My current project, and several that I've worked on before, lie squarely in the middle of this, and the writer is spot on, as I'm sure Doc Steve will attest.
Medicare and Medicaid compensation drag physicians' income down, for which they compensate by over-coding. Some claims or practice management systems have space for up to eight ICDs (diagnoses). Others allow as many as the practice can think up. The CPTs--treatments--are paid based on an allowed amount, which is not the amount that the practice actually bills. The allowed amount in other than Medicare/Medicaid cases are usually a percentage of the Medi/Medi rates.
If you're going to get paid at half rate for doing something, it makes sense to claim you did two things and get your full rate or close to it. If your practice is primarily Medicare/Medicaid you might have to claim you did four or five things to be fairly compensated for one.
All of this managed by interlocking bureaucracies of HMOs, PPOs, utilization managers, case managers, risk managers, and who the hell knows what else managers, plus claims processing. The feds, in the name of economy, try to keep the compensation per CPT down, the docs have to "perform" more procedures to pay for their own increasing overhead and the overhead of the institutions. And there's always political hay to be made when anybody makes a move toward changing the system.
If you just keep squeezing his neck a little harder that goose will lay a few more golden eggs.
#1
KiloBravo an I have been in the HealthCare computer business for almost 25 years. Before that I was a hospital IT consultant specializing in computerized billing. Having that background I read the article with great interest. Jeffrey Singer has highlighted every woe we witnessed in our interaction with our client Physicians.
We cater to solo practices and small groups. Since the passage of ObamaCare we have experienced a rapid drop in customers as they retire or join large groups like Kaiser. There just isn't any significant number of new physicians starting independent practices to replace our losses.
Just one anecdotal case of what independent physicians are facing: We have a solo practice Cardiologist who reads EKGs for a local hospital and other entities. He has charged $35 for over 15 years that he has been our customer. I was recently doing some work with the practice, cleaning up their Receivables. I noticed that when Medicare reimburses him they pay about $7.50 and Medi-Cal, California's version of Medicaid, pays about $1.70 if at all. He has to write off the balance.
In the meantime he has to pay for the clerk that enters the patients info into his system, bills for the charge and possibly follows up on that billing. In addition to the time he spends interpreting the EKG he must dictate and have typed up a report for the Hospital client. Of course he has rent, utilities, payroll, equipment, etc. etc. to pay for at ever increasing amounts.
My suggestion was to discontinue reading the EKGs or if he must don't bother to bill for them, especially to Medi-Cal/Medicaid.
#2
In the meantime he has to pay for the clerk that enters the patients info into his system, bills for the charge and possibly follows up on that billing. In addition to the time he spends interpreting the EKG he must dictate and have typed up a report for the Hospital client. Of course he has rent, utilities, payroll, equipment, etc. etc. to pay for at ever increasing amounts.
This is a Mom & Pop business approach which is simply doomed, even without Obamacare.
Posted by: Rob Crawford ||
04/23/2013 17:01 Comments ||
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#4
KiloBravo grew up in England and is very familiar with where we are heading. You'll wait all day to see a GP and then if you're lucky he will schedule a EKG to take place six weeks from now with the results back six weeks after that.
The last report on England's National Health was that the Government wanted to get the wait time to see a specialist down to an average of 16 weeks. And, beware of the Liverpool Care Pathway.
Read all of this because he nails diversity square.
Back in the Tsarneav homeland, clans fight each other to the death, wiping out entire families to the last child. Here is a brief description of one man's vendetta. "He wanted to kill off all the men in the other family, and he devoted his life to that goal. He would hide someplace where he thought one of his enemies might pass by, staying there for weeks at a time if necessary. In the end, he killed about 20 people."
That should sound familiar to anyone who sat in front of the television watching the aftermath of the Boston bombings. And here's another. "The oral tradition abounds in tales of feuds sparked by the theft of a chicken culminating in the death of an entire Teip." What is a Teip you might ask. A Teip is a Chechen clan. Everyone has one in Chechnya including foreigners. To have a place in the society, you must have a Teip of your own. Otherwise. "This man has neither a Teip nor a Tukkhum."
