Re: Re: Blending of payments---O' Canada!

March 10, 2006

I do think we may be heading there in the country. I can easily see a

single fee of, say, $30 - $45 for an " office call " no matter how much

complexity/time, with total abandonment of the CPT guidelines. I honestly

think we may be going in that direction.

Blending of payments

> >

> > I haven't followed recent posts, so maybe this has already been

> > addressed. This weblink goes to an AAFP article talking about Cigna's

> > policy (and Anthem in Ohio) of making -213 -214 and -215 payments

> > " blended " in one. Yet another effort to up the insurance profits and

> > stick it to the physician once again--and who gets most affected by

> > this--the office visit leveraged family physician (versus procedure

> > specialists). I think someone's trying to turn off the ventilator on

> > the future of primary care.

> >

> > http://www.aafp.org/x42512.xml

> >

> > CB

> >

March 10, 2006

I do think we may be heading there in the country. I can easily see a

single fee of, say, $30 - $45 for an " office call " no matter how much

complexity/time, with total abandonment of the CPT guidelines. I honestly

think we may be going in that direction.

Blending of payments

> >

> > I haven't followed recent posts, so maybe this has already been

> > addressed. This weblink goes to an AAFP article talking about Cigna's

> > policy (and Anthem in Ohio) of making -213 -214 and -215 payments

> > " blended " in one. Yet another effort to up the insurance profits and

> > stick it to the physician once again--and who gets most affected by

> > this--the office visit leveraged family physician (versus procedure

> > specialists). I think someone's trying to turn off the ventilator on

> > the future of primary care.

> >

> > http://www.aafp.org/x42512.xml

> >

> > CB

> >

March 10, 2006

So then what is the answer (or is there

one). The system we have now, where the insurance companies can claim fraud if

you over code forcing the majority of physicians to under code leading to a

whole industry set up to audit charts to make sure your practice is “coding

correctly” which still gives you little protection if the insurance

company does not agree with your auditor essentially costing millions/year for

a guessing game that makes you feel safer, is certainly not adequate. I would

argue that still we have (even with 13, 14 and 15 codes) a huge incentive to

push people through and not address their problems which is why many of us made

the leap to the low overhead model. After all, a lot more money is made seeing

4 (or 6) 13s in an hour than 2 14s. All this makes me long for a different

system where I get paid to see and take care of patients without having to

refer to others because their problem is not worth my time and not having to

fear reprisals because I might be an “outlier” if I do spend the

time. So I guess the question is what is the answer?

Blending

of payments

> >

> > I haven't followed recent

posts, so maybe this has already been

> > addressed. This weblink goes to an

AAFP article talking about Cigna's

> > policy (and Anthem in Ohio) of making

-213 -214 and -215 payments

> > " blended " in one. Yet

another effort to up the insurance profits and

> > stick it to the physician once

again--and who gets most affected by

> > this--the office visit leveraged family

physician (versus procedure

> > specialists). I think someone's

trying to turn off the ventilator on

> > the future of primary care.

> >

> > http://www.aafp.org/x42512.xml

> >

> > CB

> >

March 10, 2006

The answer in my mind is to eventually get back to basics. Deal directly with your patients. I see that we need a sustainable future as a group (docs, patients, neighborhoods, the entire global network). I like to stand back and look at the entire picture here. In a recent film I remember hearing that we are looking at the end of the era for the 6000 mile ceasar salad. That means to me we need local solutions for issues and not simply wait for the government or other agencies to step up and save us from our essentially unsustainable "American Dream" lifestyle.As natural resources dwindle in the face of our exponential growth in world wide population we need to get back to basics. I heard one physicist give a talk years ago in which he said our greatest downfall of the human race is our inability to understand the "exponential function of mathematics". We are outsripping the earth's ability to provide for us as a group.The answer to many of our problems is right in front of us. Us!! Look at Katrina, for example, most of those people saved themselves floating away from flooded buildings on freezer doors. I know. I went as a medical volunteer on my own even after the local medical society sent email warnings daily to physicians proclaiming "Do Not Self Deploy". I then wrote an essay that was published in the local paper (2 entire pages with photos), the local med society, and even the Regence BCBS website where I was honored by their CFO!!! (and was on TV twice) The title "Self Deploy or Self Deplore"I think we need to SELF DEPLOY (physicians and their communities) and save ourselves. We might have to jump on a freezer door if we wait too long.We have seen what one lawyer in India could do - GanhdiWe have seen what one preacher in America could do - MLKHave we seen yet what a few caring physicians could do to turn the tide in the direction we are going regarding health and survivability on this planet???? I think our time has come. It is a survival and health issue. We are the ones to step up to the plate.Blending 99213s/99214s is one tiny piece of a larger system gone awry.I think we need to stop cowtowing (is that the word) to the "Stakeholders" I have an image of physicians in my mind on these skewers all line up ready to be barbequed by the "stakeholders" - ins companies. government, other agencies with a vested interest in our behavior....I think we need to start joining WITH our communities in a new way, not with middle men or stakeholders between us. Get the community motivated, join together in a local network to support each other now! Do not wait for the petrocollapse or some other major disaster to unite us. Do not wait until we are all trying to jump on the freezer door.It is time for a revolution. It is time for doctors to do it.PamelaPamela Wible, MDFamily & Community Medicine, LLC3575 st. #220 Eugene, OR 97405roxywible@...On Mar 10, 2006, at 10:00 AM, Brady, MD wrote: So then what is the answer (or is there one). The system we have now, where the insurance companies can claim fraud if you over code forcing the majority of physicians to under code leading to a whole industry set up to audit charts to make sure your practice is “coding correctly” which still gives you little protection if the insurance company does not agree with your auditor essentially costing millions/year for a guessing game that makes you feel safer, is certainly not adequate. I would argue that still we have (even with 13, 14 and 15 codes) a huge incentive to push people through and not address their problems which is why many of us made the leap to the low overhead model. After all, a lot more money is made seeing 4 (or 6) 13s in an hour than 2 14s. All this makes me long for a different system where I get paid to see and take care of patients without having to refer to others because their problem is not worth my time and not having to fear reprisals because I might be an “outlier” if I do spend the time. So I guess the question is what is the answer? Blending of payments > > > > I haven't followed recent posts, so maybe this has already been > > addressed. This weblink goes to an AAFP article talking about Cigna's > > policy (and Anthem in Ohio) of making -213 -214 and -215 payments > > "blended" in one. Yet another effort to up the insurance profits and > > stick it to the physician once again--and who gets most affected by > > this--the office visit leveraged family physician (versus procedure > > specialists). I think someone's trying to turn off the ventilator on > > the future of primary care. > > > > http://www.aafp.org/x42512.xml > > > > CB > > > > > > > > > > > > > > > >

