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Old 10-17-2012, 10:16 PM   #1
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Doctors

I made a visit to a new doctor last August, and today I went back for a physical including labs.

I had previously gone to a Doc in a northern suburb, a guy that I really liked and respected. He took plenty time with me, I felt he was skilled and that he understood and respected my POV. Then his clinic stopped seeing Medicare patients, although they did continue with Medicare Advantage.

Anyway, one day last winter I had bronchitis and went to a clinic near my home. Nice young woman doctor. But it really went downhill fast. She didn't care at all what I wanted or didn't want, and she resorted to scare tactics-like you have a really nice life, do you want to have a heart attack and ruin it?

I tried, because I ways expect that relationships that are at base social (in a broad sense) will work out well for me. They always have. Gradually I realized that I as obsessing about how to get along with her, short of just putting her in complete charge of my body. And her clinic was busy, and she was always rushed although she did try to take time with her patients- but because of this she was always running really late- the clinic would not schedule long enough visits for her to do what she felt she needed to do.

Meanwhile I read a popular book by a local MD. I called his office and scheduled an appointment. So today I had a full physical, which took along time, and for which he conducted an interview sitting in his office, then several hours later brought me back to his office to discuss his findings.

I am basically kind of phobic about medical care, but this was an excellent experience for me. Didn't hurt that everything turned up fine, but also really nice was his reassuring and pleasant manner.

As we get older we are pretty well stuck with going to doctors, and it surely is nice when they are not only well credentialed but also very pleasant. Even his office staff is personal and very pleasant. A lot of Drs offices have a bunch of young girls at the desk who are mainly acting like they really hope that you don't infest them with cooties.

I just hope that he doesn't retire anytime soon!

Ha
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Old 10-17-2012, 10:45 PM   #2
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I can sure relate to what you're saying, Ha. My doc for the last 25 years is retiring at the end of November. He did make a recommendation for a new doc, but you never know. Keeping my fingers crossed that the new doc will work out.
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Old 10-17-2012, 11:03 PM   #3
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Finding the right doctor is hard. I hate changing doctors, too. Fortunately, I have several good ones right now. I have to go to several specialists 3-4x a year and they are all great people. My primary care doctor is wonderful, too. However, I have had my share of bad ones who don't communicate.
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Old 10-18-2012, 12:52 AM   #4
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Happy to read you had a good experience, Ha. I was concerned when I saw the title of the thread first that something bad happened to you with your clinician.
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this was an excellent experience for me. Didn't hurt that everything turned up fine, but also really nice was his reassuring and pleasant manner.
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Old 10-18-2012, 06:59 AM   #5
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I recently switched doctors because my long term doc was cutting hours back at the location near me. They had two new doctors in the practice an DW and I selected a young woman with a gerontology specialty, sight unseen. Figured we could age in place with her if she stays with the practice. Both DW and I have changed our diets (LCHF) and dropped statins. I was expecting to get push back on both from the new doctor but was pleasantly surprised that she was up on virtually all the studies I have been reading and supported our decisions.
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Old 10-18-2012, 07:38 AM   #6
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Originally Posted by haha View Post
I had previously gone to a Doc in a northern suburb, a guy that I really liked and respected. He took plenty time with me, I felt he was skilled and that he understood and respected my POV. Then his clinic stopped seeing Medicare patients, although they did continue with Medicare Advantage.
Although many on here do not seem very concerned, this trend in Drs dropping Medicare worries me, especially with all the BBers that will be going on the roles and with added strains to the system coming from Obamacare.

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I just hope that he doesn't retire anytime soon!

Ha
Or stops accepting Medicare
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Old 10-18-2012, 07:49 AM   #7
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DW tells me our doctor just dropped me. Nurse told her that I hadn't been to see him in 6 years (a physical) and so they dropped me. No warning, just dropped. DW has seen him plenty. I would have thought they might use family history instead of individual history to determine patients, but evidently not. Not sure what I think about it...
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Old 10-18-2012, 09:18 AM   #8
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Hard to beat a doc who will listen and take time to discuss things with you rather than dictate treatment. I've been lucky enough to find one like that, and he's in his 30s so he'll be around for quite awhile.
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Old 10-18-2012, 10:35 AM   #9
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Although many on here do not seem very concerned, this trend in Drs dropping Medicare worries me, especially with all the BBers that will be going on the roles and with added strains to the system coming from Obamacare.
Next year I'll go on Medicare. I called and asked the doctor's office person what happens. Being a continuing patient and on Medicare Advantage, no problem.
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Old 10-18-2012, 10:44 AM   #10
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Some physicians drop Medicare because the rate of reimbursement is low and their practice can't make up the difference with private patients. This is how Medicare reimbursement is designed for all providers: Medicare (and Medicaid) pay low, the practice needs to have enough private insured patients to make up the difference.

Reimbursement is higher for Medicare Advantage patients because the insurer is able to negotiate with the provider for a set of rates for a series of services. Those rates are closer to what the insurer will pay for its private patients. The coverage is the same or broader than Medicare.

