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It's official: RIP Stim, 11/27/13

hyperalgesia

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    Single payor for basic primary care, emergencies, cancer, etc. Basic health care is a right, IMHO.
    That is insane fantasy-world thinking. But I would be willing to humor you if it were done at the state level. Nationally, I want to start building a bunker and buy weapons to defend my rights (actual, inalienable rights).

    Why can't liberals keep their fantasies on the state level? A state can recover from a disastrous experiment. A country can't.
     

    Ligament

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      Selection bias? We don't see any patients in our clinic happy with their fusion, do we? The ones seeing you are not happy with their care. You don't see the ones who are

      Your point about waiting to see a specialist, MRIs, epidurals, waiting for joint replacements, etc, is well taken and true.

      However, as much as we'd like to not admit it, specialty care is not as important as primary care. Canadians may not like their access to specialists, but they are healthier than we are. And their country isn't going bankrupt because of healthcare.

      Single payor for basic primary care, emergencies, cancer, etc. Basic health care is a right, IMHO. Pay out of pocket for the getting your MRI and ESI right away. Pay so you can get your hip replaced next week instead of next year? That's the way it 'should' be.

      Obamacare is a big mess of **** because the left and the right can't agree that the sky is blue and lobbyists are throwing money at everything. I have no faith in the government, either. But insurance companies need to be kicked to the curb, and CMS has to do some actual work, instead of farming it out to the private sector. This half and half nonsense is why Obamacare is a collosal clusterf$ck.

      Health care is NOT a right, nor is food, shelter, or "fairness."
       

      Ligament

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        Selection bias? We don't see any patients in our clinic happy with their fusion, do we? The ones seeing you are not happy with their care. You don't see the ones who are

        Your point about waiting to see a specialist, MRIs, epidurals, waiting for joint replacements, etc, is well taken and true.

        However, as much as we'd like to not admit it, specialty care is not as important as primary care. Canadians may not like their access to specialists, but they are healthier than we are. And their country isn't going bankrupt because of healthcare.

        Single payor for basic primary care, emergencies, cancer, etc. Basic health care is a right, IMHO. Pay out of pocket for the getting your MRI and ESI right away. Pay so you can get your hip replaced next week instead of next year? That's the way it 'should' be.

        Obamacare is a big mess of **** because the left and the right can't agree that the sky is blue and lobbyists are throwing money at everything. I have no faith in the government, either. But insurance companies need to be kicked to the curb, and CMS has to do some actual work, instead of farming it out to the private sector. This half and half nonsense is why Obamacare is a collosal clusterf$ck.

        Selection bias? Your telling me that there are some Canadians HAPPY to wait 6 months for an esi or sij block?? HAPPY with a 1 year wait for a pain consult??!! Seriously?
         
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        SSdoc33

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          That is insane fantasy-world thinking. But I would be willing to humor you if it were done at the state level. Nationally, I want to start building a bunker and buy weapons to defend my rights (actual, inalienable rights).

          Why can't liberals keep their fantasies on the state level? A state can recover from a disastrous experiment. A country can't.

          State level like in Massachusetts, where everyone is insured? GASP. The horror!!!

          We'd still have slavery if we let the states do what they want.
           
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          SSdoc33

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            Selection bias? Your telling me that there are some Canadians HAPPY to wait 6 months for an esi or sij block?? HAPPY with a 1 year wait for a pain consult??!! Seriously?

            No, im not. But they are happy to not pay ridiculous insurance premiums. Americans want everything and want it all for free. It doesn't work that way. That is why you have to ration care. If you can't see that getting a cardiac cath supersedes an epidural, then hare overvaluing yourself. Again, that is why the basic stuff should be covered and the specialty care should be out of pocket.

