Re: Re: This article blames the AMA and specialist for why Primary care gets paid so little

[Guest guest]

It was a boy named Hsu. And you are correct that the RVU's perpetuate the idea

that procedures should be reimbursed more than thinking or longitudinal care.

________________________________________

From:

[ ] On Behalf Of Craig Ross

[rossmd@...]

Sent: Tuesday, July 20, 2010 8:45 PM

To:

Subject: Re: This article blames the AMA and specialist

for why Primary care gets paid so little

I forgot the source but apparently the RVU thing was the idea of one individual.

When the AMA committed a committee of physicians to create the RVUs, the

committee was essentially taken over by sub-specialists much to the

disappointment of the person who created the idea. I can't remember where I read

the article about this but the history of the creation of RVUs is quite

interesting ... and sad.

Craig

>

> the-worst-paying-jobs-for-doctors: Personal Finance News from Yahoo! Finance

>

http://finance.yahoo.com/career-work/article/110106/the-worst-paying-jobs-for-do\

ctors?mod=career-salary_negotiation

> Glad I am not a member of AMA if it is true that they are kept our pay low

> --

> M.D.

> www.elainemd.com

> Office:

> Go in the directions of your dreams and live the life you've imagined.

> This email transmission may contain protected and privileged, highly

> confidential medical, Personal and Health Information (PHI) and/or legal

> information. The information is intended only for the use of the individual

> or entity named above.

>

>

>

> If you are not the intended recipient of this material, you may not use,

> publish, discuss, disseminate or otherwise distribute it. If you are not the

> intended recipient, or if you have received this transmission in error,

> please notify the sender immediately and confidentially destroy the

> information that email in error.

>

[Guest guest]

My understanding is that Hsu himself- he;s at Harvard I think- has said how badly wrong RVUs went,  it was actually his intent that RVUs work t o prevent exactly what has happenedIt WAS the  AMA it IS the  AMA and it IS specialists and  for profit insurers do not exaclty help and    some other policies as well but hugley this pay  disparity drives us apart and no one speaks about it

It is very very difficult to work with specialists  daily and not see them step up to the plate,  see their   personal wealth ,see them creating all kinds of barriers to seeing my patietns ( fill out only our form we w ill not read yours  sned it in and we will have a nurse  decided whether  your patient   deserves to be seen  here and  if we do  we will call you and make you cal l the paitent but you may have to call  later if you can get through hahaha our phones a are soo busy   becasue we willnot send a letter back to  t he address you sent it from  becasue only the doctor  gets the letter you send, our receptionsit has a  nice dusty circa 1995 book with an address for you in there that she uses   is a typical part of my life   Yesterday after days of waiting for a return call/tracking down.remembering tot call back,  etc A specialist's  office told me they will not see self pay patietns " we don;t wan them to incur the cost " !

 dear god.) I understand malpractice issues but malpr issues for orthopods do not  account for the difference in salaries (info from lawyer at MAine medical association)  a couple of years of extra training- where salaries ARE being earned frankly probably higher salaries as fellows than some fps earn- can be accounted for over a 25 yr  career as an extra month/year of salary

 But fps and their organizations will not speak up we would rather make nice. I would re join AAFP in a heart beat if they made loud effective noise about thisI am sick of making nice I would rather be paid for the good work I do.

It was a boy named Hsu. And you are correct that the RVU's perpetuate the idea that procedures should be reimbursed more than thinking or longitudinal care.

________________________________________

From: [ ] On Behalf Of Craig Ross [rossmd@...]

Sent: Tuesday, July 20, 2010 8:45 PM

To:

Subject: Re: This article blames the AMA and specialist for why Primary care gets paid so little

I forgot the source but apparently the RVU thing was the idea of one individual. When the AMA committed a committee of physicians to create the RVUs, the committee was essentially taken over by sub-specialists much to the disappointment of the person who created the idea. I can't remember where I read the article about this but the history of the creation of RVUs is quite interesting ... and sad.

Craig

>

> the-worst-paying-jobs-for-doctors: Personal Finance News from Yahoo! Finance

> http://finance.yahoo.com/career-work/article/110106/the-worst-paying-jobs-for-doctors?mod=career-salary_negotiation

> Glad I am not a member of AMA if it is true that they are kept our pay low

> --

> M.D.

> www.elainemd.com

> Office:

> Go in the directions of your dreams and live the life you've imagined.

> This email transmission may contain protected and privileged, highly

> confidential medical, Personal and Health Information (PHI) and/or legal

> information. The information is intended only for the use of the individual

> or entity named above.

>

>

>

> If you are not the intended recipient of this material, you may not use,

> publish, discuss, disseminate or otherwise distribute it. If you are not the

> intended recipient, or if you have received this transmission in error,

> please notify the sender immediately and confidentially destroy the

> information that email in error.

>

------------------------------------

[Guest guest]

One of the means of curing this is to out it and then INSIST upon a separate and higher paying fee schedule for office E & M code like visits and other in office small primary care procedures and only for primaries. We live and die by the office visit and don't tell me that balancing out half a dozen meds, in a patient with DM, high BP and High Cholesterol, isn't more complicated that they average sprained knee or basic injury.... there needs to be a PCP only fee schedule that recognizes that this is what you folks do and that what you do has real value to the patients and society as a whole...

That combined with payments for any and all insurance carrier micromanagment to offset the costs of their as of now Free paperwork, would go a long way in assisting PCP's in getting out of the hole they are in.... Until the carriers have to shoulder the entire cost of the exessive managment they will continue to insist on more and more until the entire system collapses under the weight of it....

