Overheard In The Lounge
How to Survive obamacare
Dr. Rosen: The elections are upon us and we have doctors running for office.
Dr. Dave: But they are all running in the wrong political party.
Dr. Yancy: It’s hard to understand why former colleagues in this room are now running on the Tax & Spend & Regulate party? We have traditionally been in the freedom party.
Dr. Sam: Physicians have come over into the T & S & R party for a number of years. What makes us think we have so much power that we can gain more by this force than in the free market?
Dr. Rosen: Do you think physicians still have the prestige that most of us think we have lost by this fringe group. I'm not sure that we've retained any of it.
Dr. Edwards: I agree. I still frequently see physicians make such embarrassing statements as don't you give doctors a discount?
Dr. Dave: Now that's just as bad as I saw overseas when I over heard, "Don't you give us Americans a discount?"
Dr. Yancy: Now that we've discounted all of healthcare in this country, are the T S R's happy?
Dr. Paul: I guess you're putting me in the T S R group. Let's face it there are a lot of poor people in whom having Medicaid is appreciated. We have had a Medicaid practice and that hasn't changed. What's your problem?
Dr. Milton: Now that Obama has solved the health care conundrum in this country, by over filling the Medicaid folks, has he really made health care available as was advertised?
Dr. Paul: My Medicaid practice is as full as ever. I have to see 8-12 patients an hour to fit them all in.
Dr. Rosen: Let's see. At 8 patients per hour or two every 15 minutes or a patient every 7-1/2 minutes, how can you deliver any good Quality of Care? If it takes you two minutes to record your visit, can you even get the chief complaint and good vital signs in 5 1/2 minutes?
Dr. Paul: Remember these are poor folks, some are destitute, they are happy with any attention they get and even one prescription is a treasure for them.
Dr. Edwards: I guess I've heard of the physician who had no exam table, no writing desk, and only one wall writing area for the chart. The nurse brought the patient in, the doctor started talking as the patient walked towards him, he started writing the prescription which he handed to the patient as he walked past him with his stethoscope out to catch one or possibly two breaths and then shake hands as he escorted him out the second door.
Dr. Paul: I have an advanced EMR program. I just need three words and the program types up the entire history and physical exam in a logical format.
Dr. Rosen: You've got to be kidding.
Dr. Paul: I just have to mention the organ system, such as "heart" and then one symptom, such as "can't sleep flat" and then one drug for the prescription that I've already written like "diuretic" and my favorite diuretic is already programmed into the system and, voila, the chart is completed, I sign it, and walk to the other door to greet my next patient. Five minutes max. I've gotten up to 10 or 12 patients an hour.
Dr. Rosen: What if you have a CMS (Center for Medicare and Medicaid Services) review?
Dr. Paul: I've already had a review. They thought for a family doctor I had one of the most complete records they had seen.
Dr. Rosen: So if you can maintain the pace of 10-12 patients an hour at $150, you're making $1500 to $1800 an hour or $15,000 to $18,000 a day.
Dr. Paul: Why do you think Medicaid reviews me? You just have to run a tight ship.
Dr. Rosen: If your schedule were made public, CMS would cut the re-imbursements drastically. And the internists among us that see four patients an hour would have to get another job.
Dr. Paul: That's your problem. As you can see, I'm making a lot of money on Obamacare.
Dr. Edwards: I don't think any patient of mine would come back after a 5 minute appt as you describe it.
Dr. Paul: So all doctors with sophisticated care as you have as an internist would go under. My practice with minimalist care that follows the letter of the regulation to a "T" would survive.
Dr. Edwards: But do you think your minimalist care is good Quality of Care, the Hall Mark of what is proposed by CMS?
Dr. Paul: That's not the issue in Obamacare. Your care has to pass Obamacare schedule of rapidity of care to meet the deluge of patients enrolling and still meet the CMS guidelines of their QOC. You're meeting the CMS guidelines of care which may yield higher QOC. But you will only be able to see about one-fifth the number of patients, and unless you get rid of most of your support staff, you won't be able to meet your mortgage and practice obligations, much less have anything left over for you and your family.
Dr. Edwards: So in reality you're saying that I have to lower the quality of care.
Dr. Paul: Would you like for me to spell that out for you?
Dr. Edwards: No thanks. You come across loud and clear. No one in Washington has ever made it any clearer.
Dr. Paul: Why should they?
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