Medical Tuesday Blog
Has Obamacare Arrived Early?
Dr. Rosen: Last week everyone seemed depressed over the happenings in medicine.
Dr. Milton: We have had an influx of new welfare patients into our HMO. We’re adjusting.
Dr. Ruth: We have not participated in accepting the MediCal patients who have been newly added to our HMO.
Dr. Edwards: I’ve always had a base of 10-20% of my practice being welfare. We have accepted these with careful scrutiny.
Dr. Michelle: How do you scrutinize MediCal or Welfare patients?
Dr. Edwards: It isn’t easy. But we feel an obligation to the poorer members of our society. We can usually determine after the second visit whether they are the Dregs of Society and are “takers” and happy being “takers” or are they temporarily down and out and appreciate the American Freedom of opportunity and looking for a brighter day tomorrow. Look at the billionaires in our culture who came to America with very little cash in their pockets.
Dr. Yancy: I have a MediCal free practice and I intend to keep it that way. If I see a MediCal patient who really needs my surgical care, I may see one on an individual basis. But I don’t charge for my services. It’s charitable and free. I’m not going to deal with the state bureaucracy, hassles, condescending attitudes, such as let’s see a copy of your medical records or surgery reports within one week for one-third of my standard fee. My estimate is that the hassles and their costs frequently exceed the one-third fee they pay me. This means that I’m doing charity but not recognized as such. I’ll just do real charity in these cases.
Dr. Rosen. Yancy brings up an excellent point. When we do MediCal which just barely covers our office cost but none of the doctors net fee, we get criticized for doing what amounts to charity. Why not do real charity and not charge anything for those in the MediCal ranks we see. Then control those ranks to say ten percent of our practice. Physicians would then be praised instead of constantly criticized.
Dr. Michelle: Milton, how are you adjusting to your influx of MediCal patients into your HMO?
Dr. Milton: It was a bigger eye opener than I would have ever thought. The very first day that those 500 welfare MediCal patients were place into our panel, we were deluged with unbelievable demands on our office.
Dr. Michelle: What do you mean? Didn’t you just have a different type of office patient?
Dr. Milton: If that were all there was to it, we would have been happy to service this population. But my wife, who runs my single employee office, normally came to work and had two or three phone messages and then she proceeded to the day’s work. The very first day, this increased to 60 messages. We hadn’t fully realized that these 500 patients don’t work, they all have cell phones, they called the office at all hours of day or night, and some even showed up expecting to be seen immediately. One even threatened to sue if we didn’t see him immediately. It took my wife three house to get through all these phone messages and then another two hours to process these requests. And mind you, these patients had not yet been seen or evaluated but that didn’t stop them from requesting prescriptions, lab work, x-rays, referrals before their first appointment.
Dr. Rosen: And if you tried to explain to these folks that it would be a violation of the Medical Practice Act to do any one of those things without an exam, they would probably not understand this jeopardy of your license to practice Medicine or Surgery. And then add that would also eliminate your sole source of income would fall on deaf ears. They know that all doctors are rich and don’t need an income.
Dr. Edwards: This reminds me of one patient that complained a lot about doctors making too much money. The rich just don’t want to pay taxes to help the poor folks. I asked him that perhaps the rich should pay 100%? He replied, “Certainly, they can well afford it.” I then suggested that perhaps the rich should pay 200% in taxes. He again replied, “Certainly, they can well afford it.”
Dr. Rosen: That’s an excellent illustration of entitlements vs charity. Many of my TSR friends think that welfare is charity. But force charity or entitlement is not charity at all. With entitlement, people always want more. There never is enough. It brings out the worst in human beings. With charity from the heart, there is always thankfulness; it brings out the best in us.
Dr. Milton: That probably characterizes the difference in these patients very well. The paying patient is always appreciative. All at once we have a whole slew of patients who are not only extremely demanding, but also very litigious. They report every little variance they are not use to, to their HMO and this brings a large amount of paper work to clear our name. Last week a patient asked me for some suggestions on reducing her weight. I pointed out to her that to maintain her weight, pointing with my hand, she had to be eating 2,000 calories per day. By reducing that by one-fourth or 500 calories would equal 3500 calories or one pound per week. She reported me to her HMO as saying that I insulted her by saying she was fat. I not only got letters from the HMO, but also the state agency overseeing HMO to explain my non-professional behavior and a copy of the medical chart. The HIPAA regulations essentially allow all government and insurance agencies access to a patient’s chart without the patient’s knowledge.
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