Re: Article - Some doctors asking Medicare patients to switch plans

[Guest guest]

Is the price cut for medicare across the board or will primary care be spared? They pay us. primary care so little as it is. Do they know what this could mean to health care in America? They can't be thinking right. Who turned their lights off? Where is the common sense? Anyway, I am hopeful like every year that it is just threats and then they back down and primary care gets a raise.....

 

Interesting angle from this clinic.

 

Also, as usual, the comments section is always interesting.

Some blaming " Obamacare " for this particular problem (not related, IMHO), others blaming the doctors, others the gov't, etc.

 

http://community.seattletimes.nwsource.com/reader_feedback/public/display.php?thread=401597 & offset=80#post_2195043

 

Locke, MD

========================================

http://www.highlinemedicalcenter.org/highline_medical_group/patient/important-notice-to.htm

  Important Notice to All Seniors

Our relationship with you is very important. As your health care provider, we want to make sure you get the care you need, when you need it. That is why we are asking that you switch to a Medicare Advantage plan during this fall’s annual election period.

In 2011, traditional Medicare is projected to cut its reimbursement by 30 percent, which will make it extremely challenging to sustain our practice in the future. Because of the uncertainty of Medicare reimbursement, we may not be able to continue to treat Medicare patients in 2011. Switching now to a Medicare Advantage plan will help ensure that you will be able to see us in the future. We know this is a hassle and we apologize. Many other physician groups across the nation are struggling with this same issue and have asked their patients to make a similar change.

We do believe that you will benefit from switching to a Medicare Advantage plan. There are a variety of coverage options, so you can choose which is best for you. Many offer additional services and benefits such as vision and dental. All of them limit your out-of-pocket costs and two of the plans have no monthly premium at all. Most importantly, you can continue to see your regular primary care provider while having access to Highline specialists and the services of Highline Medical Center.

We are asking you to change to a Medicare Advantage plan by December 31, 2010.

Questions about Medicare Advantage?

We know that Medicare coverage can be confusing. If you have questions, please contact our Patient Advocate, Bonnie Jennings, at ext. 246 or by email at info@....

You can also attend one of our free informational meetings to get all the answers to your questions. The meetings will be held on Highline Medical Center's Main Campus in Somer's Auditorium at the 3 Cedar Entrance. Highline Medical Center's Main Campus is located at 16251 Sylvester Rd SW in Burien, WA.

========================================

 

http://seattletimes.nwsource.com/html/localnews/2013525407_medicaredocs26m.html

 

Some doctors asking Medicare patients to switch plans

Some local doctors, once again faced with a large cut in what the government pays them for treating Medicare patients, are telling senior patients they must switch by year's end to better-paying private Medicare Advantage plans.

, 72, was one of about 6,000 patients who recently received a letter from Highline Medical Group, a consortium of 35 doctors in eight clinics in the South Puget Sound area, telling them to switch plans by Jan. 1, when traditional Medicare reimbursements are set to shrink by 25 percent.

" It's kind of scary when your doctor sends you a letter saying 'I'm going to quit serving you,' " said , a retired Boeing research engineer. " I prefer traditional Medicare and want to stay on it, but feel I am being forced off. "

In the letter, doctors told the patients: " We know this is a hassle and we apologize. "

---- snip/snip ----

Some argue that doctors could and should become more efficient. AARP state advocacy Director Ingrid Mc agrees that medicine must move from paying for " quantity " of care to paying for " quality and outcomes. "

" But in the interim, " she adds, " we cannot deny we will have a serious access problem if we cut doctors' pay under Medicare by 25 percent. It would be ugly. "

Ugly was what Highline Medical Group's administrator, Purcell, was trying to avoid.

" We really want to see patients, but we're having to ask them to get into something that will give us some kind of economic stability, " she said. " At some point, it's very hard to continue business. "

Many other clinics have encouraged or required seniors to switch to Medicare Advantage plans, she said, " primarily due to the differential in payment. "

Corgiat, spokeswoman for the Polyclinic, a large Seattle multi-specialty group, said Medicare Advantage plans also allow more flexibility in caring for chronically ill patients.

