“Congress has already missed the deadline for new legislation to block cuts of 21% in Medicare payments to doctors. The pay reduction officially took effect June 1, but the Centers for Medicare and Medicaid Services — the federal agency that oversees the giant health systems — put a hold on processing physician payments for 10 business days…”
Lets play the imagination game. You have a contract to work for a certain pay. Your “employer” tells you that you will have a 21% cut in pay. Oh, and by the way, she is not sure they will cut your pay, so while deciding on what to do you to skip a paycheck for the next two weeks while she decides whether to pay you the old payscale for another month or the new cut in pay.
You have been offered some other jobs, doing the same thing, that will pay you 40% more than you are currently making.
Doing the math, you calculate that you can make $0.79 and maybe payed two weeks late, with your current employer. OR You can refuse the offer from your current employer and accept the offers for $1.40 without a two week delay.
What would you choose?
So why do I as a physician continue to accept Medicare? Honestly, every time I decide that I can no longer see any Medicare patients, I fall asleep with the faces and stories of each of my patients who are forced onto the Medicare roles. When I get up the next morning, I decide to take it on the chin again. I guess its another day, another cycle. For now my creditors and my family are stuck in this with me because, I am in this to take the best care of my patients.
But when I have to close my doors, unable to pay the bills, or when I go belly up because I can not pay back the loans … then … who gets good care?
Call you Representative or Senator and demand a “Real Fix”… a real free market based fix… or vote them out.
Since my last posting in March, the Federal Government has changed the Medicare Reimbursement 3 times. Medicare (CMS) has held payments to providers twice, to give congress time to “deliberate”. Currently, Medicare is paying us 21% less then last year. Last year, Medicare was paying providers 20% less than most other insurance plans. So we are getting paid around 40% less than most insurance plans, to provide care for a Medicare recipient. As a clinic, we are staying with our Medicare and Tricare patients at this point.
I have not updated this blog due to the frequent indecision and promises from this years Congress. As of now there is no change for our Medicare and Tricare patients. Unfortunately, I am not convinced that the Federal Government can both expand medical care insurance coverage and maintain or improve pay to providers. This means that more and more providers will decide to drop care for government programs. Right now, my analysis is that I either make a few dollars or lose money each time I see a medicare patient. The variation depends on how much time I spend with patients. Because I personally chose to spend adequate time with each patient, I frequently lose money each time I see a medicare patient. This is because the health of most patients on Medicare is more complicated than those younger patients. To provide competent care, this requires more time with the patient and more time for my staff and myself on task that are not paid. Those tasks for which we do not get paid are telephone calls, arguing with insurance managers about authorizing tests, coordinating tests and advocating for insurance coverage of needed medication.
I am often asked whether a Medicare Secondary Insurance, improves my pay. The answer is “No”. Medicare sets the maximum that a physician can be paid for a service. A secondary insurance only pays you for your portion of the bill.
The take home message is that we are still providing excellent care for all of our patients, including those with Medicare and Tricare. I just wanted you to know that my creditors want paid regardless of who’s insurance I take. At some point, without a change in Medicare, I will have to choose. I will either choose “stay in business” or “drop Medicare”. Every clinic is dealing with the same decisions right now.
“Will Congress stop Medicare physician payment cuts?
By Caralyn Davis
Created Mar 1 2010 – 1:56pm
A 21 percent reduction in Medicare Part B physician payments officially takes effect today after the Senate last week failed to follow in the House’s footsteps and approve a measure to provide a temporary 30-day reprieve. However, the Centers for Medicare and Medicaid Services (CMS) anticipates that a deal will be worked out.
Late Friday afternoon, CMS issued an email message saying it would give Congress some wiggle room: “We believe Congress is working to avoid the negative update that will take effect March 1. Consequently, CMS has instructed its contactors to hold claims containing services paid under the MPFS [Medicare Physician Fee Schedule] for the first 10 business days of March.”
Due to the cut in Medicare payments, I will no longer be able to see Medicare patients. This current round of cuts means that I will have to pay out of my pocket to take care of medicare patients. I will be notifying Medicare patients over the next few weeks as to how we will transition, for my existing medicare patients. Since the Medicare rates determine Tricare payments, I will have to limit the number of Tricare patients I see as well.
