Re: Re: will primary care survive - ????!!!

[Guest guest]

You mean you will be an insurance representive

 

HOW IN THE WORLD CAN ANYBODY NOT SEE THAT THE PROBLEM IS:the insurance companies..it's not the docs, nps/pas, it's not the patients, it's not the pharm reps/companies...if i had deep pockets then i would be entertained by congress and rub shoulders with the higher ups in the white house.

but then if i had deep pockets i wouldnt be a doctor... ill be a superstar!!grace> > > > Subject: will primary care survive

> To: > Date: Sunday, February 27, 2011, 4:19 PM> > > >  >

> RE can there be a model that works?>

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[Guest guest]

Folks,

I have the simpliest and most important reform to make... It returns a free market situation to the set-up all while leaving people with the main heart of the old fashioned insurance without totally attempting to blow them up which of course they will fight to the death because it means their own death, and therefore the loss of all of their huge income and profits... and that one vital change, reform is????

One: Take away the majority of the anti-trust waiver so they are no longer allowed to use any of their data among themselves to harm patients and providers... Only allow them to use some small left over to keep an eye of the rates they do need to set. Perhaps have the gov't collect the data and then they can only access clean, non determinate data via some gov't source, portal to do their basic number crunching. No more shared data directly across carriers and no more across carrier conversations about anything and have it all come down on them like the wraith of god just like the FTC has done to all of us for years now...

Once this is done, the most important part of all of this is the following... One like most businesses, we should have to post and openly discuss our fees just like a lawyer does. I charge $1500 inclusive for that kind of a defense, $250 per hour plus expenses for that kind of a case.... We should return to a similar time and materials kind of billing system clearly defined and openly shared and discussed. Posting and discussing is NOT colluding it is informing the general public so that they can then make well informed choices.

But most importantly with the removal of the carriers' anti-trust waiver is to bring an end to any and all "Networks" and plans with any sort of differences between any "In or Out of Network" collusion. Because the real collusion started back when the HMO's and other managed care plans started to use the unfair advantage of their control over our access to our own customers, the patients. Interfering with the Free Market which would level the playing field between any and all providers, who can charge as little or as much as they feel the market and their patients can aborb. Once we return to a system of we charge what we charge to provide what we provide, and then based upon the services the patient and the doctor chose based on healthcare facts, the carriers will pay what they will pay, much like Auto Body Repair shops still do to this day.... No gov't supported repair shops out there with gov't supported coding systems.... The

carriers are attempting right now to make Auto Body Repair just like us with in and out of network differences... They bill time and materials, factory parts verses aftermarket parts, deductable and personal choices...

This will return a free market structure to our prices allowing us to charge what any of us feel is fair and that our customers will accept or absorb. Some of us will charge more for quality or large clinics with more services on-site, while others will charge less and do the mass market, "Next" take a number and attempt to make a profit on sheer numbers volumm... Then the consumers will start to learn what their plans will and won't pay or cover, this is back to between them and their plans, no us and their plans, and they will make choices based upon the variety of things most consumers make such choices on... Quality verses prices and quantity and the like... But In-network must be made "Illegal" as the worst and most hidious form of Collusion and Anti-Free Trade which it really is.

That is the Artifical Market Force that has been poisoning our industry and stopping us from applying reverse pressure back against the gov't and the patients based upon the next insane requirements or demands for prior auths, or technology, or this hoop or that hoop. It allows us to raise our prices when the cost of fuel raises ours, when our med mal goes up, when medical waste hauling goes up, when our rent goes up, when the cost of our own health insurance goes up.... and to charge appropriate market prices for any and all paperwork and hoops that the insurance carriers request or come up with. Once we can pass these real and insane, stupid expenses Back towards those who created them without fear of cost or impact.. once we can allow our patients to go to any and all doctors with nothing more than a valid state license, No privilages or other required from the "Network Hoops" or requirements, you are a licensed State doc, then

you can see patients and any and all patients can come equally into your office, then the whole system will go through a major market adjustment period... and eventually settle back down over some hard to define period of time.... with the name, reputation, price, relationship, quality of service and doctor leading the way and setting the standard again... just as it always should have been....