Some of The Polyclinic's 160 doctors still take patients on original Medicare, although most limit the number. If the cut goes through, The Polyclinic and other groups say they would have to stop accepting those patients.

For the doctors at Highline Medical Group, which is affiliated with Highline Medical Center, the financial situation is even more acute because they all practice primary-care medicine, unlike groups such as The Polyclinic that include specialists — typically better reimbursed by Medicare.

About 80 Highline patients become eligible for Medicare every month, Purcell said.

In the past, clinics have been able to compensate for low Medicare payments because most of their patients have private insurance that pays better, she said, but economic pressures have squeezed those payments, too. " This is a complex problem, " Purcell said of the payment system. " It's very broken. "

To keep their doctors, Highline's Medicare patients must pick one of six Advantage plans from three insurers — before Jan. 1. Many with original Medicare have a supplemental policy that helps pay their share of medical bills and they worry that once they cancel those supplemental plans they won't be able to get them back.

With federal subsidies to Medicare Advantage slated to start decreasing in 2011, many patients also worry that they'll pay more out-of-pocket.

In addition, the companies that run Advantage plans can close them as they see fit. And dozens of plans did close in Washington this year, leaving more than 40,500 seniors to find new coverage.

" We're between a rock and a hard place, " said Theresa Duke, whose husband is on traditional Medicare and doesn't want to lose his Highline doctor. Even if he switches to an Advantage plan now to keep his doctor, there's no guarantee, she says, that Highline will accept Advantage plans down the road. " Now I'm worried. "

, who attended one of a series of meetings Highline Medical Group is holding to help patients sort out their options, said he noted that the Medicare Advantage plans had lots of co-payments of various sizes.

" The co-pays are really weird, " he said, ranging from $5 to $50. " It got confusing. "

When he broke his wrist in August, Medicare covered the costs, with his supplemental, he said. If he'd been insured by the Advantage plan he's considering, he would have had seven or eight co-payments, he calculated. " It adds up to some serious money! "

, who's been seeing Highline doctors for 20 years, said he understands their dilemma and doesn't blame them for not wanting to lose money.

He and his wife will make the switch " just because I don't trust Congress, " he says. " We'll go with a Medicare Advantage plan and hope that a year from now, we're not sorry. "

