While most of the country was completely unaware, a very important piece of legislation was passed by the U.S. Senate yesterday. However, it is only a short-term band-aid to a major gash in the U.S. health care system... a wound affecting over 44 million Americans plus 1500 new Americans every day. What is it? Read on my friend!
Medicare reimbursement for physicians. Now, I know that may sound selfish coming from a future physician, but let me explain the facts. Physicians in this country were due for a 10.1% reimbursement cut on January 1st, which has now been pushed back 6 months to give legislators more time to resolve an issue that they have stalled on, and band-aided every year for the past 6 years. While medicare reimbursement rates to other types of health care providers have gone up over the past few years, the rate for physicians and private insurers who provide medicare type benefits to seniors have stayed flat. The only reason they have stayed flat and not decreased is the repetitive band-aid approach. The problem is that the cost of operating a medical clinic is going sky high, so if reimbursement rates do not follow it becomes very difficult for a physician to give time to medicare patients or to accept new medicare patients (think Baby Boomers hitting retirement...). As a future physician, and the son of parents getting closer to medicare age, I am deeply concerned about the impacts of medicare reimbursement on quality of care for our seniors!
Many physicians are practicing in areas where their patient base is 30, 40, or even greater than 50% medicare! So many physicians are facing the ethical dilemma of not seeing Medicare patients, or having to charge them an extra fee to make up the difference, or reducing their visit time with medicare patients to see more patients total. None of these options are good options, especially if you know somebody who is on medicare, will be on medicare in the near future, or if you are on medicare yourself.
The 10.1% pay cut that was due on January 1st will still take place at the end of June if Congress doesn't finally act to fix this thing. In fact, the next 8 years are scheduled for 5% cuts each year under the current algorithm that bases physician reimbursement on whether or not spending growth is more or less than an economics-derived target rate. If spending growth in health care exceeds the target rate, physicians get a pay cut. The problem is that everything in health care is getting more expensive, at a rate faster than economic inflation. So ultimately we are looking at a 40% pay cut from Medicare by 2016. It is pretty much a guarantee that Physicians will not see Medicare patients regularly if that is the case. Best-case scenario is that they have their mid-level providers like Physician Assistants and Nurse Practitioners see them, but -40% will still make that virtually impossible from a business standpoint.
Medicine should not be a business and physicians should not have to worry about what patients they can and can't see in order to stay in business. The medicare system as it stands is going to force Physicians to put business ethics above medical ethics and that is wrong. We need our congressional and senatorial leaders to make this change for the future of our seniors and our health care system. We need our next president to care about health care for seniors, reducing health care costs (reduce costs for physicians and reimbursement cuts are not a problem), and improving the quality of health care in America!
Wednesday, December 19, 2007
Friday, December 14, 2007
Crawling to the finish line
Well, I've met my match. Throughout my collegiate career I always managed to hold off until Christmas break to get sick. But not this year! Not only am I breaking my trend, I'm now on my second cold in the last month. Of course my mind has decided to try and formulate some reasons for this new found immunological breakdown...
1. I'm 28, not 25, or 21. Apparently I'm not invincible... who knew?
2. The 4 month long finals week.
3. 5 exams over a 10 day period just wasn't enough challenge... "Go big or go home!"
4. Woot. (certain people will understand)
5. Several months of sniffing formaldehyde in the anatomy lab has convinced my body that it is, in fact, dead.
6. Speaking of anatomy lab... a thorough dissection of the male genitalia has been shown to have all sorts of side effects in male medical students (i.e. mild-to-moderate depression, lower abdominal/inguinal pain, deep feelings of disloyalty to one's team).
7. Bacteria and Viruses thrive in moister environments... There's more humidity in Des Moines than Colorado... THEREFORE... humidity kills! There, I said it.
I need a cough drop... and a hug.
1. I'm 28, not 25, or 21. Apparently I'm not invincible... who knew?
2. The 4 month long finals week.
3. 5 exams over a 10 day period just wasn't enough challenge... "Go big or go home!"
4. Woot. (certain people will understand)
5. Several months of sniffing formaldehyde in the anatomy lab has convinced my body that it is, in fact, dead.
6. Speaking of anatomy lab... a thorough dissection of the male genitalia has been shown to have all sorts of side effects in male medical students (i.e. mild-to-moderate depression, lower abdominal/inguinal pain, deep feelings of disloyalty to one's team).
7. Bacteria and Viruses thrive in moister environments... There's more humidity in Des Moines than Colorado... THEREFORE... humidity kills! There, I said it.
I need a cough drop... and a hug.
Thursday, December 6, 2007
Disco Doctor?
