Treated differently by Doc now that I have Medicare?
10-15-18, 04:42 PM
#26
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Firearms in the house are a serious risk factor for child injury or death, suicide and/or domestic violence. Telling your doctor you have firearms in the house should lead to a deeper assessment of issues like whether children know where your guns are kept, depression and anger management, and suggestions of how to mitigate those risks. Counseling, medication, storing weapons in a gun safe separately from the ammunition, etc. are all possible interventions that would not impinge on your right to own firearms.
10-15-18, 05:21 PM
#27
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Firearms in the house are a serious risk factor for child injury or death, suicide and/or domestic violence. Telling your doctor you have firearms in the house should lead to a deeper assessment of issues like whether children know where your guns are kept, depression and anger management, and suggestions of how to mitigate those risks. Counseling, medication, storing weapons in a gun safe separately from the ammunition, etc. are all possible interventions that would not impinge on your right to own firearms.
10-15-18, 06:34 PM
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But how would they know if they don't ask? Perhaps the question was on your questionnaire because of a concern the physician had from other information they've heard?
And keep in mind we are not the best judges of our own mental or emotional state. Physicians are training in eliciting and interpreting such data.
What's the harm in sharing such information with your physician to get a trusted independent assessment of your home's firearms safety?
And keep in mind we are not the best judges of our own mental or emotional state. Physicians are training in eliciting and interpreting such data.
What's the harm in sharing such information with your physician to get a trusted independent assessment of your home's firearms safety?
10-16-18, 08:08 AM
#29
Full Member
But how would they know if they don't ask? Perhaps the question was on your questionnaire because of a concern the physician had from other information they've heard?
And keep in mind we are not the best judges of our own mental or emotional state. Physicians are training in eliciting and interpreting such data.
What's the harm in sharing such information with your physician to get a trusted independent assessment of your home's firearms safety?
And keep in mind we are not the best judges of our own mental or emotional state. Physicians are training in eliciting and interpreting such data.
What's the harm in sharing such information with your physician to get a trusted independent assessment of your home's firearms safety?
11-02-18, 08:32 PM
#30
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As medicare does not pay for physicals, only a welcome and annual wellness visit, some doctors will only stick to these. The practice my doctor belongs to has decided to eat the coat of a full physical as the doctors feel that this is best for us at our age.
11-06-18, 03:22 PM
#31
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I became Medicare primary last July. I had a total knee replacement in Sept and I did notice a difference from the level of care I received from the hip replacement I had a few years ago. Not so much from the surgeon, I had the same doc. for both procedures, but the hospital itself. I wanted to get a second opinion from another Surgeon and was told that he did not accept medicare at all.
When I had the hip replacement I went to an inpatient rehab after I left the hospital. I had intentions of doing the same thing after the knee but I found out medicare wouldn't cover it since it was a single joint replacement and I didn't meet other criteria such as being over 85 yrs of age or a BMI of over 35. I guess it pays to be a big fat load.
I'll be going for my first annual checkup since becoming medicare primary so I'll be curious to see if I receive different treatment.
In reality the whole health care system has suffered in recent years. I think Dr John Mandrola summed it up here.
Dr John M
--------------------------------------------------------------------------------
A Corrosive Force in Medical Care
Posted: 17 Oct 2017 04:58 AM PDT
It comes in a large white envelope each month. It’s marked confidential.
When I hold it up to the light, I can see through the envelope. I can’t see the details, but the colored graphs give it away.
It’s my monthly productivity report. Most employed doctors get these graphs.
These “dashboards” of value include your own productivity as well as many graphs on how you stack up with other doctors across the country. It shows your employer if you are a hard worker.
The measure of productivity we use is called the relative value unit or RVU.
Doing an ablation, cath, stent or valve replacement earns a bunch of RVUs.
Listening to patients, examining patients, counseling patients, hugging patients earns very few RVUs.
Doing important research, teaching colleagues, and reading the medical evidence earns zero RVUs.
Too often, in too many medical systems, RVUs have become the primary unit of success.
No, you can’t be a mean and nasty doctor. And no, you can’t be a totally unskilled doctor who has too many complications.
But short of those extremes, if you make few waves, have good templates on your electronic health record so documentation is complete, and do tons of procedures, you are valuable.
If, on the other hand, you like slow conservative medicine, or narrative notes rather than templates, or worse, if you are thoughtful and frank about silly policies, you become an outlier. If you do these things, your RVU tally usually does not reach the 75% of standard. Then trouble can come to you.
These trends are not so problematic for people close to the end of their career.