-- M.D.www.elainemd.comOffice: 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 have no great insight on this matter, but I have a sneaky suspicion that the Congress will pass the one month repeal (putting the pay cut off until January 1) and then the new Republican majority in the House will let it languish. They got elected by pushing fiscal responsibility and many desire an end to entitlement programs. Even a temporary reprieve of the Medicare SGF will cost billions of dollars. The end result of letting the cut go through will be lower Medicare costs, terrible access to a government program ( " See we told you the governement can't do anything as well as the private sector--it should be privatized " ), and angry seniors who will generally blame this on the Dems passage of Obamacare (even though one does not have anything to do with the other).I hope I'm wrong. From what I understand, nearly everyone agrees that the payment formula needs to be changed to encourage quality over quantity, but most agree it will take 2 years or so to figure this out. Who knows, maybe letting the payment cut go through will actually push the changes we seek through faster. It might also cause huge chaos and cost people's lives. Either way, it is a dangerous political game. Is the price cut for medicare across the board or will primary care be spared? They pay us. primary care so little as it is. Do they know what this could mean to health care in America? They can't be thinking right. Who turned their lights off? Where is the common sense? Anyway, I am hopeful like every year that it is just threats and then they back down and primary care gets a raise.....   Interesting angle from this clinic.   Also, as usual, the comments section is always interesting. Some blaming " Obamacare " for this particular problem (not related, IMHO), others blaming the doctors, others the gov't, etc.   http://community.seattletimes.nwsource.com/reader_feedback/public/display.php?thread=401597 & offset=80#post_2195043  Locke, MD ======================================== http://www.highlinemedicalcenter.org/highline_medical_group/patient/important-notice-to.htm  Important Notice to All SeniorsOur relationship with you is very important. As your health care provider, we want to make sure you get the care you need, when you need it. That is why we are asking that you switch to a Medicare Advantage plan during this fall’s annual election period. In 2011, traditional Medicare is projected to cut its reimbursement by 30 percent, which will make it extremely challenging to sustain our practice in the future. Because of the uncertainty of Medicare reimbursement, we may not be able to continue to treat Medicare patients in 2011. Switching now to a Medicare Advantage plan will help ensure that you will be able to see us in the future. We know this is a hassle and we apologize. Many other physician groups across the nation are struggling with this same issue and have asked their patients to make a similar change. We do believe that you will benefit from switching to a Medicare Advantage plan. There are a variety of coverage options, so you can choose which is best for you. Many offer additional services and benefits such as vision and dental. All of them limit your out-of-pocket costs and two of the plans have no monthly premium at all. Most importantly, you can continue to see your regular primary care provider while having access to Highline specialists and the services of Highline Medical Center. We are asking you to change to a Medicare Advantage plan by December 31, 2010. Questions about Medicare Advantage? We know that Medicare coverage can be confusing. If you have questions, please contact our Patient Advocate, Bonnie Jennings, at ext. 246 or by email at info@.... You can also attend one of our free informational meetings to get all the answers to your questions. The meetings will be held on Highline Medical Center's Main Campus in Somer's Auditorium at the 3 Cedar Entrance. Highline Medical Center's Main Campus is located at 16251 Sylvester Rd SW in Burien, WA. ========================================   http://seattletimes.nwsource.com/html/localnews/2013525407_medicaredocs26m.html  Some doctors asking Medicare patients to switch plans Some local doctors, once again faced with a large cut in what the government pays them for treating Medicare patients, are telling senior patients they must switch by year's end to better-paying private Medicare Advantage plans. , 72, was one of about 6,000 patients who recently received a letter from Highline Medical Group, a consortium of 35 doctors in eight clinics in the South Puget Sound area, telling them to switch plans by Jan. 1, when traditional Medicare reimbursements are set to shrink by 25 percent. " It's kind of scary when your doctor sends you a letter saying 'I'm going to quit serving you,' " said , a retired Boeing research engineer. " I prefer traditional Medicare and want to stay on it, but feel I am being forced off. " In the letter, doctors told the patients: " We know this is a hassle and we apologize. " ---- snip/snip ---- Some argue that doctors could and should become more efficient. AARP state advocacy Director Ingrid Mc agrees that medicine must move from paying for " quantity " of care to paying for " quality and outcomes. " " But in the interim, " she adds, " we cannot deny we will have a serious access problem if we cut doctors' pay under Medicare by 25 percent. It would be ugly. " Ugly was what Highline Medical Group's administrator, Purcell, was trying to avoid. " We really want to see patients, but we're having to ask them to get into something that will give us some kind of economic stability, " she said. " At some point, it's very hard to continue business. " Many other clinics have encouraged or required seniors to switch to Medicare Advantage plans, she said, " primarily due to the differential in payment. " Corgiat, spokeswoman for the Polyclinic, a large Seattle multi-specialty group, said Medicare Advantage plans also allow more flexibility in caring for chronically ill patients. Some of The Polyclinic's 160 doctors still take patients on original Medicare, although most limit the number. If the cut goes through, The Polyclinic and other groups say they would have to stop accepting those patients. For the doctors at Highline Medical Group, which is affiliated with Highline Medical Center, the financial situation is even more acute because they all practice primary-care medicine, unlike groups such as The Polyclinic that include specialists — typically better reimbursed by Medicare. About 80 Highline patients become eligible for Medicare every month, Purcell said. In the past, clinics have been able to compensate for low Medicare payments because most of their patients have private insurance that pays better, she said, but economic pressures have squeezed those payments, too. " This is a complex problem, " Purcell said of the payment system. " It's very broken. " To keep their doctors, Highline's Medicare patients must pick one of six Advantage plans from three insurers — before Jan. 1. Many with original Medicare have a supplemental policy that helps pay their share of medical bills and they worry that once they cancel those supplemental plans they won't be able to get them back. With federal subsidies to Medicare Advantage slated to start decreasing in 2011, many patients also worry that they'll pay more out-of-pocket. In addition, the companies that run Advantage plans can close them as they see fit. And dozens of plans did close in Washington this year, leaving more than 40,500 seniors to find new coverage. " We're between a rock and a hard place, " said Theresa Duke, whose husband is on traditional Medicare and doesn't want to lose his Highline doctor. Even if he switches to an Advantage plan now to keep his doctor, there's no guarantee, she says, that Highline will accept Advantage plans down the road. " Now I'm worried. " , who attended one of a series of meetings Highline Medical Group is holding to help patients sort out their options, said he noted that the Medicare Advantage plans had lots of co-payments of various sizes. " The co-pays are really weird, " he said, ranging from $5 to $50. " It got confusing. " When he broke his wrist in August, Medicare covered the costs, with his supplemental, he said. If he'd been insured by the Advantage plan he's considering, he would have had seven or eight co-payments, he calculated. " It adds up to some serious money! " , who's been seeing Highline doctors for 20 years, said he understands their dilemma and doesn't blame them for not wanting to lose money. He and his wife will make the switch " just because I don't trust Congress, " he says. " We'll go with a Medicare Advantage plan and hope that a year from now, we're not sorry. " -- M.D. www.elainemd.comOffice: 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 sneaking suspicion is the following is in our future (no evidence for it, but how else can the circle get squared?)...