One cause of fatigue is thyroid gland failure. Thyroid gland failure is relatively common. One in five women will have thyroid failure over their lifetime. Men are about half as likely to have thyroid failure. It is very likely that you know someone with thyroid failure (this is also called Hypothyroidism). The symptoms of thyroid failure are often very vague and have a slow onset. It is not uncommon for me to see someone who has been having symptoms for months to years prior to diagnosing thyroid failure. The most common symptoms are weakness, tiredness, depression, and mild weight gain. Other possible symptoms of thyroid failure are sensitivity to cold, constipation and irregular menstrual periods. As you might notice those symptoms have quite a bit of overlap with other diseases.
So how do know if you have thyroid failure? First, I recommend writing down all the symptoms that you think might be related to thyroid disease. I am only considering thyroid problems in this article. When you speak with your Doctor about your symptoms, he or she will need to consider other possible diagnosis. Historically, it has been helpful to record your morning body temperature for the diagnosis of thyroid disease. Your morning body temperature is affected by thyroid function, but also by many other factors. This is less reliable a diagnostic tool, with many newer blood tests available. When you review the internet for information on testing for thyroid disease, you will notice mention of isolated t3 deficiency. In most of us we make T3, one of the two thyroid hormones released by your gland, from T4. There are rare individuals who do not make enough T3 from T4. This has implications with regard to the diagnosis of thyroid disease. In those individuals who are very symptomatic but have normal screening test for thyroid disease, it is helpful to review their T3 level. Isolated T3 deficiency is quite uncommon, but I do not know the actual incidence of how rare it is.
If you have symptoms of Thyroid disease, please contact your physician with a list of your symptoms. Testing and treatment for thyroid disease is usually easily accomplished.
The Colorado Department of Health is recommending that most people with Influenza “… do not need to be seen by a health care provider…”. They are concerned that when people get out of the house, with they have Flu, they will just spread the disease. They also point out that most people will not have complications from the Flu and may not need any specific treatement. These recommendations are contained in a Press Release entitled, “Flu Patients Encouraged to Call Doctor Before Making a Visit to clinics or Hospital Emergency Rooms.”
At Family Health Center we have another option, Why Call When You Can Click! With our Online Virtual Office Visit, you can have an office visit anytime of day. You will not have to wait through the Phone Tree, or wait for a message to get back to you over the phone. Once you submit your symptoms via the Virtual Office Visit, the Physician will evaluate and provide education and treatment recommendations back to you via a secure email message. You will get a response within a day*, including a faxed prescription if needed.
So I recommend you sign up today for our Online Services at CallFHC.com. Just click on the chart and follow the directions. Once you are signed up you can access the Virtual Online Office Visit, Ask questions of the Staff and even request prescription refills.
You wonder, is this a cold or is the the Flu? What should I do for the Flu? How Long will I be sick from the Flu? Do I need medication, to get better? How long do I need to stay out of School or work?
The symptoms of Influenza include; cough, fever, sore throat, runny nose and muscle achiness. Although most people with seasonal flu will have fever, some people with H1N1 may not have fever. The most common symptom is the achiness. In healthy adults, the muscle achiness is less with H1N1 than seasonal flu. In contrast, the common cold infrequently includes fever or muscle aches. Although not often a helpful diagnostic clue to the physician, it is helpful to know that, you feel more “sick” with the flu than a cold or another respiratory infection.
If you do not have diabetes, asthma, emphysema or other chronic diseases you may not need to be seen or treat influenza. You should stay at home, rest, and keep from becoming dehydrated. You may use tylenol or ibuprofen or naproxen for relief of fever and achiness. Sometimes an antihistamine is useful to slow the nasal drainage. The H1N1 tends resolve in less than a week. The seasonal flu can tak up to 2 weeks to run its course in a healthy child or adult.
