A positive story

http://www.chron.com/disp/story.mpl/business/steffy/5484544.html

Houston Chronicle Business writer Loren Steffy has written an article that praises a local bank for having sound fiscal policies. After my post regarding critics and criticism, I'm happy to see a positive leaning story.

Immigration and business

http://www.chron.com/disp/story.mpl/business/5398754.html

This is the best article on immigration issues I've read. It points out all of the relevant issues concisely, and without emotion.

Primary care issues- can we survive

www.memag.com/memag/Medical+Practice+Management%3A+Business+Operations/Practice-Overhaul-Contest-Turnaround-help-for-inco/ArticleStandard/Article/detail/479380?contextCategoryId=43934

The article above is about a private practice that is trying to improve business practices without compromising patient care. What I find interesting is the idea that PCP's should see 30-35 patients a day. It's do-able, but not preferable. Patients want more time from their doctors. Doctors need to see more patients as reimbursement per patient is decreasing. The current practice models are not sustainable in the long-term unless all of us join large groups.

Meanwhile, concierge practices see 10-15 people per day and make more money- without having to deal with insurance hassles. More money per patient and fewer patients calling after hours. It sounds great for me, but I can't say the same thing for the general public (especially the general public in the lower 75% income group). As someone with a struggling new practice, I have to choose between the bird in the hand (low reimbursement insurance covered patients- of whom there are many) and the bird in the bush (a concierge practice- where I have to hope that there are at least 250 families willing to give me $2,500 per family to care for them). I definitely need to phrase it as $200 per month.

But with practices going out of business and large group practices being slow to move into some of the new suburbs, the general public is beginning to lose access to health care services due to a lack of PCP's. This is a problem for both the poor and the middle class. I don't have a solution that is workable, I'm just saying this is an unrecognized problem.

http://laissezfairehealthcare.com/2007/12/22/primary-care-physicians-an-endangered-species/

Another aticle addressing the practice of primary care medicine. I can't add anything to this except to say, "yep, he's right".

http://www.thehealthcareblog.com/the_health_care_blog/2007/12/bad-medicine-ho.html

And finally, the most comprehensive blog post I found on the subject.

Sicko moment

With apologies to Michael Moore....

A particular health insurance company has been the bane of my existence. They lost my paperwork when I enrolled. Their physician payment rates are lower than anyone else's, unlike their stock price or bonuses to their executives. They have been hosing patients, too- increasing payments and having inconvenient "glitches" causing them to lose money in their HSA accounts.

Then when they said I could get paid to see their patients, they entered the wrong address, phone number and Tax ID number, so they could not send any payment for 3 months. Then, they denied payment on some claims because we did not submit them properly (with address and Tax ID number matching their database) within 90 days. According to our calculations, this company owes my office at least $10,000.

But here's the kicker: this week, they actually mailed me a bill.

Yep, they claimed to have overpaid my office for one claim, so they want a refund. Insurance company "X" has gone from underpayment, to denying payments, to charging payments when doctors see their patients.

On a related note, the same company was going to fine doctor's offices $50 every time one of their patients was sent to a non-contracted lab.

Why 14,000 ain't what it used to be

http://www.nytimes.com/2007/07/18/business/18leonhardt.html?em&ex=1184990400&en=1645e4bc997c8a3b&ei=5087%0A

You know how the stock market keeps hitting new highs, while the spending power of most of us is getting lower? Here's some perspective why. This is also why I read more than one newspaper- to get more from a story besides a number and quotes from useless talking heads.

Adapt or die (or be bought out)

I sure hope I'm able to change and adapt with the changing times while keeping focused on my patients and their needs.

http://www.chron.com/disp/story.mpl/business/steffy/4865569.html

Another ethical dilemma- childern and Medicaid

http://www.slate.com/id/2167190/?nav=navoa

This article is about Medicaid and doctors' payments. Since Medicaid has lost my application 3 times, I'm not currently accepting Medicaid patients (I won't get any money for seeing them until they complete my paperwork). They pay 25-50% less than other insurers. They require more paperwork for referrals and therefore cost me more time (and money) when I see their patients. And they kept me on their provider list after I switched jobs and had to dis-enroll from Medicaid- but medicaid staffers kept signing me up as various patients' PCP. This meant that not only would I not get paid to see the patient, but any other doctor who saw the patient would not get paid either.

