Contributed by Rob Lambert MD
This post is going to be a compilation of quotes from physicians who are far more articulate than I am, and who are also still in the trenches of the battle between providers, and CMS. Sadly the very organization that was formed to insure health care to seniors (and others) has been corrupted by unknown forces (ie, too numerous to mention.
I can only sit here in my ‘lofty position’ either at the top or the bottom of the system.
My main advantage is I no longer have to look at my checkbook and decide what to pay first, or if at all.
IRS, State Franchise Board, Payroll (probably the most important since my staff depends upon this for their very survival) (God bless them they must be more motivated (or in a self survival mode) than I ever was. Include also my accountant, attorneys, consultants, HIT vendors, Membership dues to 5 or six professional societies, including three separate medical society dues, County, State and the AMA. State Licensing fees ( a total rip off, outmoded, obsolete, underfunded )(our state fees are supposed to pay to run these organizaions)…However that money is probably been sequestered or is going to pay off some bonds to build a road.
Medical Staff dues (for three hospitals) Malpractice premiums, property and liability, worker compensation premiums.
That is enough about me , on to some other thoughts from those in the trenches.
Rob Lamberts is one of those innovative leaders in practice management he was into EMRs and HIT long before the dawn of medicine by the byte. Now he is breaking new ground in direct pay revenue cycle. However that is a misnomer since there is no ‘cycle’ People actually pay at the door, in return for a substantial discount due to the decrease in overhead of not using IT, nor billing services, nor being at the mercy and whim of CMS and countless other insurance companies whose prime goal (despite the glowing marketing press releases) is to deny payment. This requires multiple billing cycle and more overhead.
“I’m Rob and I am a recovering doctor. Yeah, I am recovering…doing a lot better, actually. Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid, and insurance companies. I’ve had to learn how to manage my own money (now that I can’t count on them to bail me out any more), but things are looking a lot better. I am beginning to see how much better it will be to be on my own.”
The key was when I realized that the system wasn’t going to change no matter how much I accommodated its unreasonable requests. I felt that if I only did what it asked of me, however unreasonable, it would stop hurting me and, more importantly, my patients. But I’ve come to see that all the promises to take care of me and my patients were written in sand, and that it couldn’t resist the temptation to cheat on me. I tried to do what it asked of me, but as time went by I couldn’t take how dirty it made me feel.
But I can’t sit around and wait for the system to change any more. My patients were getting less and less of my time, and I was getting to the breaking point. I know there are a lot of other doctors who are willing to do whatever the system asks, but I can’t sit around and watch it self-destruct. It’s not what’s best for the system, for us doctors, and for our patients. Sometimes the best thing you can do for someone is to let them self-destruct and pray that they finally take responsibility and learn the hard lessons. I just hope that happens soon.”
Dr Lambert comes from the perspective of a group medical practice which he founded years ago as a solo doctor. Time and events corrupted his basic model despite and efforts to halt the steady deterioration in the group culture. He resigned from the very group that he formed decades ago.
“But I don’t want to brag. I’m no saint, and the system I’ve built to this point is far from perfect. I’ve still not taken a paycheck, (HOW DOES HE DO THAT?) and that can’t go on too much longer. Things could still go wrong. But my decision to no longer try to live in my dysfunctional and destructive relationship has been worth the pain and uncertainty. I miss the patients I had to leave behind, and I am sad to hear about the care they are getting. I hope I can build something good enough that lets me offer to them what my new patients have, something I’d given up on: hope for the future of health care.”
Rob made a radical change to no longer take Medicare, nor private health insurers and accept only cash. He refuses to deal with insurers and any agreements are between patients and their insurer. Dry Rob gets paid by patients, and they bill their insurance companies. That is the way it always worked until CMS and HHS entered the room.
That’s all I’ve got for now. Thanks for listening. One day at a time.
Logo attributable to “Musings of a Distractible Mind”
Thoughts of an odd, but not harmful primary care physician.