Check out this article: http://www.msnbc.msn.com/id/21599495/
"Associated Press -
updated 1:42 p.m. CT, Fri., Nov. 2, 2007
SYRACUSE, N.Y. - A dentist was dancing to a song on the radio while drilling on a woman's tooth, and she wound up in the hospital when the drill bit snapped off and lodged near her eye, a lawsuit alleges." And what song was he dancing to...
1976 hit song 'CARWASH'!!! What the heck??? We all know that the only appropriate disco song for the doctor's office is 'Stayin Alive' by the BeeGee's! I hear that they're going to make a movie about this Dentist, and John Travolta will be playing the lead...
"Associated Press -
updated 1:42 p.m. CT, Fri., Nov. 2, 2007
SYRACUSE, N.Y. - A dentist was dancing to a song on the radio while drilling on a woman's tooth, and she wound up in the hospital when the drill bit snapped off and lodged near her eye, a lawsuit alleges." And what song was he dancing to...
1976 hit song 'CARWASH'!!! What the heck??? We all know that the only appropriate disco song for the doctor's office is 'Stayin Alive' by the BeeGee's! I hear that they're going to make a movie about this Dentist, and John Travolta will be playing the lead...
The Myth of Medical School
Have you ever wondered what medical school really is like? I did before I got here. There is this social myth or mystique or urban legend or drunken monologue in our world about the secret society of medical school. While it is hard and challenging, it definitely is not what you think it is... so let me reveal to the world the truth... and it all starts with free lunches!
"Free lunches???" is what you are saying. Yes, free lunches are near and dear to the medical student amongst many other things. You see with our class load and debt load combining with the requirement of extracurricular activities (to get into a good residency), clubs and other organizations wishing to get a portion of our time are limited to the lunch hour. Essentially, Free lunch = attendance. Of course by "free" I mean that my club dues OR my tuition pay for it, but "FREE" sounds so much nicer. That is a nice segway to the fact that aside from our classes and studies we do have to be involved in clubs and community service/outreach both to satisfy the humanitarian values that most of us have and to help us get into that all important but completely and subjectively undefined "good residency" after medical school. In my case I am a member of 4 clubs and am an active 1st year leader for one of them; the Student Osteopathic Medical Association or SOMA.
Another vital aspect of medical school is your ability to acquire the prime study spaces. Many students think this is an acquired or teachable skill, but I happen to think it is a gift bestowed by God upon a select few individuals. Seeing the sad, longing faces of other students wander past the closed door of the room that you just snagged, knowing that they will make 2 or 3 more passes by your door just to be sure it is occupied is both shaming for a few seconds yet mostly exhilirating. Away with you to the glorified cherrywood voting booths we call 'study carrels'!
So let me get to the point. Medical school is hard academically and somebody must have some intellectual and intestinal fortitude to get through. But really it isn't just classes and studying. It is a lifestyle that is unique and there is camraderie that is so enjoyable! You do have to find joy in the little things like free lunches and stumbling upon the one open study room, but is that really different than a co-worker proactively smiling and saying hello, or getting a compliment from your boss, or realizing they're serving your favorite lunch in the cafeteria?
"Free lunches???" is what you are saying. Yes, free lunches are near and dear to the medical student amongst many other things. You see with our class load and debt load combining with the requirement of extracurricular activities (to get into a good residency), clubs and other organizations wishing to get a portion of our time are limited to the lunch hour. Essentially, Free lunch = attendance. Of course by "free" I mean that my club dues OR my tuition pay for it, but "FREE" sounds so much nicer. That is a nice segway to the fact that aside from our classes and studies we do have to be involved in clubs and community service/outreach both to satisfy the humanitarian values that most of us have and to help us get into that all important but completely and subjectively undefined "good residency" after medical school. In my case I am a member of 4 clubs and am an active 1st year leader for one of them; the Student Osteopathic Medical Association or SOMA.
Another vital aspect of medical school is your ability to acquire the prime study spaces. Many students think this is an acquired or teachable skill, but I happen to think it is a gift bestowed by God upon a select few individuals. Seeing the sad, longing faces of other students wander past the closed door of the room that you just snagged, knowing that they will make 2 or 3 more passes by your door just to be sure it is occupied is both shaming for a few seconds yet mostly exhilirating. Away with you to the glorified cherrywood voting booths we call 'study carrels'!
So let me get to the point. Medical school is hard academically and somebody must have some intellectual and intestinal fortitude to get through. But really it isn't just classes and studying. It is a lifestyle that is unique and there is camraderie that is so enjoyable! You do have to find joy in the little things like free lunches and stumbling upon the one open study room, but is that really different than a co-worker proactively smiling and saying hello, or getting a compliment from your boss, or realizing they're serving your favorite lunch in the cafeteria?
