survivability

[Guest guest]

that's precisely the crux of the matter-- "I've done all humanly possible to shave costs to the boneI do my share of work for uninsured and Gov't contractsI deliver on the principles of patient-centered collaborative care" we have been doing our best, each in our own way, to find workable niches, and variations on a theme thereof, within the current system. that still doesn't fix the current system, rather IMP's are only a testament to our flexibility and ingenuity to find palatable means to do what we believe is right, and to survive. that is in spite of, rather than due to, a broken system, yet a cynical observer might say, it is the mother of invention, that the IMP wouldn't exist without the pressure of the current system. perhaps, yet rather than expect and anticipate the worst to produce the

best, let us look forward with hope and anticipation of better. isn't that what we offer our patients? it requires us to organize, publicize and prosyletize (sp?). now it is time to either fix the system, or deconstruct it and start anew, either way to form it around our standards. LL "L. Gordon " wrote: One of the shocking discoveries on

our network is the degree of regional variation.It is very evident that some environments are so difficult as to make it extremely unlikely that any practice can survive without subsidy. We see subsidy from hospitals, from within the practice (e.g. "Robin Hood" types or doing a lucrative side business).One wonders if there are microclimates where IMPs - in spite of doing everything right - would fail to survive due to a combination of financial factors.I suspect that Southern CA is one such place. Cost of living is very high and average reimbursement is very low.We must explore innovations in financing so that IMPs can survive anywhere.While we work on payment reform, some will experiment in their own ways.I could hold my head up in public if:I've done all humanly possible to shave costs to the boneI do my share of work for uninsured and Gov't contractsI deliver on the principles of patient-centered collaborative

careThen I could say "I've done all I can, and there still exists a gap that is unsupportable in my region due to extraordinary:malpracticecost of livingreimbursementI add my voice to those crying out for health care financing reform to free me from having to charge more for certain activities. These benefits should be available to all as a right. Until we as a country are willing to do this hard work, I'll continue to do the best I can."GordonAt 08:04 AM 10/13/2006, you wrote: So, you are going to be a cash only style of practice (ie, no insurances)? Otherwise, I would think a “registration fee” would be a violation of your contracts. California sounds like a whole other planet from where I practice in central Ohio because people here would laugh & walk right out the door if I requested a similar “registration fee”

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