 

1. Medicare fee schedule gets its 20+% cut.

2. Physicians opt out, go non-par, stop taking new Medicare patients.

3. Large uproar from seniors

4. Federal gov't says you have to accept Medicare if you want your DEA

5. State gov't says you have to accept Medicaid if you want a state medical license

 

No evidence that this will happen - but how else will the gov't meet both needs -- lower expenses in Medicare/Medicaid combined with full coverage of the senior voting block by a doctor.

 

Locke, MD

 

 

 

I have no great insight on this matter, but I have a sneaky suspicion that the Congress will pass the one month repeal (putting the pay cut off until January 1) and then the new Republican majority in the House will let it languish. They got elected by pushing fiscal responsibility and many desire an end to entitlement programs. Even a temporary reprieve of the Medicare SGF will cost billions of dollars. The end result of letting the cut go through will be lower Medicare costs, terrible access to a government program ( " See we told you the governement can't do anything as well as the private sector--it should be privatized " ), and angry seniors who will generally blame this on the Dems passage of Obamacare (even though one does not have anything to do with the other).

I hope I'm wrong. From what I understand, nearly everyone agrees that the payment formula needs to be changed to encourage quality over quantity, but most agree it will take 2 years or so to figure this out. Who knows, maybe letting the payment cut go through will actually push the changes we seek through faster. It might also cause huge chaos and cost people's lives. Either way, it is a dangerous political game.

[Guest guest]

RE my future sense--

1) Medicare is different in different states, in PA it's one of my LOWER payors (Medicaid is lowest so I don't take them anymore), so this Medicare issue is really dependent on which state you live in..

A) My area, these cost issues are forcing many docs who were independent to sell to hospitals for the "promise" of ongoing income.

Soon, those docs discover that they're forced to take ALL COMERS, since the docs work FOR the hospitals, who cannot refuse ANYONE... ie, a clinic.

2) Some policymakers feel that Medicare should NOT be funded AT ALL, ie, entitlement, NOT means tested, so those that have ONLY Medicare end up in the clinics (NOT foreseen but a result of these initiatives as the burden of admin compliance only makes sense in the larger clinics, ie hospital run institutional medicine sites).

3) Those of us that "value" our independence (and sanity) will eventually no longer accept "straight" Medicare as the reimbursement "drifts down" to the Medicaid level due to the "sorry, we don't have the money to have 10 people cared for, but somehow we can fund that second PET scanner" effect.

I'm only hoping that the "carrot and stick" effect continues -- realize NOONE is being "forced" to use an emr (yet -- the state boards of medicine are trying that issue, STUPID); there will be a "penalty later" if you don't of 2% (regardless that it will cost you 10% PER YEAR to maintain these "mainstream behemoths" right now).

