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LakePirate
11-07-2006, 05:48 PM
As many of you know I recently moved back to Atlanta. My prescription is about to run out and I need a doctor as we approach cold and flu season. Well I went online to my former Doctor's site and requested an appointment. I was greeted with a call this morning from his nurse/office manager. She informed me that the practice has elected to go to Concierge Medicine. She promised a 2 hour annual physical, minimum 30 minute visits with the Doctor during appointments, 24 hour access to my doctor via cell phone and a guarantee of an appointment within 48 hours if sick....all this for the low low rate of $1500 a year. Told her no thanks.

Is this what we have to do to get the type of Medical care we deserve? Wow :confused:

Link (http://www.physiciansnews.com/business/204.kalogredis.html)

6ballsisall
11-07-2006, 05:50 PM
Interesting concept to say the least, I have never heard of that before........

I will say I, like many other middle class americans am concerned about health care and it's future for the working class.

BrianM
11-07-2006, 06:00 PM
As many of you know I recently moved back to Atlanta. My prescription is about to run out and I need a doctor as we approach cold and flu season. Well I went online to my former Doctor's site and requested an appointment. I was greeted with a call this morning from his nurse/office manager. She informed me that the practice has elected to go to Concierge Medicine. She promised a 2 hour annual physical, minimum 30 minute visits with the Doctor during appointments, 24 hour access to my doctor via cell phone and a guarantee of an appointment within 48 hours if sick....all this for the low low rate of $1500 a year. Told her no thanks.

Is this what we have to do to get the type of Medical care we deserve? Wow :confused:

Link (http://www.physiciansnews.com/business/204.kalogredis.html)
My in-laws goe to a doctor with this type of arrangement. I guess it is ok if you are in frequent need of your doctor and have the extra $$. I'll pass. :rolleyes:

LakePirate
11-07-2006, 06:12 PM
I think it is sad that Medical care has come to this. But, if I had the resources to do so, I might consider it. No offense to Big Mac and I cannot speak of other areas or for all doctors, but around here the service is less than desirable. You can walk and exchange oxygen for carbon dioxide?..here take some (antibiotic/anti-inflammatory) and if you don't get better call back. 2 hours in the waiting room/exam room 5 minutes with a PA.

bigmac
11-07-2006, 07:43 PM
Interesting concept to say the least, I have never heard of that before........

I will say I, like many other middle class americans am concerned about health care and it's future for the working class.As well you should be. It's going to suck. Prices will go up, access will go down. The baby boomers are going to overwhelm the system. There are major doctor shortages looming. There are simply not enough resources to go around to accommodate the load, and not enough money to pay for the drain on the resources that exist. Application of new technology? Forget it - there's no money for that. The only solution to high prices is to limit access and ration care. That's where we're headed.

TMCNo1
11-07-2006, 08:02 PM
As many of you know I recently moved back to Atlanta. My prescription is about to run out and I need a doctor as we approach cold and flu season. Well I went online to my former Doctor's site and requested an appointment. I was greeted with a call this morning from his nurse/office manager. She informed me that the practice has elected to go to Concierge Medicine. She promised a 2 hour annual physical, minimum 30 minute visits with the Doctor during appointments, 24 hour access to my doctor via cell phone and a guarantee of an appointment within 48 hours if sick....all this for the low low rate of $1500 a year. Told her no thanks.

Is this what we have to do to get the type of Medical care we deserve? Wow :confused:

Link (http://www.physiciansnews.com/business/204.kalogredis.html)


That sucks,
At our family doctor 2 miles away they do their regular appointments from 9:00am till 3:30 pm, from 8:00am till 9:00am and 3:30 pm till 4:30pm, they have a cronic/emergency, first come/first served clinic available and we have never had to wait more than 10 minutes for a clinic appointment.

bigmac
11-07-2006, 08:45 PM
I think it is sad that Medical care has come to this. But, if I had the resources to do so, I might consider it. No offense to Big Mac and I cannot speak of other areas or for all doctors, but around here the service is less than desirable. You can walk and exchange oxygen for carbon dioxide?..here take some (antibiotic/anti-inflammatory) and if you don't get better call back. 2 hours in the waiting room/exam room 5 minutes with a PA.The way medicine is practice is highly regionalized and varies widely from state to state, even varies in different locations within states and this variation is directed by the dominant insurance companies in those regions. Concierge medicine is virtually unheard of here, except maybe for a few old doctors who are looking to cut back.

