Anesthesiologist

[mforce00]

I will be seeing an anesthesiologist next week for pain control and I'm not sure what to expect. Has anyone here tried seeing an anesthesiologist and how was your experience? What procedures did you have done?

[Kathi49]

mforce,

My spinal pain management doctor is an anesthesiologist. And he is a "gem"! :) I have said it before on other posts but he is quick, efficient and most of all compassionate. I have had trigger point injections, facet injections, selective nerve root injections and just recently a lumbar facet rhizotomy. I can only recall maybe two times where the injections were pretty painful but that was because I was badly inflamed. Others may come along and have a different viewpoint. But I just love my doc! :)

[Lea]

My PM is an anesthesiologist. Many are. Mine is a Spinal Interventionalist as well. He's tops!!

[Bobbi]

My pain management doctor is also an Anesthesiologist. I think that that is more common than not :).

[mforce00]

When I was calling places, the pain management docs just seemed to be regular docs. There were only 2 anesthestiology places in my area, versus like 10 pain doc places.

[suede]

I have to say that for my experience most PM Dr's are anesthesiologist.
Linda

[hoops2u]

My PM also can do anesthesiology, and does, but the best PM/anesthesiologist I had was the one honest enough to tell me that every time I had an injection/block in the spine, I was actualy adding to the scar tissue which is a major contributor in chronic pain with back surgery patients.

I had had several series of blocks including facet, can't remember what the others were called, none worked and one was particularly painful for about two weeks. So, after i understood the aftermath, and the fact they didn't help me much, I quit having them.

Good news is that for the people they help, they really help. I was in recovery with a lady who swore by them and had a series of three twoce a year.

Good Luck.
hoops

[sunshiney_dayz]

Mine is one as well and I LOVE him !!! My hero !!!

[Bobbi]

I don't know if anyone answered your questions about what procedures an anesthesiologist/PM doc has performed (for us/each person whom has a PM who is also an anesthesiologist).

I've had multi-level, bilateral ESIs and RFs (C, T, and L spine -and SI joints). Each turned out very well for me in terms of pain relief. Some of the procedures encompassed my facet joints - degenerating.

Though the effects were very beneficial, there are some drawbacks, such as weight gain and making my adrenal glands go a bit haywire at times. (Too, my monthly cycle has been "off" at times, and that's also not a wanted or desired effect).

Would I have the procedures again? Yes, but, for me, not at this time. I just want my body getting back to its place where it was before the worst of my spinal probs. and procedures commenced.

I've had to buy a new wardrobe (not an inexpensive feat) and go through weeks of bleeding.

There was a boo-boo a couple times; the tip of a needle "appeared" (by imaging) to snap and left an "artifact" and, during one of the procedures, some of the numby/numbing stuff got into the epidural space. Did I mind that I couldn't feel my legs at all and had to wait a few hours after recovery in order to return home? Nope. It was the first time in several months that I was pain free in my hips and legs. The doc was totally honest about what had happened, and I had/have no prob. with that. It was nice just not to feel any pain for a bit of time :).

I'm not making light of anything; I just enjoyed the pain-free time while it lasted.

[BrokenBladder]

my mother went to a Pm doctor who was also an anesthesiologist and he did trigger point injections on her. I remember that she hated having it done but it did give her some temporary relief.
It won't hurt to go and see the good doctor, but just make sure to ask plenty of questions and most important.....follow you gut instint.

[lobelsteve]

My PM also can do anesthesiology, and does, but the best PM/anesthesiologist I had was the one honest enough to tell me that every time I had an injection/block in the spine, I was actualy adding to the scar tissue which is a major contributor in chronic pain with back surgery patients.

hoops

This is far from what I call the "best". This information is totally unfounded and iiresponsible. For a doctor to say that- he had no clue what he was talking about. The only literature on creating scar tissue durign an injection type of procedure would be from the older injections during myelogams. The older contrast would cause arachnoiditis. Also, chymopapain could have caused scar tissue formation as it was dissolving disc tissue- but it was more known for its anaphylactic reactions.

A needle into the epidural space injecting, Omnipaque or Isovue, Lidocaine or Marcaine, Celestone, Kenalog, or Betamethasone, and normal saline- will not create scar tissue.

None of these will dissolve current scar tissue either.

Hypertonic saline and Hyaluronic acid (Wydase) may be helpful in softening scar tissue. Otherwise I would not perform target catheter adhesiolyis for epidural fibrosis in post-laminectomy syndrome patients. The use of a Racz catheter and hypertonic saline, though advocated by many aneshtesiologists, only works in studies performed by Dr. Racz himself. He sells catheters. The doctors still get paid for performing an adhesiolysis, but they are unlikely to be anywhere near the actual scar tissue.

[sunshiney_dayz]

I had one( of many) of those steroid injections and the next day thought my head was going to explode. Every time I stood up my head hurt SOOOOOOOOOOOOOOO bad....I went back in ( this was to a doc who was suppoed to be a pro at this) and had to get a blood batch...It was really weird.....I was told that it caused my brain to sit on my skull and that was what the pain was....because of fluid leakage....Not fun...Needless to say I was a tad gun shy when I went for another

[Jo6]

I'll just say, Me Too! I thought most were .

