Crazy medical office policy on FAA medicals

Jenkins1009 said:
Gary F said:
Can you explain how this is supposed to work? I grew up in the the government's (military) medical system, was also part of the military's medical system as a practicing physician and have extensive experience working in the VA system during my residency. It was not a good experience. Patients could wait months for tests that I can get same day in the civilian system. I often had great difficulty obtaining specialty consults for active duty soldiers in a timely manner. You are badly misinformed if you think that the government can run medicine well.
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"Patients routinely rank the veterans system above the alternatives, according to the American Customer Satisfaction Index." In 2008, the VHA got a satisfaction rating of 85 for inpatient treatment, compared with 77 for private hospitals. In the same report the VHA outpatient care scored 3 points higher than for private hospitals.[3]
"As compared with the Medicare fee-for-service program, the VA performed significantly better on all 11 similar quality indicators for the period from 1997 through 1999. In 2000, the VA outperformed Medicare on 12 of 13 indicators." [4]
A study that compared VHA with commercial managed care systems in their treatment of diabetes patients found that in all seven measures of quality, the VHA provided better care.[5]
A RAND Corporation study in 2004 concluded that the VHA outperforms all other sectors of American health care in 294 measures of quality; Patients from the VHA scored significantly higher for adjusted overall quality, chronic disease care, and preventive care, but not for acute care.[6]
A 2009 Congressional Budget Office report on the VHA found that "the care provided to VHA patients compares favorably with that provided to non-VHA patients in terms of compliance with widely recognized clinical guidelines — particularly those that VHA has emphasized in its internal performance measurement system. Such research is complicated by the fact that most users of VHA’s services receive at least part of their care from outside providers." [2]
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This is it? A survey of patient satisfaction as proof that the government can run medicine? Who commissioned the survey and how did that influence the methods? How was the sampling accomplished? Which VA hospitals were compared to which private hospitals and how were the patients selected and questioned? It would be helpful to know more about the methods behind the survey but even if you take this at face value it is hardly a vindication of government run medicine. VA hospitals that are co-located with university hospitals may provide decent medical care. In these hospitals the VA draws from talent that would not be available at the VA without the university. Another issue is that government heavily influences medical care in private hospitals through Medicare and Medicaid controls that can lead to patient dissatisfaction. Quality is very difficult to measure in medicine. I have extensive experience with both systems and I will take a good private hospital any day.
The justification for government take over of the medical system is that costs are out of control and cannot be sustained much longer. The government's solution is to attempt to coerce physicians to practice in a manner that academics and bureaucrats have decided is efficient. Rationing is an inevitable result. This will lead to many unintended consequences as physicians and patients learn how to game the system. Many of the currently practicing physicians will retire early leading to longer wait times which are common in military medicine as well as countries with socialized medicine. I am amazed how many people put more trust in experts who have never practiced medicine to solve the problems in the system.
 
The OP and several others here have had a bad experience with a physician or a medical practice. A big advantage of the current system is that you can go somewhere else for medical care. In a government run system you often have limited options for choosing your provider. A physician does not need to be an expert in business to know that if you have poor patient satisfaction your practice will not thrive.
 
Jenkins, you're drinking the kool-aid.

The VAH very strongly "teaches to the test". I've worked in both university and VAH settings and I was always shocked that the same person (me) was unable to deliver the care needed in the VAH setting- but across the street was always able to do so.
 
TangoWhiskey said:
He hasn't even called me. :dunno: Maybe Brenda round-filed my number.
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Has his practice been bought out by a hospital? One way to destroy a physician's work ethic is to change from fee for service to salaried employee. This is when you are more likely to see somebody avoiding work or sneaking out a side door at quitting time.
 
Gary F said:
The OP and several others here have had a bad experience with a physician or a medical practice. A big advantage of the current system is that you can go somewhere else for medical care. In a government run system you often have limited options for choosing your provider. A physician does not need to be an expert in business to know that if you have poor patient satisfaction your practice will not thrive.
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You are confusing a single payer system like Great Britain with government run plans that use private providers like much of Europe and Japan. There is no restriction on who you can see or how often you can see them.

From Newsweek 8/16/2010:

In Japan to gauge a health-care system’s success, it’s standard to consider three points: quality, coverage, and cost. On all three measures, Japan stands at or near the top in every comparative ranking.

Quality: The Japanese have the world’s longest life expectancy and the best recovery rates from just about every major disease. Infant mortality is less than half the U.S. rate. Japan usually leads the world in rankings of “avoidable mortality”―its effectiveness in curing diseases that can be cured.