BTW, although the carriers have an anti-trust waiver, exemption from the feds, none of the specialists nor the AMA have such wonderful and all too powerful coverage... Personally, I believe that the present fee system and the AMA group whose name elludes me for the moment who "proposes" the RVU's to the gov't for their consideration, that they are colluding and violation of anti-trust laws, setting fees and controlling market and rates for their own self betterment... Likewise, I believe that one could even say the same about the federal gov't and the AMA and the specialists because it is their accepting of and using almost exclussively the AMA's recommendations for which to set the Federal Medicare Fee Schedule and the same Federal Gov't is the main consumer and payor of medical services in this country. How can or should it be legal, and not a violation of some sort of price control and fixing, conflict of interest to have the

payor and consumer of the care, be in charge and have the final word on the setting of the fees that they will eventually have to pay to a service provider??? When you really stop and look at it from this perspective, OF COURSE it makes immediate sense that even a 5 year old would see through it all....

Well, that's about it from the quaint little Campus of Colgate and the Colgate Goalie Clinic in Hamilton NY.... Be well one and all...

To: Sent: Wed, July 21, 2010 11:25:28 AMSubject: Re: Re: This article blames the AMA and specialist for why Primary care gets paid so little

My understanding is that Hsu himself- he;s at Harvard I think- has said how badly wrong RVUs went, it was actually his intent that RVUs work t o prevent exactly what has happenedIt WAS the AMA it IS the AMA and it IS specialists and for profit insurers do not exaclty help and some other policies as well but hugley this pay disparity drives us apart and no one speaks about itIt is very very difficult to work with specialists daily and not see them step up to the plate, see their personal wealth ,see them creating all kinds of barriers to seeing my patietns ( fill out only our form we w ill not read yours sned it in and we will have a nurse decided whether your patient deserves to be seen here and if we do we will call you and make you cal l the paitent but you may have to call later if you can get through hahaha our phones a are soo

busy becasue we willnot send a letter back to t he address you sent it from becasue only the doctor gets the letter you send, our receptionsit has a nice dusty circa 1995 book with an address for you in there that she uses is a typical part of my life Yesterday after days of waiting for a return call/tracking down.remembering tot call back, etc A specialist's office told me they will not see self pay patietns"we don;t wan them to incur the cost" ! dear god.) I understand malpractice issues but malpr issues for orthopods do not account for the difference in salaries (info from lawyer at MAine medical association) a couple of years of extra training- where salaries ARE being earned frankly probably higher salaries as fellows than some fps earn- can be accounted for over a 25 yr career as an extra month/year of salary But fps and their

organizations will not speak up we would rather make nice. I would re join AAFP in a heart beat if they made loud effective noise about thisI am sick of making nice I would rather be paid for the good work I do.

On Wed, Jul 21, 2010 at 10:08 AM, Kennedy, Jim <jim.kennedy@ ucdenver. edu> wrote:

It was a boy named Hsu. And you are correct that the RVU's perpetuate the idea that procedures should be reimbursed more than thinking or longitudinal care.____________ _________ _________ _________ _From: Practiceimprovement 1yahoogroups (DOT) com [Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Craig Ross [rossmdyahoo (DOT) com]Sent: Tuesday, July 20, 2010 8:45 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so littleI forgot the source but apparently the RVU thing was the idea of one individual. When the AMA committed a committee of physicians to create the RVUs, the committee was essentially taken over by sub-specialists much to the disappointment of the person who created the idea. I can't remember where I read the article about this but the history of the creation of RVUs is quite interesting ... and sad.Craig>> the-worst-paying- jobs-for- doctors: Personal Finance News from Yahoo! Finance> http://finance. yahoo.com/ career-work/ article/110106/ the-worst- paying-jobs- for-doctors? mod=career- salary_negotiati on> Glad I am not a member of AMA if it is true that they are kept our pay low> --> M.D.> www.elainemd. com> Office: > Go in the directions of your dreams and live the life you've imagined.> This email transmission may contain protected and privileged, highly> confidential medical, Personal

and Health Information (PHI) and/or legal> information. The information is intended only for the use of the individual> or entity named above.>>>> If you are not the intended recipient of this material, you may not use,> publish, discuss, disseminate or otherwise distribute it. If you are not the> intended recipient, or if you have received this transmission in error,> please notify the sender immediately and confidentially destroy the> information that email in error.>------------ --------- --------- ------

[Guest guest]

Et Al.

Please not our E & M reimbursement from CMS has increased 25% since 2004. Please update your fee schedules to optimally collect all your entitled. 99215 is now approximately $125, 99214 is $97, 99213 is 67.

What are you all seeing now that consult codes have been merged into E & M pool.

To: Sent: Wed, July 21, 2010 12:33:02 PMSubject: Re: Re: This article blames the AMA and specialist for why Primary care gets paid so little

One of the means of curing this is to out it and then INSIST upon a separate and higher paying fee schedule for office E & M code like visits and other in office small primary care procedures and only for primaries. We live and die by the office visit and don't tell me that balancing out half a dozen meds, in a patient with DM, high BP and High Cholesterol, isn't more complicated that they average sprained knee or basic injury.... there needs to be a PCP only fee schedule that recognizes that this is what you folks do and that what you do has real value to the patients and society as a whole...

That combined with payments for any and all insurance carrier micromanagment to offset the costs of their as of now Free paperwork, would go a long way in assisting PCP's in getting out of the hole they are in.... Until the carriers have to shoulder the entire cost of the exessive managment they will continue to insist on more and more until the entire system collapses under the weight of it....

