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View Diary: "Can't choose your own doctor" - What the heck does that mean, anyway? (updated) (106 comments)

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  •  RG - In addition most physicians won't accept (3+ / 0-)

    Medicaid patients and an increasing number won't accept new Medicare patients.

    "let's talk about that"

    by VClib on Sun Aug 18, 2013 at 09:04:10 AM PDT

    [ Parent ]

    •  Yes, but that's not really all that new of (3+ / 0-)
      Recommended by:
      VClib, Alexandra Lynch, Kevskos

      a problem . . . ..

      •  I agree, but the ACA is dramatically increasing (2+ / 0-)
        Recommended by:
        Alexandra Lynch, divineorder

        the number of Medicaid patients. Who is going to treat them?

        "let's talk about that"

        by VClib on Sun Aug 18, 2013 at 09:12:08 AM PDT

        [ Parent ]

        •  My feeling is that this is where increasing (1+ / 0-)
          Recommended by:
          Alexandra Lynch

          (or maybe "emerging" would be a better word) abilities of "robots" to provide health care is going to be key.

          There was a diary in which this was discussed at some length in the past 2 to 6 weeks . . ..

        •  there is a move to increase the clinics (3+ / 0-)

          available to people for basic care.  We really really need single payer...

          •  ^^^ (3+ / 0-)
            Recommended by:
            greenbell, Sue B, historys mysteries
            We really really need single payer...

            Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

            by divineorder on Sun Aug 18, 2013 at 11:55:09 AM PDT

            [ Parent ]

            •  Yes we do (0+ / 0-)

              but that would exacerbate, not ameliorate, the topic at hand  - which is the looming shortage of physicians.

              •  Maybe (2+ / 0-)
                Recommended by:
                divineorder, Roadbed Guy

                Part of the single payer argument is more efficient physician time.

                I can see more patient if less of my time is spent dealing with insurance companies.

                I believe this to be true, but it's possible there a big element of faith rather than evidence to support it.

                The plural of anecdote is not data.

                by Skipbidder on Sun Aug 18, 2013 at 02:08:00 PM PDT

                [ Parent ]

                •  Most physicians have staff who deal (1+ / 0-)
                  Recommended by:
                  Skipbidder

                  with insurance companies - so the cost of having these people in the system could be considered to be "waste" that could be eliminated.

                  Another argument is that if people could / would regular see physicians before problems became extreme, $$s (via not having to undergo crisis-type medical intervention) would be saved.

                  However, stats that I have seen that "end of life" medical care consumes a huge amount of this country's medical care budget don't make that argument all that convincing, either!

                  •  Staff isn't enough (1+ / 0-)
                    Recommended by:
                    Roadbed Guy

                    I deal plenty with insurance companies quite a bit on my own. It sure seems like it sucks up a large amount of time. This is in addition to my overhead cost contribution to the staff who initially screen these interactions.

                    In addition, part of the way we practice at all is geared toward trying to appease nongovernmental companies or jump through hoops to get paid.

                    Medicare is administered by private companies in different areas of the country. Amazingly enough, they have a large degree of latitude in interpreting the Medicare Documentation Guidelines, and sometimes have made rulings that are directly contradictory to those published guidelines. My own carrier will not answer any questions when I send them. They simply refer me back to the (often vaguely-worded) Documentation Guidelines or their own quite useless online material. It is difficult to usefully train resident doctors on how to document to billing standards when you know that they may practice in a different state and thus find different interpretations of the rules.

                    We do spend a lot of money at end of life. Part of this is cultural. We tend to have less acceptance of the idea that death is part of life. We tend to try non-evidence-based approaches (or ones with evidence that is shaky at best) after the evidence-based ones fail. We are sometimes ignoring what is considered to be best practice according to consensus expert opinion of our professional societies. Efforts to have better goals of care discussions with patients have been thwarted (largely but not entirely by religious conservatives). These get demonized as "death panels". And providers of hospice care have been feeling the squeeze recently, with some of the bigger organizations dealing with fraud accusations (sometimes fairly and sometimes quite unfairly).

                    The plural of anecdote is not data.

                    by Skipbidder on Mon Aug 19, 2013 at 04:26:31 PM PDT

                    [ Parent ]

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