I am in mega pain this morning, but not because of a bad Dr. Nothing can make the pain go away, just not so bad at times. Jo

[oh_snap]

This is far from what I call the "best". This information is totally unfounded and iiresponsible. For a doctor to say that- he had no clue what he was talking about. The only literature on creating scar tissue durign an injection type of procedure would be from the older injections during myelogams. The older contrast would cause arachnoiditis. Also, chymopapain could have caused scar tissue formation as it was dissolving disc tissue- but it was more known for its anaphylactic reactions.

A needle into the epidural space injecting, Omnipaque or Isovue, Lidocaine or Marcaine, Celestone, Kenalog, or Betamethasone, and normal saline- will not create scar tissue.

None of these will dissolve current scar tissue either.

Hypertonic saline and Hyaluronic acid (Wydase) may be helpful in softening scar tissue. Otherwise I would not perform target catheter adhesiolyis for epidural fibrosis in post-laminectomy syndrome patients. The use of a Racz catheter and hypertonic saline, though advocated by many aneshtesiologists, only works in studies performed by Dr. Racz himself. He sells catheters. The doctors still get paid for performing an adhesiolysis, but they are unlikely to be anywhere near the actual scar tissue.

Doc, thanks for posting this. Over the years, so many things have been posted about ESIs, etc, that may or may not be medically correct.

Many have been helped by having ESIs, avoiding surgery or other more invasive procedures altogether. ESI posts here and on the SD forum will show that they work for some, have troublesome side effects for others, and for some, perhaps due to the ability of the doc performing, are absolutely non-beneficial.

I would assume that to call yourself an intervential pain management specialist that one would be credentialled in "intervential pain management"? (seems pretty clear cut).

What other things should a patient look at when considering a doctor for doing interventional pain procedures, ie, ESIs, SCSs, pumps, etc. I understand that neurosurgeons like to do the SCS too, and that there may be some overlap.

[lobelsteve]

Doc, thanks for posting this. Over the years, so many things have been posted about ESIs, etc, that may or may not be medically correct.

Many have been helped by having ESIs, avoiding surgery or other more invasive procedures altogether. ESI posts here and on the SD forum will show that they work for some, have troublesome side effects for others, and for some, perhaps due to the ability of the doc performing, are absolutely non-beneficial.

I would assume that to call yourself an intervential pain management specialist that one would be credentialled in "intervential pain management"? (seems pretty clear cut).

What other things should a patient look at when considering a doctor for doing interventional pain procedures, ie, ESIs, SCSs, pumps, etc. I understand that neurosurgeons like to do the SCS too, and that there may be some overlap.

Training is everything. Board certification from the ABMS member boards is important. I'd stop by before an appointment and look around the waiting room. If the patients look like you, it is a good fit. If they look like "socio-economically deprived hooligans", find a new doctor.

[krashleen]

Mine is ABMS member/certified and I love him. I have been his patient for going on four years.
He does all my injections, when/if I need them.

Patient, kind and compassionate. Truly a gem.

[lobelsteve]

Mine is ABMS member/certified and I love him. I have been his patient for going on four years.
He does all my injections, when/if I need them.

Patient, kind and compassionate. Truly a gem.

I hate kind and compassionate.:D
I'd rather be mean like House. Patients do not seem to like that though.

[Kathi49]

I just checked and my PM is ABMS/certified as well. :)

I had to laugh at the "hooligan" description though. It is just the opposite where I go (a spine group). Yes, they might be sitting with stiff necks and bad backs, etc., but no hooligans that I can see. :) Or I should say not socio-economically deprived.

And I am laughing at being mean and I really shouldn't be. I had a PM once, actually a Resident, that was pretty darn mean or arrogant I should say. The Director himself was great so I usually asked for him to do the injections. I definitely didn't want the other guy! :eek: I know, I know Residents have to train but I sure as heck didn't like being the guinea pig. It was pure torture. But, back then I was simply referred to them and didn't know the place I go to now existed.

But, again I will say, my current PM is great! And, honestly, I think compassion goes a long way. Sure, he cuts up with me and that sort of thing but when it comes down to the wire and he is doing an injection or a procedure, he is so kind. And it doesn't hurt to know he can relate to spinal pain as he has had a two level cervical fusion himself.

[Kira]

My PM doc is not an anesthesiologist. She is Physical Medicine and Rehab (also known as physiatry... no, not psychiatry :rolleyes: but physiatry). The other docs at my pain clinic are mostly neurologists, I think.

I don't have spinal problems, though, so I don't get all of the procedures that these guys are talking about. But I believe that my doc does do those kinds of procedures for other patients.

I really like this doc, and I got lucky because she was the first PM doc I went to.

Now, with neuromuscular docs, I had to switch twice before I found one I like and who knows what he is talking about, but that's another story for another day...

