Million Med March

[TomAiello 25]

Anyone seen this organization?

Thoughts? Especially from anyone who's a doctor?

It looks to me like if that takes off, they've got one heck of a base for creating change in the healthcare system. And honestly, I'd trust a group of doctors a lot more than I'd trust a bunch of lawyers who think they know how to run everything.

-- Tom Aiello

[email protected]
SnakeRiverBASE.com

[TrophyHusband 0]

"Little of the health care dollar even goes pharmacies and hospitals, much less to physicians"

in all of the discussion about healthcare, i've yet to see a breakdown of what our healthcare dollar actually pays for. i don't think we can begin to talk about heathcare reform until we know exactly where all of the money is going, yet, the subject seems to be glossed over. its refreshing to see the issues brought up by this letter, and i hope they are brought up more often as obama pushes his healthcare reform.

"Your scrotum is quite nice" - Skymama
www.kjandmegan.com

[TomAiello 25]

Here's the actual text, for those to lazy to click through:

Quote

I’m tired, mad as hell and just not going to take it anymore.

I’m tired that I cannot practice medicine the way medicine is meant to be practiced: with care, quality and timeliness. Economically I feel handicapped as most of the health care dollar goes for administrative costs to health insurance companies, and a large part going to the salaries and bonuses of the executives of these companies, money meant for patient care. It disgusts me that so much money goes to pay medical malpractice premiums and tails, and that our livelihoods are at risks as attorneys consider us lottery tickets, using their clients as entry fees. It bothers me that pharmaceutical companies now look for diseases on which to use their patented chemicals, rather that looking to improve patient care with lower cost, but equally effective medications.

Little of the health care dollar even goes pharmacies and hospitals, much less to physicians. Now the current administration wants to decrease payments to these three, in order to ‘save’ the health care system. We already have enough capable people leaving our profession, or declining the arduous journey to become an American trained physician; not to mention the huge number of physician who discourage their own children from following in their footsteps. How sad when we don’t want our own progeny to follow us all because we are treated like thieves, or worse, as children who cannot govern ourselves. And don’t get me started on the AMA or the specialty colleges, who rarely stand up for the regular, non-ivory tower doctors that roll up their sleeves and care for patients on a daily, fee-for-service basis. The attitude in our county towards physicians does nothing but create a loss of quality, well trained, American-trained physicians.

Doctors get far less of the healthcare dollar than do pharmacies or hospitals, yet without us they would be out of a job. What is the joke: hospitals would be great places to work if it wasn’t for all those doctors? There are around 1 million doctors in the country, yet there are over 25 million people in the health care industry. Each physician supports about 25 people…where those in the health care industry do not actually treat or care (for) about patients. Once we actually get reimbursed, we have our medical school loans and ever rising business costs to pay for with our ever decreasing dollars.

Our patients suffer as physician must see more patients every year just to make the same amount (or often less) money than last year; physician burnout is a well documented and a worrisome trend in our profession. This affects our ability to actually treat patients properly. Then, adding the paperwork and increased regulations put upon us by the state and federal governments, we have even less time to treat patients, read journals, go to seminars or get sleep. Quality of care suffers.

On top of everything else we need to deal with malignant hospital administrators and medical staff members or nursing staff members who can, just for untoward facial grimaces, suspend us and report us to the National Practitioner Data Bank, thus irrevocably ruining our careers, well before any investigation or fair hearing needs to be called. We worked our butts off to get top grades in college, to get into medical school, then residency programs where we often worked 80, 100 or even 120 hours a week, for what? So we could give up nights, weekends, holidays, birthdays, anniversaries and even the birth of our children to practice that vocation to which we were drawn. And how are we treated? We are considered the most vile criminals, cheats and depraved practitioners with no sense of integrity or consciousness, only out to harm those we have struggled so long to serve. If we are so bad, so vile and so depraved, shouldn’t we let our patients get treated by witch doctors with voodoo medicine. But of course, that is already being practiced in US hospital.