So I'm hopeful -- I like seeing individual pts, working with them, but NOT for free. I LIKE using software that works well, I like using outsourcing to people that do a good job FOR me (billing company that maintains people and their software).

I do NOT like and I will NEVER NEVER NEVER work FOR a hospital, EVER EVER AGAIN....

And many other docs eventually will get this message too....

Matt in Western PA

Solo FP since 2004 (really that long?)

FP finished residency in 1988

Re: Article - Some doctors asking Medicare patients to switch plans

,

My sneaking suspicion is the following is in our future (no evidence for it, but how else can the circle get squared?)...

1. Medicare fee schedule gets its 20+% cut.

2. Physicians opt out, go non-par, stop taking new Medicare patients.

3. Large uproar from seniors

4. Federal gov't says you have to accept Medicare if you want your DEA

5. State gov't says you have to accept Medicaid if you want a state medical license

No evidence that this will happen - but how else will the gov't meet both needs -- lower expenses in Medicare/Medicaid combined with full coverage of the senior voting block by a doctor.

Locke, MD

I have no great insight on this matter, but I have a sneaky suspicion that the Congress will pass the one month repeal (putting the pay cut off until January 1) and then the new Republican majority in the House will let it languish. They got elected by pushing fiscal responsibility and many desire an end to entitlement programs. Even a temporary reprieve of the Medicare SGF will cost billions of dollars. The end result of letting the cut go through will be lower Medicare costs, terrible access to a government program ("See we told you the governement can't do anything as well as the private sector--it should be privatized"), and angry seniors who will generally blame this on the Dems passage of Obamacare (even though one does not have anything to do with the other).

I hope I'm wrong. From what I understand, nearly everyone agrees that the payment formula needs to be changed to encourage quality over quantity, but most agree it will take 2 years or so to figure this out. Who knows, maybe letting the payment cut go through will actually push the changes we seek through faster. It might also cause huge chaos and cost people's lives. Either way, it is a dangerous political game.

[Guest guest]

Sigh...Matt, you have pulled away the curtain to show me wearing rose colored glasses yet again.

I keep forgetting what an insurance paradise I live in (for now) in the Colorado mountains.

Medicare is my lowest payor - actually Medicaid is my lowest, but who's counting? 

So I am continually looking for an excuse to drop Medicare - but feel bad for the 10-15% of our practice that is on Medicare and the lack of other providers in the valley accepting new patients, so continue accepting assignment for now.

But I constantly forget that in many Medical Zombie dead zones around the country - Medicare is the BEST payor -- yikes!

For them, a drop in Medicare fees is a big big hit.

Sorry I keep forgetting the situation everyone else is dealing with regarding Medicare.

 

Not sure what the answers are - just know I'm not planning to move from here for now.

But worried about Zombie Medicine invading the valley in the future - and trying to figure out how to fight it off.

Probably with the rules below - interestingly, many seem to be good advice to fight off Zombie Medicine/Insurance.

 

http://zombie.wikia.com/wiki/Zombieland_rules

 

1 The Rules

1.1 1. Cardio

1.2 2. Double Tap

1.3 3. Beware of Bathrooms

1.4 4. Seatbelts

1.5 5. Travel Light

1.6 6. Don't Be A Hero

1.7 7.Limber Up

1.8 8. When In Doubt, Know Your Way Out

1.9 9. The Buddy System

1.10 10. Check The Back Seat

1.11 11. Enjoy The Little Things

The Rules Edit

1. Cardio Edit

To escape a pursuing zombie you will need to out-run it, and this means being in good shape.

2. Double Tap Edit

One shot to a zombie usually isn't enough to kill it. Be on the safe side and take a second shot.

Most zombies won't die from just one hit unless it's a shot to the head, and it will instead get up in very little time - and will then bite you. The most effective way to prevent this is to take a second shot/hit to their head which will stop them from attacking again, and surely one more shot can't do too much harm! For this to work, you will need at least 2 shots in your gun at all times so you can double tap without having to worry about reloading in time (you usually won't get that time). Luckily, the second shot should be easier as the first shot should take the zombie to the floor and temporarily prevent the zombie from moving

3. Beware of Bathrooms Edit

You are at your most vulnerable while sitting on the toilet, so always take extra care.

