RE: Re: Here I am...a healthy person who just needs a physical every 2 years

[Guest guest]

But ,It does matter. See that’s the problem. The patient is the one with the problem. We are supposed to address the patient’s problem through great access, comprehensive care, and coordination with specialists (when necessary), and then, with the patient, develop an individualized plan of care which will lead the patient on the path of better health (i.e. I get exactly the care I want and need…). That is our job. If a patient wants a burger, we should be giving him a burger (though hopefully talking him into eating a salad instead). The system is set up so that there is constant tension between us and our patient and serves as the wedge driving us apart. That is why so many docs balk at staying in the system. The problem is that patient also balk at paying for stuff outside the system. We have to change the system. That is the only solution. From: [mailto: ] On Behalf Of LiepmannSent: Monday, November 29, 2010 9:07 AMTo: Subject: Re: Here I am...a healthy person who just needs a physical every 2 years " Here I am...a healthy person who just needs a physical every 2 years - andmy insurance covers these physicals for " free " - no copay or co-insurance,plus my monthly premiums have gone up 15% again this year - for no reason.Then the doc wants to charge me a monthly or annual fee for care that Ilikely won't use because I only go to the doctor every 2 years.I'd be irritated, too. " He could get the service level he wants at a Doc-In-the-Box. No continuity, no comprehensive care, no coordination, no long term relationship.It's as if you walked into the Escoffier room and told them you don't want to make a reservation, you don't want a linen tablecloth or napkins, you don't want the rolls, " All I want is a hamburger. " , and objected to paying $65 for a meal.You've gone to the wrong place. If you want McBurgers, go to McBurgers! Don't go to the Rolls-Royce dealer to buy a Yugo.....You have every right to define a level of service, and charge for it. If somebody DOESN'T WANT WHAT YOU'RE SELLING, THEY DON'T HAVE TO BUY IT!!!BUT--- that DOESN'T mean you have to sell tires or potato chips because that's what somebody wants!!

[Guest guest]

Well Regence says if they only want a burger I should just give them a burger

and if they want to just window shop, I must give them that option too.

I got a call that my Guy has sent some emails that ruffled some legal contract

people at Regence. The friendly informative rep called me this AM and told me

patients must have the choice to see me without having to pay extra fees in

order for me to be compliant with my contract. I informed her that my form does

give patients a choice to not incurr charges but she says the legal people felt

my website doesn't make it clear that patients have a choice and she recommended

that I change my website to reflect that. I asked her to identify the part of

the contract that states this, but she was just passing on a message and really

attempting to help me stay in compliance

[Guest guest]

Call back and ask to speak to a supervisor, and demand to see what part of the contract says this. I doubt it really does.

Cote' Re: Here I am...a healthy person who just needs a physical every 2 years

I think you still have the option of accepting or not accepting any particular patient, right?Many practices require that patients come in annually for a well exam. You could do that.If they press you so hard that you have to take him, I'd be sure that you charged him for every jot and tittle, and gave absolutely no service you don't explicitly get paid for. But I wouldn't take him under those circumstances anyway. Why voluntarily enter into an adversarial relationship?Re:"if they want to just window shop, I must give them that option too." --Does that mean that they won't include these folks in your "quality" reports (had this done, had that done) they're so keen on making? I doubt it. PLWell Regence says if they only want a burger I should just give them a burger and if they want to just window shop, I must give them that option too. > I got a call that my Guy has sent some emails that ruffled some legal contract people at Regence. The friendly informative rep called me this AM and told me patients must have the choice to see me without having to pay extra fees in order for me to be compliant with my contract. I informed her that my form does give patients a choice to not incurr charges but she says the legal people felt my website doesn't make it clear that patients have a choice and she recommended that I change my website to reflect that. I asked her to identify the part of the contract that states this, but she was just passing on a message and really attempting to help me stay in compliance>

[Guest guest]

Another view-

Ok, so we're talking about Eugene Oregon, with quite possibly the

highest insurance payments for office visits in the continental United

States and you're messing around with one of your (better?) payor

sources over a non-covered benefits fee of $120 per year?