[Bobbi]

Kira, I wish that I knew nothing about the procedures; it would mean, I don't have spinal problems. Ohhh, how much so I wish that I didn't :). When I was not aware of where life would take me and my spine... that state of mind was blissful :).

Between surgery and procedures? I think it comes down to personal choice at times. By that I mean, surgery isn't always an option, but... with health care professionals monitoring, I've been afforded the luxury of time until I hear the words: "It's time."

It is good to have doctors whom are skilled, ain't it :). At times I think of when mine announce the word "retire." I dread those days :(. My ENT retired, and that felt like a huge loss. He was such a good doctor.

[Jo6]

Bobbi, you are good with this Dr. thingy,eh? :D

The "retire" word doesn't bother me,but the words "it is time" makes me want to have a nervous breakdown!!

kind and compasionate is not a must for me so I guess me and old Doc Lobel would get along. I'm having a heck of a time with my Drs., they keep dying off, retiring, or get so rich they don't have to work etc!

Then comes "the hunt"! not much to choose from, they are to old or 22 and just got out of med. school and just barely old enough to drink.

My PM Dr. is an Anesthesiologist, not sure why most of them are. When I need something, he is there. Does his work, makes sure I'm ok and then he is gone.

Now if he don't up and die on me I just may live longer than him. Nice thought, he is not young nor old :p Jo

[lobelsteve]

I'm having a heck of a time with my Drs., they keep dying off, retiring, or get so rich they don't have to work etc!


:D :D :D :D :) :D :D :D :D

I am 1.1 million dollars in debt. Just under a third is my student loans, 1/3 each are my two mortgages. One house is selling in 2 weeks and then I can finally be a negative millionaire no longer.

[mforce00]

How can a doctor be that much in debt? Something else must be at play here. Med school is only $120k, and regular college can vary, but still that debt is excessive. How many days do you work a week and how long have you been practicing for?

[Bobbi]

Jo, that'd be tough... having a doctor die. Between that and retiring, I prefer to hear that mine are retiring. Either option sucks!

As long as my doctors have drivers' licenses or are old enough to vote, that'll work for me :D.

I did have a neurologist and when she told me that she wanted to inject botox in my butt (SI Joints), and I had never heard of that being done before, I just wondered: Does it have laugh lines or something? or is my head in my a$$? After learning that the cost of the botox was highly inflated (by her), and that she had just opened a "side" business called something about the "fountain of youth" well, the search was on for a different neurologist.

Finding a new doctor isn't easy, is it?


Dr. Lobel: Are you planning to celebrate your upcoming ... less indebtedness? :D

[krashleen]

How can a doctor be that much in debt? Something else must be at play here. Med school is only $120k, and regular college can vary, but still that debt is excessive. How many days do you work a week and how long have you been practicing for?
Is this our business?

Dr Lobel is on here answering questions, and taking time. I was brought up to not ask questions about finances.
Sorry just my thoughts. Don't mean to call you out on this, and please do not take offense.

[lobelsteve]

Is this our business?

Dr Lobel is on here answering questions, and taking time. I was brought up to not ask questions about finances.
Sorry just my thoughts. Don't mean to call you out on this, and please do not take offense.

Med school only $120k?

My undergraduate studies ran 24k per year, medschool was $50k per year.
Mom and dad are not rich so I maxed out my Staffords, Perkins, and gtot private loans called IHELP's.

My dear Aunt SallieMae /:10 day payoff amount: $260,940.74
Graduated Emory Pain Medicine Fellowship June 2005 after EVMS PM&R Residency 2001-2004.

I'm hoping for identity theft- would that person then get stuck with my loan payments?;)

I went into it for the money.....well not yet apparently.

[Bobbi]

This is rich:

I'm hoping for identity theft- would that person then get stuck with my loan payments?

I've gotta remember that line; it's too good not to gently borrow :cool:.

[Kira]

Med school is NOT only $120,000. I came out with $240,000 of debt. Granted, it took my five years instead of four (due to 17 hospitalizations in 2 years), but still... and that is not counting the money I had to borrow from my parents (who are broke) and the credit card debt I developed.

With interest, the $178,000 of loans I consolidated into one chunk will end up being closer to $330,000 by the time I have paid them back. I don't know about how much the rest of my loans will end up being, but it will be substantially more than the original amount borrowed.

I was fortunate enough to have a scholarship that paid for most of undergrad, but many people have sizeable undergrad debt as well when they start med school.

I am now in a graduate program (Master's of Public Health) because I am not healthy enough to do a residency right now. I would be racking up more debt from that tuition, except that I literally hit my lifetime cap for federal student loans (besides PLUS loans, which are different). Fortunately, I have a Project Assistant/Research Assistant position, and that comes with tuition remission and health insurance.

After med school, when you are a resident, the average salary is roughly $40,000/year. Depending on what part of the country you live in, that may only cover rent, food, transportation, etc. It is liveable, but not enough to make substantial loan payments. Residency typically lasts 3 to 7 years. Many specialists go on to do fellowships after residency, ranging from 1 to 3 years. Fellowships don't pay much better than residency.