BTW, although the carriers have an anti-trust waiver, exemption from the feds, none of the specialists nor the AMA have such wonderful and all too powerful coverage... Personally, I believe that the present fee system and the AMA group whose name elludes me for the moment who "proposes" the RVU's to the gov't for their consideration, that they are colluding and violation of anti-trust laws, setting fees and controlling market and rates for their own self betterment.. . Likewise, I believe that one could even say the same about the federal gov't and the AMA and the specialists because it is their accepting of and using almost exclussively the AMA's recommendations for which to set the Federal Medicare Fee Schedule and the same Federal Gov't is the main consumer and payor of medical services in this country. How can or should it be legal, and not a violation of some sort of price control and fixing, conflict of interest to have the

payor and consumer of the care, be in charge and have the final word on the setting of the fees that they will eventually have to pay to a service provider??? When you really stop and look at it from this perspective, OF COURSE it makes immediate sense that even a 5 year old would see through it all....

Well, that's about it from the quaint little Campus of Colgate and the Colgate Goalie Clinic in Hamilton NY.... Be well one and all...

From: <jnantonucci@ gmail.com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Wed, July 21, 2010 11:25:28 AMSubject: Re: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so little

My understanding is that Hsu himself- he;s at Harvard I think- has said how badly wrong RVUs went, it was actually his intent that RVUs work t o prevent exactly what has happenedIt WAS the AMA it IS the AMA and it IS specialists and for profit insurers do not exaclty help and some other policies as well but hugley this pay disparity drives us apart and no one speaks about itIt is very very difficult to work with specialists daily and not see them step up to the plate, see their personal wealth ,see them creating all kinds of barriers to seeing my patietns ( fill out only our form we w ill not read yours sned it in and we will have a nurse decided whether your patient deserves to be seen here and if we do we will call you and make you cal l the paitent but you may have to call later if you can get through hahaha our phones a are soo

busy becasue we willnot send a letter back to t he address you sent it from becasue only the doctor gets the letter you send, our receptionsit has a nice dusty circa 1995 book with an address for you in there that she uses is a typical part of my life Yesterday after days of waiting for a return call/tracking down.remembering tot call back, etc A specialist's office told me they will not see self pay patietns"we don;t wan them to incur the cost" ! dear god.) I understand malpractice issues but malpr issues for orthopods do not account for the difference in salaries (info from lawyer at MAine medical association) a couple of years of extra training- where salaries ARE being earned frankly probably higher salaries as fellows than some fps earn- can be accounted for over a 25 yr career as an extra month/year of salary But fps and their

organizations will not speak up we would rather make nice. I would re join AAFP in a heart beat if they made loud effective noise about thisI am sick of making nice I would rather be paid for the good work I do.

On Wed, Jul 21, 2010 at 10:08 AM, Kennedy, Jim <jim.kennedy@ ucdenver. edu> wrote:

It was a boy named Hsu. And you are correct that the RVU's perpetuate the idea that procedures should be reimbursed more than thinking or longitudinal care.____________ _________ _________ _________ _From: Practiceimprovement 1yahoogroups (DOT) com [Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Craig Ross [rossmdyahoo (DOT) com]Sent: Tuesday, July 20, 2010 8:45 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so littleI forgot the source but apparently the RVU thing was the idea of one individual. When the AMA committed a committee of physicians to create the RVUs, the committee was essentially taken over by sub-specialists much to the disappointment of the person who created the idea. I can't remember where I read the article about this but the history of the creation of RVUs is quite interesting ... and sad.Craig>> the-worst-paying- jobs-for- doctors: Personal Finance News from Yahoo! Finance> http://finance. yahoo.com/ career-work/ article/110106/ the-worst- paying-jobs- for-doctors? mod=career- salary_negotiati on> Glad I am not a member of AMA if it is true that they are kept our pay low> --> M.D.> www.elainemd. com> Office: > Go in the directions of your dreams and live the life you've imagined.> This email transmission may contain protected and privileged, highly> confidential medical, Personal

and Health Information (PHI) and/or legal> information. The information is intended only for the use of the individual> or entity named above.>>>> If you are not the intended recipient of this material, you may not use,> publish, discuss, disseminate or otherwise distribute it. If you are not the> intended recipient, or if you have received this transmission in error,> please notify the sender immediately and confidentially destroy the> information that email in error.>------------ --------- --------- ------

[Guest guest]

Use the CMS website and type in a few other counties, cities worth of fees and see the lousy level of reimbursement... We are now in the very low $90's for 4's and just a few bucks above $60 for 3's... And we have obscene Med Mal as compared to the rest of the country as I understand it.... But again, a real level 4 should cover up to a half hour's worth of time. I see nothing wrong with any of us getting at the very least $125 per half and $250 per whole hour... Our lawyers are easily getting this these days and they studied many years less than even PCP's. At least 4 years less and their office expenses, overhead per client, is all a lot less.Finally they are fully in a free market and totally allowed to bill for forms, letters written on behalf of the clients and any other sort of tedious labor

intensive and time consuming chores.... So really either we should be allowed (that's my take on it...) to bill for any and all tedious CCHIT and other staff members work or clerical stuff just like them or otherwise we should be paid an extra $50 per hour to compensate for all this other stuff so we can afford the staff and lost time that it all consumes and costs us....

Signing off from Colgate and Hamilton, last ice session of camp is in progress as we speak....

To: Sent: Thu, July 22, 2010 1:30:02 PMSubject: Re: Re: This article blames the AMA and specialist for why Primary care gets paid so little

Et Al.

Please not our E & M reimbursement from CMS has increased 25% since 2004. Please update your fee schedules to optimally collect all your entitled. 99215 is now approximately $125, 99214 is $97, 99213 is 67.

What are you all seeing now that consult codes have been merged into E & M pool.

From: Bleiweiss <hockeyref1yahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Wed, July 21, 2010 12:33:02 PMSubject: Re: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so little

One of the means of curing this is to out it and then INSIST upon a separate and higher paying fee schedule for office E & M code like visits and other in office small primary care procedures and only for primaries. We live and die by the office visit and don't tell me that balancing out half a dozen meds, in a patient with DM, high BP and High Cholesterol, isn't more complicated that they average sprained knee or basic injury.... there needs to be a PCP only fee schedule that recognizes that this is what you folks do and that what you do has real value to the patients and society as a whole...