I really don’t need to feel guilty that the profession I have chosen also puts food on my table, clothes my wife and kids, and allows my children to get a college education (not premed of course.) Yet what am I to do when 25% to 50% of my procedures, which are ‘authorized’ by insurance companies, are not compensated because, although authorized, they are now determined to be uncovered benefits. I have patients come back for follow-up visits, so maybe I will have to sell vitamins and other services to make up for the loss of payments.

Quality of care suffers with less time to see patients and less reimbursement received when we do see patients. We cannot do pro bono work as we have in the past as we have to see an ever increasing number of patients. This extra work is forced upon us when insurance companies, especially Medicare and Medicaid, constantly refuse to pay us in a timely fashion for our time and efforts. And, then once we do see patients our clinical acumen is stifled as we must follow a cookbook approach to patient care.

When healthcare insurance companies siphon money away from patient care and into the hands of the their executives, to support a life style that demands sometimes more than $30 million/year, this decreases money to medical schools for training and research that might create advances in medical care that actually benefit patients. Insurance companies have no incentive to provide better care if it in turn might make patients live longer. Medicine is going corporate, and we, physicians are just flipping burgers so corporations have an improved bottom line.

It is time that we stood up for ourselves. Our founding fathers gave up their lives, liberty and freedom, so that we, their progeny could live in the land of the free and home of the brave. But we are passively giving up our noble lives as physicians, without liberty to practice as we know we should, and without the freedom to stop the government and the insurance companies from turning us in to hourly workers rather than the true professionals we believe we are and forever should be.

I am going Washington DC. At noon, on Thursday, October 1 2009. I will be on the mall with a few other physicians. We simply decided that we will not work that day and perhaps the day before and maybe even the day afterward. We are not ‘organizing’ anything other than a vacation from the stress of work, so we enjoy our nation’s capital and perhaps even say hello to our congressmen or members of the administration. Perhaps we can show the country that we are worth more than a $5 co-pay; that physicians are more important than a mid-level healthcare worker; and that our profession is needed, our services are required and our practice is a calling to be respected, not a trade that is to be negotiated to the lowest bidder.

I want our services adequately reimbursed so that we may spend more time with our patients, and I want less paperwork. I want less money going into the hands of insurance companies administration costs, less money going into the hands of pharmacy companies for the development of drugs that are either unsafe or targeted for ‘diseases’ they seem to invent. I want drugs that are as affordable in the US as in Canada or Mexico. I want medical malpractice reform, with caps on all damages, so that we can practice without the fear of needless and unwarranted lawsuits that only benefit the attorneys. I want the National Practitioner Data Bank reformed so entries are made AFTER all administrative remedies have been executed, so due process is given to all physicians and that all entries are reviewed by an independent board of physicians without any ties to the accusing hospital, state or local medical societies prior to submission. And I want compensation for services that pay us enough to allow us to continue formal and informal continuing education, that pay us enough to manage our practices and allow us a living that compensates us for our years of study and training.

And, most of all, I want you to join me for a vacation in Washington, DC. I want us to get together, informally, so we can share experiences with each other. I am inviting you to come there for a vacation. I want you to invite 10 of your physician colleagues and let them know that you are going to be in Washington DC on October 1 2009, and invite them to come themselves. I want you to tell them to invite 10 more their physician colleagues to join them, and so on.

I have purchased my flight to Washington, DC. I have informed my patients that I will not be available to care for them the week of October 1, 2009, and suggest that they make alternative arrangements for care. Perhaps they can find a good mid-level healthcare practitioner to take care of their traumas, emergencies or deliveries.

Perhaps we can actually have a ‘million med march’ however spontaneously it may be. See you in DC.

-- Tom Aiello

[email protected]
SnakeRiverBASE.com

[kelpdiver 2]

so like the mom march, this one will be well short of a million. Might be the dozen med march.