So, if you went to college right after high school, and med school right after that, and residency right after that, you would START paying your loans when you were between 29 and 33 years old. That is the age when many people are starting a family, buying a home, etc. Mortages, car loans, etc get tacked on to the huge pile of debt you already have from your education.

Another point is that not all doctors make huge sums of money anymore. Many primary care docs make between $90-110,000 when they first start out. Now, that is nothing to sneeze at, but it is not the millions of bucks people envision when they think of doctors' salaries. With a $5,000 loan payment each month, and mortage, and kids, and whatnot, that isn't THAT much money. Enough to live comfortably on, for sure, but not enough to just pay off the loans in a couple of years and forget about it.

There are certainly still docs who make a lot more money than that... plenty of them. Mostly ones that do loads of procedures, like interventional cardiology, orthopedic surgeons, some dermatologists, etc.

But the point is that docs are not all as well-off as people think.

[Pharmacist.steve]

Kira ...
Most people fail to realize that the "neighborhood family doc" is nothing more than a small businessman/woman. Patient find it hard to understand why the doc will not take THEIR INSURANCE or limits the number of patients with THEIR INSURANCE in the practice. Just because THEIR INSURANCE is very slow to pay... low allowables ... or lose or reject claims for no apparent reason..People rebel when the doc wants them to pay their copay at time of service .. when everyone knows that 50% of all bankruptcies are caused by medical bills - sometimes even when patients have insurance.
The same insurance industry that raises your liability insurance premiums turns arounds and lowers what is allowable for procedures.

Things have changed since "managed care" entered the picture.. yet some people have watched one too many Dr Welby shows

[oh_snap]

I am not clear why any doctor should have to explain their income, or give anyone a profit/loss statement, here or anywhere.

Do we look at lawyers that also run up huge education sums in order to get a law degree, and ask them to cap their fees or work for less than cost? No, we assume that if they are charging $300 an hour that they are damn good. And damn good, means good for those that need 'em.

Part of the cost of medicine is covering startup fees (which, in my mind include education costs), office lease or paying a percentage of income to an established practice, insurance (against both lawsuits and disability), self-employment taxes, office equipment, technology, continuing education, employees.

Why should a doctors' cost (among other things) to be a doctor be any different than any other profession?

Wouldn't the more appropriate question be why does it cost so much to become a doctor? If we want lower costs at our end, we can't expect any one person to take on the cost of a quarter million debt, and still keep their fees low in return.

Even the people that go into medicine to "do good" should still expect to somehow recoup their education expenses. What makes doctoring any different than the other fields and the cost of their degress/credentials?

Money rules. We can't expect something of value, for nothing.

Again, this is just my take on things. I do know that things are more complex than what I have brought up here.

When I work, I expect to be compensated for both my ability/knowledge, and business overhead, and those costs are built into my fees. Why should docs be any different, especially when lives are at stake?

This whole health insurance system makes things especially more complicated, and I must suggest that if fees (paid out) were more in line with actual costs (including everything mentioned above) as well as "profit" (value of the service)...that this current trend of going to cash only patients, and forcing private insurance, W/C or litigated patients to the fringes would stop.

We can't expect doctors to work for less than cost. Why? Because the end result is that they will be forced to work at volume in order to be profitable. Why don't we like that? Because we end up feeling like our health is on some quickly moving conveyor belt.

Now, here's the disclaimer: I know that this is a heated and complicated issue. I guess I would hope that if we expect docs to see our side of the world, that we could also "try" to see theirs. Not looking for an argument unless it leads to revelation.

[Bobbi]

Here's a "vanity" issue about my doc... and a couple of thoughts.

One time when I was being the typical me, and my PCP is as nice as can be (heck, the woman has been my main-stay of health care for a decade), she asked me if I could have anything in the world, not health related, what would it be. I said: A Lexus. Hey, I've seen myself riding in my friend's car and we looked darn'd good in our reflections while cruising downtown. Like, I'm not gonna look with those pretty lights and huge windows :D.

My doctor said: "Take mine."

Y'know, for as well as the woman has treated me for so many years, I say she's more than earned that ride of hers! I just don't want those payments that go with the "ride" or all the pressures and stresses that led her to being able to get one for herself.

People have "beef" with what doctors do: Try going through the schooling (major yucko to have to do some stuff and see blood and other stuff) and still continue.

Maybe it is superficial, but... dang'd to go through the nasties and I just like that my doctors "present" so well. What gets me is when my friends hear my docs speaking and they compliment them on their attire. Okay, soooo, I told one friend to check out my rheumatologist's shoes. Hey! They were cool :).

I just know ... ain't no way I could do all for people my doc's do.

Right now... My life is at such a crossroad. New job offer and it comes down to HMO or PPO. If I go with the latter, it means I pick up the tab on the diff. between the HMO and PPO and it's "hush-hush" between one of the owners of the company and me.

I don't jest about how I feel toward my doctors. I'm going to pick up the difference in the cost.

