Re: ACO's --> end of solo? --> Re: AnyoneFollowing This?

[Guest guest]

key here is who gets pennies now

Re: [practicemgt] Anyone Following This?

>

> Once again Glenn, you've expressed my thoughts better than I could.

>

> As an independent small group owner, I don't think that AAFP supports

> us in this fight.

>

> R. Pierce MD

> Rockport, Maine

> www.midcoastmedicine.com

>

>

>

>

> On 12/28/2009 12:13 PM, gswheetfastmail (DOT) us wrote:

>> But my AAFP leadership assured me that this legislation was good

>> overall, though admittedly imperfect! How could it be so flawed?

>>

>> The truth is, for various reasons, I suspect our leadership would have

>> swallowed ANY bill, as long as it had healthcare reform in the title.

>> Honestly, it seemed that no matter what got crammed into this bill, no

>> matter how much good stuff got taken out, we kept modifying our degree

>> of support, but never withdrew it. Our Board of Directors sees some

>> significant difference between saying "support" and "endorse", but in

>> the end, laws either pass or fail, regardless of whether the legislators

>> can claim 100%, 90%, or 65% support from the doctors.

>>

>> Guaranteed, all they heard in Congress was that the AAFP was on board.

>> Qualifying our support is of what meaninful consequence after this bill

>> is signed into law?

>>

>> Will we be allowed to obey only 80% of its provisions because the AAFP

>> was only 80% satisfied with it?

>>

>> As to the provisions that effectively aim for the extinction of

>> solo/small groups, it is clear that our leadership sold us out.

>> When confronted with this, I can already tell you what we will hear:

>> 1) Silence. Hope the questioner goes away.

>> 2) "Oh, no." "You're reading this all wrong. It won't be that bad."

>> 3) "This was a necessary compromise to ensure the overall position of

>> primary care in HCR. Better to have large groups of primary care than

>> multiple solo specialists as the future of healthcare in the U.S."

>>

>> I've refused to give a dime to our PAC as I feel it is advancing the

>> cause of Corporate, Top-heavy Family Medicine (at best), and Corporate,

>> Top-heavy Primary Care (with the FP gradually being phased out to the

>> NP/PA model) at worst. I've listened to Board members within our own

>> specialty say that they think this is the future of primary care and

>> that we should be preparing to be managers rather than face-to-face

>> clinicians. They may be right (I pray not), but I'm not going to fund a

>> lobbyist to facilitate that process. My money will go to oppose such

>> trends.

>>

>> The AAFP claims to be strong medicine for America. Our support for this

>> so-called HCR looks more like a placebo with nauseating side-effects.

>>

>> Glenn Wheet, MD

>> South Bend, MD

>>

>>

>>

>>

>> On Thu, 24 Dec 2009 16:04:19 -0500, "Pennie Marchetti"

>> <pmarchettiameritech (DOT) net> said:

>>

>>> Just to scare you some more, here are some details about the bill that

>>> just

>>> passed that make me want to weep.

>>>

>>>

>>> From the Wall Street Journal

>>> http://online.wsj.com/article/SB10001424052748704254604574613992408387548.html

>>> :

>>>

>>>

>>> Primary-care doctors who refer patients to specialists will face

>>> financial

>>> penalties under the plan. Doctors will see 5% of their Medicare pay cut

>>> when their "aggregated" use of resources is "at or above the 90th

>>> percentile of national utilization," according to the chairman's mark of

>>> Section 3003 of the bill. Doctors will feel financial pressure to limit

>>> referrals to costly specialists like surgeons, since these penalties will

>>> put the referring physician on the hook for the cost of the referral and

>>> perhaps any resulting procedures.

>>>

>>> Next, the plan creates financial incentives for doctors to consolidate

>>> their practices. The idea here is that Medicare can more easily apply its

>>> regulations to institutions that manage large groups of doctors than it

>>> can

>>> to individual physicians. So the Obama plan imposes new costs on doctors

>>> who remain solo, mostly by increasing their overhead requirementssuch as

>>> requiring three years of medical records every time a doctor orders

>>> routine

>>> medical equipment like wheelchairs.

>>>

>>> The plan also offers doctors financial carrots if they give up their

>>> small

>>> practices and consolidate into larger medical groups, or become salaried

>>> employees of large institutions such as hospitals or "staff model"

>>> medical

>>> plans like Kaiser Permanente. One provision, laid out in Section 3022,

>>> allows doctors to share with the government any savings to the government

>>> they achieve by delivering less carebut only if physicians are part of

>>> groups caring for more than 5,000 Medicare patients and "have in place a

>>> leadership and management structure, including with regard to clinical

>>> and

>>> administrative systems."

>>>

>>> While these payment reforms are structured as pilot programs in the

>>> legislation, this distinction has little practical meaning. Medicare is

>>> being given broad authority, for the first time, to roll these

>>> demonstration programs out nationally without the need for a second

>>> authorization by Congress.

>>>

>>>

>>> And then there's this proof of what we've all felt intuitively - that

>>> government intrusion in our business is already unbearable:

>>>

>>> http://healthcare.nationalreview.com/post/?q=NjZhZGE1ODZhOGJlMDY0OTU3ZDBjYjdjZmRlYWJlZmM=

>>>

>>> The Public Welfare Code contains 109 pages of rules governing providers.

>>> This includes rules governing the National Practitioners Database, HIPAA,

>>> as well as other administrative regulations. A mere ten years earlier,

>>> the

>>> number of pages was only seven!

>>>

>>> That's an increase of 1,457% over ten years. Ouch! Don't expect that to

>>> go down.

>>>

>>> Merry Christmas, here's hoping we all survive the New Year.

>>>

>>> Pennie Marchetti, MD

>>> Stow, Ohio

>>> solo practice

>>>

>>> At 10:27 PM 12/22/2009, you wrote:

>>>

>>>> "Why else would they pursue healthcare bills that their own party's left

>>>> wing detests, unless they are doing so with a wink and a nod indicating

>>>> that the liberals will eventually get everything they want & #8211; a

>>>> single-payer system?"

>>>>

>>> ---

>>> You are currently subscribed to practicemgt as: gswheetfastmail (DOT) us

>>> To unsubscribe or to manage your settings, please go to

>>> http://members.aafp.org/members/cgi-bin/myaafp.pl?op=subscriptions & type=lists

>>>

>

> ---

> You are currently subscribed to practicemgt as: drkdrkleinman

> To unsubscribe or to manage your settings, please go to http://members.aafp.org/members/cgi-bin/myaafp.pl?op=subscriptions & type=lists

>

> ---

> You are currently subscribed to practicemgt as: lockecoloradogmail

> To unsubscribe or to manage your settings, please go to http://members.aafp.org/members/cgi-bin/myaafp.pl?op=subscriptions & type=lists

>

-- PATIENTS,please remember email may not be entirely secure and that Email is part of the medical record and is placed into the chart ( be careful what you say!)Email is best used for appointment making and brief questionsEmail replies can be expected within 24 hours-Please CALL if the matter is more urgent . MD ph fax impcenter.org