That combined with payments for any and all insurance carrier micromanagment to offset the costs of their as of now Free paperwork, would go a long way in assisting PCP's in getting out of the hole they are in.... Until the carriers have to shoulder the entire cost of the exessive managment they will continue to insist on more and more until the entire system collapses under the weight of it....

BTW, although the carriers have an anti-trust waiver, exemption from the feds, none of the specialists nor the AMA have such wonderful and all too powerful coverage... Personally, I believe that the present fee system and the AMA group whose name elludes me for the moment who "proposes" the RVU's to the gov't for their consideration, that they are colluding and violation of anti-trust laws, setting fees and controlling market and rates for their own self betterment.. . Likewise, I believe that one could even say the same about the federal gov't and the AMA and the specialists because it is their accepting of and using almost exclussively the AMA's recommendations for which to set the Federal Medicare Fee Schedule and the same Federal Gov't is the main consumer and payor of medical services in this country. How can or should it be legal, and not a violation of some sort of price control and fixing, conflict of interest to have the

payor and consumer of the care, be in charge and have the final word on the setting of the fees that they will eventually have to pay to a service provider??? When you really stop and look at it from this perspective, OF COURSE it makes immediate sense that even a 5 year old would see through it all....

Well, that's about it from the quaint little Campus of Colgate and the Colgate Goalie Clinic in Hamilton NY.... Be well one and all...

From: <jnantonucci@ gmail.com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Wed, July 21, 2010 11:25:28 AMSubject: Re: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so little

My understanding is that Hsu himself- he;s at Harvard I think- has said how badly wrong RVUs went, it was actually his intent that RVUs work t o prevent exactly what has happenedIt WAS the AMA it IS the AMA and it IS specialists and for profit insurers do not exaclty help and some other policies as well but hugley this pay disparity drives us apart and no one speaks about itIt is very very difficult to work with specialists daily and not see them step up to the plate, see their personal wealth ,see them creating all kinds of barriers to seeing my patietns ( fill out only our form we w ill not read yours sned it in and we will have a nurse decided whether your patient deserves to be seen here and if we do we will call you and make you cal l the paitent but you may have to call later if you can get through hahaha our phones a are soo

busy becasue we willnot send a letter back to t he address you sent it from becasue only the doctor gets the letter you send, our receptionsit has a nice dusty circa 1995 book with an address for you in there that she uses is a typical part of my life Yesterday after days of waiting for a return call/tracking down.remembering tot call back, etc A specialist's office told me they will not see self pay patietns"we don;t wan them to incur the cost" ! dear god.) I understand malpractice issues but malpr issues for orthopods do not account for the difference in salaries (info from lawyer at MAine medical association) a couple of years of extra training- where salaries ARE being earned frankly probably higher salaries as fellows than some fps earn- can be accounted for over a 25 yr career as an extra month/year of salary But fps and their

organizations will not speak up we would rather make nice. I would re join AAFP in a heart beat if they made loud effective noise about thisI am sick of making nice I would rather be paid for the good work I do.

On Wed, Jul 21, 2010 at 10:08 AM, Kennedy, Jim <jim.kennedy@ ucdenver. edu> wrote:

It was a boy named Hsu. And you are correct that the RVU's perpetuate the idea that procedures should be reimbursed more than thinking or longitudinal care.____________ _________ _________ _________ _From: Practiceimprovement 1yahoogroups (DOT) com [Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Craig Ross [rossmdyahoo (DOT) com]Sent: Tuesday, July 20, 2010 8:45 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so littleI forgot the source but apparently the RVU thing was the idea of one individual. When the AMA committed a committee of physicians to create the RVUs, the committee was essentially taken over by sub-specialists much to the disappointment of the person who created the idea. I can't remember where I read the article about this but the history of the creation of RVUs is quite interesting ... and sad.Craig>> the-worst-paying- jobs-for- doctors: Personal Finance News from Yahoo! Finance> http://finance. yahoo.com/ career-work/ article/110106/ the-worst- paying-jobs- for-doctors? mod=career- salary_negotiati on> Glad I am not a member of AMA if it is true that they are kept our pay low> --> M.D.> www.elainemd. com> Office: > Go in the directions of your dreams and live the life you've imagined.> This email transmission may contain protected and privileged, highly> confidential medical, Personal

and Health Information (PHI) and/or legal> information. The information is intended only for the use of the individual> or entity named above.>>>> If you are not the intended recipient of this material, you may not use,> publish, discuss, disseminate or otherwise distribute it. If you are not the> intended recipient, or if you have received this transmission in error,> please notify the sender immediately and confidentially destroy the> information that email in error.>------------ --------- --------- ------

[Guest guest]

I am not sure how you mean this   I think we are paid stupidly and that specialists and their procedures and their RUC presence has worked against family practice

Much o f it is the system as built

I made the mistake  heaven knows what possessed me last night to try to look  at 2011 CMS physician fee schedule rules in the federal register  well  it is interesting to read how they approach things, think it through, take comments  etc, all very democratic  and civilized  and academic thoughtful  but it is bizarre beyond belief that this stuff is done! All this devising of complex  rules then  re adjust them titrate them up a nd or down and fragment them into the  practice expense part,  the geography part,  the malpractice  etc  for each of thousand of mintuia of codes.

There is an entire page on how they approach coding  for canalith  repositioning maneuver  Well, bundled into E and M but PT''s do this  procedures and they cannot bill E and M and so  do this and that   My GOD!

When I do a 99215 I am wiped out for a while afterward Kev It  is like a bad migraine, there's aftermath.  125.00? For an hr   which is followed by reading sorting scannign and the weight of responsibility that  keeps me up at night etc.

