MEMORANDUM

RECD Castle Gormogon

IN RE Order [redacted] from Confucius, Œc. Vol., commanding Dr. J to report on what it’s like to be spied upon by someone other than Gs

UNCLASSIFIED
TO BE READ ALOUD TO GP
POST ON BLOG

Dear ŒV,

Per your prodding, I offer commentary on the following article, that was picked up by Byron York, and here where you picked it up. Dr. J. noticed it somewhere a few weeks ago, maybe here, or via a link from Drudge.

Basically, the Sebelius wing of the Obama Administration is going to use mystery shoppers to determine the ability of Medicare and Medicaid patients (i.e., people whose healthcare is paid for with yours and Dr. J.’s taxes) to get into the offices of primary-care doctors who accept patients with Medicare and Medicaid.

The mystery shoppers will try to make appointments as a privately-insured individual, an individual on gov’mint dole insurance (a/k/a the big MM), and then HHS will follow up with a call asking if the office accepts private, Medicare/Medicaid, and ‘self pay’ patients and look for discrepancies. There is no word regarding consequences for discrepancies.

The reason for this is that in the eyes of the government, either you DO or you DON’T take medicare/medicaid patients. If you don’t accept new Medicare/Medicaid patients, you can’t be reimbursed for established patients either.

Doctors, especially doctors who work in solo or small group practices, can only see a fixed percentage of Medicare/Medicaid patients because reimbursement is both smaller and less likely to occur compared to payment from patients who have private insurance. This is called a payor mix. For example if Dr. Jones gets $150/visit with an insured patient and $100/visit with a Medicare patient, and he sees 40 patients a day, his revenue stream ranges from $4,000-6,000. If he needs to clear $5,000 a day to keep the office open, he probably needs to see at least 25 insured patients and no more than 15 medicare/medicaid patients to do so. Dr. J. who works in a not-for-profit Ivory Tower within a multispecialty group of well over 1,000 doctors probably would need to generate $3,000-4,000 a day to help keep the lights on and make a living.

Doctors with full panels of patients tread a fine line where they say they accept new patients, and maintaining a payor mix that will allow them to keep their doors open.

Now, there is a reason to be concerned. This is yet another example of the Trojan Horse rearing it’s ugly horsey head in Obamaland. The goal, as Dr. J. as stated a gazillion times, is to cause private medicine to collapse under the weight of regulation resulting in the masses to beg for government-run healthcare. It is well established that President Obama dislikes doctors. He sees us as performing unnecessary procedures for profit. Recall him suggesting that Granny get a blue pill instead of a pacemaker (especially when there is no blue pill for sick sinus syndrome, or heart block, or whatever granny’s pacemaker indication was) independent of the fact that granny might be 70 with relatives that have ALL lived into their 90s, and that we take tonsils ‘for a sore throat.’ I suspect he’s jealous because in addition to having a sweet ride, and getting the ladies, we also have the esteem of the community because we do something worthwhile to earn our keep, while he’s spent his days as a politician, an ‘organizer,’ and as a lawyer, all of which which as we all know require lapses of ethical judgement.

Dr. J. digresses. Tevi Troy at the Corner nails it…this sort of thing discourages the solo or small group practitioner. Indeed, all around New Atlantis and the surrounding communities, private practices are being bought up by hospitals (who, truth be told, are one of the winners in Obamacare legislation). We are being nudged, as Cass Sunstein likes say, into doing what the government wants us to do.

This is the price of allowing government to become a major player in healthcare (which it did in 1965 with the creation of Medicare and Medicaid). The consumer relationship the patient had with the doctor has been short-circuited.

Primary-care doctors already do not get paid enough for their services. Making their lives worse will certainly further discourage folks from going into primary care. Medical students are choosing specialties with better reimbursement (surgery) or better lifestyle aspects (radiology or emergency medicine, for example). The primary-care shortage is FAR from over. The progressive solutions include paying for medical school and not paying residents (who make ≈$45K starting) to discourage them from spending too much time training for jobs that are too-well remunerated. Of course, of the authors of that article, Dr. Bach is a CMMS advisor AND firmly ensconced in an Ivory Tower flush with cash-paying patients (Memorial Sloan Kettering), and it is not clear if Dr. Kocher even sees patients anymore. A solution such as this would be disastrous for the future of medicine. A shortage of specialists isn’t bad while you are healthy, but when it’s 2AM and you need that angioplasty…you have been warned.

Warmest Regards,

Dr. J.
Royal Surgeon of the Gormogons

Confucius, Œc. Vol.

Don’t ask impertinent questions like that jackass Adept Lu.