Friday, November 30, 2007
Elections and Healthcare Reform
While next year's election has much bigger issues at hand than healthcare reform (i.e. Iraq!) I have had quite a few people ask me about my views on candidates, their healthcare plans, and what the issues are in the healthcare system. Remember that I do live in the capitol of Iowa and we are one month away from the Iowa caucuses that will make or break many of the campaigns. In fact, two presidential candidates (Joe Biden & Mitt Romney) have spoken at my school regarding their healthcare plans. Being a political junkie this is like candy for me.
So here's the short, sweet version of the healthcare reform issues:
1. Democratic universal healthcare concepts are NOT socialized medicine like Canada and Europe. All of the major democratic candidates are proposing a national health insurance payor AS AN ADDITIONAL OPTION to private insurance companies.
2. How do we get the 47 million uninsured people in this country insured?
-We need to deregulate the health insurance industry to allow more competition and the reduction of insurance prices. Adding a governmental national payor to the mix can drive competition and drive costs down.
-We need to require insurance companies to insure everybody regardless of pre-existing conditions for a fair and equitable price.
-We need consumers to have access to these different companies' pricing structures
-We need to have regulations in place regarding employers carrying catastrophic insurance so that major medical costs for one member of a group plan do not raise rates for all members.
-We need to require those individuals who can afford health insurance (at the newer competitive rates) to buy insurance like we require car insurance.
-We need to ensure that every person who qualifies for medicare/medicaid is aware that they are qualified and are enrolled.
-For those that do not qualify for medicare/medicaid and do not make enough to buy private insurance (about 15 million people) we provide a stipend for that insurance (and ensure that they use it to buy into the national payor program. Our government currently pays hundreds of millions of dollars annually to hospitals to cover the cost of free care given to those who are not covered under insurance. We can redirect this money to the stipends and get everybody covered.
3. We need tort reform in medical liability and legal reform in medicare reimbursement. Did you know that a family practice doctor has to spend tens of thousands of dollars annually for malpractice insurance (an anesthesiologist may pay $100,000 annually!)? Setting liability limits and monitoring liability insurance companies will reduce this single largest expense of physicians which we can pass on to the patients. Also, our government keeps allowing medicare/medicaid reimbursements to physicians to decrease (10.1% next year unless congress acts to change it) leaving physicians to be forced to increase rates to non-medicare patients and subsequently higher health insurance rates. Health insurance companies follow whatever medicare does and drops their reimbursements along with medicare.
4. Prescription drugs. I hear all this talk about the government buying drugs from Canada so we can get the cheaper rate. Why don't we look at the pharmaceutical companies??? These companies create a phenomenal product, but they spend billions and billions of dollars annually on marketing paraphernalia (pens, notepads, etc), free lunches for physicians/nurses/etc, and paying physicians $500-$1000 to give a one hour lunch talk to other physicians about a drug. Granted these physicians are making a questionable decision regarding medical ethics, but when a pharmaceutical company is offering you $30,000 a year just to give 30-35 free lunch talks... how hard would that be for you? Some of us are fighting this infiltration of pharm companies into medical ethics (http://www.pharmfree.org/)
So which presidential candidates do I think have it right in their healthcare plans? Barack Obama on the Democratic side and Mitt Romney on the Republican side. What I've described is the Obama plan, and also very similar to what Mitt Romney put in place successfully in Massachusetts, however he doesn't believe the federal government should mandate this system nationwide ("Let the states decide"). So that's the long and the short of it. Check out:
http://www.ama-assn.org/ama/pub/category/17712.html
http://www.barackobama.com/pdf/HealthPlanFull.pdf
http://www.nytimes.com/2007/11/25/magazine/25memoir-t.html?_r=1&ei=5087&em=&en=14f86674a4b9bfd7&ex=1196226000&adxnnl=1&oref=slogin&adxnnlx=1196486558-vP9f3Z6CHCRLvNIQN5uSBQ
Thanks for reading and God Bless! E-mail me at richard.w.rapp@dmu.edu with any questions!
So here's the short, sweet version of the healthcare reform issues:
1. Democratic universal healthcare concepts are NOT socialized medicine like Canada and Europe. All of the major democratic candidates are proposing a national health insurance payor AS AN ADDITIONAL OPTION to private insurance companies.
2. How do we get the 47 million uninsured people in this country insured?
-We need to deregulate the health insurance industry to allow more competition and the reduction of insurance prices. Adding a governmental national payor to the mix can drive competition and drive costs down.
-We need to require insurance companies to insure everybody regardless of pre-existing conditions for a fair and equitable price.
-We need consumers to have access to these different companies' pricing structures
-We need to have regulations in place regarding employers carrying catastrophic insurance so that major medical costs for one member of a group plan do not raise rates for all members.
-We need to require those individuals who can afford health insurance (at the newer competitive rates) to buy insurance like we require car insurance.