There are three ways to avoid influenza. The first, somewhat obvious strategy, is to avoid people who have the flu. The better option is to get vaccinated against influenza. The third is to take a medication if you are exposed to the flu. If you have not been immunized and have asthma, diabetes, heart disease, a rheumatic disease, emyphsema or another chronic illness and are exposed to influenza, you should receive the flu vaccine and begin on a antiflu medication. You would need to see your physician to get the medication. At Family Health Center you may do a tradional office visit or be seen online via the Virtual Office Visit. With the Virtual Office Visit you can be evaluated without having to come to the Office.
The most important consideration this flu season is to keep everyone around you healthy as well. Stay home or keep your children home if sick with flu like illness. Influenza is highly contageous and spreads easily. You may return to work or school one full day after your fever resolves. If you have no fever, then you should stay home until the cough or sneezing is controlled.
Check back tomorrow for more flu related news and tips.
The El Paso County Health Department will close its immunization clinics begining October 7th, 2009. They will be focusing on H1N1 management. This will mean a couple of things. I will continue to be available for comprehensive International Travel Advice and Immunizations. The El Paso County Health Department runs a Travel Clinic, I can fill the gap. Their routine immunzation clinic will also close during this time period. I will continue to provide well child evaluation and immunization. I can also see new patients for their well child and immunization needs. Be sure to refer your friends and family for our services, including seasonal influenza immunization to CallFHC.com.
Currently we are seeing H1N1 increased across Colorado and Colorado Springs. Hand washing is important, but recent evidence is that hand washing is less important compared with not inhaling the virus. Avoid people with a cough and fever. Stay home if you have a cough and fever. Keep your children home if they have cough and fever. If you have symptoms of concern, you may be seen at the clinic, or better yet be seen online, via a Virtual Office Visit. Once you register online, you can submit a virtual office visit easily from your patient portal. I will get back to you within 24 hours with a treatment plan. Sign up at Family Health Center Online Office.
We have known for a long time that Vitamin D deficiency can lead to bone mineral loss. Profound and prolonged Vitamin D deficiency was the cause of Rickets (this was discovered a milenia ago). Across the United States there is at least 25% of us that are vitamin D deficient. In Nursing homes or in other individual that do not get outside often, there are as high as 75% of persons with a deficiency. There is a higher rate of Vitamin D deficiency in Colorado then was previously recognized. Some researchers think that this is a result of our carefulness in protecting against skin cancer. Even low levels of sunscreen block our ability to make vitamin D. Most of us are out in the bright sun less often and using more sun screen. This results in less vitamin D production. It is still improtant to avoid skin cancer, so I do continue to recommend sunscreen.
Vitamin D deficieny is now linked with:
- Increased Pain in patients with Fibromyalgia and other chronic pain syndromes.
- Increased risk of death from heart disease.
- Double the risk of death from any cause.
- Increased fatigue and perhaps a higher risk of depression
- Thin bones and pathologic bone fractures.
- worse asthma symptoms.
- increased frequency of colds in the winter time.
Foods that are rich in Vitamin D include dark fish, Vitamin D fortified milk, egg yolk and Vitamin D fortiefied cereals.
If you are taking calcium with Vitamin D supplement, you still may not be getting enough vitamin D. Vitamin d deficiency can be detected with a simple blood test. This test is called 25-OH-vitamin D level. If you are low, then you need to take 12 weeks of higher dose Vitamin D. You should have your level tested, after the 12 weeks to see if you have corrected, and to decide how much vitamin D you should take regularly.
There are problems with taking too much Vitamin D. However, you would need to take excessive amounts for a very long time to get into problems. As long as you are testing at appropriate intervals, you will not get an overdose of Vitamin D.
If you wish to have your vitamin D levels check, please contact us at Family Health Center. You can do an online office visit at CallFHC .com or call us to make an appointment.
I have a new look to my blog. This page will be my strictly health related weblog.
Since I still think the Federal Government is woefully misguided and may potentially make decsions that will impact your health and destroy our country in a short period of time, I will continue to write my thoughts and recommendations in a blog. You may access my political blog at Dr Roberson Political Medlings.
Uncategorized | Kent Roberson | June 3, 2010 | 
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