Why the medical field is going downhill

[disneysteve]

Just one of hundreds of stories I could tell....

I ordered a nebulizer for an asthma patient - not an uncommon order at all. A couple of days later, I get a fax from the medical supply company. They can't accept my order because the prescription needs to be dated next to my signature. Keep in mind that prescription pads are preprinted with a line for the patient's name and a line for the date. It was filled out appropriately with the date right where it said "Date" on the prescription. Apparently, that's no longer good enough. It also needs to be dated a second time next to the signature.

This apparently is a new Medicare rule to reduce fraud. How that reduces fraud I have no idea but in the meantime, it wasted my time, my staff's time, the medical supply company's time, and delayed the patient getting the equipment they needed by several days.

To put this in perspective, the way it used to work was that I would see a patient, order the nebulizer, fax the prescription to the company, and they would typically deliver the machine to the home that same day.

They are creating so many inane rules and regulations that it's becoming exceedingly difficult to actually treat patients. There are a lot of reasons for rising healthcare costs but this is certainly one of them.

[ua_guy]

I see this from the perspective of providing IT services to healthcare organizations via electronic medical records, billing, and patient access applications. The business side is a hot mess, and stupidity is reigning supreme in this industry. I can only imagine the frustration of a doc in a small family practice trying to stay on top of all the regulations and "bull****" in the name of providing good care, or even getting paid for what you do.

It's been a long process, but I think it's time I need to find employment in another industry. I fear it's going to get a lot worse before it gets better, and when it does, the business side of the equation is going to become so lean and efficient that a lot of people will be a lot of people in the industry looking for jobs, because they are no longer needed.

[bjl584]

Just one of hundreds of stories I could tell....

I ordered a nebulizer for an asthma patient - not an uncommon order at all. A couple of days later, I get a fax from the medical supply company. They can't accept my order because the prescription needs to be dated next to my signature. Keep in mind that prescription pads are preprinted with a line for the patient's name and a line for the date. It was filled out appropriately with the date right where it said "Date" on the prescription. Apparently, that's no longer good enough. It also needs to be dated a second time next to the signature.

This apparently is a new Medicare rule to reduce fraud. How that reduces fraud I have no idea but in the meantime, it wasted my time, my staff's time, the medical supply company's time, and delayed the patient getting the equipment they needed by several days.

To put this in perspective, the way it used to work was that I would see a patient, order the nebulizer, fax the prescription to the company, and they would typically deliver the machine to the home that same day.

They are creating so many inane rules and regulations that it's becoming exceedingly difficult to actually treat patients. There are a lot of reasons for rising healthcare costs but this is certainly one of them.

Being that you are a physician and "in the trenches" so to speak, what sort of things do you think can be done to fix these problems that seem to plague healthcare? The ACA is a hot topic of debate and is constantly in the news. The Supreme Court just stripped one of it's provisions in the past week or so. Do you think the ACA is a step in the right direction or wrong direction? I'm curious as to what you and fellow doctors think needs to be done to fix the healthcare system in America.

[disneysteve]

II can only imagine the frustration of a doc in a small family practice trying to stay on top of all the regulations and "bull****" in the name of providing good care, or even getting paid for what you do.

Exactly!

I think it's time I need to find employment in another industry.

I'm not looking to change industries as I'm not sure what else I would do, but I am actively seeking other opportunities in the medical field. Not necessarily instead of my office practice but rather new niches that I can incorporate into what I already do.

For example, I used to be the on-call doctor for the nicer hotels in the Philadelphia area. After 9/11, that business dried up as business travel dropped off to almost nothing. Then the recession happened which didn't help either. Now, travel is back and I just contacted a company that does that now (the 2 companies I used to work for are no longer around). I'm waiting to hear back from them.

I'm also looking into doing some online/virtual medical consultations. That's a new and upcoming field that might ease some of the pressures we deal with.

Brian, I can certainly comment on that when I have a little more time. It obviously isn't an easy answer.

[moneybags]

I'm also looking into doing some online/virtual medical consultations. That's a new and upcoming field that might ease some of the pressures we deal with.

My insurance company provides this as an options. I have not used it yet.

[disneysteve]

My insurance company provides this as an options. I have not used it yet.

I'm not really sure about it. Kind of hard to do a history and physical when you can't do the "physical" part. On the other hand, it's not really any different than when one of my patients calls my office, tells us what's wrong, and we call in a prescription for them.

[jIM_Ohio]

Require everyone which works for a health insurance company to be a licensed doctor

[Gary4587]

Its due to health insurance companies.

