I do appreciate that Louise and Pam thought I could give a reasonable answer to their questions over the Internet. It certainly is a new form of consultation to me… but I may have to take it up permanently for the following reasons. Below is a copy of a LTE in our Local newspaper today, and my response. Both of which were forwarded to Rep. Herger.

I am going to change all the names to protect the innocent…I will not change the name of the guilty, Congressman Wally Herger.

I could add reams to this, but will say that for me the primary reason I am unable to make a living here in the US as a primary care physician is that I refuse to follow the 10-minute per patient rule of most HMO’s. Many of my patients take up to 10 minutes just to walk into the room! I do have walker/wheelchair access in hallway, all exam rooms and bathroom and need it!. That was a special cost of my office startup, and is not recoverable by any fee.  Many of my patients no longer drive well and no longer think very well, so a family member comes along on the visit. Many of them need to take a day or half day off of work to do so.

I cannot in good conscious tell them that I will only address one problem in 10 minutes or at most 2-3 problems in 20 minuntes, that they must return for other problems.That is the maximum time I am allowed to charge under Medicare. Many are on multiple medications with multiple interactions, multiple pharmacy plans for obtaining, multiple side effects.  Go ahead addres that in 10 minutes, especially if the patient can't hear very well.

Many have a list of problems that require evaluation and attempts at counseling for treatment, and involve a combination of the above, evaluation of home safety, diet, other health related habits and practices,  plus teaching good body mechanics, back and neck exercises, et. I am good at diagnosing and treating back problems, better than many physical therapists who I have actually taught my exercises. Can I get paid for this? Absolutely not…it is a freebie.

So I often need 30-40 mintues with each family, remember that above, so we have multiple-sided  discussions too! But I have never in good conscious been able to treat my paptients in any other way. I believe many of these problems apply to the doctor who wrote the first letter below. I do not expect mine to be placed in the paper, but I am now seriously considering mailing a copy of this to all my patients. I have sent them to Rep. Herger.

Here is a copy of my email to Rep. Herger.

 

Dear Congressman Herger;

In case you missed it, here is a copy of a letter to the editor from todays Paper with my response following.

Letter: Medicare patients may suffer

Article Launched: 07/02/2008 12:00:00 AM PDT

On the basis of an inherently flawed financial formula adopted by Congress many years ago as to how Medicare payments to health care providers are adjusted, on July 1, there was a planned 10.8 percent cut in Medicare physician payment services.

Many physicians in Our County already are declining to see Medicare patients because the current fee schedule is inadequate to meet overhead expenses. This 10.8 percent cut would make caring for Medicare patients unsustainable for many, if not most of us.

On June 24, the House of Representatives overwhelmingly passed Bill HR 6331 which would avert this devastating cut in reimbursement for 18 months, in which time Congress will readdress the basic formula. The bill is now in the hands of the Senate. The House vote was 355-59 in favor of passage of the bill.

Wally Herger was one of six California congressmen who voted against passage of the bill. If the bill fails in the Senate, I suggest that our seniors seeking unavailable health care go to Herger’s Chico office for their medical needs, no appointment necessary.

– Dr. **

Here is my response.

To The Editor:

I was delayed writing this because I appreciated the piece called LEARN TO THINK REPUBLICAN and was emailing it to everyone politically connected that I knew. (including the Blend, you can find it in two threads, the LCR one and another McCain one I think.)

Well, that’s what I get for reading the LTE’s down the left side … then up the right! I hadn’t read Dr. **’s letter yet!  He wrote a great piece, and like most of us physicians, would not have gone politically public unless someone harmed his patients. And I also feel I must speak out.

Medicare already will only pay for a recipient  to receive ‘sick services’ not for wellness care at all. (and now will pay 11% less for them)  Most of Dr. ** are ill. He is one of our ANGELIC oncologists. And one of the most hard-working and intelligent  physicians I have ever met!  Mine are not all ill luckily I work hard at keeping them healthy. I am an Internist, a Primary Care physician.  But I must ‘make up’ illness codes for all my medicare patients on their wellness visits or I will not get paid a dime!

One of our best family practitioners, just closed his practice as he could not meet his overhead and make a living. I presume that may have been because he is a male and must have a female with him in the room when he examines female patients. Being a woman I do not, so I only have the one employee now, my nurse/receptionist.  Even then my practice has actually long been more of just a ‘hobby’. I make less than my nurse some months. I have absolutely counseled my daughter, who has just applied to medical school, to NEVER consider being a Primary Care physician in the US.

In Arizona so few doctors see Medicare patients you may have to make 300 phone calls to find one. I have a retired University of Arizona employee who had just turned 65 and wanted to move back to help in family care there. But she COULD NOT find  a physician, period, even of any of the 10 SHE HAD PREVIOUSLY SEEN!  Other patients wanted to move to Santa Rosa, CA but NO primary care doctors there take medicare. They are all ’boutique’ doctors, eg you pay membership and flat annual fee to see them. They take NO Health Insurance payments at all for people over 65! 

Dr ** has a great idea.  All who call me now looking for a new physician we will refer directly to Mr. Herger’s office. Good luck on your reelection Mr. Herger.

This along with Dr. **s letter, will be prominently posted in my office and exam rooms.  Medicare patients deserve caring physicians. Mr. Herger’s ilk are forcing us out of practice.

CC: Dr **, Representative Wally Herger.

This may be more than any of you wanted to know about medical care in the US today, but it is the part I am very familiar with. I could go into a lot more but will just conclude that both the FP doctor and myself belong to the PNHP, Physicians for a National Health Plan, feeling the 30-40% of all medical care costs that go to pay for the care and feeding of the health insurance industry would be better spent….. on health care. Imagine that!