Learn what physicians think about the real issues.

On Sermo, physicians collaborate on everything from patient care and medical ethics to healthcare reform and practice management. We’ve highlighted some of their most vibrant discussions on the Sermo Blog.





Undercover Patients


From Daniel Palestrant, Founder & CEO of Sermo
Nearly 1,000 physicians on Sermo responded to a proposal in which the government sends 'undercover patients' to root out physicians fraudulently participating in Medicare and Medicaid. Click below to scroll through the physician comments.

Originally Posted to the Sermo Community
By: sayaah, Otolaryngology

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Undercover Patients

Rooting Out Fraud With Undercover Patients

By Peter Landers

Democrats and Republicans generally agree on the need to root out fraud in Medicare and Medicaid, but Sen. Tom Coburn, an Oklahoma Republican, threw out one idea that President Barack Obama hadn't included in his health-care overhaul plan.

Coburn, himself a doctor, said the government should send undercover patients into doctors' offices to probe whether the doctors were willing to break Medicare rules - not unlike mystery shoppers ferreting out bad customer service at stores. Obama said he'd consider putting the proposal into his plan.

Others liked it, too. "I thought your suggestion of undercover patients … is a great idea, and one that we can come together on," said Sen. Charles Schumer, a New York Democrat.

Last year, Coburn proposed using health-care professionals make undercover visits to doctors or hospitals to check out the quality of care.

Medicare and Medicaid fraud includes cases where doctors bill the government for procedures that didn't happen. Estimates of the size of Medicare fraud vary widely. PolitiFact.com looked at the issue last year and threw out one estimate of $13 billion a year.

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From the Founder: Our profession, down but not out


A recent survey of 1,000 physicians, part of the soon to be released Physician Sentiment Index (PSI) done on Sermo, confirms what many of us already know; we as physicians have remarkably little insight into the business underpinnings of our profession, and even less optimism about the future of our profession. While 82% of physicians state that they have a "clear" or "vague" understanding of what cash flow is, only 25% of respondents could select the correct definition from a list of options. Perhaps most striking, a disturbing 70% of MDs surveyed believe their financial situation will be the same or worse next year. While this isn't surprising, after all we went to medical school, not accounting school, it is certainly not encouraging and makes me wonder if these trends are linked.

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As physicians, the loss of control of our financial fate is inseparable from the gradual demise of our profession.

By any measure, doctors find themselves in an increasingly untenable position. Payers have long had intrinsic advantages over physicians and even shifting to fee-for-service introduces unique challenges to physician owned and managed practices. I have discussed these challenges for over a year now, and even predicted that companies or technologies would come along that help address inefficiencies and the information imbalance that exists between payers and physicians. This week, Sermo will announce a partnership between Sermo and athenahealth. Positioned between the doctor and the payer, athenahealth pools the collective experience of thousands of physicians' claims data into something called a rules engine to help even the playing field between physicians and insurers. In key metrics, such as claims rejection rate, accounts receivable, and yes cash flow, athenahealth has shown that technology can help physicians directly benefit from one another.

I believe the appeal of companies like athenahealth and Sermo is their unique ability to allow individual physicians to leverage many of the same technologies and strength in numbers that the insurance companies have long benefitted from. For the healthcare industry, it is the opportunity to help level the playing field. For physicians, it is the opportunity to turn the billing process into a strategic advantage, increasing the ability for us to stay in practice and provide the best possible care to our patients.

So, the discussion for the community…..do you think EMR, EHR, and/or billing technologies can be used to improve the financial independence of physicians?

Daniel Palestrant, MD

Founder & CEO

Sermo, Inc.

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From the Founder: The Chickens Came Home to Roost


Almost nine months ago, the Sermo community warned that the biggest threat to physicians in this country is the AMA.

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FtF:The biggest threat to US Physicians: The AMA

As the AMA gave the policy makers a platform to claim physician support for each and every version of their healthcare reform bills (including the most recent one), the AMA argued that they needed to do this to keep "a seat at the table" and address the most important issue, the pending SGR Medicare payment cuts. Tort reform,insurance reform, simplification of billing, none of them were worth fighting for because the AMA was going to deliver on the SGR fix. Well today, the Chickens Came Home to Roost, with a revelation that Monday physicians will in fact face a 21% cut in payments. And here is what the AMA President had to say:

The Cuts Are Happening

This is a seminal moment in the history of medicine in this country. We as physicians have a choice to make. We can continue to be the pawns in the our own profession while the AMA sells their endorsement to protect their own CPT revenue or we can (finally) recognize this as the wake up call it is.