 I refuse to be grateful for improvements that are so small . I will not act grateful that rates for X Y and Z have gone  up  25% since X year, when in the last 6 years  my health isnruacne, my own bills  have gone up a darn sight more than that.

I want and deserve better.

 

Et Al.

 

Please not our E & M reimbursement from CMS has increased 25% since 2004. Please update your fee schedules to optimally collect all your entitled.  99215 is now approximately $125, 99214 is $97, 99213 is 67.

 

What are you all seeing now that consult codes have been merged into E & M pool.

 

To:

Sent: Wed, July 21, 2010 12:33:02 PMSubject: Re: Re: This article blames the AMA and specialist for why Primary care gets paid so little

 

    One of the means of curing this is to out it and then INSIST upon a separate and higher paying fee schedule for office E & M code like visits and other in office small primary care procedures and only for primaries. We live and die by the office visit and don't tell me that balancing out half a dozen meds, in a patient with DM, high BP and High Cholesterol, isn't more complicated that they average sprained knee or basic injury.... there needs to be a PCP only fee schedule that recognizes that this is what you folks do and that what you do has real value to the patients and society as a whole...

 

    That combined with payments for any and all insurance carrier micromanagment to offset the costs of their as of now Free paperwork, would go a long way in assisting PCP's in getting out of the hole they are in.... Until the carriers have to shoulder the entire cost of the exessive managment they will continue to insist on more and more until the entire system collapses under the weight of it....

 

    BTW, although the carriers have an anti-trust waiver, exemption from the feds, none of the specialists nor the AMA have such wonderful and all too powerful coverage... Personally, I believe that the present fee system and the AMA group whose name elludes me for the moment who " proposes " the RVU's to the gov't for their consideration, that they are colluding and violation of anti-trust laws, setting fees and controlling market and rates for their own self betterment.. . Likewise, I believe that one could even say the same about the federal gov't and the AMA and the specialists because it is their accepting of and using almost exclussively the AMA's recommendations for which to set the Federal Medicare Fee Schedule and the same Federal Gov't is the main consumer and payor of medical services in this country. How can or should it be legal, and not a violation of some sort of price control and fixing, conflict of interest to have the

payor and consumer of the care, be in charge and have the final word on the setting of the fees that they will eventually have to pay to a service provider??? When you really stop and look at it from this perspective, OF COURSE it makes immediate sense that even a 5 year old would see through it all....

 

    Well, that's about it from the quaint little Campus of Colgate and the Colgate Goalie Clinic in Hamilton NY.... Be well one and all...

 

From: <jnantonucci@ gmail.com>To: Practiceimprovement 1yahoogroups (DOT) com

Sent: Wed, July 21, 2010 11:25:28 AMSubject: Re: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so little

 

My understanding is that Hsu himself- he;s at Harvard I think- has said how badly wrong RVUs went,  it was actually his intent that RVUs work t o prevent exactly what has happenedIt WAS the  AMA it IS the  AMA and it IS specialists and  for profit insurers do not exaclty help and    some other policies as well but hugley this pay  disparity drives us apart and no one speaks about it

It is very very difficult to work with specialists  daily and not see them step up to the plate,  see their   personal wealth ,see them creating all kinds of barriers to seeing my patietns ( fill out only our form we w ill not read yours  sned it in and we will have a nurse  decided whether  your patient   deserves to be seen  here and  if we do  we will call you and make you cal l the paitent but you may have to call  later if you can get through hahaha our phones a are soo

busy   becasue we willnot send a letter back to  t he address you sent it from  becasue only the doctor  gets the letter you send, our receptionsit has a  nice dusty circa 1995 book with an address for you in there that she uses   is a typical part of my life   Yesterday after days of waiting for a return call/tracking down.remembering tot call back,  etc A specialist's  office told me they will not see self pay patietns " we don;t wan them to incur the cost " !

 dear god.) I understand malpractice issues but malpr issues for orthopods do not  account for the difference in salaries (info from lawyer at MAine medical association)  a couple of years of extra training- where salaries ARE being earned frankly probably higher salaries as fellows than some fps earn- can be accounted for over a 25 yr  career as an extra month/year of salary

 But fps and their

organizations will not speak up we would rather make nice. I would re join AAFP in a heart beat if they made loud effective noise about thisI am sick of making nice I would rather be paid for the good work I do.

On Wed, Jul 21, 2010 at 10:08 AM, Kennedy, Jim <jim.kennedy@ ucdenver. edu> wrote:

It was a boy named Hsu. And you are correct that the RVU's perpetuate the idea that procedures should be reimbursed more than thinking or longitudinal care.

____________ _________ _________ _________ _From: Practiceimprovement 1yahoogroups (DOT) com [Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Craig Ross [rossmdyahoo (DOT) com]

Sent: Tuesday, July 20, 2010 8:45 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so little

I forgot the source but apparently the RVU thing was the idea of one individual. When the AMA committed a committee of physicians to create the RVUs, the committee was essentially taken over by sub-specialists much to the disappointment of the person who created the idea. I can't remember where I read the article about this but the history of the creation of RVUs is quite interesting ... and sad.

Craig

>> the-worst-paying- jobs-for- doctors: Personal Finance News from Yahoo! Finance> http://finance. yahoo.com/ career-work/ article/110106/ the-worst- paying-jobs- for-doctors? mod=career- salary_negotiati on

> Glad I am not a member of AMA if it is true that they are kept our pay low> --> M.D.> www.elainemd. com> Office:

> Go in the directions of your dreams and live the life you've imagined.> This email transmission may contain protected and privileged, highly> confidential medical, Personal

and Health Information (PHI) and/or legal> information. The information is intended only for the use of the individual> or entity named above.>>>> If you are not the intended recipient of this material, you may not use,

> publish, discuss, disseminate or otherwise distribute it. If you are not the> intended recipient, or if you have received this transmission in error,> please notify the sender immediately and confidentially destroy the

> information that email in error.>------------ --------- --------- ------

[Guest guest]

Isnt that by design?I do not think the pricing structure is intended to keep the small practitioner in businessWhat you want  and deserve   does not enter into the picture.