Some may remember when my doggie's doctor was going through bone marrow transplant following his diagnosis of leukemia. She didn't have a "plan" for treatment, and even though he was not allowed to care for the furry friends following bone marrow transplantation ... He came in to be with "us" when she had an appointment and we donated new doors for his office. I'll never forget (and I don't know that my pooch has) how kind and caring and honest he always had been. He was her doctor from day 3 of her life, and always made every appointment she had.

The point? He was true to the core. He had bad days and good, and: He was always there for us. (I say was because he is now deceased). The way he treated my doggie and her mother and father and brothers and sisters and grandparents? It led me to think about how I want doctors to treat me: As an individual patient. They needn't hold my hand but treat me - not as someone entering a revolving door.

As I'm looking at HMO v. PPO... it's a no-brainer. Even if it means I pay out of pocket, I am staying with my doctors. The care and rapport means more than the cost.

I don't know how others' doctors approach care, yet I do mine know and they remember my birthday and other times. They give me heartfelt cards and presents. They've done better than my "family" many times over and over again.

Though I know, in these rough times, I'd save a bundle by going with HMO: I just want my doctors. If, by seeing them, it affords them some pleasures in life? Cool by me. These people have had to see me at the worst of times and do stuff I cannot imagine doing. I've been treated so well and admire them... also because they've stated, "I'm sorry" at times.

When a doctor looks at me and does so face-to-face, it's not a profession I'm dealing with, but another person :). Some of mine helped me through my roughest of college years. They're keepers and I don't care if anyone thinks I'm a whimp for feeling as I do. They stuck by me... and I will stay with them.

[Bobbi]

P.S'er to my post:

I just had an addendum to my thought process...

When I think about it, there really is nothing or no way, in this world or likely my lifetime, that I could possibly "repay" my doctors for all that they've given me. Their job doesn't require that they give me perfect health; I didn't have that from the onset.

But.... it's been invaluable that they've given me their best "care."

I only wish that for each person that each could, at least, feel the same with one doctor. If and when that happens, maybe just give thanks. It multiplies :).

[Kira]

I only wish that for each person that each could, at least, feel the same with one doctor. If and when that happens, maybe just give thanks. It multiplies.

I LOVE my metabolic/genetics doc. He has been really good to me. He genuinely cares and remembers all the little details of my medical history, etc. It is easy to get in touch with him. He always somehow finds out about it and calls me when I have been in the ER or had labs drawn... one time he called me from his kid's soccer game. Plus, he's really smart.

I also really like my neuromuscualr doc, though he's kind of quirky. During one of my hospital stays this past summer, he just showed up in my room to see how I was doing... I hadn't called him, and my team of inpatient docs said they hadn't called him/consulted him, either. The ER docs may have called his office, but it was the middle of the night and he wouldn't have been there anyway. Somehow he found out that I was in the hospital and just plain came to visit me... so that was nice.

I have had other good docs, too. But I should go to bed and quit babbling...

[Bobbi]

Kira, your post affirms the reasons I don't look for other doctors :).

I hope, when your head hits the pillow you have peaceful and happy dreams. It's good to be able to sleep with positive thoughts flowing... and there seems to be a shortage at times.

May you have as restful as possible sleepy time :cool:. I'm headed that way, too.

[lobelsteve]

I am not clear why any doctor should have to explain their income, or give anyone a profit/loss statement, here or anywhere.

Do we look at lawyers that also run up huge education sums in order to get a law degree, and ask them to cap their fees or work for less than cost? No, we assume that if they are charging $300 an hour that they are damn good. And damn good, means good for those that need 'em.

Part of the cost of medicine is covering startup fees (which, in my mind include education costs), office lease or paying a percentage of income to an established practice, insurance (against both lawsuits and disability), self-employment taxes, office equipment, technology, continuing education, employees.

Why should a doctors' cost (among other things) to be a doctor be any different than any other profession?

Wouldn't the more appropriate question be why does it cost so much to become a doctor? If we want lower costs at our end, we can't expect any one person to take on the cost of a quarter million debt, and still keep their fees low in return.

Even the people that go into medicine to "do good" should still expect to somehow recoup their education expenses. What makes doctoring any different than the other fields and the cost of their degress/credentials?

Money rules. We can't expect something of value, for nothing.

Again, this is just my take on things. I do know that things are more complex than what I have brought up here.

When I work, I expect to be compensated for both my ability/knowledge, and business overhead, and those costs are built into my fees. Why should docs be any different, especially when lives are at stake?

This whole health insurance system makes things especially more complicated, and I must suggest that if fees (paid out) were more in line with actual costs (including everything mentioned above) as well as "profit" (value of the service)...that this current trend of going to cash only patients, and forcing private insurance, W/C or litigated patients to the fringes would stop.

We can't expect doctors to work for less than cost. Why? Because the end result is that they will be forced to work at volume in order to be profitable. Why don't we like that? Because we end up feeling like our health is on some quickly moving conveyor belt.

Now, here's the disclaimer: I know that this is a heated and complicated issue. I guess I would hope that if we expect docs to see our side of the world, that we could also "try" to see theirs. Not looking for an argument unless it leads to revelation.

