Guest guest Posted October 31, 2007 Report Share Posted October 31, 2007 --Good points. Having a " cold " should not cost $50. I agree.But having an appt with me should cost $50 or more.That is exactly why I put in the extra effort with my patients to educate them. I'm hoping next time they come in when they need me and are able to take care of their comfort and mild illness themselves.Actually, this may explain why I feel like I have so few " simple " appts. Perhaps my efforts are working and patients only come in when they really are sick, and therefore the appt is appropriately a 99214. I guess this points to the HYH stuff and patients feeling capable in self care, etc.... maybe it's time to formally get into a cohort. Gordon when does the next group start?Tim > On Wed, October 31, 2007 9:30 am EDT, Jean Antonucci wrote:> > > That may be true in one sense,Straz.Can't argue with what it costs us to> do the service how thorough we try to be etc..> BUT> why should having a cold cost 50.00?> I think my own fees are outreageous frankly.> > I think that if i am worried my kid has a strep throat and the test proves> to be warrented and they do or do not have strep but do get a 99213 + a> strep test -- WHY is that gonna cost 2 tanks of gas???> Wrong wrong wrong.> Stupid stupid stupid.> AND then there is the time Mom took ffrom work and driving around looking> for parking etc.> Something big is very wrong with health c are delivery and costs.> > Re: $25 for uri/conjuct ? .... Re: Re:> Will Medicare or other> > > > I kind of see this as the difference between Urgicare and Primary Care.> Urgi Care, which can be done less expensively, focuses on the problem at> hand. Primary Care uses each interaction with a patient to focus on> maintaining good health. You are right, that is not always what is> desired. And that's why some people are very happy with RediClinics and> Minute Clincs.> > But, I think this is also the trap that the uninsured and indigent fall> into, they seek quick fixes to problems they can't ignore, and aren't> really getting primary care. Because they have to pay for it. I hear> it all the time with dental care too when I ask if my patients are> seeing their dentist regularly. I get the answer " No because I don't> have dental insurance. " When did having insurance have anything to do> with getting care. You can pay for care. This is the mentality I see> more and more. In the end, they will go get the tooth pulled because> it's the cheapest alternative and too late to do anything else.> Urgicare for uninsured and underinsured is the equivalent to this. My> thoughts anyway.> > Kathy Saradarian, MD> > " I believe that you are not always meeting the patients needs when you> turn each problem visit into a broad ranging approach......this is> just not what what is wanted all the time. " > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2007 Report Share Posted October 31, 2007 " why should having a cold cost 50.00? I think my own fees are outreageous frankly. " Bravo! lets get back to reasonable views, not base our views on this perverted insurance environmet. I work my ass off to make a living for myself and the insurance companies and drug companies. If we eliminate them, the patients and our incomes would get a break! then we could just charge what is reasonable! > > That may be true in one sense,Straz.Can't argue with what it costs us to > do the service how thorough we try to be etc.. > BUT > why should having a cold cost 50.00? > I think my own fees are outreageous frankly. > > I think that if i am worried my kid has a strep throat and the test proves > to be warrented and they do or do not have strep but do get a 99213 + a > strep test -- WHY is that gonna cost 2 tanks of gas??? > Wrong wrong wrong. > Stupid stupid stupid. > AND then there is the time Mom took ffrom work and driving around looking > for parking etc. > Something big is very wrong with health c are delivery and costs. > > Re: $25 for uri/conjuct ? ... Re: Re: > Will Medicare or other > > > > I kind of see this as the difference between Urgicare and Primary Care. > Urgi Care, which can be done less expensively, focuses on the problem at > hand. Primary Care uses each interaction with a patient to focus on > maintaining good health. You are right, that is not always what is > desired. And that's why some people are very happy with RediClinics and > Minute Clincs. > > But, I think this is also the trap that the uninsured and indigent fall > into, they seek quick fixes to problems they can't ignore, and aren't > really getting primary care. Because they have to pay for it. I hear > it all the time with dental care too when I ask if my patients are > seeing their dentist regularly. I get the answer " No because I don't > have dental insurance. " When did having insurance have anything to do > with getting care. You can pay for care. This is the mentality I see > more and more. In the end, they will go get the tooth pulled because > it's the cheapest alternative and too late to do anything else. > Urgicare for uninsured and underinsured is the equivalent to this. My > thoughts anyway. > > Kathy Saradarian, MD > > " I believe that you are not always meeting the patients needs when you > turn each problem visit into a broad ranging approach......this is > just not what what is wanted all the time. " > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 2007 Report Share Posted November 1, 2007 So, the other day my refrigerator was broken. The repair man comes over, takes out a hammer, Taps on the refrigerator and presents me a bill for $200. So I says-this is outrageous-just for tapping on the refrigerator! He takes the bill back, tears it up and writes another bill- One Dollar for Tapping on the Refrigerator and $199 for Knowing Where to Tap. Seriously, I agree it might not be worth $50 for an upper respiratory infection but it is