-We need to ensure that every person who qualifies for medicare/medicaid is aware that they are qualified and are enrolled.
-For those that do not qualify for medicare/medicaid and do not make enough to buy private insurance (about 15 million people) we provide a stipend for that insurance (and ensure that they use it to buy into the national payor program. Our government currently pays hundreds of millions of dollars annually to hospitals to cover the cost of free care given to those who are not covered under insurance. We can redirect this money to the stipends and get everybody covered.
3. We need tort reform in medical liability and legal reform in medicare reimbursement. Did you know that a family practice doctor has to spend tens of thousands of dollars annually for malpractice insurance (an anesthesiologist may pay $100,000 annually!)? Setting liability limits and monitoring liability insurance companies will reduce this single largest expense of physicians which we can pass on to the patients. Also, our government keeps allowing medicare/medicaid reimbursements to physicians to decrease (10.1% next year unless congress acts to change it) leaving physicians to be forced to increase rates to non-medicare patients and subsequently higher health insurance rates. Health insurance companies follow whatever medicare does and drops their reimbursements along with medicare.
4. Prescription drugs. I hear all this talk about the government buying drugs from Canada so we can get the cheaper rate. Why don't we look at the pharmaceutical companies??? These companies create a phenomenal product, but they spend billions and billions of dollars annually on marketing paraphernalia (pens, notepads, etc), free lunches for physicians/nurses/etc, and paying physicians $500-$1000 to give a one hour lunch talk to other physicians about a drug. Granted these physicians are making a questionable decision regarding medical ethics, but when a pharmaceutical company is offering you $30,000 a year just to give 30-35 free lunch talks... how hard would that be for you? Some of us are fighting this infiltration of pharm companies into medical ethics (http://www.pharmfree.org/)
So which presidential candidates do I think have it right in their healthcare plans? Barack Obama on the Democratic side and Mitt Romney on the Republican side. What I've described is the Obama plan, and also very similar to what Mitt Romney put in place successfully in Massachusetts, however he doesn't believe the federal government should mandate this system nationwide ("Let the states decide"). So that's the long and the short of it. Check out:
http://www.ama-assn.org/ama/pub/category/17712.html
http://www.barackobama.com/pdf/HealthPlanFull.pdf
http://www.nytimes.com/2007/11/25/magazine/25memoir-t.html?_r=1&ei=5087&em=&en=14f86674a4b9bfd7&ex=1196226000&adxnnl=1&oref=slogin&adxnnlx=1196486558-vP9f3Z6CHCRLvNIQN5uSBQ
Thanks for reading and God Bless! E-mail me at richard.w.rapp@dmu.edu with any questions!
Why a Blog?
Well I believe that if you have something to say then somebody out there is probably willing to read a few sentences of it. But really what this blog thing is about for me is sharing my thoughts and experiences regarding my life as a husband, friend, non-friend, etc who happens to be a medical student. That way those that I care about and those who stumble upon this blog can understand more about this world I live in. You will probably get glimpses into my academic life, spiritual views, political views, and poetic sides. Regardless, just know that I appreciate the opportunity to share, and you taking the time to read!
God Bless!
God Bless!
Ahhh, Welcome to the insanity!
So welcome to my world! My name is Rick and I am medical student. If that sounds like an A.A. introduction well, it almost is. You see, many people might find a personal flaw in somebody who is intentionally forking over $150,000+ over four years so that they can:
1. Study all the time
2. Spend less time with their family, friends and hobbies
3. Take 1-3 'final equivalent' exams each week
4. Dissect and learn every (and I do mean every) part of a noble (and I do mean noble) body donor.
5. Learn a job where the majority of their income comes from health insurance companies and the government.
But the kicker is that I am going to be a doctor, hopefully even a healer. I take that seriously despite my joking. In the future people will come to me at their weakest points and I will have the amazing privilege of helping guide them back to strength! Not only that, but I get to educate them about the miracles taking place every second within their bodies! To me, that makes it worth the hardships of applying to, and surviving medical school. Thus, you have now seen my heart fully exposed!
1. Study all the time
2. Spend less time with their family, friends and hobbies
3. Take 1-3 'final equivalent' exams each week
4. Dissect and learn every (and I do mean every) part of a noble (and I do mean noble) body donor.
5. Learn a job where the majority of their income comes from health insurance companies and the government.
But the kicker is that I am going to be a doctor, hopefully even a healer. I take that seriously despite my joking. In the future people will come to me at their weakest points and I will have the amazing privilege of helping guide them back to strength! Not only that, but I get to educate them about the miracles taking place every second within their bodies! To me, that makes it worth the hardships of applying to, and surviving medical school. Thus, you have now seen my heart fully exposed!
Subscribe to:
Posts (Atom)