A comprehensive 99215 visit every two years would more than cover your

enhanced access costs wouldn't it? That would be upwards of $150,

maybe close to $200 ? Heck, even 1 visit per year for the occasional

illness or referral of a friend would cover close to $100 at Eugene, OR

rates.

I get the fact that this particular patient is not a good fit and

probably has a personality disorder, but it seems to me that the $120

access fee is an unneeded barrier to building a really nice paying

practice.

If your panel is full, then institute a fee perhaps, but before that point why make it harder than it has to be?

Best Regards,

BenSubject: RE: Re: Here I am...a healthy person who just needs a physical every 2 yearsTo: Date: Monday, November 29, 2010, 2:43 PM

Well Regence says if they only want a burger I should just give them a burger and if they want to just window shop, I must give them that option too.

I got a call that my Guy has sent some emails that ruffled some legal contract people at Regence. The friendly informative rep called me this AM and told me patients must have the choice to see me without having to pay extra fees in order for me to be compliant with my contract. I informed her that my form does give patients a choice to not incurr charges but she says the legal people felt my website doesn't make it clear that patients have a choice and she recommended that I change my website to reflect that. I asked her to identify the part of the contract that states this, but she was just passing on a message and really attempting to help me stay in compliance

[Guest guest]

Tell Regence you can't take care of pts who threaten you. Get w malpractice carrier, if they agree, tell regence you lawyer advises you not to take on pt that threaten you. This guy is a law suit waiting to happen

 

Well Regence says if they only want a burger I should just give them a burger and if they want to just window shop, I must give them that option too. I got a call that my Guy has sent some emails that ruffled some legal contract people at Regence. The friendly informative rep called me this AM and told me patients must have the choice to see me without having to pay extra fees in order for me to be compliant with my contract. I informed her that my form does give patients a choice to not incurr charges but she says the legal people felt my website doesn't make it clear that patients have a choice and she recommended that I change my website to reflect that. I asked her to identify the part of the contract that states this, but she was just passing on a message and really attempting to help me stay in compliance

-- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.

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[Guest guest]

I'm not sure what the talk about window shopping is about(maybe I missed

a few emails) but we offer Meet & Greet appointments of 15 min. And I'd

say ~90+% decide to sign on and become a pt and see me for a full NP

eval. It's always been time well spent and I've been doing it for 8 yrs now.

>

> I think you still have the option of accepting or not accepting any

> particular patient, right?

> Many practices require that patients come in annually for a well exam.

> You could do that.

> If they press you so hard that you have to take him, I'd be sure that

> you charged him for every jot and tittle, and gave absolutely no

> service you don't explicitly get paid for. But I wouldn't take him

> under those circumstances anyway. Why voluntarily enter into an

> adversarial relationship?

>

> Re: " if they want to just window shop, I must give them that option

> too. " --Does that mean that they won't include these folks in your

> " quality " reports (had this done, had that done) they're so keen on

> making? I doubt it.

> PL

>

> Well Regence says if they only want a burger I should just give them a

> burger and if they want to just window shop, I must give them that

> option too.

> > I got a call that my Guy has sent some emails that ruffled some

> legal contract people at Regence. The friendly informative rep called

> me this AM and told me patients must have the choice to see me without

> having to pay extra fees in order for me to be compliant with my

> contract. I informed her that my form does give patients a choice to

> not incurr charges but she says the legal people felt my website

> doesn't make it clear that patients have a choice and she recommended

> that I change my website to reflect that. I asked her to identify the

> part of the contract that states this, but she was just passing on a

> message and really attempting to help me stay in compliance

> >

>

>

Attachment: vcard [not shown]

[Guest guest]

I don't disagree with your points, .

Just trying to put some context on the patient's feelings.

He is obviously at the wrong clinic for what he needs. You have educated him on this and he should move on -- not raise hell with your ability to make a living.