[pirana 0]

Quote

"Little of the health care dollar even goes pharmacies and hospitals, much less to physicians"

in all of the discussion about healthcare, i've yet to see a breakdown of what our healthcare dollar actually pays for. i don't think we can begin to talk about heathcare reform until we know exactly where all of the money is going, yet, the subject seems to be glossed over. its refreshing to see the issues brought up by this letter, and i hope they are brought up more often as obama pushes his healthcare reform.

No surprise the article does not go into details, just shameless appeals to emotions. At least amongst the business segments that are regulated as to loss-ratios in MN; 90%+ of all dollars taken in via premiums are paid out in claims. Self-insured groups, political subdivisions (read government employee programs), most collectively bargained contracts, and a few others use loopholes to get around that requirement. They also use their status to avoid benefit mandates (some good, some bad), fees and assessments that finance care programs for the poor (foisting a disproportionate share of that burden onto small group and individual purchasers).

There is some very good info on where the dollars come from and where they go; especially for the non-profit and not-for-profit entities. On the for profit side it is more of a shell game.

" . . . the lust for power can be just as completely satisfied by suggesting people into loving their servitude as by flogging them and kicking them into obedience." -- Aldous Huxley

[TomAiello 25]

Do you have a cite for the data, so we can all go educate ourselves?

-- Tom Aiello

[email protected]
SnakeRiverBASE.com

[pirana 0]

Here you go. There is even a document in their menu called where it came from and where it went. There is a ton of this information available, but no wonder the parties trying to impose their will do not share it.

Granted, it can be quite boring stuff to most people, but I think it is more that they really have no use for facts.

Of note is that total admin costs (in the where the money goes chart) is 7%.

http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPage

Somebody else will have to make it a clickylinkythingy.

" . . . the lust for power can be just as completely satisfied by suggesting people into loving their servitude as by flogging them and kicking them into obedience." -- Aldous Huxley

[GeorgiaDon 340]

Here you go:
http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPage

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[CheriAiello 0]

Quote

Here you go. There is even a document in their menu called where it came from and where it went. There is a ton of this information available, but no wonder the parties trying to impose their will do not share it.

Granted, it can be quite boring stuff to most people, but I think it is more that they really have no use for facts.

Of note is that total admin costs (in the where the money goes chart) is 7%.

Seven percent of the cost to administration doesn't sound like that much, but from what I can tell, that's the clearly administrative money.

What it doesn't appear to include is the amount of money that is paid out to various sectors (physicians, hospitals, etc.), that ALSO goes to cover the administrative costs of providing medical care. My former office was run in a pretty lean manner, and we still had four full-time staffers for two docs (in Idaho, one of the less bureaucratic states in which to practice medicine).

The hospital I currently work with has an army of coders and billers, who spend countless hours making sure the ICD-9 codes are exactly right. Because, if the hospital bills for the femur fracture the wrong way (and there are a gazillion ways to code a femur fracture), the patient's entire stay may be denied--and then the paperwork has to be redone for appeal. The cost for that portion of health care is going to show up in the hospital portion (if I'm reading correctly), and not in admin costs.

Similarly, the cost of the all the people you see working back there in the charts when you go to your doctor's office is going to show up in the physician portion of the pie.

There are other areas where the costs of the burden of practicing medical care in our current fashion are going to show up in non-administrative areas, as well, but that's the first example that came to mind.

Interestingly, there is a small movement in medicine for small, low overhead practices. These docs seem very happy. The primary way they keep their overhead low is by not taking insurance (including Medicaid or Medicare). Most of these docs are able to get by with one staff member (and many have no office staff). These docs are able to focus on providing care to patients and don't have to deal with most of the bullshit paperwork that the rest of us spend way too much time on.

Bottom line--I think the reporting of seven percent of health care costs as going to administrative expenses is a bit of an oversimplification.