Zombies seem to sneak up on people who are at their most vulnerable, although it probably just seems like this as zombies just attack with no special circumstances. However, this does not change the fact that toilets are places you want to be careful around - if you are caught with your trousers down then there's not much you can do about running away, so you better have brought a gun with you. The best way to stay safe is to check each bathroom before you enter, in every cubicle and every section as it isn't rare to find one just waiting there. Also remember that just because it's not socially acceptable to climb under cubical doors, it doesn't mean the zombies won't do it.

4. Seatbelts Edit

You won't be driving along easy roads anymore: with numerous things to avoid you need to be ready for a crash!

The reason for seatbelts is fairly obvious as it pretty much carries over from the reason we are advised to wear them normally - being thrown at the windscreen doesn't usually end well. In Zombieland, however, you're much more likely to be flying through the windscreen as you try avoding escaping vehicles, dodging through abandoned cars or slamming on your brakes (or just driving faster) as a zombie steps in front of your car. For this reason, it's usually a good idea to stick on a seatbelt so you don't make the embarrassing mistake of dying from a cause other than zombie. However, some people argue that wearing a seatbelt is an inconvenience as it slows you down valuable seconds while trying to get out of the car which is being fast approached by zombies. It's also argued that crashing is a fairly ridiculous thing to worry about when the majority of people are trying to eat you. These doubts aside, it is usually safest to wear belts.

5. Travel Light Edit

While trying to get away from a mass of zombies, the last thing you want is to be heaving luggage around.

Zombies can surprise you at any moment by coming from behind objects or running toward you when you aren't expecting it, and you'll need to make a fast get away. As well as cardio to out-run the zombie you'll also need to be light on your feet, and that means reducing the weight of the objects you are carrying with you. So instead of a big heavy suitcase that may be able to carry all of your personal possessions and luxuries, you'd be safer with a smaller amount of luggage such as a backpack or anything that is easy to carry and won't slow you down. Under some circumstances it might be best to carry nothing but weaponry, but if you are seeking shelter and there is a lower chance of being attacked by zombies then it's always best to bring a bag with medical supplies, spare magazines and perhaps maybe a lightweight luxury.

6. Don't Be A Hero Edit

Possibly the most important rule of all. Don't risk your own life just to make yourself look good.

When taking risks in Zombieland, the risk is pretty much always that you might get eaten alive by zombies. This isn't a risk you want to be taking so rather than trying to go for the " bad boy look " , simply take a step back and keep yourself safe. Unfortunately you won't make yourself look too impressive if a zombie is currently biting into your arm. Then you can instead let someone else take the risk and do the job themselves while remaining at a safe distance. However, remember that there are certain circumstances where perhaps this rule should be ignored, so that maybe you save someone who makes staying alive worth it, or making sure that you will still have a partner to back you up later - as they might be responsible for saving your life later. Of course, if you are a bandit/murderer or just a person who lets people die pointlessly then you are arguably no better than a zombie yourself and the world would probably be safer with one more brainless zombie, so please disregard this rule and die like a moron.

7.Limber Up Edit

Before going into a zombie-infested area, you will need to prepare for the impending running by limbering up.

When approaching an area which will definitely or is likely to have zombies, it is always best to limber up using a few moves so that you are in peak physical condition when moving in. This means that if a zombie or numerous zombies do appear and begin to chase you, then you are able to out-run them without worries about pulling muscles or injuring yourself while running - something that could mean life or death. Of course, if you are suddenly ambushed by zombies while unprepared then limbering up will obviously be a rather unwise move, as getting away from or killing the zombies is your main priority.

8. When In Doubt, Know Your Way Out Edit

You will always need to know the way out of every room of every building you enter, in case you are caught unaware.

