student to be, yet your post completely misses her point. She was discussing her thoughts on rural areas and you attacker her by bringing up the example of your CITY experience.


Well the thing he does have a point but the internet makes it look like he might have been rude putting it across.. I truly think that our opinions (me soon to be resident... later new attending and later maybe a senior patner) will change as we move from student to resident to attending to senior partner....

Sophie, don't change your ideals and stand by them. Unfortunately life has taught me to be a realist. I will try to help people but if they wont help themselves... well prepare to be on medicare/medicaid.

(This whole argument is moot, medicare/medicaid will never pay well and deep inside us we all want to help but may be held back by many circumstances. Change topics? How many medicare agents does it take to approve a prescription?)
 

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I know you are an MD and I am only an MD student to be, yet your post completely misses her point. She was discussing her thoughts on rural areas and you attacker her by bringing up the example of your CITY experience.

In TN's defense, I believe they were replying to my comment that many FPs who do OB do it in rural areas and not in cities, because that is where the greater need is, and where OBGyns often can't make it.

I think TN was trying to illustrate that there are some city FPs who do OB successfully. My point was just that most of us who do OB do end up in rural or underserved areas because that is where the greater need for docs who can do OB and also take care of the rest of the family happens to be.
 

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I also still perhaps foolishly think that part (not all) of my responsibilty as a physician will be to take care of people. I'm not willing to suffer personally or have my business suffer, but I find it somehwat irresponsible that physicians are refusing to accept ANY medicare/medicaid patients (which increases the burden on those who do), when, as flawed and broken as it is, it's still the only safety net we have in this country for the uninsured or underinsured. I guess if you practice in an affluent area with very few older people or poor people, you can do this, and make more money. But like I said, pretty soon the MAJORITY of the US population will be over 65, and most of them have Medicare.

There are county indigent programs, but most of the folks needing this assistance are working people, skirting the edge of poverty, but making "too much" to qualify for public assistance from the county or city.

I understand the frustration, even as a mere student (but not for long...!), but I've also started and run a successful business, and I'm not as green as you might think.

There are ways to make the bottom line work without suffering financially, and still take medicare and medicaid. One of them is to work in a federally qualified or rural health clinic, which is what I plan to do. Reimbursement rates are higher than some insurance plans, and as you say, they are paid more quickly.

For me, I make enough, heck I make more than most specialists since I also do administrative stuff. So, sure I can see Medicare and Medicaid people, but it's the PRINCIPLE. As long as there are FP's willing to see M/M people, especially Medicaid people, CMS has NO incentive to change their ridiculous fee schedules. Sophie, why would you take $7 PMPM for all their care and liabily??? Absolute INSULT. And yet b/c of people like YOU, they keep doing it. people LIKE YOU! Allow MY field to continue to slide in terms of reimbursements. So yes, you can stand as a student and tell me how you are going to save the world and eat Ramen noodles for the rest of your life, but not me my friend, I will help the less fortunate when our Government reimburses me APPROPRIATELY. Can't wait to see your attitude after 5 years, nah make that ONE year in private practice. :D :D :D
 

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That's cause there will always be new graduates who come to the area and of course they gotta start having patients... when you are new and dont have an established number of patients, you will take anyone. After a couple of years they start fine tuning.

What does that mean though? Does that mean you start dumping the patients you took in the first place who were on medicare to replace them with self-pay/private insurance? That seems wrong to dump patients like that. You can only carry so many patients, so you can't just keep adding perfect payers as they come along.
 

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Sophie, why would you take $7 PMPM for all their care and liabily??? Absolute INSULT. And yet b/c of people like YOU, they keep doing it. people LIKE YOU! Allow MY field to continue to slide in terms of reimbursements. So yes, you can stand as a student and tell me how you are going to save the world and eat Ramen noodles for the rest of your life, but not me my friend, I will help the less fortunate when our Government reimburses me APPROPRIATELY.

Your post is entertaining, but has nothing to do with who I am. I never said anything about starving myself to save the world. I said that ***part*** of my responsibility was to take care of people who need to be taken care of. I didn't say I would sacrifice my practice or my quality of life for it. And I keep saying, over and over, that I plan to work in a rural health clinic where reimbursements are significantly higher for medicare and medicaid.

But that's kind of boring. It's much more fun to make a caricature of me. That's okay, because I know who I am and what I want, and whether anonymous people on the internet understand that is of no consequence to me.

I don't believe that the way to send a message to Washington is by making the people who need my care most suffer even more. I know the system as it is now is very, very broken, but I believe it is far more constructive to VOTE, and to get involved with professional organizations that make physician's lobbying power stronger, than to refuse to see Medicare and Medicaid patients on principle alone.
 

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I know you are an MD and I am only an MD student to be, yet your post completely misses her point. She was discussing her thoughts on rural areas and you attacker her by bringing up the example of your CITY experience.

See post #19 by Sophie in regards to having to go rural and not being able to compete with "expert" Ob/Gyn docs. That was the post to which I was referring with my addressing my CITY. I will admit that I was deeply (well, at least somewhat) offended by the insinuation by Sophie that I knew nothing of rural people or the circumstances surrounding such. I bet dollars to donuts that I have more experience and more intimate knowledge about the facts of life in rural areas than 99.99% of MD's or DO's out there today. I've f'in lived it while most others are simply idealists trying to "educate" others about it. No offense, Sophie. So, no I don't feel like I missed her point at all. Nor do I feel like I attacked her.