Coverage: Japan’s health-insurance sys-tem covers everybody, including illegal aliens. It pays for physical, mental, dental, and long-term care. The Japanese are the world’s most prodigious consumers of medical care; on average they see the doctor about 15 times per year, three times the U.S. norm. They get twice as many prescriptions per capita and three times as many MRI scans. The average hospital stay is 20 nights―four times the U.S. average.

Cost: And yet Japan produces all that high-quality care at bargain-basement prices. The aging nation spends about $3,500 per person on health care each year; America burns through $7,400 per person and still leaves millions without coverage.


Japan has universal coverage, but it’s not “socialized medicine.” It’s largely a private-sector system. There is government insurance for the unemployed and the elderly, but most people rely on private plans. Japanese doctors are the most capitalist and competitive in the world. But we’re talking Japanese-style free enterprise here; there’s significant government regulation of the private players. Health insurers are required by law to cover everybody, and to pay every claim; the corollary is that everybody is required to buy health insurance. The price for a given treatment is identical everywhere in Japan. Officials say this is designed to attract doctors to rural communities, but that’s not working very well; many small towns on the outer islands have no doctor at all these days.
 
Jenkins1008 said:
You are confusing a single payer system like Great Britain with government run plans that use private providers like much of Europe and Japan. There is no restriction on who you can see or how often you can see them.

From Newsweek 8/16/2010:

In Japan to gauge a health-care system’s success, it’s standard to consider three points: quality, coverage, and cost. On all three measures, Japan stands at or near the top in every comparative ranking.

Quality: The Japanese have the world’s longest life expectancy and the best recovery rates from just about every major disease. Infant mortality is less than half the U.S. rate. Japan usually leads the world in rankings of “avoidable mortality”―its effectiveness in curing diseases that can be cured.

Coverage: Japan’s health-insurance sys-tem covers everybody, including illegal aliens. It pays for physical, mental, dental, and long-term care. The Japanese are the world’s most prodigious consumers of medical care; on average they see the doctor about 15 times per year, three times the U.S. norm. They get twice as many prescriptions per capita and three times as many MRI scans. The average hospital stay is 20 nights―four times the U.S. average.

Cost: And yet Japan produces all that high-quality care at bargain-basement prices. The aging nation spends about $3,500 per person on health care each year; America burns through $7,400 per person and still leaves millions without coverage.


Japan has universal coverage, but it’s not “socialized medicine.” It’s largely a private-sector system. There is government insurance for the unemployed and the elderly, but most people rely on private plans. Japanese doctors are the most capitalist and competitive in the world. But we’re talking Japanese-style free enterprise here; there’s significant government regulation of the private players. Health insurers are required by law to cover everybody, and to pay every claim; the corollary is that everybody is required to buy health insurance. The price for a given treatment is identical everywhere in Japan. Officials say this is designed to attract doctors to rural communities, but that’s not working very well; many small towns on the outer islands have no doctor at all these days.
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Then we could just fine everyone into being skinny!!! :mad2:

http://www.nytimes.com/2008/06/13/world/asia/13fat.html
 
I do not expect to be able to convince you that we are headed for disaster but we are. I have been practicing medicine for about 20 years in various settings and have carefully followed the changes in how hospitals and physicians are reimbursed. Non physician clerks already have the power to deny payment for expensive medical procedures after the fact based on a narrow interpretation of "guidelines". This and other changes are pushing physicians to leave private practice to become salaried employees where the government can exert even more control by manipulating the rules for reimbursing the (hospital) employer. I recently attended a medical staff meeting at my hospital where the new Medicare rules were explained. The future appears bleak. In my opinion most patients will suffer as this new huge government bureaucracy (Obamacare) takes complete control of medicine. Get ready for time-card punching physicians who take orders from bureaucrats who are attempting to fulfill an unrealistic political agenda.
 
Gary F said:
I do not expect to be able to convince you that we are headed for disaster but we are. I have been practicing medicine for about 20 years in various settings and have carefully followed the changes in how hospitals and physicians are reimbursed. Non physician clerks already have the power to deny payment for expensive medical procedures after the fact based on a narrow interpretation of "guidelines". This and other changes are pushing physicians to leave private practice to become salaried employees where the government can exert even more control by manipulating the rules for reimbursing the hospital. I recently attended a medical staff meeting at my hospital where the new Medicare rules were explained. The future appears bleak. In my opinion most patients will suffer as this new huge government bureaucracy (Obamacare) takes complete control of medicine. Get ready for time-card punching physicians who take orders from bureaucrats who are attempting to fulfill an unrealistic political agenda.
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Oh come on Gary, who are you to tell us what is going to happen. Just because you work in the system and see what is happening on a daily basis you can't possible be as smart as those people in Washington who assure us that life will be wonderful and nothing with change.

PS, where is the sarcasm emoticon?
 
