Medical Tuesday Blog

The Struggle To Treat With CMS In The Exam Room

Sep 22

Written by: Del Meyer
09/22/2016 4:39 AM 

Dr. Rosen: How is the Presidential campaign coming along? Is Donald Trump still putting his foot in his mouth? Did ISIS really get started by Pres Obama and Sec’y Clinton?

Dr. Edwards: I think Mr Pence put that away nicely today.

Dr. Ruth: How’s that? I must have missed it.

Dr. Edwards: Mr Pence outlined very convincingly that Iraq was in a stable position until Pres Obama and Sec’y Clinton came along and changed the strategy which allowed ISIS to develop.

Dr. Milton: That tells me that Mr. Trump and Mr. Pence are in close contact and speaking the same language. That’s encouraging.

Dr. Ruth: That really is indicating that this campaign is going into depth on issues.

Dr. Michelle: I was really getting very concerned. I hope you’re right, Ruth. I was wondering if I could continue to practice for four more years with the increasing burden of just seeing patients and obtaining necessary tests and procedures with the prolonged process of obtaining prior authorization on almost everything we feel necessary for optimal and quality patient care. Why are we spending more time on getting authorization for basic tests, but also on time to get the medication approved? Patients have been on a well working drug for years and they are rebelling against the trial and error of trying other drugs or options that they’ve gone through before. They went through this hassle years ago when their current drug was chosen.

Dr. Yancy: Medicare and the other insurance carriers including their HMOs do not understand that they are increasing the cost of healthcare. To compare the simple process of renewing a medication that they’ve been on for years, versus writing a prescription for a comparable drug that the patient and physician feels is less effective or has more side effects that require the patient to return for several follow up visits for further evaluation of the treatment will cost considerable more that the cost of the medication.

Dr. Sam: You’re missing the whole bureaucratic thinking, Yancy. They don’t pay for the follow up visits because it’s for the same problem, and they don’t pay twice for a minor medical issue in the same month, and they feel you should be able to do that in one visit.

Dr. David: Or they think the one visit should include all the follow up phone calls for evaluation of their preferred drug until an approved drug is prescribed.

Dr. Milton: With Mrs. Clinton that whole process will not change. We know this from the national health plan she tried to force down our throats in the 1990s when her husband was president and he put her in charge of National Health Care. With her election, she will essentially be working inside our practice forever. She’s like all members of her party that feel doctors are gouging the system. That perception is well displayed when hospitals and laboratories get all their increased payments and physician payments are decreasing.

Dr. Edwards: One health care executive mentioned in the news recently that doctors gouged the system when Medicare started. This is just pay back for all the money they made in the 1960s and 1970s.

Dr. Rosen: A generation of doctors is considered by some to be about 40 years of practice after 12 to 15 years of training. This is the same mentality that we should be responsible for the decisions that were made in a previous generation and correct them. They don’t want to treat our past as history to be studied and learned from so we don’t make more mistakes in the future. There is some truth that doctors did well in the1960 when Medicare was implemented. I’ve heard doctors brag about how the Medicare/MediCal combination was a gold mine. This just further reflects that health care from the top down seldom works for the people that it should work for.

Dr. Ruth: But what can Mr Trump do to stop this health care hemorrhage? To cancel the plans that have been forced upon us for eight years and change the system again will irritate a number of our patients. Isn’t this a rather no win situation? The patients will damn us if Mr Trump cancels the Obama Plans. And the patients will damn us for anything newly implemented because no bureaucrat understands the practice of medicine and therefore, anything new will be criticized also. Then the Grand Old Party of Lincoln and Reagan will be voted out of office in four years and we will then be like the Europe that our forefathers escaped from two centuries ago. Is it possible to have a third century of freedom recorded in World History?

Dr. Rosen: We also have to remember that few doctors understand the entire health care picture. The doctors that seem to rise to the top are frequently also bureaucrats well trained by insurance carriers. Some have even made it into Congress without educating their members. When they said they would be an advocate for the doctors, they were really advocating government medicine. In my years as a medical editor, I received health plans written by members of the medical society. Some were long, hand written directions on how things should work. I pointed out problems in their proposals and they would respond, “Let me send you some more plans next week that would solve the health issues of our country.”

Dr. Milton: In the ideal health plan that some of us have been working on for several years; all these issues have been discussed at length. In our meetings every Thursday after office hours, sometimes, lasting for three or four hours, we have done a lot of work on a number of issues. However, none of us had the financial resources to proceed from an incubator proposal to a true entrepreneurial start up.

Dr. Edwards: Sometimes we met with the UCD Business Start Ups on Thursdays, and as soon as we mentioned health care, the discussion seemed to freeze up. Everyone seemed to think that it was too expensive and too complicated to become involved in.

Dr. Rosen: These concepts can be reviewed in the HealthPlanUSA, our companion newsletter. These unfortunately were also interrupted with the demands of the current Obama Care interferences with the practice of medicine which promised to save costs. We are bringing those newsletters up-to-date. We all know they were not successful in saving medical expenditures. The entire system is falling apart as insurance company after insurance company is leaving the field. It seems they are all losing money after the Obama Care incentive money dried up. To use taxpayer’s monies to break even to develop a new scheme of health care will never be successful. It will take a real entrepreneur such as the Koch Brothers, Peter Thiel, Jeff Bezos, Lukas Walton, Larry Ellison, and other Billionaires which now number 1800 of which 190 are women. Some of these are mega contributors to Mrs. Clinton. How sad when one thinks the main qualification to be president, for some voters, is gender.

Dr. Edwards: Equally sad is that many entrepreneurs and billionaires have become enamored with government control. They think they are big enough to influence government to their benefit. That is why the Democratic Party has become the party of the Rich. I believe the stats are now that about 5% of the wealthiest Americans are Liberal Democrats.

Dr. Milton: That’s why they no longer represent us. We are losing representative government which was the hallmark of our country since its founding.

Dr. David: And if Mrs. Clinton enters the White House, she will continue to expand many government programs with taxpayer monies.

Dr. Sam: She’s had good training by Bernie during the primaries. He saw no problems with returning to the 91percent marginal tax rate that it took Reagan to reduce to about 35 percent as I recall.

Dr. Yancy: I had a patient last month who felt Medicare was not spending enough on his care tell me that increasing the taxes to 100 percent would solve the problem. When I asked him, isn’t that taking all of their income? He replied, “The rich can well afford it.” I thought then I would test his understanding of money by asking, “Well if you think the rich can afford 100 percent, do you think the rich should pay 200 percent in taxes?” He replied, “Absolutely, they can well afford it.”

Dr. Ruth: And to think that citizens that ignorant of wealth can vote!

Dr. Michelle: I don’t think that is a debatable issue.

Dr. Ruth: It is even more amazing that citizens that ignorant can run for president!

Dr. Rosen: I don’t think we really have to worry. I think Trump will take Hillary’s home state of New York and may take 49 states just like Reagan did in 1984. The American people are not dummies. They want a change from what we have now. And Trump is the change that the Grand Old Party of Lincoln which freed the slaves and of Reagan who eliminated confiscatory taxes in our time desperately needed. We need to vindicate those that died in the American Revolution to provide us with this great experiment in human freedom.

Dr. Ruth: Peggy Noonan had a great article in this morning’s WSJ. It is impossible to change a liberal’s point of view by logic or reason. We can only change the course of history by beating them at the polls. Beating them on November 8, 2016, is crucial. Otherwise, they will simply march on and destroy the American Heritage.

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