worth money to take continuous, compassionate, evidence-based care of patients and we do need to get paid for our knowledge. > > > > > > That may be true in one sense,Straz.Can't argue with what it > > costs us to > > > do the service how thorough we try to be etc.. > > > BUT > > > why should having a cold cost 50.00? > > > I think my own fees are outreageous frankly. > > > > > > I think that if i am worried my kid has a strep throat and the > > test proves > > > to be warrented and they do or do not have strep but do get a > > 99213 + a > > > strep test -- WHY is that gonna cost 2 tanks of gas??? > > > Wrong wrong wrong. > > > Stupid stupid stupid. > > > AND then there is the time Mom took ffrom work and driving around > > looking > > > for parking etc. > > > Something big is very wrong with health c are delivery and costs. > > > > > > Re: $25 for uri/conjuct ? ... Re: > > Re: > > > Will Medicare or other > > > > > > > > > > > > I kind of see this as the difference between Urgicare and Primary > > Care. > > > Urgi Care, which can be done less expensively, focuses on the > > problem at > > > hand. Primary Care uses each interaction with a patient to focus on > > > maintaining good health. You are right, that is not always what is > > > desired. And that's why some people are very happy with > > RediClinics and > > > Minute Clincs. > > > > > > But, I think this is also the trap that the uninsured and indigent > > fall > > > into, they seek quick fixes to problems they can't ignore, and > > aren't > > > really getting primary care. Because they have to pay for it. I > > hear > > > it all the time with dental care too when I ask if my patients are > > > seeing their dentist regularly. I get the answer " No because I > > don't > > > have dental insurance. " When did having insurance have anything to > > do > > > with getting care. You can pay for care. This is the mentality I > > see > > > more and more. In the end, they will go get the tooth pulled > > because > > > it's the cheapest alternative and too late to do anything else. > > > Urgicare for uninsured and underinsured is the equivalent to this. > > My > > > thoughts anyway. > > > > > > Kathy Saradarian, MD > > > > > > " I believe that you are not always meeting the patients needs when > > you > > > turn each problem visit into a broad ranging approach......this is > > > just not what what is wanted all the time. " > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 2007 Report Share Posted November 1, 2007 It seems that everyone here is quite satisfied just scraping by " eligible for SCHIP " as compensation for what they do in society. I am not arguing for making less, I am arguing for making more and deserving more. But IF you are stuck on the idea of seeing 36-60 patients per week, I don't see how you will be able to increase income. I would not be thinking I can make a living doing that and seeing my patients for $25-$50. Right now I am looking for ways of seeing fewer than I am seeing now in an urgent care setting, and hopefully making a better living at it. > > ly, if were paid reasonably and allowed to see > patients and educate them without restriction of > time/cost then they wouldn't be coming in for a common > cold. They would be able to distinguish a complicated > URI. > > While I understand the need to break down the system > to it's basics, we live and work in an unidealistic > world, a world where we must pay our bills, pay for > our children's livelihood, and so we can continue to > practice medicine. > > The listserve functions as a way to not only be able > to take better care of patients but to do it > efficiently and yes, to make a profit. Why shouldn't > we? The mentality that a doctor should settle for $25 > for any visit is absurd. Try telling your plumber, > contractor, lawyer, carpenter or accountant that > you'll be paying $25 for their services. > > By whatever means, we have all spent hundreds of > thousands of dollars for our education and training. > We should justifiably be compensated for that. > > Soma > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 2007 Report Share Posted November 1, 2007 And what about those without insurance and lots of moolah? How do they fit in with this idyllic scene? I guess they can go to the ER or pay the price that the insurances demand you charge them. Who is autonomous after signing these insurance contracts? > > > > ly, if were paid reasonably and allowed to see > > patients and educate them without restriction of > > time/cost then they wouldn't be coming in for a common > > cold. They would be able to distinguish a complicated > > URI. > > > > While I understand the need to break down the system > > to it's basics, we live and work in an unidealistic > > world, a world where we must pay our bills, pay for > > our children's livelihood, and so we can continue to > > practice medicine. > > > > The listserve functions as a way to not only be able > > to take better care of patients but to do it > > efficiently and yes, to make a profit. Why shouldn't > > we? The mentality that a doctor should settle for $25 > > for any visit is absurd. Try telling your plumber, > > contractor, lawyer, carpenter or accountant that > > you'll be paying $25 for their services. > > > > By whatever means, we have all spent hundreds of > > thousands of dollars for our education and training. > > We should justifiably be compensated for that. > > > > Soma > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 2007 Report Share Posted November 1, 2007 Tell me that 10 minutes of your time is worth more than that if that is what the patient needs and wants? > > Rodger, > > FYI, Hardly scraping by. > > Charging $25-50 per patient is absurd. > > Soma > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 2007 Report Share Posted November 1, 2007 I did not say anything about abandoning the patients. If we