Gary F said:
I do not expect to be able to convince you that we are headed for disaster but we are. I have been practicing medicine for about 20 years in various settings and have carefully followed the changes in how hospitals and physicians are reimbursed. Non physician clerks already have the power to deny payment for expensive medical procedures after the fact based on a narrow interpretation of "guidelines". This and other changes are pushing physicians to leave private practice to become salaried employees where the government can exert even more control by manipulating the rules for reimbursing the (hospital) employer. I recently attended a medical staff meeting at my hospital where the new Medicare rules were explained. The future appears bleak. In my opinion most patients will suffer as this new huge government bureaucracy (Obamacare) takes complete control of medicine. Get ready for time-card punching physicians who take orders from bureaucrats who are attempting to fulfill an unrealistic political agenda.
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But, but, but -- there were Doctors in REAL white coats at the White House?!?!?!

hero_doctors.jpg
 
Hey-

Let's keep this out of spin.

Thanks.
 
The United States spends twice as much on health care per capita ($7,129) than any other country . . . and spending continues to increase. In 2005, the national health care expenditures totaled $2 trillion. Source: National Center for Health Statistics

The United States is the only wealthy, industrialized nation that does not have a universal health care system. Source: Institute of Medicine of the National Academy of Sciences

Life expectancy at birth in the US is an average of 78.14 years, which ranks 47th in highest total life expectancy compared to other countries. Source: CIA Factbook (2008)

The United States ranks 43rd in lowest infant mortality rate, down from 12th in 1960 and 21st in 1990. Singapore has the lowest rate with 2.3 deaths per 1000 live births, while the United States has a rate of 6.3 deaths per 1000 live births. Some of the other 42 nations that have a lower infant mortality rate than the US include Hong Kong, Slovenia, and Cuba. Source: CIA Factbook (2008)

Is our system one that doesn't need change?
 
We are getting nowhere fast so I will make my last post on this subject.

Things are not better in socialized medical systems, especially if you get sick. There are plenty of Canadians receiving treatment in U.S. hospitals since the waiting time at home is excessive. Some hospitals in Britain resemble those in a third world country. Don't try to bamboozle me with statistics about infant mortality, what about differences in maternal illegal drug use? There are many other factors determining infant mortality other than the quality of medical care including lack of access to OB/GYN in rural areas after they have been sued out of existence by trial lawyers. Cancer and heart disease outcomes are better here than anywhere else.

I guess you believe that the large majority of physicians who are against the proposed changes in health care are all greedy and unsympathetic for those who are unable to pay for medical care. I donate my services through a local medical care access coalition as do many of my colleagues. I have never even asked someone if they are able to pay. Nobody in this country (as per federal law) is refused essential medical care if you can get to any Emergency Department.

The last thing to consider, do you want the entire medical system to be run by the same type of financial wizards who created the state and municipal pension plans?
 
I just like a system where I receive the care I need, and going in, I'm made aware of the correct price, and departing the facility, I can pay for it and be done. And an opportunity to get preferred pricing if I hand over actual cash cash or a check (aka no costs for processing plastic or insurance claim).

I am just now getting the requests for payment for office visits made last February. Something I offered to pay for right then but was told, "No, we'll bill you."
 
AdamZ said:
As Slpike said keep this out of Spin!. Please
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Sorry. I did not understand the jargon. I assume you mean that the controversial topic that resulted from thread drift should be moved to The Spin Zone. I just discovered The Spin Zone and the reason for it's existence.
 
Gary F said:
Sorry. I did not understand the jargon. I assume you mean that the controversial topic that resulted from thread drift should be moved to The Spin Zone. I just discovered The Spin Zone and the reason for it's existence.
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...then you can see a clear example of how a topic can get its way there! :hairraise:

I, myself, am biting my tongue here, as there's much to say, but most such responses are squarely in the spin-zone, and I don't roll that way.
 
"Patients routinely rank the veterans system above the alternatives, according to the American Customer Satisfaction Index."
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Who you gonna believe, the guy who has actually worked there and seen it from the inside, or the folks whose job it is to make the system look good?
 
Jenkins1009 said:
Is our system one that doesn't need change?
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Of course.

But THIS change is worse than none at all.

Life expectancy and infant mortality statistics are very misleading, because of the different ways different countries accumulate the data. For example, some countries don't count a "live birth" unless the baby lives for a week. And life expectancy is affected by a lot more than just health care. Accident rates, diet, obesity..etc.

But it sounds like you already have your mind made up and don't want to be confused by facts.
 
Gary F said:
The last thing to consider, do you want the entire medical system to be run by the same type of financial wizards who created the state and municipal pension plans?
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Yeah, what we need is the same people running the DMV and the TSA to run health care. That'll fix it.

I'm done with this thread.
 
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