            This may be a fantasy, granted. By it is the fair way to do things. Right now, everyone is getting screwed except insurance, pharma, and device companies.
             

            seaofred

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              The stim cut alone is 15% for me and I really didn't do that many trials. What's the change in cesi in dollars, and all of our other procedures?
              I saw a breakdown of pain procedures and if you are doing them in the office CESI and LESI took a 50-60% decrease. I think both were a little north of $100. ASC and hospital went up.
               

              pmrmd

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                However, as much as we'd like to not admit it, specialty care is not as important as primary care. Canadians may not like their access to specialists, but they are healthier than we are. And their country isn't going bankrupt because of healthcare.

                Single payor for basic primary care, emergencies, cancer, etc. Basic health care is a right, IMHO. Pay out of pocket for the getting your MRI and ESI right away. Pay so you can get your hip replaced next week instead of next year? That's the way it 'should' be.

                This is one of the biggest lies of the liberal left. The "health" of the society is very much rooted in the culture. American culture is all about instant gratification, whether it be the lottery, food, or healthcare. We the people seem to care little about our health and our waistlines confirm it. But we want the care we need want right now. Put the Canadian system here tomorrow and people will riot. Every kid that gets mowed down in da hood and every soldier that succumbs to an IED counts against our WHO average life expectancy. Every goofball who can't maintain a job and prefers buying MJ to health insurance counts against our WHO standings with respect to access to care. Calling one country "healthier" than another needs to account for these kinds of variables. We find that the system we had was doing just fine, with the innovation and results that led those with the means to come here for their care.

                If you want healthcare improved, start with the people and not government.
                 
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                emd123

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                  I saw a breakdown of pain procedures and if you are doing them in the office CESI and LESI took a 50-60% decrease. I think both were a little north of $100. ASC and hospital went up.

                  Cesi and LESI in office down 60%?

                  ?????

                  Please tell me you don't know what you are talking about or you are a troll. The proposed cut before last weeks final, was 2%.

                  http://www.asipp.org/documents/Physicians2014P.pdf

                  Please post a link.

                  Plus, if there are so many damn drastic cuts talked about, with stim down 90%, epidurals down, but overall were down only 4%? Which is it? Unless they are calling stim an "increase" since the CPT part goes up, despite the L code elimination (overall 90% cut), and factoring it into the average as an "increase" for us and not factoring the massive L code loss to balance it out.

                  And where is ASIPP on this? We need them to post the final CMS fee schedule, not just the proposed one, so this rumor frenzy can stop.
                   
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                  Dr. Ice

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                    I love when people talk about how canadians and europeans are healthier becuase their medical system is superior. It makes me laugh. Maybe the reason they are healthier is because...they are healthier. No system is going to create healthier individuals if the mentality of the average american is just to be as lazy as humanly possible and expect the healthcare system, any system to save them. We live in a self perpetuated nanny state in this country and thats the problem.
                     

                    lonelobo

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                      I love when people talk about how canadians and europeans are healthier becuase their medical system is superior. It makes me laugh. Maybe the reason they are healthier is because...they are healthier. No system is going to create healthier individuals if the mentality of the average american is just to be as lazy as humanly possible and expect the healthcare system, any system to save them. We live in a self perpetuated nanny state in this country and thats the problem.

                      Spoken like someone who probably has never had to choose between paying for healthcare or feeding their family
                       

                      stim4u

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                        Medicare is a failure, Social Security is failing, Medicaid is a joke. Economy blows, taxation is nuts, educational system is worse than Bush. What has this administration done that is SUCCESSFUL????
                        Obamacare will never muster up 7M people by march and will ultimately implode due to cost. Socialized medicine is a shame and the data manipulated by the governments, just read editorials about the British health care corruption and horrible patient care covered up. Medicare reimbursement may have been decreasing prior to Obama, but not to this extent, and specifically our pain medicine field has been destroyed by a group of 15 doctors not answerable to Congress . Name a social program that is working in this country?
                        Progressives are the death of this country.....
                         

                        sig999

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                          Cesi and LESI in office down 60%?