What’s really scary, though, is that this is the milieu in which a younger generation is learning the craft. I was shocked to learn that a major teaching center (will remain nameless) has its teaching faculty on 100% productivity compensation. Imagine that. Teachers of young people whose paychecks are determined by how many RVUs they generate.
This, my friends, is happening in many of the places you go to get health care.
It’s why I tweeted this yesterday.
I'm concerned about the practice of Medicine. "Productivity" is slowly but surely extracting care from healthcare. It's bad. Really bad.
— John Mandrola, MD (@drjohnm) October 16, 2017
Productivity and the RVU has no place in medical care. There needs to be a different system of valuing the care of people with disease.
JMM
Related posts:
Struggling with the (relative) value of humanistic medical care —
Measuring quality of medical care. How can a consumer know?
People are not units — US healthcare policy obstructs good doctoring
When I had the hip replacement I went to an inpatient rehab after I left the hospital. I had intentions of doing the same thing after the knee but I found out medicare wouldn't cover it since it was a single joint replacement and I didn't meet other criteria such as being over 85 yrs of age or a BMI of over 35. I guess it pays to be a big fat load.
I'll be going for my first annual checkup since becoming medicare primary so I'll be curious to see if I receive different treatment.
In reality the whole health care system has suffered in recent years. I think Dr John Mandrola summed it up here.
Dr John M
--------------------------------------------------------------------------------
A Corrosive Force in Medical Care
Posted: 17 Oct 2017 04:58 AM PDT
It comes in a large white envelope each month. It’s marked confidential.
When I hold it up to the light, I can see through the envelope. I can’t see the details, but the colored graphs give it away.
It’s my monthly productivity report. Most employed doctors get these graphs.
These “dashboards” of value include your own productivity as well as many graphs on how you stack up with other doctors across the country. It shows your employer if you are a hard worker.
The measure of productivity we use is called the relative value unit or RVU.
Doing an ablation, cath, stent or valve replacement earns a bunch of RVUs.
Listening to patients, examining patients, counseling patients, hugging patients earns very few RVUs.
Doing important research, teaching colleagues, and reading the medical evidence earns zero RVUs.
Too often, in too many medical systems, RVUs have become the primary unit of success.
No, you can’t be a mean and nasty doctor. And no, you can’t be a totally unskilled doctor who has too many complications.
But short of those extremes, if you make few waves, have good templates on your electronic health record so documentation is complete, and do tons of procedures, you are valuable.
If, on the other hand, you like slow conservative medicine, or narrative notes rather than templates, or worse, if you are thoughtful and frank about silly policies, you become an outlier. If you do these things, your RVU tally usually does not reach the 75% of standard. Then trouble can come to you.
These trends are not so problematic for people close to the end of their career.
What’s really scary, though, is that this is the milieu in which a younger generation is learning the craft. I was shocked to learn that a major teaching center (will remain nameless) has its teaching faculty on 100% productivity compensation. Imagine that. Teachers of young people whose paychecks are determined by how many RVUs they generate.
This, my friends, is happening in many of the places you go to get health care.
It’s why I tweeted this yesterday.
I'm concerned about the practice of Medicine. "Productivity" is slowly but surely extracting care from healthcare. It's bad. Really bad.
— John Mandrola, MD (@drjohnm) October 16, 2017
Productivity and the RVU has no place in medical care. There needs to be a different system of valuing the care of people with disease.
JMM
Related posts:
Struggling with the (relative) value of humanistic medical care —
Measuring quality of medical care. How can a consumer know?
People are not units — US healthcare policy obstructs good doctoring
The source of funding shouldn't affect patient care a lot. I mean, it does because it may limit diagnostics or hospitalizations or medical management. But it shouldn't affect the office visit itself.
Ponder for a moment: what could have been eating at the doctor? His wife filing for divorce (happens here all the time)? A child died of an overdose of opioids (happened here to one of our staff members)? A child was found guilty of murder and given life without parole (also happened here)? His dog got run over yesterday? He spent all damn night in the hospital and he's a bit tired and cranky? He threw his back out and it hurts like hell (me over the last week)? Administrators lectured him about productivity not being high enough (absolutely happens here. So I'm told)? You just diagnosed cancer in a good friend? And your chief of staff just told you not to complain about anything because you make so much money?
It's not that mysterious, you know.
__________________
Momento mori, amor fati.
Momento mori, amor fati.
11-12-18, 03:54 PM
#32
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My sister just had a knee replacement and her surgeon recommended in-patient PT. Medicare paid for it for a few days.
