Re: dislocation story; It's all out of control

[Guest guest]

Gee, Tim...I guess I was undercharging the guy in the park last summer when he dislocated his arm. I had him lie on a picnic table with his arm hanging down over the edge and I sat underneath pulling straight down with about a two pound pull. After about eight minutes the thing gently slipped into place and we used the picnic table cloth as a triangular bandage sling. I told him to check in with his doctor, asked for a beer in payment and went quickly away. Joanne, secret park MD in Drain, ORFrom: TimScheffel

Subject: It's all out of controlTo: Date: Monday, February 15, 2010, 10:45 AM

Thank you for standing up against the medicalindustrial complex. Things are so upside down in terms of healthcare priorities and I fear that the big players are emboldened by the lack of legislative effectiveness to change the system. Witness the ever increasing insurance rates, the exoribtant costs for hospital and specialty services, etc; and then the push to get primary care folks to be 'triagists' and funnel patients for procedures.

In Alaska a group of private docs, led by a retired specialist are asking the state for a couple million so they can set up an 'efficient' clinic for medicare only patients. They hope to address the appalling access problem that we have in our state for medicare beneficiaries. Guess how they plan to solve it? Take $$ from the state to set up a clinic and then hire an FP who will be expected to see "fifty patients a day" supervised by this private group of specialists and others who will administer the clinic. They believe that a couple million dollars will get them set up. So, I wonder how much care we IMP's could provide if we had that money plus what we could bill? Oh, and in Alaska we get 1.5X the normal medicare rate.

My point is that things are so out of balance that it actually makes sense to our state legislators and others that our elderly should be cared for by setting up a factory to process them. "They may not like being seen for such brief visits, but they will be greatful that they have someplace to go". And that's for an insured population!

The working people w/o insurance are really screwed. We have federally funded CHC's but their sliding fee scale doesn't allow for much of a discount for unisured, working families. The CHC where I live charges about $100 for a 99213 to anyone who is twice the poverty level. And there is no help at all for when those same patients need lab, xray, specialty care, etc. Recent examples of costs: Patellar tendon repair > $10K cash; simple anterior shoulder dislocation > $5k with f/u PT at $200/visit; D & C following first trimester fetal demise > $7k (hospital fee only, the FP who actually did the procedure charged about $150. The costs are devastating to the financial health of these patients.

I think the solution has to be more like a revolution by primary care folks who simply refuse to deal with for profit insurance companies and insist that our professional organizations take a firm stand on our and our patient's behalf.