This is a hugely complex issue, but the bottom line is that you ARE getting the health care you deserve - or at least health care you're paying for. The problem is that you're not paying enough.

lsupcar
11-07-2006, 09:09 PM
Health care is not a constitutional right. The USA is not yet a socialist state, and you can get what you pay for.

André
11-07-2006, 09:20 PM
The problem is that you're not paying enough.
...said the Doctor!;)

bigmac
11-07-2006, 09:33 PM
...said the Doctor!;)I can assure you those increases in what people are paying for medical care aren't going to me, or to any other doctor I know or have heard of.

LP is complaining about access. He thinks he deserves better access for what he pays in health insurance premiums. He should have more time with the doctor, and not have to wait so long for an appointment. If he needs a prescription filled, his doctor should be sitting right there by the phone waiting for his call. Not unreasonable IMHO, except that that is exactly what virtually all Americans think - they all want medical care, they want it now, and there are only so many doctors and only so many hours in the day. And insurance companies are paying the doctors less and less, while their expenses go up and up - and medicare just announced a 5% cut in physician reimbursement again... in the meantime, the office staff expects a raise every now and again. The rent on his office goes up. His billing service wants more money because the bills are getting increasingly complex, thanks to the insurance companies. His malpractice insurance is going up and up. Continuing education costs more and more.

And it ain't getting any better....

André
11-07-2006, 09:39 PM
I can assure you those increases in what people are paying for medical care aren't going to me, or to any other doctor I know or have heard of.

LP is complaining about access. He thinks he deserves better access for what he pays in health insurance premiums. He should have more time with the doctor, and not have to wait so long for an appointment. If he needs a prescription filled, his doctor should be sitting right there by the phone waiting for his call. Not unreasonable IMHO, except that that is exactly what virtually all Americans think - they all want medical care, they want it now, and there are only so many doctors and only so many hours in the day. And insurance companies are paying the doctors less and less, while their expenses go up and up - and medicare just announced a 5% cut in physician reimbursement again... in the meantime, the office staff expects a raise every now and again. The rent on his office goes up. His billing service wants more money because the bills are getting increasingly complex, thanks to the insurance companies. His malpractice insurance is going up and up. Continuing education costs more and more.

And it ain't getting any better....
Ever heard or read about our public health system in Québec?
Beleive me,you don't want to be sick here,you want to die...:(

BriEOD
11-07-2006, 09:47 PM
Medical care is affecting all facets of American society. The military/VA is also being radically affected. Congress has changed laws and many of our retirees, who were promised free medical care for life after serving 20 years when they came in, now have to pay for a portion of their medical care. I saw a retiree with a bumper sticker the other day that said: "another veteran lied to by Congress and the American people." While our active duty GIs still get free medical care, the drastic increase in cost to provide care to the force has caused leaders to pull money from other programs. For example, in the latest Defense Review the AF identified a critical need to update an aging aircraft fleet. Many of our planes, KC-135s, C-130s, B-52s are from the 50s and 60s. Congress would not allocate any additional funds and told the AF to make it work within the constraints of their budget. The AF has decided their largest expense is personnel, primarily medical care, and is reducing the force by 50K personnel within the next year or so. However, the deployment tempo for Iraq and Afghanistan will remain at the same level. Do more with less people ... or ... shut up and color.

PendO
11-07-2006, 11:06 PM
Health care is not a constitutional right. The USA is not yet a socialist state, and you can get what you pay for.

What I am paying for is bankrolling the insurance company and multiple layers of management through the ranks (IMO). Appx 10K of my annual wages goes to pay for insurance, even if I don't use it ... the insurance company increases my rates every year, and decreases the amount they will pay the physician for services, meanwhile, the Doc's malpractice insurance rates go up just like my premiums ... someday maybe the consumers (you and I) can work with the providers (Docs) and cut the Insurance companies out of the loop ... then again, I still remember how much my dad's cancer surgeries (2X) and Chemo (2X) cost ... without insurance the bills would have been catastrophic ... so, for those of us who are healthy the premiums seem like a waste, but when/if you get really sick, an Insurance company may prevent you from having to face poverty face to face.