[disneysteve]

Its due to health insurance companies.

Partially. It's also partly due to government. It's also party due to a lack of personal responsibility on the part of patients. It's also due to abuses within the healthcare system by doctors and hospitals.

There isn't one place to point fingers which is why there is no simple fix. We've reached a point where it is a totally systemic problem that will take a monumental effort to correct. Quite honestly, I don't think it's possible to fix. Efforts are being made to address certain aspects of the problems but so many of the issues are so deeply ingrained into the system now that I don't think it's possible to turn back.

[ua_guy]

Partially. It's also partly due to government. It's also party due to a lack of personal responsibility on the part of patients. It's also due to abuses within the healthcare system by doctors and hospitals.

There isn't one place to point fingers which is why there is no simple fix. We've reached a point where it is a totally systemic problem that will take a monumental effort to correct. Quite honestly, I don't think it's possible to fix. Efforts are being made to address certain aspects of the problems but so many of the issues are so deeply ingrained into the system now that I don't think it's possible to turn back.

What are your thoughts on a single-payer system?

[disneysteve]

What are your thoughts on a single-payer system?

Could be good; could be just as bad as what we have now. It depends on how it is administered. If they still have a ton of ridiculous rules, restrictions, prior authorization requirements, etc., then it doesn't matter if there is one payer or 100 payers.

Medicare is the current model for a single payer system and many of the rules that drive us nuts (like having to sign the prescription twice) are Medicare rules, so from that standpoint, the single payer isn't any better.

We need to go back to a system where healthcare decisions are made by healthcare providers.

One of my staff members spent over an hour on the phone today to get authorization for a legally blind diabetic patient to get a sugar meter that talks since she can't see well enough to use a standard meter. She had to make multiple calls to the insurer, the pharmacy, the durable medical supplier, and back to the insurer to gather all of the information that they were requesting for the authorization. It was a colossal waste of time for something that was a no-brainer decision: patient can't see, they need equipment that they are able to use.

[creditcardfree]

I'm just going to share that my husband in the military has to submit travel reimbursement requests, most are automated in some way online. Travel for deployment overseas and travel to a change of station are all by paper submission I think, but my husband had these rejected over and over before he finally got everything correct and paid out. I asked him about it and he said the company under contract to process these payments has an incentive to reject, as they are paid for each submission they touch. Reject three times and you have been paid three times for the same item to be processed.
Not sure if this is still going on.

I mention all of this since it makes me wonder about the rejection you had with Medicare. Something needs to change. I encourage you, DS, to contact your senator and personal rep with the stories you tell us. They need to know this information.

[disneysteve]

the company under contract to process these payments has an incentive to reject

I don't know if the insurance companies actually get paid extra to reject claims but they do obviously have an incentive. Every time they reject a claim, they create the possibility that the provider won't bother to appeal it. I'm sure billions in legitimate claims don't get paid because the doctors just don't have the time and manpower to do file all of the appeals.

The other thing that we love is when we are required to get pre-approval for something but the pre-approval authorization letter clearly states, "Pre-approval is not a guarantee of payment." Then what the hell is it and why did we need to waste our time getting it? If you can give approval in advance and then refuse payment after the fact, what's the point?

[disneysteve]

A couple more example:

1. The NJ DMV has a form that I need to fill out to authorize a patient to get a disabled license plate. I have no problem with that. However, about a year ago, in addition to filling out the form, they started requiring a written prescription as well. So now I have to fill out the whole form, that gives all of the details about why the patient needs the disabled plate, but I also have to write a prescription (on a pad that costs me money to print) that says the same thing. Why? It's another waste of time.

2. There are various forms that I need to fill out periodically that, on a single-page, single-sided form, require me to write the patient's name in 3 different places and sign my name in 3 or 4 different places - on one sheet of paper. Could they not design the form to enter the patient's name at the top and have the doctor sign at the bottom and have that be sufficient?

[greenskeeper]

Partially. It's also partly due to government. It's also party due to a lack of personal responsibility on the part of patients. It's also due to abuses within the healthcare system by doctors and hospitals.

There isn't one place to point fingers which is why there is no simple fix. We've reached a point where it is a totally systemic problem that will take a monumental effort to correct. Quite honestly, I don't think it's possible to fix. Efforts are being made to address certain aspects of the problems but so many of the issues are so deeply ingrained into the system now that I don't think it's possible to turn back.

The government screws up everything it touches, why we would want more of it is beyond me.