For the record, I know FP's doing c-sections in Memphis, Nashville, Knoxville, and the Tri-Cities area (Kingsport, Johnson City, and Bristol) which represents all but one of the largest metro areas in Tennessee (leaving out only Chattanooga, where I am sure there are FP's doing sections but I don't personally know of any). There are a lot of misconceptions about FP in general, and I hate to see them furthered with misinformation.

And for the record, I would never show you disrespect simply because you are a pre-med and I am a (newly minted) MD. That's not my style.
 

sophiejane

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See post #19 by Sophie in regards to having to go rural and not being able to compete with "expert" Ob/Gyn docs. That was the post to which I was referring with my addressing my CITY.

OK, really. This is getting ridiculous. I said nothing about "expert"...I just meant that there are more OBGyns in urban areas and thus ---in many (not all!) areas--fewer opportunities for FPs to do OB in cities.

Can't we all just get along?

Now, back to the topic at hand, pleeeeaaase...???
 

Tn Family MD

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OK, really. This is getting ridiculous. I said nothing about "expert"...I just meant that there are more OBGyns in urban areas and thus ---in many (not all!) areas--fewer opportunities for FPs to do OB in cities.

Can't we all just get along?

Now, back to the topic at hand, pleeeeaaase...???

By you saying FP's are incapable of competing with Ob/Gyn's, the unspoken message is that Ob/Gyn's are experts and lowly FP's can't compete with that. You may not have intended it to sound that way, but it's pretty hard to interpret any other way. At least for me. That's all. No offense, again. I'm outtie.
 

Faebinder

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What does that mean though? Does that mean you start dumping the patients you took in the first place who were on medicare to replace them with self-pay/private insurance? That seems wrong to dump patients like that. You can only carry so many patients, so you can't just keep adding perfect payers as they come along.

You dont dump them... but at a certain point, when your appointment book is overbooked... guess who are the new patients you wont be taking anymore? Medicare/Medicaid.. probably stop taking medicaid before medicare...

Slowly your practice will turn into insured population as you stop taking medicare/medicaid and even other crappy insurances that don't reimburise that much better than M&M. (And medicaid according to my information gives you like 10 dollars for something that can take an hour... something like suturing a few cuts on the face of a 7 year old is simple but can take you an entire hour as you try to make sure the 7 is still and not going berserk.)

Many private practice docs (not just FM) who stop taking medicare/medicaid dont dump their patients, usually they still see them and if you have known them for a while and they suddenly (due ot some reason or another like bad times) switch to medicare/medicaid, then a good person would not tell them that they wont see them anymore.... just dont expect to get reimburised for it that well.
 

Emedpa

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also medicaid( at least in my state) will not pay anything in an er setting for some things:
dental pain- not paid
odontogenic infection -paid

listing the dx as
#1 abscess #2 niddm(because you considered it and checked a bs, etc)-paid
#1 niddm, #2 abscess-not paid

ditto this one:
#1 h/a, #2 htn -paid
#1 htn, #2 h/a- not paid

we actually had to come up with a list of things that were paid and try to make our dx fit into acceptable codes. it's really quite absurd. also if the pt has a pcp and they come to the er for a nonemergent problem while the pcp has business hours-not paid.....
 

iatrosB

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You dont dump them... but at a certain point, when your appointment book is overbooked... guess who are the new patients you wont be taking anymore? Medicare/Medicaid.. probably stop taking medicaid before medicare...

Slowly your practice will turn into insured population as you stop taking medicare/medicaid and even other crappy insurances that don't reimburise that much better than M&M. (And medicaid according to my information gives you like 10 dollars for something that can take an hour... something like suturing a few cuts on the face of a 7 year old is simple but can take you an entire hour as you try to make sure the 7 is still and not going berserk.)

Many private practice docs (not just FM) who stop taking medicare/medicaid dont dump their patients, usually they still see them and if you have known them for a while and they suddenly (due ot some reason or another like bad times) switch to medicare/medicaid, then a good person would not tell them that they wont see them anymore.... just dont expect to get reimburised for it that well.

I guess I still don't get it. What happens to all those patients you took at the begining to "overbook" yourself? I can understand if they die or move away, then you have open spots at that point to fill with better insured patients. But if they stick around, a significant portion of your patient base is medicare (it's not like they are going to switch from medicare to something else, as opposed to vice versa).
 
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What does that mean though? Does that mean you start dumping the patients you took in the first place who were on medicare to replace them with self-pay/private insurance? That seems wrong to dump patients like that. You can only carry so many patients, so you can't just keep adding perfect payers as they come along.

You can't really "dump" Medicare patients unless you opt out of Medicare, but you can stop accepting new patients.

In my case, I'm basically closed to new Medicare patients off the street (with rare exceptions, usually limited to immediate family member of established patients), but as my patients "age into" Medicare (meaning they convert from commercial payors to Medicare after age 65) I will continue to see them.

Everyone's different, though. That's just the way I'm doing it.
 
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