MEDICARE
All Medicare providers (e.g. physicians, NPs, PAs, etc.) are eligible to earn a 1 percent incentive on their total Medicare Part B allowed charges by electronically prescribing a total of 25 times from Jan. 1 to Dec. 31, 2011 and having at least 10 percent of their total Medicare Part B charges made up of denominator codes.
Additionally, providers who want to avoid a 1 percent penalty in 2012 must report an e-prescribing measure through their claims at least 10 times between Jan. 1 and June 30, 2011. Furthermore, providers who successfully report the e-prescribing measure in 2011 will also be exempt from a 1.5 percent penalty in 2013. CMS requires that this submission be performed through claims; providers are not allowed to use a registry or electronic health record (EHR) to avoid the penalty in 2012.
If you plan to participate in the EHR incentive program in 2011, you will not be eligible to collect the 1 percent e-prescribing bonus. CMS does not allow physicians to collect both bonuses. However, since NPs and PAs are not eligible for the Medicare EHR incentive program, they can continue collecting the e-prescribing bonus.
Clearly practicing medicine will continue to be more complex over time. If your wondering if there are better practice opportunities that fit your unique needs in these complex times reply deroode@integrohealthcare.org.
To relieve the complexity, many physicians are eliminating Cecil, Harrison, and our other Hippocrates Modern Colleague, and just subscribing to the Medicare Newsletters which will guide and direct you to do the best practices for remuneration and not be influence by using the Best Practices Cecil, Harrison and their Kin.
Del Meyer, MD
Lean Health Care vs Gluttony in Pain Management
A frequent occurrence in front line medicine as practice by family physicians, internists and emergency room physicians is the patient’s demands for laboratory proof of almost any diagnosis, whether it’s peptic disease or a fractured rib. Or even a sprained ankle. Articles have been written on the examination of the ankle, taking into account the type of injury and whether an x-ray will prove helpful. ER physicians who are experts in this diagnosis are not allowed to make clinical diagnosis by the patients who demand an x-ray. It the physician spends time explaining the reason for no further tests, the patient will listen politely and still demand an x-ray. A physician can spend the equivalent of two appointment times ($250) explaining why further testing is not necessary, the patient will always win having the unnecessary expense expended by either returning to the ER when the next doctor arrives and state his ankle is still painful. Frequently he may not have even taken the prescribed analgesics. That’s why as an intern, I always carried a bottle of extra-strength Tylenol and would give out two pills with a cup of water in the triage room and continue my triage rounds. Sometimes before I returned to the same place in the triage ward, perhaps 45 to 60 minutes later in the busy county hospital, the ankle pain would be resolved. When asked, what were the two marvelous pills you gave my wife, I would only state they were extra strength PAIN pills. I found out rapidly in my internship, if I stated they were Tylenol, they would be back very soon with the same pain. By not mentioning Tylenol the pain would generally be resolved--sometimes permanently.
The recently enancted health care law was not reviewed by the congressmen who passed it nor by the citizens at large.
A report in the news stated that congress is fairly unknowlegeable about Medical Care. They depend on their staff assistants to modify and implement the law which they aggree is unworkable to make it work.
Since this is a major change in our personal health care, including it's confidentiality, this seems like a poor way of improving our health care in this country.
When the uninformed and medically illiterate attempt to improved health care, it will always be catastrophic.
The only solution is to vote all present incumbents out of office.
Elect a major constitutional and conservative majority to impeach the president and reverse all billls that he signed and resume health care reform.
Health care reform must include eliminating the socialistic HMO bureaucracy which the public misinterprets as free enterprise.
In free enterprise doctors would have the opportunity to compete with the doctor down the street both in fee and quality.
Under the HMO socialistic setup, the worst doctors get the same payment as the best, the very antithesis of a free market situation.
Under free enterprise, the best and most efficient doctors would compete not only on price, but also on quality of care.
It's ime to throw out all government programs such as managed care and allow competition to reduce health care costs. Competition or the free market is the most ruthless way to decrease the cost of health care. Everyone benefits--except maybe the HMOs.
The only way to do this is vote all incumbents out of officie in November.
Del Meyer, MD
Is it fair that the older board certified physicians do NOT have to undergo MOC (maintenance of cerfitication) or re-certificaton because they have been 'grandfathered' in?