THis is hilarious. When a plumber comes to your house to fix a leak, do you hand him $20 copay and an insurance card?

When a patient comes through my door, I get paid 60-90 days later from an insurance company who takes my bill and cuts it into a third. I have no say in the process and cannot see what they are paying the doctor down the street (anti-trust). THere is no other business model that is as deplorable as medicine. I can charge $1,000,000 per follow-up appointment- your copay is still $20 and the insurance may pay $50 2 months later. More often they ask that you resend the progress note, or that the ICD9 codes did not match the note perfectly, or that they needed to review the patients records before submitting reimbursements.....

And lets not get started with medicaid. It costs $18 to submit a claim that they pay $12 on, so I lose $6 for submitting a bill. No thanks.

This is where the AMA has failed doctors and the insurers have kicked our butts. Notice that Dr's pay has not risen in 10 years and the CEO o BC/BS gets a multimillion dollar bonus every year. Sad.

[Jo6]

Yes, it is sad, Dr. Lobel. I cannot even think of the Insurance Co. with out my BP going sky high!!:mad:

Now, if my pitiful post about finding a good Dr. and keeping them has caused anybody to feel bad, I am truly sorry.

I did have a very good Dr., had gone to him for many years. Suddenly he retired. I asked another Dr. how he was and the Dr. told me he had Parkensons D. The next time I asked about the first DR. 2nd DR. told me he had died:(

I was crushed. He was a very good Dr., but I also counted him my friend.

Bobbi, hubby retired in June and we had to do the insurance and HMO thing too. I have 6 or 7 Drs. We decided to pay out of pocket what the Inc. didn't pay so I would not have to go hunting new Drs. again.

Most of my Drs. are good Drs. At least one is in the business to make money. He as much tells me this. He is the one I had to hunt up when the good DR. W. died. I am still trying to find someone that will at least care enough to listen even if I go 2 seconds past the 10 mins. he has so kindy given me.:eek: I have little respect for him and don't give a rats a$$ if he has any for me.

I didn't ask anybody why they charged so much or how much they made. As stated before by someone else here I was also taught to mind my manners and one was don't ask personal questions.

Bobbie, I think maybe we both are lucky with our Drs., but we both know that could change with a blink of an eye.

In answer to the first question, most Pain M. Drs. are Anesthesiologist, or it seems that way. One of the Drs. here will have to tell me why if they are inclined to do so. I don't know the answer to that.

Good luck with the Drs. visit. :) Julia

[Kira]

One of my courses this semester is Health Care Management and Policy. We have been talking a lot about economic stuff lately. Did you know that nearly $2 trillion dollars were spent on health care in 2005? Health care spending is literally rising at exponential rates in this country... rose 6.9% in 2005 and makes up nearly 16% of the Gross Domestic Product. The average amount spent per patient in 2005 was just under $7000. We spend the most on healthcare in the world by far...

Yet we have mediocre health outcomes on such key measures as lifespan, infant mortality... There are outrageous and unacceptable health disparities in those same measures, as well as in incidence of major chronic diseases (like diabetes, renal failure, high blood pressure) and in access to care. Currently, about 16% of the population is uninsured, and 9% of children are uninsured (more children are covered by state SCHIP programs for the near-poor). How can we spend so much, yet have relatively little success? How can we spend that much money and yet let so many people fall through the cracks?

Our system is broken, and there is not a clear way to fix it.

----------------------------

When a patient comes through my door, I get paid 60-90 days later from an insurance company who takes my bill and cuts it into a third. I have no say in the process and cannot see what they are paying the doctor down the street (anti-trust). THere is no other business model that is as deplorable as medicine. I can charge $1,000,000 per follow-up appointment- your copay is still $20 and the insurance may pay $50 2 months later. More often they ask that you resend the progress note, or that the ICD9 codes did not match the note perfectly, or that they needed to review the patients records before submitting reimbursements.....

And lets not get started with medicaid. It costs $18 to submit a claim that they pay $12 on, so I lose $6 for submitting a bill. No thanks.


We learned in the same class that, for a $100 bill:
-The most generous of the private, non-HMO, non-PPO policies may pay about $80
-HMOs and PPOs pay about $40 to $45
-Medicaid and Medicare pay about $15 to $25

I don't know how good those estimates are, but it sounds like a colossal pain in the butt... and one that I am glad I haven't really had to deal with yet. I know the day is coming when I will have to deal with it, but for now I am still safe :)

[Pharmacist.steve]

Our system is broken, and there is not a clear way to fix it.

IMO.. there are four MAJOR underlying reasons for this broken system

The INSURANCE INDUSTRY... over the last 5-10 yrs nearly all the insurance companies have de-mutalized and gone out as a public company. As a non-profit mutual company owed by the people that they insured they had one charge -- the health of the people that was insured.. today as a public company .. the "ownership" and the "insured" are not mutually inclusive. I had some life insurance when Metropolitan life de-mutalized .. I was given shares in the company valued at $15/share in 2000.. today those same shares are worth $63.00..