LakePirate
11-07-2006, 11:24 PM
Big Mac

Yes and no as to complaining about access. Do I think you should be able to get an appointment sometime within the next 6 months, yes, do I expect a script to be written when I call, no, but 2 or 3 days should be enough time.

Mostly what I have been annoyed with is the lack of time and concern shown by doctors seen by myself and my wife. The Doctors in this region have so many patients that they cannot possibly serve them. Let's look at my wife's situation, she had some symptoms with her digestive tract and the GP who saw her blamed it on her quitting smoking. We both knew that there was something wrong and she pressed him for a referral to a gastro, he reluctantly did and after several tests, most of which were fruitless but standard protocol, found that her gall bladder needed to be removed. Had we not been so persistent she would still be having problems.

6ballsisall
11-07-2006, 11:32 PM
Something to add to the whole insurance colundrum..........

Our family doctor since I was in 3rd grade retired at the age of 45 NOT because she made a ton of cash (though I doubt she was hurting to much) but she got so tired of dealing with insurance companies. She said towards the end of her career (she retired about 4 years ago) the red tape it took to get someone ok'd to see a specialist was unbelievable. She cited multiple occasions where insurance companies pleaded for her to not recommend a specialist, she said their was even forms of rewards coming to docs that didn't refer specialists etc....

I agree w/ Pendo on the rate increases. I literally have been to a doc once in the past 2 years, and before that, it had been a good 3 more years. I don't take any medication at all, I don't turn anything in to the insurance companies for reimbursement YET I am suppose to bend over each year when the insurance companies want 20-30% more than last year. :mad:

bigmac
11-07-2006, 11:33 PM
... someday maybe the consumers (you and I) can work with the providers (Docs) and cut the Insurance companies out of the loop ....

Yeh, and look at this (http://www.harp.org/hmoexecs.htm)...

What LakePirate was up against is a doctor doing just that...taking the insurance companies out of the loop.

The insurance companies have literally taken over health care. They have added such an amazing layer of bureaucracy that it would amaze career military personnel like BriEOD. A third of the 120 people that work in my clinic are there only to manage insurance company billing. Our accounts receivable averages over 100 days because that's how long it takes them to get us a check to pay for their insureds' health care.

I'm not a fan of the Canadian model - that plan is based on outrageous value-added taxes and rationing care. Ask Andre how long it would take him to get his hernia fixed, his coronary artery stented, or his hip replaced. I can just tell you, Americans would never agree to wait 2.5 years for a painful hernia to be fixed. It is simply not in our nature to be denied something we think we need, or something we think we deserve.

Our system is a mess, no question, but I sure don't have the answer - I have my own problems. I'm working 12 hour days and every 4th weekend/weekday on call just trying to keep up with the patient load. I'm on call tonight, just finished the second of three (so far) emergency operations. To be sure, it's interesting work, but it's stressful, and it takes me away from my family and my hobbies.

Leroy
11-07-2006, 11:36 PM
I feel for you LP, hope something works out. It's sad to see a great country like this treat good people like yourself in this manner.

I feel sorry for Physicians with an average salary or 150k to 550k in the US. http://www.physicianssearch.com/physician/salary2.html I can tell you about the lifestyle of all of the doctors I know :)

I paid $4k for a 5 minute procedure last December for my son (meniscus tear) and then the hospital, MRI and other services. In engineering there are many internationals and they are more and more using dental and medical from their annual visit back home.

When I compare what we get in the US compared to the social medical system we had while living in Belgium for two years I would take the Belgium system in a minute. I get most of this from my wife a nurse.

Insurance is broken, physicians salaries are out of wack (sorry Bigmac), there is too many procedures done that is unnecessary and too many people crying wolf without taking care of themselves. Even with the money we are spending on health care, we are falling behind in longevity.

And like Bigmac says its so complex I don't know where to begin and the people making the money don't want us to even know where to begin.

PendO
11-07-2006, 11:43 PM
man, I sure don't think physicians/specialist are the least bit overpaid ... with all the schooling they are in their mid 30's before they can start a practice ... If someone is going to make a good wage I'd prefer it to be my Surgeon ... if someone is going to bill $500-800 an hour I'd prefer it to be a doc, not an attorney:) Even on their best day an attorney can't do the type of work a Doc can ... IMO

bigmac
11-07-2006, 11:47 PM
Big Mac

Yes and no as to complaining about access. Do I think you should be able to get an appointment sometime within the next 6 months, yes, do I expect a script to be written when I call, no, but 2 or 3 days should be enough time. I agree that those are reasonable expectations. As I mentioned, health care policies vary widely from place to place. My malpractice insurance is about $14,000/year. That's cheap. I have a buddy in Chicago that's paying $108,000/year. He can't charge any more for his operations than I can, so he has to do more of them or hang it up. So, if you want an appointment with him, you're gonna have to wait because he carries a lot more patients than I do.