abandoned the insurance companies, and charged reasonable fees based on time spent with the patient, and let them submit the bill we would be free to charge what they could afford. I think the only way out of this is to do the usual....undercut the price system. If I see someone for 10 minutes, and that is all the patient desires, I feel $25 is both affordable and fair. If I want to completely write off the visit because the patient is in hard times, I can. If I spend 20 minutes, then $50 is fair. If I spend and extended amount of time as the need arises, then a larger fee is fair. I just can't see going on with insurance companies dictating our practices. But abandoning our patients???? Who said that? > > > Rodger, > > I understand your anger, I really do. You should have been on the AAFP listserv 2 years ago when we founded the Coalition to Rescue Family Medicine (known as CRFM). But, like herding cats, we couldn't act together. > > There is a lot of anger over the financial situation; it's not fair that we are not in a free market and everyone controls our fees and income but oursevles. But we are also at crossed purposes as it is not fair to take it out on the patient either. They are paying higher copays, higher amounts of their health insurance premiums out of their paychecks and getting less for it too. Costing them more isn't fixing the problem (like not taking insurance,etc). > > Many of us feel stuck and hope that people like Gordon and many others out there will get our message heard that what we do is valuable although not dramatic and we need to get paid. > > Am I content scraping by? No, not at all. But I feel a little stuck because I have close relationships with patients, some 16 years now, some multple generations within a family, and I am not going to abandon them. They are what bring me joy in my work. I love these relationships and providing the care. > > Of course, I have started doing this when we were paid better and watched income go down and down as our reimbursement stagnated and all the costs keep rising. So I have had an opportunity to live in a " better time " . Maybe being in UrgiCare you aren't getting any satisfaction because you are making these relationships. I don't know. But don't be angry at us because we won't abandon our patients and are wracking are brains to find a way to get through it. Many of us are very ready for change. Talk of a needed revolution was on the AAFP listserv 2 years ago and frequentl with CRFM (the Coalition thing). But not at the cost of our patients and that is where many of us our stuck. That and if we all walked off the job there would be plenty with different morals to step in and run faster on the wheel seeing our patients and reaping the profits so it wouldn't hurt anyone but ourselves. > > Rodger, been there with the anger. But we aren't the problem. We aren't much of a solution yet either but trust us, we are all thinking about it all the time. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2007 Report Share Posted November 4, 2007 Let me clarify I do not mean that our care of a uri is only worth $25 for 10 minutes. I feel all of us are grossly undervalued. Perhaps others do not agree with my feeling that the insurance companies deserve to be sidelined. If we are to accomplish that, we need to undercut them and attract patients to use cash. To do this we need to charge less then we deserve and work our asses off. > > > > > > Rodger, > > > > I understand your anger, I really do. You should have been on the > AAFP listserv 2 years ago when we founded the Coalition to Rescue > Family Medicine (known as CRFM). But, like herding cats, we couldn't > act together. > > > > There is a lot of anger over the financial situation; it's not fair > that we are not in a free market and everyone controls our fees and > income but oursevles. But we are also at crossed purposes as it is > not fair to take it out on the patient either. They are paying higher > copays, higher amounts of their health insurance premiums out of their > paychecks and getting less for it too. Costing them more isn't fixing > the problem (like not taking insurance,etc). > > > > Many of us feel stuck and hope that people like Gordon and many > others out there will get our message heard that what we do is > valuable although not dramatic and we need to get paid. > > > > Am I content scraping by? No, not at all. But I feel a little > stuck because I have close relationships with patients, some 16 years > now, some multple generations within a family, and I am not going to > abandon them. They are what bring me joy in my work. I love these > relationships and providing the care. > > > > Of course, I have started doing this when we were paid better and > watched income go down and down as our reimbursement stagnated and all > the costs keep rising. So I have had an opportunity to live in a > " better time " . Maybe being in UrgiCare you aren't getting any > satisfaction because you are making these relationships. I don't > know. But don't be angry at us because we won't abandon our patients > and are wracking are brains to find a way to get through it. Many of > us are very ready for change. Talk of a needed revolution was on the > AAFP listserv 2 years ago and frequentl with CRFM (the Coalition > thing). But not at the cost of our patients and that is where many of > us our stuck. That and if we all walked off the job there would be > plenty with different morals to step in and run faster on the wheel > seeing our patients and reaping the profits so it wouldn't hurt anyone > but ourselves. > > > > Rodger, been there with the anger. But we aren't the problem. We > aren't much of a solution yet either but trust us, we are all thinking > about it all the time. > > > Quote Link to comment Share on other sites More sharing options...
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