There are providers ( large corporate groups and entities) willing to provide those services and also promise better coordination of care and cost savings ( those magic words) and at the quality desired 9 which you and I think is not good enough). Small practitioners are seen as dysfuntional overusers, so by design they expect and WANT consolidation ( read all those oped pieces in all newspapers)

And so .. the ongoing consolidation of physician practices as in all other industries..I really think we should stop expecting any  dramatic change in pricing structure for the better...

and refocus on what we do best (  and market it as good value to the actual consumers like in all other industries)think artisanal cheeses versus kraftfarmers market versus food4less etc etc

How we do that,- isnt that what this mailing list all about.Sangeetha

 

 

Just wanted you to know that they are higher to make sure you aren't leaving money on the table. 

 

 

PS All practices in my area are selling to hospital.  Even large family practice group, and larger cardiology group, oncologist/hematologist.  Yet and I continue to stand our ground, looking for ways to continue to be efficient and give the care people need. 

To:

Sent: Thu, July 22, 2010 4:26:35 PMSubject: Re: Re: This article blames the AMA and specialist for why Primary care gets paid so little

 

I am not sure how you mean this   I think we are paid stupidly and that specialists and their procedures and their RUC presence has worked against family practice

Much o f it is the system as builtI made the mistake  heaven knows what possessed me last night to try to look  at 2011 CMS physician fee schedule rules in the federal register  well  it is interesting to read how they approach things, think it through, take comments  etc, all very democratic  and civilized  and academic thoughtful  but it is bizarre beyond belief that this stuff is done! All this devising of complex  rules then  re adjust them titrate them up a nd or down and fragment them into the  practice expense part,  the geography part,  the malpractice  etc  for each of thousand of mintuia of codes.

There is an entire page on how they approach coding  for canalith  repositioning maneuver  Well, bundled into E and M but PT''s do this  procedures and they cannot bill E and M and so  do this and

that   My GOD!When I do a 99215 I am wiped out for a while afterward Kev It  is like a bad migraine, there's aftermath.  125.00? For an hr   which is followed by reading sorting scannign and the weight of responsibility that  keeps me up at night etc.

 I refuse to be grateful for improvements that are so small . I will not act grateful that rates for X Y and Z have gone  up  25% since X year, when in the last 6 years  my health isnruacne, my own bills  have gone up a darn sight more than that.

I want and deserve better.

On Thu, Jul 22, 2010 at 1:30 PM, Egly <kevin_eglyyahoo (DOT) com> wrote:

 

Et Al.

 

Please not our E & M reimbursement from CMS has increased 25% since 2004. Please update your fee schedules to optimally collect all your entitled.  99215 is now approximately $125, 99214 is $97, 99213 is 67.

 

What are you all seeing now that consult codes have been merged into E & M pool.

 

From: Bleiweiss <hockeyref1yahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) com

Sent: Wed, July 21, 2010 12:33:02 PMSubject: Re: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so little

 

    One of the means of curing this is to out it and then INSIST upon a separate and higher paying fee schedule for office E & M code like visits and other in office small primary care procedures and only for primaries. We live and die by the office visit and don't tell me that balancing out half a dozen meds, in a patient with DM, high BP and High Cholesterol, isn't more complicated that they average sprained knee or basic injury.... there needs to be a PCP only fee schedule that recognizes that this is what you folks do and that what you do has real value to the patients and society as a whole...

 

    That combined with payments for any and all insurance carrier micromanagment to offset the costs of their as of now Free paperwork, would go a long way in assisting PCP's in getting out of the hole they are in.... Until the carriers have to shoulder the entire cost of the exessive managment they will continue to insist on more and more until the entire system collapses under the weight of it....

 

    BTW, although the carriers have an anti-trust waiver, exemption from the feds, none of the specialists nor the AMA have such wonderful and all too powerful coverage... Personally, I believe that the present fee system and the AMA group whose name elludes me for the moment who " proposes " the RVU's to the gov't for their consideration, that they are colluding and violation of anti-trust laws, setting fees and controlling market and rates for their own self betterment.. . Likewise, I believe that one could even say the same about the federal gov't and the AMA and the specialists because it is their accepting of and using almost exclussively the AMA's recommendations for which to set the Federal Medicare Fee Schedule and the same Federal Gov't is the main consumer and payor of medical services in this country. How can or should it be legal, and not a violation of some sort of price control and fixing, conflict of interest to have the

payor and consumer of the care, be in charge and have the final word on the setting of the fees that they will eventually have to pay to a service provider??? When you really stop and look at it from this perspective, OF COURSE it makes immediate sense that even a 5 year old would see through it all....

 

    Well, that's about it from the quaint little Campus of Colgate and the Colgate Goalie Clinic in Hamilton NY.... Be well one and all...