Bottom-line: everyone needs to eat and government programs pay a lower rate assuming the business can make it up on other patients. It's not the best business model, but it's what we've got. Practitioners are business people as well, if taking Medicare patients means bankruptcy, you know what choices they will make.

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Old 10-18-2012, 11:24 AM   #11
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Some physicians drop Medicare because the rate of reimbursement is low and their practice can't make up the difference with private patients. This is how Medicare reimbursement is designed for all providers: Medicare (and Medicaid) pay low, the practice needs to have enough private insured patients to make up the difference.

Reimbursement is higher for Medicare Advantage patients because the insurer is able to negotiate with the provider for a set of rates for a series of services. Those rates are closer to what the insurer will pay for its private patients. The coverage is the same or broader than Medicare.

Bottom-line: everyone needs to eat and government programs pay a lower rate assuming the business can make it up on other patients. It's not the best business model, but it's what we've got. Practitioners are business people as well, if taking Medicare patients means bankruptcy, you know what choices they will make.

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Rita, isn't that slated to gradually end under Obamacare, when the Medicare Advantage subsidy from Medicare gets gradually cut? With MA, you can be herded into a narrower and narrower chute, since while you can return to Medicare, you cannot get a supplement without a health check. Which eventually few will pass.

Ha
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Old 10-18-2012, 01:07 PM   #12
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Rita, isn't that slated to gradually end under Obamacare, when the Medicare Advantage subsidy from Medicare gets gradually cut? With MA, you can be herded into a narrower and narrower chute, since while you can return to Medicare, you cannot get a supplement without a health check. Which eventually few will pass.

Ha
I didn't quite follow this. Could you give a few more details or maybe an example?
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Old 10-18-2012, 01:34 PM   #13
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I didn't quite follow this. Could you give a few more details or maybe an example?
I'll try. All MA plans are not the same, from the pts POV or the doctors. A doctor or clinic may accept all, or the case of my former clinic, a subset of those plans that were more profitable for them. One of them was a plan offered by themselves. Each year the lineup would change, and I felt that it was certainly possible that finally, only their own plan would be accepted. Kind of a back door route to an HMO.

As far as getting back on a supplement once you have left and returned to Medicare, it is state specific so you'll have to check it out in your state.

Ha
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Old 10-18-2012, 01:50 PM   #14
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Originally Posted by haha View Post
Rita, isn't that slated to gradually end under Obamacare, when the Medicare Advantage subsidy from Medicare gets gradually cut? With MA, you can be herded into a narrower and narrower chute, since while you can return to Medicare, you cannot get a supplement without a health check. Which eventually few will pass.

Ha
My fear also...
.................................................. ...............
Back to Doctor...
In 2004, when we moved, we signed on with a young lady doctor, 6 months out of school... Best move we've ever made... Each year's checkup is 1 hour... complete... Am not into gratuitous comments, but she's smart, and I'll take smart and up to date over long time wisdom. One of the things that gives us confidence, is that when there is ANY question about symptoms, medication, or vague physical complaints, she will follow up... on-line, or with a specialist. Now... 8 years later, she is regarded among the best doctors in our four county area... and still takes the time to be super thorough.

In the early years, (ages 55 to 68) I felt indestructible and laughed at the blood tests... ha! Cholesterol @ 350, triglycerides @ 1,000... so what... felt great... Dr. suggested that was not too good. Now... Blood pressure under 120, cholesterol (still high 185) but much better, and triglycerides 149... The "old school" attitude about one aspirin a day... no more... When she prescribes, I listen... Takes a lot for a "know-it-all" to learn humility.

All that said... Trust, but verify... an hour or two on-line helps to understand the why's.
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Old 10-18-2012, 07:40 PM   #15
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Our local clinic (about two miles from our house) is a teaching clinic from the UH medical school. Most of the staff are interns working for the attending. I think they're only working there for a year or two, because I've never been seen by the same one twice.

The advantage is that they're inquisitive and quite familiar with their own ignorance. They don't hesitate to say "Let me go look that up" or to spend more time asking more questions. At the end they'll brief their attending and occasionally have the conversation in front of me, usually bringing up more issues for more research.

Some communicate better than others, some listen better than others, a few really need to find another medical field to specialize in. But when the patient is a teachable moment, everybody works hard to get the most out every conversation and to make sure the problem is fully addressed.

No grumpy old docs in that group.
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Old 10-19-2012, 12:56 PM   #16
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Rita, isn't that slated to gradually end under Obamacare, when the Medicare Advantage subsidy from Medicare gets gradually cut? With MA, you can be herded into a narrower and narrower chute, since while you can return to Medicare, you cannot get a supplement without a health check. Which eventually few will pass.

Ha
It is true the subsidy will continue to be reduced. I am still not convinced that MA will go away, especially as those who have it seem to like it. Cutting the subsidy doesn't solve the problem of access to care as more and more physicians refuse to participate in Medicare, but will participate in MA. This was by design: the insurers get paid a flat monthly amount (the subsidy) and risk that they and their contracted providers can provide care within the amount of the subsidy.

The access to care is the issue (along with Medicare's payment schedule), and so that will drive changes to the policies under development.

The whole thing is still broken. The Affordable Care Act simply piled onto a broken health care system.

-- Rita
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