Where was Tamerlan's Teip in America? Americans don't talk about their Teips. Instead Tamerlan found the same Teip that so many other Pakistanis, Egyptians, Somalis and other Muslim immigrants find when they live in a non-Muslim country. Tamerlan's Teip, like Nidal Hasan's Teip, was Islam.
The Afghan soldiers murdering American soldiers often do it unprompted and sometimes even without any prior planning. They do it because in tribal cultures honor is complicated and murder is casual. Life is cheap, especially the lives of men without teips.
Tamerlan took possession of his Teip. And then he began to kill on behalf of his Teip. You can call it the Clash of Civilizations or a clash of clans. At the Boston Marathon, the Tsarneav brothers began killing the members of the Boston Teip or the American Teip in defense of the honor of the Islamic Teip. We can call this sort of thing terrorism, and it is, but it's also something much more primitive and much less calculated.
The Afghan soldiers murdering American soldiers often do it unprompted and sometimes even without any prior planning. They do it because in tribal cultures honor is complicated and murder is casual. Life is cheap, especially the lives of men without teips.
Americans were under the impression that Tamerlan was a member of Teip America. He wasn't. Teip America is fine for some some natives, but it was much too big for him. It had no shape or purpose. Nothing for him to claim possession of and defend. Teip America gave him everything for free and wouldn't even let him fight to take it. Teip America gave him the good life, but took away his honor.
#1
"Spengler" has written many essays related to this, how Islam offers some kind of immortality to tribes otherwise doomed by the modern world, and how they won't go into nonexistence without causing a big ruckus.
Native Americans once lived like that, although most of them won't admit it. The 1887 book "History of the Ottawas and Chippewas of Michigan", mentions one episode of the near genocide of one Michigan tribe by another. The author admits he was the descendant of a tribe conquered, enslaved & later incorporated into the Ottawas. Then there were the Aztecs, the first tribe to make Mexican food out of real Mexicans. The issue is not so much diversity but barbarism and the failure of modern politically correct people who think they are the "Best and the Brightest" to comprehend what that means.
#1
The FBI does not discuss how it deals with sort of thing, because that would give potential terrorists an edge in avoiding detection.
Terrorists need an "edge" with the FBI ?
In the meantime army commanders have been ordered to pay attention to religious or political activities of their subordinates and sound off if radical or dangerous behavior appears to be in the works. This is a lot to ask from officers who know that some bad publicity not only makes the army look bad but damages career prospects.
Fire 6 or 8 Army generals and everyone else will get the message.
While Nidal Hasan may have been stopped with more aggressive monitoring, not enough is known about what the Tsarnaev brothers were doing while unmonitored and preparing for the terrorist attacks.
Who cares? They continued to be met and we were able to wrote great reports for Main, that's all we asked !
#2
If there is any comfort to be had here it's that all of this once again shows the Left lives in a mythical view of the world. That's important in that if there is ever another civil war, the people on the other side will be operating upon false premises and understanding of their opponents.
If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle
― Sun Tzu, The Art of War
#3
The left is so tied up with how things are said, they actually believe that if we stopped calling it "Islamic Terrorism" the Islamists would stop terrorism.
Just like the Patient Protection and Affordable Care Act...so where is the affordability in that?
Check the names the Democrats put on their legislation, all of these misleading feel good names, how can you be opposed to fluffy bunny protection when the bill only has a few billion for cronyism in it? Quit being so mean to the fluffy bunnies.
Posted by: Bill Clinton ||
04/23/2013 10:35 Comments ||
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#4
This is a reason or good example of why the Islamist Jihad, which is GLOBAL, is EXPANDING.
While Radicalist Mullahs, Preachers, Madrassas, etal. tell loyal Muslims to go ahead + kill or behead the Infidel, + wage violent Jihad, US + WESTERN GOVTS COME ALONG + EFFECTIVELY AGREE WID THEM DESPITE PROCLAIMING CONTRARY INTENTIONS.
Directly or indirectly, the Jihadis - current + future - will interprete pervasive US-Western PCorrectness + Waffle-isms AS DE FACTO WEAKNESS + A SIGN FROM GOD THAT THEIR VIOLENT JIHAD IS CORRECT, RIGHTEOUS, + ABOVE ALL WINNING.