Is it legal to do this? Is it ethical to do this? The intent of MOC and re-certification is to maintain or increase the quality of healthcare, but if you exempt a large number or percentage of physicians from the process, are you really doing the public any good? I feel that if a specialty organization requires its members to participate in the MOC or to re-certify, then all of its members should have to participate in the process. Elitism has no place in modern medicine and older physicians should undergo the same oversight and evaluation as younger physicians. ****************************************************************************
The certificate that was at one time a mark of special distinction is now required to make a living. The ABMS has actively fostered this trend, and as a result is now in the position to charge whatever they want for something you have to have. One of the wisest senior clinicians I ever knew told me (in a different context) "Beware of those who create the need for themselves". The unfortunate recertifiers have a lifetime of ever-increasing fees to look forward to, the proceeds of which will be used to create more and more hoops that they have to jump through. I refuse to apologize for not having to participate in this rat race. I would urge those that are required to recertify to consider banding together and boycotting the whole process. It needs to be torn down and reconstructed.
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Okay. I'm an old guy; I don't have to take the recertification exams.
But what's wrong with you youngsters? First, no one has ever proven that recertification does, indeed, improve the quality of health care. It's a speculation. Possibly a valid one. But not proven. Second, why is it that you youngsters put up with it? Certification and recertification has created a multi-million dollar industry whose major goal isn't improvement of health care: the goal is to continue the growth and profitability of this multi-million dollar industry! Do they have to justify the enormous costs of the examinations? No. Do they have to justify the physicians' travel costs, lodging and meals? No. Do they have to justify the length of time these recertification exams take away from patient care? No. While the medical boards cannot quantify just how much recertification exams improve health care, they can quantify how they arrive at the costs of the examinations. Will they do that? Of course not. In my estimation, a recertification examination should cost no more than $50 or $100. That medical boards should be able to design effective examinations that a doctor can take at leisure in his home in front of his computer screen. As each question is answered, the system should easily be able to tell the doctor if the chosen answer is right or wrong, and it should be able to supply educational facts and reasons for the correct answer, along with educational facts and reasons about any selected wrong answer. For no cost beyond that initial $50 to $100, the doctor should be able to re-take the examination again and again until he passes. But, again, the agenda of the medical boards is not education and improvement of health care. The agenda is to maximize the income the boards receive from those examinations. So why do you youngsters so blithely plunk down your money and proceed down the recertification path? ****************************************************
One malpractice study indicated that board certification has a high loss ratio than fully trained non-certifide physicians.
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It is estimated that 90 % of people with vision loss generally obtain glasses to correct their loss. It is estimated that only 25 % of people with hearing loss obtain hearing aids. Hearing aids are very good at amplifying the sound and bring the volume back to normal. However, all hearing loss is not conductive. Much of it is perceptive--unable to distinguish between many words.
The audiogram easily measures the hearing loss with a curve which we all are familiar with. However, it's the perception or discimination score that is far more important. This is the part of an audiogram when the audiologist turns up the back ground noise and repeats the works for you to say back to her. One frequently finds discrimination scores that are in the 80s and 90s which means that you are able to correctly identify 80-90% of the words stated. If it is 80%, you hear 8 words out of ten. Thus people with hearing impairment of the perceptive type with an 80 % score can discriminate 8 words out of ten. That is why people with hearing impairment don't hear the first word or two and always work backwards to determine the first word of a sentence. It is important for people talking to a person with hearing aids, to always speak in sentences. To say "yes" or "no" is seldom understood. So always say, "Yes, you can." or "No you can't" for proper understanding by the person with loss of hearing.
However, if your discrimination score, when the audiologist plays street noise or restaurant or kitchen noise and goes through the same work recognition test and your score drops to 40%, that means you hear four words out of ten and you no long can put a sentence together. That's why people with hearing aids watch your lips very carefully since lip reading helps understanding. Never talk to a person wearing hearing aids from his back or side. Wait until you have his attention and speak to him directly from the front.
People with hearing problems of the peception type with poor discrimination scores, have huge problems when dining. WIth back ground noise, they have great difficulty communicating across the table.
We are in the process of rating restaurants to facilitate those with hearing loss dine. We would like your help when you dine to rate the restaurant whether they are sensitive to people with hearing loss. When you make a reservation and ask for a quiet table was it quiet? Were they sensitive to your predicament and tried to accommodate?
Please respond to this blog with your rating of the restaurants. Although we are in the Sacramento area, we are interested in restaurants throughout California and adjacent states being rated for travelers. Our long term goal is to rate restaurants throughout the country for all travelers.
Delbert H Meyer, MD
Hearing score: 80%
Discrimination score: 40%