Thursday, March 27, 2014

10 Reasons Doctros Are Pulling Their Hair Out

In the 2013-2014 era, doctors and providers are being asked to adapt to massive changes in their practices, businesses, and their modus operandi.  The stress from all these changes will be felt in the doctor-patient relationship.

Why are doctors unhappy?
  1. Conversion of ICD-9 to ICD-10.  Nobody is sure of its value, but are painfully aware of the costs.  Having a code for a crash landing in a space craft would be relevant only for Sandra Bullock in Gravity!
  2. Confusion created by the Affordable Care Act roll-out.  Not sure who's on first?  Who's covered? What's the fee schedule?  What are the new, complex rules?
  3. High deductible insurance plans making payments at time of service mandatory.  Creating a new class of de-facto self-pay patients who formally were covered.
  4. Acute or chronic reimbursement issues as? Fee for service will be replaced by outcome measurements.  What outcome measurements?  Who's measuring?
  5. No relief from malpractice liability in most states.
  6. Dealing with the Electronic Health record.  Did I purchase the right one?  The continuous moving target of getting meaningful use money. The accompaniment of possible claw backs if the data is not filled out correctly.
  7. Hiring more help (scribes, medical assistants, Nurse Practitioners, and Physician Assistants) to see potentially less patients.
  8. Hiring more consultants to see potentially less patients.
  9. Becoming the most expensive data technician in the room.
  10. Fill in the blank __________________ yourself.
Practicing medicine is rapidly changing and providers will have to adjust to the new realities.  At what cost to the provider and patient will be determined in the future.

Monday, March 10, 2014

High Deductible Insurance Angst

In Popeye cartoons, the hamburger-loving character Wimpy would always say "I'll gladly pay you Tuesday for a hamburger today".  This sort of entreaty will become the new medical office mantra for poor patients with high deductible insurance plans.  The underlying problem is that these individuals will continue to have no available funds through Tuesday, and beyond.  Those who cannot afford high deductibles will likely seek care elsewhere (or no where), once the door to the doctor's office becomes shuttered by these huge tolls.
Let's look at some definitions of a high deductible health plan, a co-pay, and a health savings account.
  • High-deductible Health Plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan.  Being covered by a HDHP is also a requirement for having a health savings account.  Some HDHP plans also offer additional "wellness" benefits provided before a deductible is paid.  High-deductible health plans are a form of catastrophic coverage, intended to cover for catastrophic illnesses.
  • Co-pay is a payment made by a beneficiary (esp. for health services ) in addition to that made by an insurer.
  • Health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP).  The funds contributed to an account are not subject to federal income tax at the time of deposit.  Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent.  HSAs are owned by the individual.
When the HDHP was introduced, it included a significant ability to save money through an HSA where the  individual could theoretically manage their own healthcare expenses through a tax-deductible vehicle.  any money not spent can remain in personal interest bearing account and spent, if needed, at a later date.

However, as of 2015, the HSA permissible maximum contribution is being diminished from $6,500 to $2,500 annually.  this leaves the individual with a minimal tax advantage. 

How does the Affordable Care Act fit in?
The ACA intends to provide subsidized coverage with high deductibles with no tax benefits.  One might initially think that people selecting this coverage would expect to pay a reasonable monthly payment.  However, when huge deductibles and required co-pays are added to the total cost of insurance, the cost of a policy becomes unaffordable.
Think of it this way:  the ACA "insured" now becomes a de facto self-pay patient until the deductible is met.  Hence, there will be many defaults on what would otherwise have appeared to be reasonable and manageable monthly premiums.  Patients are simply not going to be able to pay huge deductibles, monthly premiums, AND continue to get care.  Something is going to have to give.  Over the coming year, we will see this play out, and likely CMS will create some adjustments and workarounds to counteract this present course.

Monday, March 3, 2014

Did Sisyphus Work Out?

In Greek mythology, Sisyphus was a king of Ephyra punished for chronic deceitfulness.  He was would roll an immense boulder up a hill, only to watch it roll back down.  He was compelled to repeat this action forever.

Sounds like real-life.  3 fitness tests you should be able to pass article recently posted on Fox News,  asked readers to evaluate their physical health.  Here are the 3 simple tests to judge your health:
  1. Waist size less than half your height (Failed that one)
  2. Hold the plank position (strict push-up form) for 2 minutes (Failed that one)
  3. Get to and up from a seated position with minimal use of hands and knees.  Score is 1-10 with losing a point for every use of hand or knee.  Score less than 3 was associated with a five time higher likelihood of dying versus people who got an 8 or above.  (Got a 7)  This was not a controlled double blind study.
Your physical health is a great predictor of your mental health and your work performance.  In the blog I wrote last February, Prolonging Your Career, I discussed how adding the constant stretching program Restorative Yoga, my flexibility has gone from 5% to 60%.  My blood pressure has lowered and I have lost a little weight.

Some find that gyms open 24-hours are beneficial, and heading there after a shift beneficial.  Especially when a shift has been stressful, a good workout can relieve tension and enable one to return home with some of the tension productively disbursed. 

Being a health care provider is a stressful job, so it is imperative that you take care of the shell surrounding the brain by working the core surrounding your waistline with a consistent strength and conditioning program such as Yoga, Pilates, TRX, Personal Training, etc.  Working out is a Sisyphus-like task, but does have its rewards.