At any rate, I'll have to decide whether or not to take any Medicaid patients. As much as I pride myself on accepting patients that other doctors won't, I have to be practical and stay in business, or else I ain't helping anyone.

On a related note, I'll start doing cosmetic procedures this month. I picked procedures that insurance companies do NOT cover. market economics at its best.

Corporate elder abuse

I'm rather paranoid about telemarketers. And junk e-mail. This NY Times article talks about scams directed at the elderly and how easy and lucrative they are.

http://www.nytimes.com/2007/05/20/business/20tele.html?_r=1&th&emc=th&oref=slogin

Two interesting observations. Between pages 3 and 4, I was asked to participate in a reader survey. Likely to get marketing information for a third party. Also, I read an article about culinary school graduates and their mounting debt. The next day, i got 2 e-mails about enrolling in cooking school.

Anyway, if you have elderly family, call them often so they are less likely to fall prey to scam artists who act like their friends.

Well, here goes

I signed up for the cosmetic surgery course. I hope people come in for this service; I'd like to keep the doors open here.

Roger Clemens can count

Roger Clemens is going back to New York. People here in the Houston area are acting like he's taking the petrochemical industry with him. And to think he has the nerve to take the job with more money?!?!?

Oh, wait- I know how to count, too. I'd move for more money (which I did in 2001 at the end of residency). Yes, I took a higher paying doctor job over a lower paying one. Apparently, no one who listens to sports talk radio would do that because they love their employer or hometown too much to take more money for the same job elsewhere.

Insurance issues

http://www.nytimes.com/2007/05/07/washington/07medicare.html?_r=1&hp&oref=slogin

The best part about these plans is they pay individual doctors, hospitals, and skilled nursing facilities at the same rate as Medicare, but they require enough paperwork to build an origami army.

And you can't get anything done online, either.

By the way, if an insurance company did a good deed, would that make the newspaper? Of course it would, right after Spike Lee joins the KKK

My own ethical dilemma

I have my own ethical dilemma. I'm a primary care doctor. I take care of everything from colds to diabetes. I especially like diabetes, high blood pressure, asthma, and prevention. Every month, guidelines are updated for these and other conditions. New medications, new tests, better health outcomes. There are continuing education classes in great cities to stay up to date. I can even learn online.

And I am getting ready to sign up for a cosmetic procedures class.

If I see a patient for something important, like high cholesterol, I have a 90% chance of getting $40-$120 from their insurance plans. If I perform a Botox treatment or take care of varicose veins, I will get $250-$500 from the patient. Before I sound like a greedy bastard, remember- I'll need to see 8-14 daily (with a staff of me and my wife) to break even doing primary care alone. I would like to stay in business long enough to hire staff and pay them (and Uncle Sam).

So what do you think?

See April 27 Post

Here is Loren Steffy's blog post about his column, including a rebuttal from the Philadelphia Inquirer. I appreciate anyone who lets people of different viewpoint have a say.

http://blogs.chron.com/lorensteffy/2007/04/sound_off_colum_1.html

An ethical dilemma

I like to read the business section of the newspaper. Coincidentally, I am interested in staying in bsiness with my new practice. One of the columnists that I read reglualy is Loren Steffy of the Houston Chronicle. Today, his column addresses a bank funding a column for another newspaper and how that leads to an obvious conflict of interest.

http://www.chron.com/disp/story.mpl/business/steffy/4754033.html

Of note, he addresses the newspaper industry's financial woes and points out that allowing a business to sponsor a column is a potential revenue stream. As the internet changes how information is disseminated, traditional purveyors of information (newspapers, the evening news shows) are finding it hard to keep people's attention (and revenue). So while Mr. Steffy is right to say that journalistic integrity is compromised by selling a column to a local bank, he fails to address the larger question:

How does a newspaper grow its business while maintaing its independence and integrity?

If a newspaper goes out of business, it probably won't maintain very high standards of journalism.