JOHN-WAYNE-VS-NELVILLE-CHAMBERLAIN/JIMMY CARTER.
> Chamberlain's well-intentioned written promise of peace.
> POTUS Carter's well-intentioned attempt to heal the national divisiveness wrought by the Vietnam War vee STRATEGIC, POLITICAL MORALISM which he naively or foolishly thought would result in new rapprochement wid the USSR + Commie Bloc - instead, wwhile the latter were giving their approval to Jimbo's + US' "New MOralism" they mil invaded Afghanistan + rapidly expanded pro-Commie-SOviet recolutionary communist movements worldwide.
#5
iff China does not back down vee Japan + US in NE Asia over disputed ECS islands andor SCS, Radical Islam's Hard Boyz will only become MORE inspired to expand their GLOBAL JIHAD, which IMO is aka GLOBAL MOHAMMEDDAN/ISLAMIC/MUSLIM CONQUEST.
RADICAL ISLAM = POST-1975 NORTH VIETNAMESE OFFICIO = whom, when told how the US won all the battles during in the Vietnam War [post-9-11 GWOT], FAMOUSLY REPLIED "YES, BUT THAT IS IRRELEVANT".
> NORTH VIETNAM = in the end conquered the South.
> RADICAL ISLAM = IN THE END GOT THEIR NUKES?, + OWG ISLAMIST CALIPHATE???
[Dawn] PERHAPS it is a sign of the times that Gen Kayani's ... four star general, current Chief of Army Staff of the Mighty Pak Army. Kayani is the former Director General of ISI... comments at the Pakistain Military Academy in Kakul will attract little meaningful attention or comment.
"Pakistain was created in the name of Islam and Islam can never be taken out of Pakistain ... The Pakistain Army will keep on doing its best towards our common dream for a truly Islamic Theocratic Republic of Pakistain," Gen Kayani said.
In truth, however, both the timing and the content of Gen Kayani's speech ought to be parsed carefully. Given the recent travails of election candidates facing new, and unwarranted, scrutiny of their Islamic credentials and a debate being triggered on the true ideology of Pakistain, the army chief ought to have considered whether weighing in on such matters at this time was the appropriate thing to do or not. The political battle lines have already been drawn, with religious elements and anti-democratic forces beating the drum of an exclusionist version of Pakistain's ideology and trying to make it an election issue. Has Gen Kayani, wittingly or unwittingly, given those religious elements and anti-democratic forces a boost going into next month's election?
The substance too of the comments requires close examination. Who is trying to take Islam out of Pakistain; where is the threat to the public's right to practise their Moslem faith?
In fact, the threat is in the opposite direction: to those of other faiths who are also Pak and some of whom don't even enjoy the theoretical right to practise their faith without fear or intimidation. If Islam is in fact the core of the Pak state, does that mean non-Moslem Paks have no place in this state and society? Even among Moslems, from the early 1950s, the question of which of the many different interpretations of and schools of thought in Islam ought to be given precedence over the rest has been a dangerously divisive ...politicians call things divisive when when the other side sez something they don't like. Their own statements are never divisive, they're principled... issue when the state has seen fit on occasion to tackle it.
More relevantly to Gen Kayani's institution, the exclusive, obsessive even, focus on using Islam to galvanise the armed forces is precisely where the origins of the tragic and disastrous policy of state-sponsored jihad has arisen.
Gen Kayani and the army high command should stick to questions of national security and leave it to the politicians to sort out for whom and why Pakistain was created. The ideology of Pakistain should be an issue for politics, not the armed forces.
Posted by: Fred ||
04/23/2013 00:00 ||
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Link ||
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#1
If Islam is in fact the core of the Pak state, does that mean non-Moslem Paks have no place in this state and society?
But of course! The ideology of Pakistain should be an issue for politics, not the armed forces.
Lots of luck with that, you heretic / apostate / Zionist running dog!
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trees were destroyed in the production of this weblog. We did hurt some, though. Sorry.
[Dawn] PERHAPS it is a sign of the times that Gen 
