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Editor's Note:
In the past, our medical societies met on Tuesday evenings, which then
became known as "Medical Tuesdays." Mondays and Fridays are
busy days in any practice, which precludes evening meetings on those
days. Many doctors take a half-day off on Wednesdays or Thursdays in
order to compensate for working the nights and weekends required to
cover their practice. Hence, that left Tuesdays for colleagueal and
professional meetings. In our community, the Medical Society met on the
third Tuesday of each month. Huge turnouts occurred, filling the
largest meeting room at the convention center, to discuss the
professional and practice issues of the day. The Internal Medicine
Society met on the fourth Tuesdays to discuss their unique problems;
the family physicians, surgeons, pediatricians and
obstetric-gynecologists also met on Tuesdays.
As Managed Care became
more assertive in telling doctors how to practice, the agenda at the
medical society meetings changed and attendance dropped. Meetings were
reduced from monthly to quarterly. Patterns were broken. Doctors could
no longer rely on meeting times or the month that meetings were
scheduled. Gradually, the professional meeting began to disappear. It
was counter-productive to the interests of Managed Care for doctors to
assemble and discuss issues since it increased resistance to
compliance. On two occasions in the past several years, the medical
society, in a community of more than 3,000 physicians, had less than 30
attendees (1%). Effective physician leadership disappeared. The once
noble profession was gradually being de-professionalized.
Meanwhile, Managed Care
Organization (MCO) meetings took over the vacuum and were required for
all doctors to attend or their reimbursements would drop. Five, ten and
even 25 percent of their payments were with held and paid out at the
end of the quarter. This payment was based on your attendance at the
meetings, your holding the line on referrals, writing prescriptions for
the lowest price pharmaceuticals, and writing your prescriptions on
line. The MCO came into your office and copied the charts, reviewed
them and gave you a grade on your cost performance. The notice of their
coming into your office included a notation to not tell the patient
since by the HIPAA statute, they have a right to review the
confidential patient records without the patient being aware of it.
Thus HIPAA, touted as necessary to force confidentiality, caused wide
disbursement of the private medical record to the government, insurance
industry, and made the sharing of patient records among the physicians
caring for the patient more difficulty. Thus HIPAA was another perverse
infringement on medical privacy.
____________
Dr. Edwards: We
had our Managed Care Organization meeting last night and received the
directives for our practice for another month.
Dr. Ruth: Well,
how did it go?
Dr. Edwards: We
were told to do a psychological survey of our patients to determine how
many were depressed. Then there was a lecture on which drugs to use,
whether SSRI or SNRI.
Dr. Dave: I
asked the people at my tables for examples of the latter and none knew
any.
Dr. Ruth: So
it's one of those situations that the speaker thought he was talking
everyone's language and everyone was reticent to speak up and show his
ignorance.
Dr. Edwards:
That's probably accurate.
Dr. Dave: I
think another reason was a distinct lack of interest. Don't do anything
to delay the end of the meeting.
Dr. Edwards: We
were also told of the Medicare Rule to sign our degree after our name.
We were requested to review our charts since January first and put MD
or DO behind every signature.
Dr. Dave: Some
of us took that as another rule that if it wasn't followed exactly,
would allow them to withhold more money and pay us even less at the end
of the quarter.
Dr. Sam: We were
also given notice to upgrade our billing codes to the max to earn more
Medicare money.
Dr. Edwards:
Isn't it interesting in the efforts to reduce health care costs, they
throw carrots at us which are primarily for the public to chew on to
make them think we are getting paid even more.
Dr. Sam: But
upgrading has some serious down side risks. Remember we had a doctor go
to jail in our community who thought an office visit was one code and
Medicare said it should have been another.
Dr. Ruth: Yes I
remember that one. After he apologized and said he was unaware of it
and wouldn't do it again, the federal attorney had him sign an
affidavit to his admission, and then had the judge call the bailiff to
take the doctor to jail where he stayed for two years.
Dr. Yancy: See
I've told you all dozens of times, "Never trust the government in
anything. They are never your friend.
Don't even talk to your congressman or senator. You'll just
incriminate yourself."
Dr. Sam: Now
that's sound advice you can take to the bank.
Dr. Dave: If you
must deal with your Medical Board of any branch of the government, have
your attorney make the contact and write the response. The $2,000 legal
fee per response letter is a bargain considering the alternative.
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