March 10, 2006

The only honest answer is to stop contracting with any insurance company. It will work only if enough physicians make that choice.So then what is the answer (or is there one). The system we have now, where the insurance companies can claim fraud if you over code forcing the majority of physicians to under code leading to a whole industry set up to audit charts to make sure your practice is “coding correctly” which still gives you little protection if the insurance company does not agree with your auditor essentially costing millions/year for a guessing game that makes you feel safer, is certainly not adequate. I would argue that still we have (even with 13, 14 and 15 codes) a huge incentive to push people through and not address their problems which is why many of us made the leap to the low overhead model. After all, a lot more money is made seeing 4 (or 6) 13s in an hour than 2 14s. All this makes me long for a different system where I get paid to see and take care of patients without having to refer to others because their problem is not worth my time and not having to fear reprisals because I might be an “outlier” if I do spend the time. So I guess the question is what is the answer? Blending of payments> > > > I haven't followed recent posts, so maybe this has already been> > addressed. This weblink goes to an AAFP article talking about Cigna's> > policy (and Anthem in Ohio) of making -213 -214 and -215 payments> > "blended" in one. Yet another effort to up the insurance profits and> > stick it to the physician once again--and who gets most affected by> > this--the office visit leveraged family physician (versus procedure> > specialists). I think someone's trying to turn off the ventilator on> > the future of primary care.> > > > http://www.aafp.org/x42512.xml> > > > CB> > > > > > > > > > > > > > > >

March 10, 2006

I have also come to the conclusion that the only way

to deal with this is to stop contracting with

insurance. I am into my 5th month of a cash-only

practice and I am continuing to grow, add new

patients, take care of hospital patients, and I hope

to break even and meet all of my overhead expenses

this month (my business plan had anticipated it could

take 6 months). I do not contract with any insurance

and I am opted out of Medicare. I'll share my patient

numbers for the first 6 months with you all when I

reach that milestone.

, MD

Rancho Mirage

--- Anemaria Lutas wrote:

> The only honest answer is to stop contracting with

> any insurance

> company. It will work only if enough physicians make

> that choice.

>

> > So then what is the answer (or is there one). The

> system we have

> > now, where the insurance companies can claim fraud

> if you over code

> > forcing the majority of physicians to under code

> leading to a whole

> > industry set up to audit charts to make sure your

> practice is

> > “coding correctly” which still gives you little

> protection if the

> > insurance company does not agree with your auditor

> essentially

> > costing millions/year for a guessing game that

> makes you feel

> > safer, is certainly not adequate. I would argue

> that still we have

> > (even with 13, 14 and 15 codes) a huge incentive

> to push people

> > through and not address their problems which is

> why many of us made

> > the leap to the low overhead model. After all, a

> lot more money is

> > made seeing 4 (or 6) 13s in an hour than 2 14s.

> All this makes me

> > long for a different system where I get paid to

> see and take care

> > of patients without having to refer to others

> because their problem

> > is not worth my time and not having to fear

> reprisals because I

> > might be an “outlier” if I do spend the time. So I

> guess the

> > question is what is the answer?

> >

> > Re: Blending of

> payments---O' Canada!

> >

> > It's good to consider both sides of the coin--but

> that system is

> > already played out....in Canada. My last

> conversation with a canadian

> > physician (about 2 years ago) gave me tremendous

> insight into this

> > kind of system. This person, an FP, had moved

> from there to here to

> > practice. There is no tiered code based on

> different complexity of

> > visits.

