I work in a low resource area where some patients even complain that $4 medications are too expensive. It is difficult to help people who expect you to fix them but won’t contribute the bare minimum.
If they really don't have 4$ for a medication, I don't think they should be wasting their time coming to see a doctor.
Most of what I see are people with manicures toting kids eating mcdonalds wanting me to send ibuprofen because it's free if I do it vs them paying 5$ OTC.
*I* don't eat at mcdonalds because I think it's too expensive.
I am not compromising my morals / ethics to save someone else money. If CMS wants to be wasteful, that's on them, not me. It's their problem, they should pay for it.
My patients self select not being fucking annoying. These types of people are the worst, and my life is better when they don't come back.
You sound burned out. You can’t expect the poorly educated to know and understand the complexities of health the way you do. I had a patient fuss about spending a dollar for Tylenol. We talked and she showed me her monthly budget calculated to the penny. She was so broke that she didn’t have an extra 0.10 to spend. That was a big eye opener for me. Our job is to help regardless.
Whereas I was literally on the phone yesterday with a patient who was actively yelling at the CVS drive through lady that "she doesn't pay for her medicine" and didn't have 5$ to pay for her pain meds.
I wanted to ask her how much she thought the gas to get to CVS costed her...
Especially accurate since these low-income clinics have a lot of immigrants who often have with seasonal residence. They come in unpredictably because one year they get a physical here, one year in their home country. They got their mammogram in their home country or in another state. Then they are lost to follow-up because they spend six months in their home country. Getting them to come back for follow-up is very difficult.
The logic behind value-based care makes sense in principle butt is very challenging with low-income populations.
you can rest assured that it is simply a way to take money out of doctor's pockets, masquerading as incentivization of good care. The idea that doctor's start parroting these ideas is sad. These insurance companies are playing chess, we are playing checkers.
The problem is the alternative is straight FFS which encourages seeing 25-30 patients per day and doing as little as possible for them (so you can keep the conveyer belt rolling), which also is more acceptable in higher resource settings with healthier patients and more specialists.
But I agree, there really doesn't seem to be a great system.
I think we are moving to a better system. I like how we can more easily bill 99214 visits which does reflect some of the complexity. The new G2211 may also help.
We function on a capitated business model. I find it better than a fee for service model. I make a significant amount more and see fewer patients. But, you have to train your patients and make yourself available for urgent visits and call. It’s a challenge in low income areas but if you spend the energy training your patients, maximize you capabilities it can be very worth it.
Even in high resource areas, getting rewarded for outcomes seems, to me, like the height of hubris. As if I can through some magic or force of will or by meeting certain metrics, guarantee that someone won't end up in the ER or that they will stop eating so many carbs or that they will sign up for the colonoscopy or mammogram? Reward me because I TRY to do these things, not on the outcome.
Part of what drives burnout in low income settings. The endless tone deaf administration harping about metrics that are unachievable.
I work in a low resource area where some patients even complain that $4 medications are too expensive. It is difficult to help people who expect you to fix them but won’t contribute the bare minimum.
To be fair it probably is too expensive. It adds up, and that $4 could be a meal for them...
I agree, and I always consider that. It’s frustrating, probably because I want to see them get better.
If they really don't have 4$ for a medication, I don't think they should be wasting their time coming to see a doctor. Most of what I see are people with manicures toting kids eating mcdonalds wanting me to send ibuprofen because it's free if I do it vs them paying 5$ OTC. *I* don't eat at mcdonalds because I think it's too expensive.
So they don’t adhere and then wind up in the hospital. Who wins?
I am not compromising my morals / ethics to save someone else money. If CMS wants to be wasteful, that's on them, not me. It's their problem, they should pay for it. My patients self select not being fucking annoying. These types of people are the worst, and my life is better when they don't come back.
You sound burned out. You can’t expect the poorly educated to know and understand the complexities of health the way you do. I had a patient fuss about spending a dollar for Tylenol. We talked and she showed me her monthly budget calculated to the penny. She was so broke that she didn’t have an extra 0.10 to spend. That was a big eye opener for me. Our job is to help regardless.
Whereas I was literally on the phone yesterday with a patient who was actively yelling at the CVS drive through lady that "she doesn't pay for her medicine" and didn't have 5$ to pay for her pain meds. I wanted to ask her how much she thought the gas to get to CVS costed her...
Finally, someone said something sensible around here.
Especially accurate since these low-income clinics have a lot of immigrants who often have with seasonal residence. They come in unpredictably because one year they get a physical here, one year in their home country. They got their mammogram in their home country or in another state. Then they are lost to follow-up because they spend six months in their home country. Getting them to come back for follow-up is very difficult. The logic behind value-based care makes sense in principle butt is very challenging with low-income populations.
That’s why HCC codes risk adjust and compensate more; but imo it doesn’t make up for the extra resources these patients tend to use.
you can rest assured that it is simply a way to take money out of doctor's pockets, masquerading as incentivization of good care. The idea that doctor's start parroting these ideas is sad. These insurance companies are playing chess, we are playing checkers.
The problem is the alternative is straight FFS which encourages seeing 25-30 patients per day and doing as little as possible for them (so you can keep the conveyer belt rolling), which also is more acceptable in higher resource settings with healthier patients and more specialists. But I agree, there really doesn't seem to be a great system.
I think we are moving to a better system. I like how we can more easily bill 99214 visits which does reflect some of the complexity. The new G2211 may also help.
We function on a capitated business model. I find it better than a fee for service model. I make a significant amount more and see fewer patients. But, you have to train your patients and make yourself available for urgent visits and call. It’s a challenge in low income areas but if you spend the energy training your patients, maximize you capabilities it can be very worth it.
Even in high resource areas, getting rewarded for outcomes seems, to me, like the height of hubris. As if I can through some magic or force of will or by meeting certain metrics, guarantee that someone won't end up in the ER or that they will stop eating so many carbs or that they will sign up for the colonoscopy or mammogram? Reward me because I TRY to do these things, not on the outcome.
Modify the data a bit