Sunday, December 28, 2008

I Think the Tide is Turning

It would take a lot for me to go back into outpatient medicne.  More than I think the beancounters are willing to concede.  Nonetheless, in the short time since I opted out of Primary Care, I sense a change in the national discourse.  I am hearing less and less about the problem of the uninsured, and more and more about the pending disaster of those-with-insurance-with-nowhere-to-go.  While most of the information in this article is not new to most of us, it does highlight that the crisis is growing if a major metropolitan area is starting to worry.

Rural communities have had trouble keeping doctors since before I went to medical school.  But the pool of primary care physicians has shrunk enough that larger and larger rural communities have begun to feel the pinch.  I would venture to say that the new generation of physicians wants to live near more "stuff" than previous ones.  Just look at residency programs.  

Program directors of most internal medicine, pediatric and family practice programs have known for some time that recruitment to the Midwest (even to major cities) is inherently harder than places with 320 days of sunshine, oceans or mountains.  If you're going to work 120 hours a week for less pay than a tenured grocery store cashier, you might pick the hospital in paradise versus the one in the frozen tundra.

This is why I think that the loudest cries are going to start coming from the larger cities in the nation's midsection.  I'm not seeing a lot of Locum Tenens agencies begging for help in Manhattan or San Francisco.  
It's going to be a while before there aren't physicians willing to work for the CMS pittance in exchange for a 1-bedroom rental in a cultural epicenter.  But when we've reached the day when an above average primary care physician salary can't attract anyone to a smaller city with imperfect weather, but major sports teams, an art museum, a symphony, an international airport, and premium shopping... maybe that salary isn't so above average...

Thursday, December 4, 2008

AARP Has Sold Their Soul to the Devil

One of my new-found perks of being a hospitalist is being able to enjoy daytime television not related to contracting influenza or wasting an otherwise-perfect day off.  In nearly every way, I am the antithesis of the target demographic for the commercials -- particularly the AARP Medicare Supplement Insurance ad.

Normally I zone out during healthcare-related advertisements, but the commerical was on literally every 15 minutes.  Then I noticed the fine print at the bottom.  Then I became quite irritated.

The AARP Medicare Supplement Plan is  United HealthCare in disguise.  Yes.  The insurance company which scored the lowest in a comprehensive survey of physicians.

This is the same insurance company which, after a long bloody exchange, is being dropped next year by one of the largest health centers in my area.  Why?  Because their reimbursement is laughable.  And they refuse to pony up.

Fortunately, as a hospitalist, I now get to ignore most insurance company hassles.  I don't have the energy, and am not willing to waste the time, to figure out exactly how much of a screw-job the AARP Medicare Supplement Plan is.  But I have to wonder what lurks behind their banter:

1. "I get to choose my own doctor!"

Really?  Can you find a primary care doctor?  If so, do they accept the AARP Plan?  If so, do they
give your doctor additional reimbursement to supplement Medicare's insulting breadcrumb?

2. "I don't need a referral to see a specialist."

My concerns about finding a primary doctor notwithstanding, what if your specialist wants to
order $5,000 of diagnostic evaluation? How much of that will you cover? Do you require
doctors to fill out mountains of pre-authorization paperwork? What if Medicare refuses to pay,
will you pick that up for these people?

3. "It's been endorsed by the AARP!"

Because we've never witnessed otherwise-respectable institutions sell off their souls one piece
at a time for a lil extra dough? Particularly in this economy? How do you know that someone
at the top-rung of the AARP doesn't play golf with the marketing director of UHC?

Regardless of these dubious claims, what about prescription drug coverage? I agree that physicians need 
to be more vigilant about using generics, but what about the usual suspects? Is Plavix still going to cost
these people $100 a month?

What does it say about our entitlement programs when an entire business can survive on covering
healthcare costs that Medicare refuses to?

Finally... I wonder how close a year's worth of premiums to UHC would come to a concierge medicine
retainer fee? And which one would improve the quality of our elderly's care more.