Mostly what I have been annoyed with is the lack of time and concern shown by doctors seen by myself and my wife. The Doctors in this region have so many patients that they cannot possibly serve them. Let's look at my wife's situation, she had some symptoms with her digestive tract and the GP who saw her blamed it on her quitting smoking. We both knew that there was something wrong and she pressed him for a referral to a gastro, he reluctantly did and after several tests, most of which were fruitless but standard protocol, found that her gall bladder needed to be removed. Had we not been so persistent she would still be having problems.As BriEOD mentioned, the medical profession has to do more with less too. Doctors have no choice but to see more patients. If they don't, they can't afford to keep the doors open. Medicine is less attractive than ever to college grads now, and fewer are going into medicine. Pay is down, hours are up, and the hassles with insurance companies, Medicare, state legislatures, and malpractice insurance companies and plaintiff's lawyers are at an all-time high. Today's med school graduates want a "controllable lifestyle" - meaning regular hours, less (or none) call, short work week, maybe a "shared practice" with their spouse. Exactly 1/2 of medical students today are women. The net result of that is there are fewer doctors in practice and in about 15 years the shortage will put our health care in crisis. On the positive side, there is NO shortage of foreign medical graduates just dying to come here to pick up the slack because their own country's health care system sucks worse than ours.

*sigh*

PendO
11-07-2006, 11:51 PM
It may actually pay better to be a Veterinarian or an Orthodontist ... don't have to deal with insurance ... my brother in law just opened up his own Ortho office in SoCal and he has a staff of 4 including himself, no need to deal with insurance as it is pretty much a cash deal.

Around here there have been docs in rural areas quit doing OB care as they were only delivering a few babies a year and couldn't afford the insurance ... so now you had better be sure you are in a big city when your water breaks or you have some emergency.

jkski
11-08-2006, 08:53 AM
The medical system as a whole in the US stinks, simply because the actual decision for care is being taken out of the hands of your doctor and placed in the hands of those who insure you....who knows you best???
To add insult to injury, the number of "independent physicians" are decreasing at a staggering rate, due to the increase in mal-practice and decrease in re-imbursement. Many hospitals are buying these physician practices so that they can stay in business, but this becomes a double edged sword. The hospitals are taking a close look at where the "profit centers" exist in medical re-imbursement, and then they "highly suggest" to their owned physicians that they utilize their services rather than a independent competing service that may be better for the patient.
In the past year, I have seen more physician practices expanding to include testing that they once did not venture towards...why....because they can create a new revenue stream. What this means for the patient is that we often times receive tests that we otherwise would not necessarily receive. Case in point...a doctor orders an MRI or CT on everything nowadays. YES, part of this is for "defensive medicine" however, part of it may be due to the fact that many physicians can now profit from these tests.
The point in all of this rambling is this......
If a doctor is left to practice medicine and for the good of the patient, rather than to fit the needs of a hospital or insurance company, a patient would receive better care.
Many insurance companies are now preparing to place more of the burden of care on the patient, by giving them a yearly allowance and allowing them to shop around for the best price.....be ready and start shopping now!

bigmac
11-08-2006, 09:40 AM
Case in point...a doctor orders an MRI or CT on everything nowadays. YES, part of this is for "defensive medicine" however, part of it may be due to the fact that many physicians can now profit from these tests.



This statement isn't totally untrue, but it's more complicated than that. These kinds of self-referrals are very closely watched by federal and state regulators for compliance with the very rigorous Stark II laws (http://www.aishealth.com/Compliance/HCFA/StarkII.html)enacted in 2001 (these are a rigorous expansion of the Stark laws which were enacted in 1989).