Locke, MD

 

" Here I am...a healthy person who just needs a physical every 2 years - andmy insurance covers these physicals for " free " - no copay or co-insurance,plus my monthly premiums have gone up 15% again this year - for no reason.

Then the doc wants to charge me a monthly or annual fee for care that Ilikely won't use because I only go to the doctor every 2 years.I'd be irritated, too. " He could get the service level he wants at a Doc-In-the-Box. No

continuity, no comprehensive care, no coordination, no long term relationship.It's as if you walked into the Escoffier room and told them you don't want to make a reservation, you don't want a linen tablecloth or

napkins, you don't want the rolls, " All I want is a hamburger. " , and objected to paying $65 for a meal.You've gone to the wrong place. If you want McBurgers, go to McBurgers! Don't go to the Rolls-Royce dealer to buy a Yugo.....

You have every right to define a level of service, and charge for it. If somebody DOESN'T WANT WHAT YOU'RE SELLING, THEY DON'T HAVE TO BUY IT!!!BUT--- that DOESN'T mean you have to sell tires or potato chips

because that's what somebody wants!!

[Guest guest]

,

I think peter is willing to give this gentleman a burger (physical only every 2 years) - it's just that the patient is complaining about the COST of the burger (the added fee outside the insurance premiums).

Also, the patient in this case doesn't want (need?) the added features of continuity, coordination of care, etc.

Maybe he does need them, but he doesn't want them.

Locke, MD

 

But ,

It does matter. See that’s the problem. The patient is the one with the problem. We are supposed to address the patient’s problem through great access, comprehensive care, and coordination with specialists (when necessary), and then, with the patient, develop an individualized plan of care which will lead the patient on the path of better health (i.e. I get exactly the care I want and need…). That is our job. If a patient wants a burger, we should be giving him a burger (though hopefully talking him into eating a salad instead). The system is set up so that there is constant tension between us and our patient and serves as the wedge driving us apart. That is why so many docs balk at staying in the system. The problem is that patient also balk at paying for stuff outside the system. We have to change the system. That is the only solution.

 

[Guest guest]

Sorry (and ),You guys are exactly right. I went totally tangential. At issue for me is the underlying question of why there is a disconnect between what he wants and what we are delivering. Do we just suck at marketing ourselves (so he thinks the $1 burger is just as fine as the $50 one)? Have we as primary care providers so destroyed our own image by abusing our patients’ time and not listening to their problems that patients no longer value what we say (i.e. you don’t earn respect by abusing others)? Is the lingering recession causing such a financial strain that people really just don’t have any extra money to pay additional fees on top of exorbitant insurance premiums? Have insurance co-pays lulled patients into thinking that primary care docs are worth about $1/minute (or less) and insurance reimbursement encouraged docs to think they are worth $4/minute (or more)—thus creating a huge expectation chasm?My mind swirls when I think about this stuff and the only real answer I can find lies in my relationship with my patients. Through that relationship I can imagine a time when I don’t have to worry about charging an extra fee, or worry that the patient undervalues my time, or wonder whether I overvalue it. Somehow we all meet in the middle and can focus on what is really important. Yep, still idealistic in my mind’s eye (for now). From: [mailto: ] On Behalf Of LockeSent: Tuesday, November 30, 2010 12:28 PMTo: Subject: Re: Re: Here I am...a healthy person who just needs a physical every 2 years ,I think peter is willing to give this gentleman a burger (physical only every 2 years) - it's just that the patient is complaining about the COST of the burger (the added fee outside the insurance premiums).Also, the patient in this case doesn't want (need?) the added features of continuity, coordination of care, etc.Maybe he does need them, but he doesn't want them. Locke, MD But ,It does matter. See that’s the problem. The patient is the one with the problem. We are supposed to address the patient’s problem through great access, comprehensive care, and coordination with specialists (when necessary), and then, with the patient, develop an individualized plan of care which will lead the patient on the path of better health (i.e. I get exactly the care I want and need…). That is our job. If a patient wants a burger, we should be giving him a burger (though hopefully talking him into eating a salad instead). The system is set up so that there is constant tension between us and our patient and serves as the wedge driving us apart. That is why so many docs balk at staying in the system. The problem is that patient also balk at paying for stuff outside the system. We have to change the system. That is the only solution.