                          ?????

                          Please tell me you don't know what you are talking about or you are a troll. The proposed cut was 2%.

                          http://www.asipp.org/documents/Physicians2014P.pdf

                          Please post a link.

                          And where is ASIPP on this? We need them to post the final CMS fee schedule, not just the proposed one, so this rumor frenzy can stop.

                          Thanks for posting that emd123.

                          Pardon my ignorance, but how much is the facility fee that an ASC gets for a CESI or LESI?
                           

                          emd123

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                            Thanks for posting that emd123.

                            Pardon my ignorance, but how much is the facility fee that an ASC gets for a CESI or LESI?

                            Remember though, that's not the "final" released last week. That's what we need. I don't know any of the new fees. The only thing we have concrete for 2014 is stim and Kypho from the reps. On the others, I have no clue but I'd like to know, ASAP. If anyone has the in office final CMS 2014 for esi's, rf, joints, SI, etc, please post.
                             
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                            lonelobo

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                              Medicare is a failure, Social Security is failing, Medicaid is a joke. Economy blows, taxation is nuts, educational system is worse than Bush. What has this administration done that is SUCCESSFUL????
                              Obamacare will never muster up 7M people by march and will ultimately implode due to cost. Socialized medicine is a shame and the data manipulated by the governments, just read editorials about the British health care corruption and horrible patient care covered up. Medicare reimbursement may have been decreasing prior to Obama, but not to this extent, and specifically our pain medicine field has been destroyed by a group of 15 doctors not answerable to Congress . Name a social program that is working in this country?
                              Progressives are the death of this country.....

                              Yes.... long live the Koch Brothers
                               

                              Felton55

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                                Per another thread here, it said

                                "Work RVUs for C ESI drops 38% from 1.91 to 1.18
                                Work RVUs for L ESI drops 24% from 1.54 to 1.17"

                                How does this correspond to what is in the ASIIP link saying minimal decrease?
                                 

                                emd123

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                                  Per another thread here, it said

                                  "Work RVUs for C ESI drops 38% from 1.91 to 1.18
                                  Work RVUs for L ESI drops 24% from 1.54 to 1.17"

                                  How does this correspond to what is in the ASIIP link saying minimal decrease?

                                  In posted that. I got it directly from the CMS link. What it means in dollars, I don't know. The above ASIPP link was the "proposed" fees released months ago, not the final released by CMS last week. ASIPP doesn't have the 2014 final on their site as of yet.
                                   

                                  seaofred

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                                    Cesi and LESI in office down 60%?

                                    ?????

                                    Please tell me you don't know what you are talking about or you are a troll. The proposed cut before last weeks final, was 2%.

                                    http://www.asipp.org/documents/Physicians2014P.pdf

                                    Please post a link.

                                    Plus, if there are so many damn drastic cuts talked about, with stim down 90%, epidurals down, but overall were down only 4%? Which is it? Unless they are calling stim an "increase" since the CPT part goes up, despite the L code elimination (overall 90% cut), and factoring it into the average as an "increase" for us and not factoring the massive L code loss to balance it out.

                                    And where is ASIPP on this? We need them to post the final CMS fee schedule, not just the proposed one, so this rumor frenzy can stop.
                                    Nope, not a troll. I contacted my local stim rep when I heard about the elimination of L8680. He stopped by my office and showed me a spreadsheet of all pain procedures comparing them between office/ASC/hospital. They were preliminary numbers and he even mentioned that he probably shouldn't be showing me this. It had a 58% decrease in CESI and a 51% decrease in LESI in the office. He is talking with the legal department big stim company and will give me a confirmed rate decrease on Monday.
                                     

                                    clubdeac

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                                      Medicare is a failure, Social Security is failing, Medicaid is a joke. Economy blows, taxation is nuts, educational system is worse than Bush. What has this administration done that is SUCCESSFUL????
                                      Obamacare will never muster up 7M people by march and will ultimately implode due to cost. Socialized medicine is a shame and the data manipulated by the governments, just read editorials about the British health care corruption and horrible patient care covered up. Medicare reimbursement may have been decreasing prior to Obama, but not to this extent, and specifically our pain medicine field has been destroyed by a group of 15 doctors not answerable to Congress . Name a social program that is working in this country?
                                      Progressives are the death of this country.....