No doubt there is increased utilization of diagnostic tools, and those diagnostic tools tend to be expensive, but revenue isn't truly the motivating factor. CT scanning is a good example. Ever since the beginnings of modern surgery 100 years ago, acute appendicitis was a clinical diagnosis - the surgeon laid his hands on and then pronounced the diagnosis. Typically, that surgeon was wrong about 25% of the time and that was considered acceptable - this is something we used to track to make sure a particular surgeon wasn't over-diagnosing or under-diagnosing. Now, CT scanning has become so accurate at diagnosing acute appendicitis that taking out a normal appendix is extremely rare, and CT scanning for suspected appendicitis is the standard of care. That's good, right? - no unnecessary appendectomies? .... except that that CT scan costs about $800 and everybody with suspected appendicitis has to get one. I don't own any part of the hospital's CT scanner (Stark II laws make that illegal) and don't make a dime from those scans - but if I don't order one and miss a diagnosis then I have hurt my patient trying to save his insurance company $800 and by the way I'd better call my lawyer the next morning.

jkski
11-08-2006, 10:09 AM
This statement isn't totally untrue, but it's more complicated than that. These kinds of self-referrals are very closely watched by federal and state regulators for compliance with the very rigorous Stark II laws (http://www.aishealth.com/Compliance/HCFA/StarkII.html)enacted in 2001 (these are a rigorous expansion of the Stark laws which were enacted in 1989).

No doubt there is increased utilization of diagnostic tools, and those diagnostic tools tend to be expensive, but revenue isn't truly the motivating factor. CT scanning is a good example. Ever since the beginnings of modern surgery 100 years ago, acute appendicitis was a clinical diagnosis - the surgeon laid his hands on and then pronounced the diagnosis. Typically, that surgeon was wrong about 25% of the time and that was considered acceptable - this is something we used to track to make sure a particular surgeon wasn't over-diagnosing or under-diagnosing. Now, CT scanning has become so accurate at diagnosing acute appendicitis that taking out a normal appendix is extremely rare, and CT scanning for suspected appendicitis is the standard of care. That's good, right? - no unnecessary appendectomies? .... except that that CT scan costs about $800 and everybody with suspected appendicitis has to get one. I don't own any part of the hospital's CT scanner (Stark II laws make that illegal) and don't make a dime from those scans - but if I don't order one and miss a diagnosis then I have hurt my patient trying to save his insurance company $800 and by the way I'd better call my lawyer the next morning.

While I do not argue that Strak II is intended to prevent such profiting from "self-referral", the reality is that it does happen. It may not be every physician, you included, that does this, but it is REALITY. Case in point, I just finished putting together a deal for a group of Cardiologists who purchsed their own state of the art CT scanner and started scanning with a full schedule on their first day. They themselves stated they have enough scans backlogged to get them through the first 2 months of operation, why...because they had been stockpiling the tests in anticipation of their scanner being up and running. Second case....I put together a deal for a group of Urologists who wanted their own CT scanner. Prior to having their own, they collectively would average ordering about 60-75 CT's/month, however, since having their own, they now average 130-160/month.

I am not saying that I like this practice nor that it is right or good for the medical community, in fact I think it is very wrong, however, it is reality. Again, I am not saying it is the case with all physicians, as I know many who are well above board on this, however, there are more and more cases popping up and I think it is only a matter of time until big brother needs to step in and stop it. BIGMAC, I respect you for not getting involved and hope that others follow suit.

bigmac
11-08-2006, 10:26 AM
Even with the money we are spending on health care, we are falling behind in longevity.



This comparitive longevity is a statistic that many people like to trot out to indict the US health care system - it's bogus. What isn't mentioned in the same breath is that the US is far and away the fattest nation on earth - more than 65% of US adults are obese - and getting fatter. The link between obesity and premature death is clearly established - one third of obese adults won't live to age 65.

Our comparatively low longevity rate in the US isn't a health care delivery problem, it's a Public Health issue - just like polio was...except in this case we can't just line up for an oral vaccine, we actually have to get up off our fat asses and excercise, and eat healthier food and less of it. THAT isn't the American way, though. Blaming US longevity on our health care system is like suing a gun manufacturer because you accidentally shot a family member or suing McDonalds because you spilled hot coffee in your lap.

What's remarkable is that Americans live as long as they do, considering how fat we are as a nation.

Leroy
11-11-2006, 04:26 PM
Even though I sounded like I disagreed with you I really agree with you, but we do spend too much on our health care.

I think we are on a bubble that is going to get much worse due to overweight people, myself included, but working on it.