 

From: <jnantonucci@ gmail.com> To: Practiceimprovement 1yahoogroups (DOT) comSent: Wed, July 21, 2010 11:25:28 AMSubject: Re: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so little

 

My understanding is that Hsu himself- he;s at Harvard I think- has said how badly wrong RVUs went,  it was actually his intent that RVUs work t o prevent exactly what has happenedIt WAS the  AMA it IS the  AMA and it IS specialists and  for profit insurers do not exaclty help and    some other policies as well but hugley this pay  disparity drives us apart and no one speaks about it

It is very very difficult to work with specialists  daily and not see them step up to the plate,  see their   personal wealth ,see them creating all kinds of barriers to seeing my patietns ( fill out only our form we w ill not read yours  sned it in and we will have a nurse  decided whether  your patient   deserves to be seen  here and  if we do  we will call you and make you cal l the paitent but you may have to call  later if you can get through hahaha our phones a are soo

busy   becasue we willnot send a letter back to  t he address you sent it from  becasue only the doctor  gets the letter you send, our receptionsit has a  nice dusty circa 1995 book with an address for you in there that she uses   is a typical part of my life   Yesterday after days of waiting for a return call/tracking down.remembering tot call back,  etc A specialist's  office told me they will not see self pay patietns " we don;t wan them to incur the cost " !

 dear god.) I understand malpractice issues but malpr issues for orthopods do not  account for the difference in salaries (info from lawyer at MAine medical association)  a couple of years of extra training- where salaries ARE being earned frankly probably higher salaries as fellows than some fps earn- can be accounted for over a 25 yr  career as an extra month/year of salary

 But fps and their

organizations will not speak up we would rather make nice. I would re join AAFP in a heart beat if they made loud effective noise about thisI am sick of making nice I would rather be paid for the good work I do.

On Wed, Jul 21, 2010 at 10:08 AM, Kennedy, Jim <jim.kennedy@ ucdenver. edu> wrote:

It was a boy named Hsu. And you are correct that the RVU's perpetuate the idea that procedures should be reimbursed more than thinking or longitudinal care.

____________ _________ _________ _________ _From: Practiceimprovement 1yahoogroups (DOT) com [Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Craig Ross [rossmdyahoo (DOT) com]

Sent: Tuesday, July 20, 2010 8:45 PM To: Practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so little

I forgot the source but apparently the RVU thing was the idea of one individual. When the AMA committed a committee of physicians to create the RVUs, the committee was essentially taken over by sub-specialists much to the disappointment of the person who created the idea. I can't remember where I read the article about this but the history of the creation of RVUs is quite interesting ... and sad.

Craig

>> the-worst-paying- jobs-for- doctors: Personal Finance News from Yahoo! Finance> http://finance. yahoo.com/ career-work/ article/110106/ the-worst- paying-jobs- for-doctors? mod=career- salary_negotiati on

> Glad I am not a member of AMA if it is true that they are kept our pay low> --> M.D.> www.elainemd. com> Office:

> Go in the directions of your dreams and live the life you've imagined.> This email transmission

may contain protected and privileged, highly> confidential medical, Personal and Health Information (PHI) and/or legal> information. The information is intended only for the use of the individual> or entity named above.

>>>> If you are not the intended recipient of this material, you may not use,> publish, discuss, disseminate or otherwise distribute it. If you are not the> intended recipient, or if you have received this transmission in error,

> please notify the sender immediately and confidentially destroy the> information that email in error.>------------ --------- --------- ------

[Guest guest]

Well said

 

Isnt that by design?

I do not think the pricing structure is intended to keep the small practitioner in business

What you want  and deserve   does not enter into the picture.

There are providers ( large corporate groups and entities) willing to provide those services and also promise better coordination of care and cost savings ( those magic words) and at the quality desired 9 which you and I think is not good enough). Small practitioners are seen as dysfuntional overusers, so by design they expect and WANT consolidation ( read all those oped pieces in all newspapers)

And so .. the ongoing consolidation of physician practices as in all other industries..

I really think we should stop expecting any  dramatic change in pricing structure for the better...

and refocus on what we do best (  and market it as good value to the actual consumers like in all other industries)

think artisanal cheeses versus kraft

farmers market versus food4less etc etc

How we do that,- isnt that what this mailing list all about.

Sangeetha

 

 

Just wanted you to know that they are higher to make sure you aren't leaving money on the table. 

 

 

PS All practices in my area are selling to hospital.  Even large family practice group, and larger cardiology group, oncologist/hematologist.  Yet and I continue to stand our ground, looking for ways to continue to be efficient and give the care people need. 

To:

Sent: Thu, July 22, 2010 4:26:35 PM Subject: Re: Re: This article blames the AMA and specialist for why Primary care gets paid so little 

I am not sure how you mean this   I think we are paid stupidly and that specialists and their procedures and their RUC presence has worked against family practice

Much o f it is the system as builtI made the mistake  heaven knows what possessed me last night to try to look  at 2011 CMS physician fee schedule rules in the federal register  well  it is interesting to read how they approach things, think it through, take comments  etc, all very democratic  and civilized  and academic thoughtful  but it is bizarre beyond belief that this stuff is done! All this devising of complex  rules then  re adjust them titrate them up a nd or down and fragment them into the  practice expense part,  the geography part,  the malpractice  etc  for each of thousand of mintuia of codes.

There is an entire page on how they approach coding  for canalith  repositioning maneuver  Well, bundled into E and M but PT''s do this  procedures and they cannot bill E and M and so  do this and that   My GOD!

When I do a 99215 I am wiped out for a while afterward Kev It  is like a bad migraine, there's aftermath.  125.00? For an hr   which is followed by reading sorting scannign and the weight of responsibility that  keeps me up at night etc.

 I refuse to be grateful for improvements that are so small . I will not act grateful that rates for X Y and Z have gone  up  25% since X year, when in the last 6 years  my health isnruacne, my own bills  have gone up a darn sight more than that.

I want and deserve better.

On Thu, Jul 22, 2010 at 1:30 PM, Egly <kevin_eglyyahoo (DOT) com> wrote:

 

Et Al.

 

Please not our E & M reimbursement from CMS has increased 25% since 2004. Please update your fee schedules to optimally collect all your entitled.  99215 is now approximately $125, 99214 is $97, 99213 is 67.

 

What are you all seeing now that consult codes have been merged into E & M pool.