                                      Stim4u, specifically who are these 15 mothereffers that destroyed our specialty and how do I go about putting a bounty out for their heads...
                                       

                                      lonelobo

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                                        Medicare is a failure, Social Security is failing, Medicaid is a joke. Economy blows, taxation is nuts, educational system is worse than Bush. What has this administration done that is SUCCESSFUL????
                                        Obamacare will never muster up 7M people by march and will ultimately implode due to cost. Socialized medicine is a shame and the data manipulated by the governments, just read editorials about the British health care corruption and horrible patient care covered up. Medicare reimbursement may have been decreasing prior to Obama, but not to this extent, and specifically our pain medicine field has been destroyed by a group of 15 doctors not answerable to Congress . Name a social program that is working in this country?
                                        Progressives are the death of this country.....

                                        http://www.businessinsider.com/british-satisfied-with-nhs-2013-9
                                         

                                        Ducttape

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                                          Medicare is a failure, Social Security is failing, Medicaid is a joke. Economy blows, taxation is nuts, educational system is worse than Clinton. What has this administration done that is SUCCESSFUL????
                                          Conservatives are the death of this country.....

                                          fixed it for you.

                                          medicare may be a failure to you, but i would hazard a pretty fair guess that those americans over age 65 with no viable income feel differently about it.

                                          ive said this before, i am not a fan of CMS or Sebellus or her management.

                                          i wonder if it is because she - a democrat - gets a lot of support from republicans (see wikipedia)?

                                          there definitely needed to be better management of the health care dollar. continuing on as we were would not have been viable, when the growth of health care expenditures is so much greater than any other market, while physician salaries are being reduced and monitored. where is all this money going? yelling for republican control would have done nothing for you and i - only continued to line the pockets of insurance companies and device reps and pharmaceuticals.

                                          is obamacare the solution? i dont think i ever gave the simplest inkling that it was the way to go. it is an alternative, like choosing a hangmans noose over the axe.
                                           

                                          hyperalgesia

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                                            Working for a VA sounds like a good idea. No call/weekend/paperwork...
                                            There's an s load of mindless admin work at the VA. Bright ideas come down from DC and others that are forced onto providers.
                                            There's something called VALU which stands for VA learning University which every employee has to sit for hours through interactive videos to 'teach' various things. The required topics include every PC topic that has ever offended a liberal anywhere.
                                            The latest is a requirement that the doc is directly accessible by every patient via a secure messaging system and response required.
                                            It's not all rosy at the VA.
                                            I think the care we provide is passable but for one reason only. We are comparing ourselves to a robust private market. If the socialists have their way, it's all over IMHO.
                                             

                                            hyperalgesia

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                                              State level like in Massachusetts, where everyone is insured? GASP. The horror!!!

                                              We'd still have slavery if we let the states do what they want.
                                              Well yes, you're right but you're also lucky to be able to make that point. What if we didn't let states do what they wanted and the president happened to support slavery? Things could've ended up very differently if the wrong decision was made in Washington. Like now, when the wrong decision is made, it's not a contained failure. Threats perceived by liberals about the corrupting effects of greed and money are legitimate and MUCH more threatening on a national level.

                                              The insurance industry has now redefined 'healthcare' as 'healthcare insurance' and weaved themselves into national law. They did this with money and lobbying and liberals bought right into it. I don't care if MA and every other state individually adopts mandatory insurance. I still think it's recoverable. This Obamacare deal is not recoverable. Finally, the poor have 'healthcare'.
                                               
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