Zombies can surprise you at any time, whether it be while you are sleeping, driving, relaxing or on the toilet. For this reason, you should always know the fastest and best way out of the room/building you are in, just in case you are victim to a surprise attack. Make a mental note of any other doors you can take which have the quickest route away from your current location. It may also be best to prop the door open so you do not have to spend precious time trying to unlock/open the door. But don't just know this exit way, also know how you can get to it - there's no use knowing about an emergency exit if you have no idea how to get to it. This rule is all about knowing your surroundings and preparing yourself for the worst.

9. The Buddy System  Edit

You can't always look in front of you and behind you at the same time, even though the common zombie is slow they can still surround you and trap you in a corner, so with the help of a buddy you have a better chance of clearing and keeping an area safe. There is also another great reason to follow this rule which would be in case you get an injury the assistance of another person can be perfect for this situation. If you want to be with people, It's easier using a handgun to your head.

10. Check The Back Seat Edit

Before getting into the car and driving off, check the back seat for any hiding zombies.

The temptation is to get into the safe haven of a car and drive off feeling like you are invisible to all zombies within your mobile steel cage. However, despite the car being relatively safe from outside zombies, you need to be prepared for any zombies that make leap up from behind you and start to attack. The last thing you need while driving is to have a zombie crawling up behind you trying to bite you, because even if the zombie doesn't bite you - it may manage to stop you from keeping the car going and then next thing you know, you'll have crashed the car or stopped it for all the other zombies to get to. There is also the possibility that the zombie reanimated in his seatbelt. If this is the case then kill it quickly witout getting to close. Of course if you're in a rush to jump in the car then you may not have time to check the back, but make sure you're expecting something and as soon as you get the chance, look in the back.

11. Enjoy The Little Things Edit

As well as surviving all the zombies, you'll also need to maintain a happy and sane state of mind by keeping positive.

With the constant stress of staying alive with little time to put down your gun and rest, it's important that whenever you do get the time, you spend it on entertaining yourself. Of course, in Zombieland it's not easy to entertain yourself in any extravagant way such as playing on games, playing sports or watching TV. So instead it's best to enjoy the little things that come your way whether that be having fun with another survivor, enjoying a luxury you come across, lying back and forgetting about all the problems in the world or even just destroying a whole bunch of little things. Without enjoying the little things, it's all too easy for you to lose sanity and peace of mind from the constant stress and pains of staying alive.

 

Locke, MD

 

RE my future sense--

 

1) Medicare is different in different states, in PA it's one of my LOWER payors (Medicaid is lowest so I don't take them anymore), so this Medicare issue is really dependent on which state you live in..

 

    A) My area, these cost issues are forcing many docs who were independent to sell to hospitals for the " promise " of ongoing income.

    Soon, those docs discover that they're forced to take ALL COMERS, since the docs work FOR the hospitals, who cannot refuse ANYONE... ie, a clinic.

 

2) Some policymakers feel that Medicare should NOT be funded AT ALL, ie, entitlement, NOT means tested, so those that have ONLY Medicare end up in the clinics (NOT foreseen but a result of these initiatives as the burden of admin compliance only makes sense in the larger clinics, ie hospital run institutional medicine sites).

 

3)  Those of us that " value " our independence (and sanity) will eventually no longer accept " straight " Medicare as the reimbursement " drifts down " to the Medicaid level due to the " sorry, we don't have the money to have 10 people cared for, but somehow we can fund that second PET scanner " effect.

 

I'm only hoping that the " carrot and stick " effect continues -- realize NOONE is being " forced " to use an emr (yet -- the state boards of medicine are trying that issue, STUPID); there will be a " penalty later " if you don't of 2% (regardless that it will cost you 10% PER YEAR to maintain these " mainstream behemoths " right now).

 

So I'm hopeful -- I like seeing individual pts, working with them, but NOT for free.  I LIKE using software that works well, I like using outsourcing to people that do a good job FOR me (billing company that maintains people and their software).

 

I do NOT like and I will NEVER NEVER NEVER work FOR a hospital, EVER EVER AGAIN....

 

And many other docs eventually will get this message too....

 

Matt in Western PA

Solo FP since 2004 (really that long?)

FP finished residency in 1988