 

From: Bleiweiss <hockeyref1yahoo (DOT) com>

To: Practiceimprovement 1yahoogroups (DOT) com

Sent: Wed, July 21, 2010 12:33:02 PM

Subject: Re: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so little

 

    One of the means of curing this is to out it and then INSIST upon a separate and higher paying fee schedule for office E & M code like visits and other in office small primary care procedures and only for primaries. We live and die by the office visit and don't tell me that balancing out half a dozen meds, in a patient with DM, high BP and High Cholesterol, isn't more complicated that they average sprained knee or basic injury.... there needs to be a PCP only fee schedule that recognizes that this is what you folks do and that what you do has real value to the patients and society as a whole...

 

    That combined with payments for any and all insurance carrier micromanagment to offset the costs of their as of now Free paperwork, would go a long way in assisting PCP's in getting out of the hole they are in.... Until the carriers have to shoulder the entire cost of the exessive managment they will continue to insist on more and more until the entire system collapses under the weight of it....

 

    BTW, although the carriers have an anti-trust waiver, exemption from the feds, none of the specialists nor the AMA have such wonderful and all too powerful coverage... Personally, I believe that the present fee system and the AMA group whose name elludes me for the moment who " proposes " the RVU's to the gov't for their consideration, that they are colluding and violation of anti-trust laws, setting fees and controlling market and rates for their own self betterment.. . Likewise, I believe that one could even say the same about the federal gov't and the AMA and the specialists because it is their accepting of and using almost exclussively the AMA's recommendations for which to set the Federal Medicare Fee Schedule and the same Federal Gov't is the main consumer and payor of medical services in this country. How can or should it be legal, and not a violation of some sort of price control and fixing, conflict of interest to have the payor and consumer of the care, be in charge and have the final word on the setting of the fees that they will eventually have to pay to a service provider??? When you really stop and look at it from this perspective, OF COURSE it makes immediate sense that even a 5 year old would see through it all....

 

    Well, that's about it from the quaint little Campus of Colgate and the Colgate Goalie Clinic in Hamilton NY.... Be well one and all...

 

From: <jnantonucci@ gmail.com> To: Practiceimprovement 1yahoogroups (DOT) comSent: Wed, July 21, 2010 11:25:28 AMSubject: Re: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so little

 

My understanding is that Hsu himself- he;s at Harvard I think- has said how badly wrong RVUs went,  it was actually his intent that RVUs work t o prevent exactly what has happenedIt WAS the  AMA it IS the  AMA and it IS specialists and  for profit insurers do not exaclty help and    some other policies as well but hugley this pay  disparity drives us apart and no one speaks about it

It is very very difficult to work with specialists  daily and not see them step up to the plate,  see their   personal wealth ,see them creating all kinds of barriers to seeing my patietns ( fill out only our form we w ill not read yours  sned it in and we will have a nurse  decided whether  your patient   deserves to be seen  here and  if we do  we will call you and make you cal l the paitent but you may have to call  later if you can get through hahaha our phones a are soo busy   becasue we willnot send a letter back to  t he address you sent it from  becasue only the doctor  gets the letter you send, our receptionsit has a  nice dusty circa 1995 book with an address for you in there that she uses   is a typical part of my life   Yesterday after days of waiting for a return call/tracking down.remembering tot call back,  etc A specialist's  office told me they will not see self pay patietns " we don;t wan them to incur the cost " !

 dear god.) I understand malpractice issues but malpr issues for orthopods do not  account for the difference in salaries (info from lawyer at MAine medical association)  a couple of years of extra training- where salaries ARE being earned frankly probably higher salaries as fellows than some fps earn- can be accounted for over a 25 yr  career as an extra month/year of salary

 But fps and their organizations will not speak up we would rather make nice. I would re join AAFP in a heart beat if they made loud effective noise about thisI am sick of making nice I would rather be paid for the good work I do.

On Wed, Jul 21, 2010 at 10:08 AM, Kennedy, Jim <jim.kennedy@ ucdenver. edu> wrote:

It was a boy named Hsu. And you are correct that the RVU's perpetuate the idea that procedures should be reimbursed more than thinking or longitudinal care.

____________ _________ _________ _________ _From: Practiceimprovement 1yahoogroups (DOT) com [Practiceimprovement 1yahoogroups (DOT) com] On Behalf Of Craig Ross [rossmdyahoo (DOT) com]

Sent: Tuesday, July 20, 2010 8:45 PM To: Practiceimprovement 1yahoogroups (DOT) comSubject: [Practiceimprovemen t1] Re: This article blames the AMA and specialist for why Primary care gets paid so little

I forgot the source but apparently the RVU thing was the idea of one individual. When the AMA committed a committee of physicians to create the RVUs, the committee was essentially taken over by sub-specialists much to the disappointment of the person who created the idea. I can't remember where I read the article about this but the history of the creation of RVUs is quite interesting ... and sad.

Craig

>> the-worst-paying- jobs-for- doctors: Personal Finance News from Yahoo! Finance> http://finance. yahoo.com/ career-work/ article/110106/ the-worst- paying-jobs- for-doctors? mod=career- salary_negotiati on

> Glad I am not a member of AMA if it is true that they are kept our pay low> --> M.D.> www.elainemd. com> Office:

> Go in the directions of your dreams and live the life you've imagined.> This email transmission may contain protected and privileged, highly> confidential medical, Personal and Health Information (PHI) and/or legal

> information. The information is intended only for the use of the individual> or entity named above.>>>> If you are not the intended recipient of this material, you may not use,> publish, discuss, disseminate or otherwise distribute it. If you are not the

> intended recipient, or if you have received this transmission in error,> please notify the sender immediately and confidentially destroy the> information that email in error.>

------------ --------- --------- ------