Lastly for the truly poor perhaps the gov't will continue to and expand into regulated employed gov't owned and run clinics and hospitals removing billing completely just like the VA and the Greatest Clinics in America. Docs just work their shifts and do what they feel is best for the patient, and don't worry about productivity or laying on extras for personal profit... and the patients get seen and treated. Supplies are purchased by the gov't, salaries and operating expenses are all paid for, so their in no need to track things in the present system.. again time and materials, diagnosis and treatments.... Just like our own homes, we own them and we pay all the bills. What needs to get paid for gets paid for... To a large extent the cost is secondary.... if the house needs a roof then it needs a roof and if it doesn't then we don't first have a contractor do one just for the sake of it anyway....

Perhaps some form of regulation and oversight, management might still be needed in large hospitals and clinics for those not purchased everyday kind of items and services for chronic and life threatening disease... But for day to day "office Visit" and "Cognitive Based" small and solo offices that are the meat and potatoes of most of Primary Care and other modest sized offices doing Derm, Endo, ENT, GYN and other daily most people need these services and the market would work just fine and almost certainly better... this is the path to go...

In my market vision for the future that returns common sense to all of this because the patients will pay a percentage of the bills and charges they will no longer ask for "everything" as return to a more Traditional Indemnity like model with NO networks and collusion between carriers and in-network providers.. that is the main source of the toxicity and the artificial leverage.. If we all cost the same and we all have to jump thru the same hoops, and only those that join in on this REAL collusion, this congressionally and state protected toxic collusion, the market will adjust and patients will make bread and butter choices based on what they really NEED verses using the most of their benefits that they are over charged for... to get something back from "Them".... Well if going to the more expensive specialist is going to cost me anther $50 bucks four times a year, then I have to do the math if it is really worth verses seeing my

primary for it at only $25 bucks.... or NOT at All... And that specialist and all of the specialists and the number of specialist verses primaries will all get properly, if slowly re-adjusted back into some better form of alignment based upon what the patients are willing and able to afford verses what the carriers are willing to pay for and what is really Needed care verses only Wanted care... and we the primaries will be back in the middle where we belong helping patients manage their disease and wellness and shipping them out if and when it is beyond our abilities or the patient really and honestly needs it... And if they are rich enough and they Want it then in a free market, they can have it if they are willing to pay for it....

Oh and we get paid in full at time of service, hand the patient a 1500 like claim, or at best we send in the "E Claim" once ONLY after being properly paid in full and from there it is between the patient and the carrier with no being allowed to request us to change our invoice based on collusion and pressures from the patient or the carriers... I gave Mrs half an hour of my time, she will not deny that as she was there and I documented it, now it is between the two of you whether or not to pay for Half an Hour of my time for this problem if at all... and that will be part of the market adjustment too as the carriers finally have to be held fully accountable to the customer patients for what they do or don't cover or pay for... Period short the end... We are out of the insurance game so no more insurance fraud and witch hunts, we are free market providers of a service again who bill and charge in various ways the suit us and

our patients, and then the two parties in the relationship can have at it for real and the gov't will or will Not assist the American people in dealing with, and regulating that customer insurance carrier relationship....

To: Sent: Tue, March 1, 2011 10:48:13 AMSubject: RE: Re: will primary care survive - ????!!!

Grace,

You already are a superstar. J

True, but remember the payment plan that insurance companies use was set up by and is still endorsed by the AMA (which is still profiting handsomely from the ICD insanity). The concept of insurance itself is not bad, but the insurance companies’ shareholders have come to expect large quarterly profits. That means the largest doctor organization is not really hip on true payment reform (why would they be??) and the private insurance companies don’t have the financial flexibility to try something different anyway, so we remain stagnated.

My point is that insurance companies are easy to hate (and I do hate them), but docs and some of their organizations are also partially to blame for our current state. That is why the IMP message needs to continue to spread. We are radically different. We can make things better for the future.

From: [mailto: ] On Behalf Of pricklyfinger2007Sent: Tuesday, March 01, 2011 10:25 AMTo: Subject: Re: will primary care survive - ????!!!

HOW IN THE WORLD CAN ANYBODY NOT SEE THAT THE PROBLEM IS:the insurance companies..it's not the docs, nps/pas, it's not the patients, it's not the pharm reps/companies...if i had deep pockets then i would be entertained by congress and rub shoulders with the higher ups in the white house.but then if i had deep pockets i wouldnt be a doctor... ill be a superstar!!grace> > > >

Subject: will primary care survive> To: > Date: Sunday, February 27, 2011, 4:19 PM> > > >  > > RE can there be a model that works?>