[Guest guest]

I feel a need to chime in on one aspect here -

wrote:

Also, the patient in this case doesn't want

(need?) the added features of continuity, coordination of

care, etc.

Maybe he does need them, but he doesn't

want them.

I don't feel that I need to be all things to all people. I did that

in my prior hamster wheel practice. I decided that my forte lies in

a particular kind of relationship I want to have with my patients,

which entails close communication, mutual respect, careful

attention, shared decision making, and open-minded thinking. I have

set up my internal medicine practice to foster that kind of

relationship - meaning long visits, even longer annual or semiannual

comprehensive assessments, and details health reports. If someone

does NOT want what I have to offer, well that is fine - there are

plenty of folks in the area who do offer all things to all comers.

I do make myself available, time allowing, to people who self-refer

for specific problem-solving. In that case, I offer them a

time-limited (typically 3 month) membership in my practice, and

specifically note to them that I am NOT doing primary care, only

severing as a consultant for a specific issue.

I have seen one man, a fairly prominent individual in our area, who

interviewed with me and said he wanted me as his doc, but only

wanted to come in when he had a problem, not interested in

preventative or primary care, routine screenings, etc. I declined,

took care of his immediate problem, and told him that I WOULD NOT be

his 'main' doctor under his condition. I would be happy to meet with

him, again time allowing, on a temporary arrangement, if he had a

problem - but that he needed to consider himself 'unassigned' if I

was not available on his schedule. In other words, we both had

expectations, these were not mutually compatible, so we would NOT

have the same relationship as I have with my usual folks.

I don't think that an insurance company can dictate to me which

folks I do and don't see, given that there are multiple options for

care on our area.

Steve Hersch

--

L. Hersch, MD, FACP

Meducation, P.C.

499 Chestnut Street

Ashland, Oregon 97520

Telephone:

E-Mail: meducation@...

[Guest guest]

 I would share something I heard an  otherwise obnoxious person say at some confernce-we must be prepared to walk along with  people no  matter where they are  in the health  journey  he said  That is the   job.

 If, he said we go to a n  accountant ,and we  keep a few hundred in the mattress, or we have 100,000 to  put i nto hedge funds or maybe we  are retiring on 17,000 in a cash savings account, or maybe we have self employment taxes +a  spouse with a  job +  domestic employees and etcetc  whatever the situation , the financial planner walks along with them towards their  goals, and given their expectations and needs

I find this useful  when I work .It is the same as patient centered collaborative care, in different words.You can all chew me out and go  up one side and down the other about  quality and  the pressures on us, about guidelines and outcomes,  but I still contend  it makes things  very useful on a daily basis.

Jean

 

I feel a need to chime in on one aspect here -

wrote:

Also, the patient in this case doesn't want

(need?) the added features of continuity, coordination of

care, etc.

Maybe he does need them, but he doesn't

want them.

I don't feel that I need to be all things to all people. I did that

in my prior hamster wheel practice. I decided that my forte lies in

a particular kind of relationship I want to have with my patients,

which entails close communication, mutual respect, careful

attention, shared decision making, and open-minded thinking. I have

set up my internal medicine practice to foster that kind of

relationship - meaning long visits, even longer annual or semiannual

comprehensive assessments, and details health reports. If someone

does NOT want what I have to offer, well that is fine - there are

plenty of folks in the area who do offer all things to all comers.

I do make myself available, time allowing, to people who self-refer

for specific problem-solving. In that case, I offer them a

time-limited (typically 3 month) membership in my practice, and

specifically note to them that I am NOT doing primary care, only

severing as a consultant for a specific issue.