The insurance industry consumes about 20%-25% of every medical dollar in administrative costs .. as opposed to Medicare of ~ 5% IMO we are spending too much money trying to SAVE MONEY...

Attorneys... 40yr+ ago .. who ever heard of someone suing their doctor.. whatever the outcome.. because people believed that their doctor ALWAYS was working in their best interest and doing their best. There is a local ambulance chaser on the local channel advertising that he got a settlement/payment for a person from THEIR OWN INSURANCE COMPANY.

The medical community is responding to these suits in practicing defensive medicine.. if there is a doubt .. run a test... I see drugs that cost $1000's per month.. that MAY extend a person's life a couple of months MAYBE...

Patient's expectation how often have we encountered a patient that has ignored their health or symptoms until it becomes critical and then expects the system to undo decades of neglect with a "magic pill"

non-compliance with medication is out of control.. the "silent epidemic" HBP is one of the worse... reports typically suggested that MAYBE 1/3 of patients diagnosed and treatment initiated are still compliant by the third year.

As long as someone else is picking up the "tab" for a person medical care .. there is little incentive to be proactive in managing their health... and besides we have all of the "medical miracle drugs and procedures" to take care of things.

CONGRESS 40+ yrs ago there was no such thing as Medicare/Medicaid.. today there are some 100 million people covered between the two. Once Part D was implemented it was estimated that the typical pharmacy would be billing the government for over 50% of the prescriptions filled.. Healthcare workers - particularly independent ones are employes by the government and the insurance companies without all the employee benefits - their employees are entitled to.

Congress doesn't have the go-nades to commit to some sort of universal payor system.. how hard would it be if Medicare was opened up for people to buy into it .. it has been proposed since Clinton's time....there is some 43+ million with no insurance and it has been climbing 1+ million a year as long as I can remember... Much easier to just mandate that hospital take all who walk in their door .. at least enough to stablize them and put them back on the street.

While they claim that you can't buy a Congressman... it does seem that they can be rented by the big PACs and lobbists

[BrokenBladder]

I have two insurance companies. One through my husands employer and the other is medicare. I was shocked to find out from my RA last month that medicare has yet to send them one cent of what they owe them!!!! How crazy is that? I receive good care from my RA and yet they aren't really getting paid what's due them. Something is really wrong with our heathcare system......BIG TIME!!!!!

[Kathi49]

Lisa,

I do too. BC/BS (federal) is my primary and TRICARE is secondary. I have never, in 30+ plus years of having BC ever had a problem with them paying on time; not that I am aware of anyway. Otherwise, the doc's offices would have been calling me or sending me letters and such. The issue always seems to be with TRICARE. Not that they don't pay, but they are sooooooooooo slow. It was an act of God one time to get my Bone Growth Stimulator paid for. Evidently, someone at TRICARE entered the code wrong, NOT the doc's office. I went ahead and paid the remaining $900+ and didn't get reimbursed for one full year. So, not getting reimbursed timely can go both ways. :eek: Having learned my lesson from this, I stay on top of them. I signed up online to review the status of my claims, and if I see something out of whack or not being paid...I call them right away to find out what the issues are. Lately though, I have noticed they are getting a little better. I want my docs to be paid what they are due since I value very much their excellent care.

[Pharmacist.steve]

Most billing done these days is electronic from the healthcare provider .. and cross over to the secondary is electronic as well and automatic from Medicare.

I was on the early end of electonic billing with Medicare/Medicaid back in the late 80's - early 90's... My Days Outstanding in A/R drop from in the low 100's to in the 30's

There was no "human" at the Part B processing end to mis-key-punch the numbers.. the data came directly from my computer. It was so successful in getting bills turned around quicker that the FEDS but a 14 day floor on all billing ... meaning that your submitted bills where held in a electronic que waiting for the 14 days clock to expire. then they were processed and paid.

The smarter suppliers quickly figured out which day of the week the bills were processed and submitted their bills the day before the processing cycle.. to make sure that your claims hung around in the electronic que as shortest time as possible.

[Jolene]

Well I haven't been on BT for some time, but when Kathi told me about this discussion it brought me back for a short time.

It's nice to know that Dr's are nearly as likely to complain as truck drivers are. Let's see.... Dr.s have to wait for payment, so do trucking companies. Dr.s have to invest money in their profession... Like these trucks we drive don;t cost an average of a hundred grand each now days, and trailers average 10-15 grand each. Lets see.... "I have no say in what I get paid" Well there's a simple solution.... You don;t have to take insurance. Go to strictly private care and kiss the a** of people in Hollyweird or somewhere.

While trucking companies choose what they charge, they can only charge what the market is willing to pay. They have to fight to get their money out of their customers, brokers, etc.

Another complaint is about mal practice-- Like we don;t have to fight a bunch of morons sitting behind desks telling us how to drive a vehicle that they couldn't even start let alone safely drive over 100k miles a year. Even though the AAA has factual info that proves that when a car and truck are involved in a wreck that 75% of the time the car is at fault we are constant;ly getting sued and losing simply because people think they are entitled to other people's money.