> >

> > In essence, to some degree this system occurs here

> already with busy

> > practices that shoot people through and bill all

> -213's, but in

> > Canada, an office visit has only one

> reimbursement, about $25. The

> > result of this, according to this physician, is

> that there is no

> > incentive to address more than one problem at a

> visit. " You've got

> > two things to talk about? Pick one and schedule a

> follow up next

> > week. " (That is nearly a direct quote). If

> someone has something

> > complex that might tie up office time (i.e. asthma

> > exacerbation)--- " sorry, you have to go to the

> Emergency room. "

> >

> > What a great system! I can't wait for that in the

> U.S. Oh, wait,

> > it's knocking on our back doors already. See

> blending of payments for

> > what it really is --a ceiling control on office

> visits. As I've

> > stated before, CPT level of complexity allows us a

> niche for higher,

> > in-depth care.

> >

> > Chris

> >

> > > >

> > > > isn't blending a violation of the insurance

> company's

=== message truncated ===

__________________________________________________

March 11, 2006

RE Can cash only save us?

Chris--

Where are you located (approximately) and what is the availability of docs

in your area?

I suspect that you can do what you're doing, if relative lack of doc supply,

or the docs in the area are not supplying service. How would you categorize

your practice?

Dr Matt Levin

Pittsburgh PA (East of)

Using Soapware at point of care, every pt since Dec 2004, started use in

1997.

Solo since Dec 2004.

Finished residency 1988.

Low overhead, but still $10K/month expenses.

Re: Blending of

>> payments---O' Canada!

>> >

>> > It's good to consider both sides of the coin--but

>> that system is

>> > already played out....in Canada. My last

>> conversation with a canadian

>> > physician (about 2 years ago) gave me tremendous

>> insight into this

>> > kind of system. This person, an FP, had moved

>> from there to here to

>> > practice. There is no tiered code based on

>> different complexity of

>> > visits.

>> >

>> > In essence, to some degree this system occurs here

>> already with busy

>> > practices that shoot people through and bill all

>> -213's, but in

>> > Canada, an office visit has only one

>> reimbursement, about $25. The

>> > result of this, according to this physician, is

>> that there is no

>> > incentive to address more than one problem at a

>> visit. " You've got

>> > two things to talk about? Pick one and schedule a

>> follow up next

>> > week. " (That is nearly a direct quote). If

>> someone has something

>> > complex that might tie up office time (i.e. asthma

>> > exacerbation)--- " sorry, you have to go to the

>> Emergency room. "

>> >

>> > What a great system! I can't wait for that in the

>> U.S. Oh, wait,

>> > it's knocking on our back doors already. See

>> blending of payments for

>> > what it really is --a ceiling control on office

>> visits. As I've

>> > stated before, CPT level of complexity allows us a

>> niche for higher,

>> > in-depth care.

>> >

>> > Chris

>> >

>> > > >

>> > > > isn't blending a violation of the insurance

>> company's

> === message truncated ===

>

> __________________________________________________

>

March 11, 2006

Yes, some type of collective bargaining.

>

> Date: 2006/03/10 Fri PM 02:31:27 EST

> To:

> Subject: Re: Re: Blending of payments---O' Canada!

>

> The only honest answer is to stop contracting with any insurance

> company. It will work only if enough physicians make that choice.

>

> > So then what is the answer (or is there one). The system we have

> > now, where the insurance companies can claim fraud if you over code

> > forcing the majority of physicians to under code leading to a whole

> > industry set up to audit charts to make sure your practice is

> > ?coding correctly? which still gives you little protection if the

> > insurance company does not agree with your auditor essentially

> > costing millions/year for a guessing game that makes you feel

> > safer, is certainly not adequate. I would argue that still we have

> > (even with 13, 14 and 15 codes) a huge incentive to push people

> > through and not address their problems which is why many of us made

> > the leap to the low overhead model. After all, a lot more money is

> > made seeing 4 (or 6) 13s in an hour than 2 14s. All this makes me

> > long for a different system where I get paid to see and take care

> > of patients without having to refer to others because their problem

> > is not worth my time and not having to fear reprisals because I

> > might be an ?outlier? if I do spend the time. So I guess the

> > question is what is the answer?

> >

> > Blending of payments

> > > >

> > > > I haven't followed recent posts, so maybe this has already been

> > > > addressed. This weblink goes to an AAFP article talking about

> > Cigna's

> > > > policy (and Anthem in Ohio) of making -213 -214 and -215 payments

> > > > " blended " in one. Yet another effort to up the insurance

> > profits and

> > > > stick it to the physician once again--and who gets most

> > affected by

> > > > this--the office visit leveraged family physician (versus

> > procedure

> > > > specialists). I think someone's trying to turn off the

> > ventilator on

> > > > the future of primary care.

> > > >

> > > > http://www.aafp.org/x42512.xml

> > > >

> > > > CB

> > > >

March 11, 2006