I have seen one man, a fairly prominent individual in our area, who

interviewed with me and said he wanted me as his doc, but only

wanted to come in when he had a problem, not interested in

preventative or primary care, routine screenings, etc. I declined,

took care of his immediate problem, and told him that I WOULD NOT be

his 'main' doctor under his condition. I would be happy to meet with

him, again time allowing, on a temporary arrangement, if he had a

problem - but that he needed to consider himself 'unassigned' if I

was not available on his schedule. In other words, we both had

expectations, these were not mutually compatible, so we would NOT

have the same relationship as I have with my usual folks.

I don't think that an insurance company can dictate to me which

folks I do and don't see, given that there are multiple options for

care on our area.

Steve Hersch

--

L. Hersch, MD, FACP

Meducation, P.C.

499 Chestnut Street

Ashland, Oregon 97520

Telephone:

E-Mail: meducation@...

-- PATIENTS-please remember  that email may not be entirely secure, and that Email is part of the medical  record and is placed into your  chart ( be careful what you say!)

Email is best used for appointment making and  brief  questionsEmail replies can be expected within 24 hours-Please CALL  if the  matter is more urgent .     MD    

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[Guest guest]

Good point, Steve.

Your comments made me wonder...does having an insruance card:

 

1. Make the patient think that they should get the same style of treatment at each clinic that accepts that particular insurance.

Sort of like having a Mcs Card - and expecting that you will be able to get the same type of environment, same type of food, same type of service -- no matter which Mc's Clinic one attends.

 

2. But perhaps we are like Best Western motels (Best Western International is The World's Largest Hotel Chain® with more than †4,000 hotels in †80 countries. Our uniqueness is found in each hotel's charm and local appeal while maintaining a commitment to quality, service and value.) Meaning that there is Anthem or United - and docs/clinics sign up to participate with Anthem (or Best Western), but we are still independent, individual docs/clinics with our own unique approach and look and fees, etc.

Some Best Westerns I would stay at and feel I got a great value.

Other BW's I would not go back to.

You just have to check out each Motel/Clinic to see if you are a good fit.

Not bitch (as the patient in question did) about how this particular Motel/Clinic doesn't fit hit needs.

 

Maybe that is a way to wrap our heads around the issue at hand -- the patient having an insurance card - but not fitting with the independent clinic that accepts his insurance.

 

Locke, MD

 

I feel a need to chime in on one aspect here -

wrote:

Also, the patient in this case doesn't want (need?) the added features of continuity, coordination of care, etc.

Maybe he does need them, but he doesn't want them.I don't feel that I need to be all things to all people. I did that in my prior hamster wheel practice. I decided that my forte lies in a particular kind of relationship I want to have with my patients, which entails close communication, mutual respect, careful attention, shared decision making, and open-minded thinking. I have set up my internal medicine practice to foster that kind of relationship - meaning long visits, even longer annual or semiannual comprehensive assessments, and details health reports. If someone does NOT want what I have to offer, well that is fine - there are plenty of folks in the area who do offer all things to all comers.

I do make myself available, time allowing, to people who self-refer for specific problem-solving. In that case, I offer them a time-limited (typically 3 month) membership in my practice, and specifically note to them that I am NOT doing primary care, only severing as a consultant for a specific issue.

I have seen one man, a fairly prominent individual in our area, who interviewed with me and said he wanted me as his doc, but only wanted to come in when he had a problem, not interested in preventative or primary care, routine screenings, etc. I declined, took care of his immediate problem, and told him that I WOULD NOT be his 'main' doctor under his condition. I would be happy to meet with him, again time allowing, on a temporary arrangement, if he had a problem - but that he needed to consider himself 'unassigned' if I was not available on his schedule. In other words, we both had expectations, these were not mutually compatible, so we would NOT have the same relationship as I have with my usual folks.

I don't think that an insurance company can dictate to me which folks I do and don't see, given that there are multiple options for care on our area. Steve Hersch-- L. Hersch, MD, FACP

Meducation, P.C.499 Chestnut StreetAshland, Oregon 97520 Telephone: E-Mail: meducation@...