So Dr's are no different than anyone else. We all have things to deal with in our chossen professions. As I was saying to Kathi, one of the reasons insurance costs are so high is that many people run to the Dr for every hang nail. Their mentality is that insurance pays it why not? If they had to pay for the small things I bet they wouldn't run to the Dr.

Ok- I've stirred enough for today. I'm sure I will be kept appraised of the happenings at BT.

[Mark N]

This discussion is enough to make this economics teacher crazy. There are several basic problems but I read a story that expained it best. It went like this [sorry I don't remember who wrote it]

Imagine if we had food insurance, why not food is a necessity and why shouldn't people be guaranteed a basic good. When you go to the store and run up a bill for $100 dollars you give your card to the cashier and he deducts 80% so that you pay $20.

Now what happens, when you go to the store you will buy the more expensive items because you only pay 20% of the cost. Instead of hamburger you buy steak, instead of beer you buy good wines. You do this because you can live better at the same price yu paid earlier.

What does the store do? They stock steak and get rid of cheaper cuts of meat. They buy more sophisticated liquors and get rid of the cheaper wines and beer.

What is the end result? People without insurance get pushed out of the market because the hamburger and beer they bought isn't for sale any more. People with insurance buy more expensive products because they can afford to and the stores don't carry anything else. The end result is our market has fewer options and people without insurance are out of luck.

This isn't the only issue with medical care in this country but it is one that people have forgotten about. The choices we make as a society have major impacts on the industry. If we want to be able to sue even in cases of no fault to anyone then doctors will cover their asses as any rational person would. If we demand that we can run to the doctor for any small problem ie colds, fevers that last one day, ect for little cost to us the system will become expensive to run.

We need to deal with the insurance issue, litigation issue, and personal responsibility issue in this country. If I were king I would have personal savings accounts for medical expenses this makes each person responsible for their decisions, catastrophic insurance for every person in this country [this covers the insurance issue as everyone is covered], and a review board responsible for determining medical malpractice and the awards doled out to people harmed by negligence [this deals with the liability issue]. Just my 2 cents worth and that may be all it is worth.

[Jolene]

Mark, your opinion is worth 2 cents? Heck it went up in value while I've been gone... :D :p

[lobelsteve]

This discussion is enough to make this economics teacher crazy. There are several basic problems but I read a story that expained it best. It went like this [sorry I don't remember who wrote it]

Imagine if we had food insurance, why not food is a necessity and why shouldn't people be guaranteed a basic good. When you go to the store and run up a bill for $100 dollars you give your card to the cashier and he deducts 80% so that you pay $20.

Now what happens, when you go to the store you will buy the more expensive items because you only pay 20% of the cost. Instead of hamburger you buy steak, instead of beer you buy good wines. You do this because you can live better at the same price yu paid earlier.

What does the store do? They stock steak and get rid of cheaper cuts of meat. They buy more sophisticated liquors and get rid of the cheaper wines and beer.

What is the end result? People without insurance get pushed out of the market because the hamburger and beer they bought isn't for sale any more. People with insurance buy more expensive products because they can afford to and the stores don't carry anything else. The end result is our market has fewer options and people without insurance are out of luck.

This isn't the only issue with medical care in this country but it is one that people have forgotten about. The choices we make as a society have major impacts on the industry. If we want to be able to sue even in cases of no fault to anyone then doctors will cover their asses as any rational person would. If we demand that we can run to the doctor for any small problem ie colds, fevers that last one day, ect for little cost to us the system will become expensive to run.

We need to deal with the insurance issue, litigation issue, and personal responsibility issue in this country. If I were king I would have personal savings accounts for medical expenses this makes each person responsible for their decisions, catastrophic insurance for every person in this country [this covers the insurance issue as everyone is covered], and a review board responsible for determining medical malpractice and the awards doled out to people harmed by negligence [this deals with the liability issue]. Just my 2 cents worth and that may be all it is worth.

Hope you don't mind if I share this with my Fellows.
Also, billing in January and February is always the lowest as nobody wants to pay their deductible all at once.

[Bobbi]

Mforce, I hope that your appointment goes well for you this week. Let us know how it turns out, okay?



Jolene, long time no "see"; I hope that you're not working too hard, yet... one of my neighbors also drives truck and even during his "off" time, he continues working ;). (Getting preparations made for his daughter's wedding, he's re-landscaping his backyard.)

One thing about running to the doctor just because... For each doctor's visit, my insurance deducts from the sum of available. Now, if insurance were to give the benefit of a discount for frequent-users, I might need to reconsider :).

What my insurance has done is, encourage people not to go to the doctor by setting up an opt-in health program wherein people earn points that go toward "gifts" (like, flying mileage, crystal, children's toys, etc.). For each healthier living course that a person completes and applies to lifestyle, the points are awarded. (I'm sure that insurance gets the items in bulk and it has, thereby, reduced its cost; and, thus, the CEO gets his annual "reward" :D.)