Sermo has created a medium, whereby, physicians, for the first time can coordinate their efforts and take a stand. Hundreds of times a day the doctors of this country use Sermo to improve the care we provide our patients. It is truly magical. Today, however, we need to help ourselves.

Take that stand.

Daniel Palestrant, MD

Founder & CEO

Sermo, Inc.

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From the Founder: Antitrust Warfare


Not since the days of monopoly busting and Standard Oil has anti-trust been such a contentious topic in American politics. Today, Teddy Roosevelt has been replaced by Nancy Pelosi and the oil barons have been replaced by……doctors? The healthcare debate is quickly turning into a dog fight about monopolies and price controls, and in doing so, unveiling some of the dark truths about how the money really flows in this country's largest industry.

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Turns out antitrust law has become so contorted and subverted that it now serves the interests of those it was meant to regulate far more than those it was meant to protect. This past week, the FTC announced a consent decree with Roaring Fork IPA, a physician network in Colorado ( click here). Of course, this is less than a week after the Speaker of the House announced that she will pin her party's hopes of resurrecting healthcare reform on repeal of the 1945 McCarran-Ferguson Act, a little known antitrust exemption that benefits the insurance industry ( click here).

So why has antitrust become all-the-rage-all-of-a-sudden?  The Sherman Antitrust laws were originally intended to prevent monopoly behaviors, however, it has become a key tool in keeping physicians as indentured servants in our healthcare system.  As Medicare continues to reduce payment rates, more and more providers are choosing to opt-out rather than contract to deliver services at a loss. Most notably, the Mayo Clinic chose to do this a few weeks back ( click here).  What is fascinating, however, is that the FTC is claiming that the Roaring Fork's decision (unlike Mayo's) constitutes an anti-trust violation so egregious that it is worthy of an investigation and the consent decree.  With 65 physicians, Roaring Fork represents well less than 1% of the physicians in Colorado, so why the anti-trust concern?

The answer lies in the cozy relationship between the insurance industry and the FTC.  Insurers are determined to make sure that physicians are kept from having any leverage nor allowing market forces to create a balanced supply-demand between physicians and patients.  The net goal of both is keeping physician payment artificially low, while maximizing insurance company profits.  For physicians, Roaring Fork should be a wake up call to accelerate their efforts to decrease their dependence on third party payers and their adoption of technologies and services that can even the playing field.

Today we are witnessing a Kafka-esque sequence of events.  Teddy Roosevelt, the original trust buster, would literally bust out laughing if he could see the incumbent political party pinning their hopes for their highest profile political effort on repeal of an anti-trust exemption, while the government chases after……..doctors, for ostensibly violating this same law.  Only in America.

 

Daniel Palestrant, MD

Founder & CEO

Sermo, Inc.

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It's 3am. I can't keep my solo practice open anymore.


From Daniel Palestrant, Founder & CEO of Sermo
Nearly 500 physicians on Sermo responded to one's Family Physician's tale regarding his struggle to keep his business afloat. In the end, he was forced to leave his solo practice due to financial hardship. Click below to scroll through the physician comments.

Originally Posted to the Sermo Community
By: doctorfurl, Family Medicine

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It's 3am. I can't keep my solo practice open anymore.

It has finally happened.  I have been keeping my income just high enough to pay personal expenses because I have a second job (moonlighting in an ER).  The income from my almost 5-year old solo family practice is not enough to make it.  I am making about 1/2 of what I should.  Between ER and FP, I am working about as much as I did as a resident.  I soon won't have the ER gig anymore.  They are trying to get rid of part-timers so as to fill their schedules more readily.  I can't commit to full time with them, as they have full-timers already.  Ah, the politics of shift work...

Part of the problem is a horrible management company that I joined 2 years ago.  (My mistake, but there are 300 other docs in this God-forsaken company)  The amount they charge (aprox 25%) for what little they do amounts to financial sodomy.  Suffice it to say, the contract I signed indicated to me and my lawyer that they would do a lot more.  They know I don't have any money for court costs, so they just do as little as they want.  I am powerless to change it, for if I walk away the debt on the office is mine (at least 100k) and if I stay, I can't make the overhead and get a reasonable salary.  I will post more about the management company later, so that no one else deals with them.  I can't mention them specifically until the contract issues are resolved.  They have an army of lawyers.

I'm exhausted.  I'm 39 years old.  I looked at myself in the mirror, and I look like the after picture of a US President.  You know, the before compared with the after, the after shot always looks like they aged 20 years compared to the before.  I sleep about 3 hours a day, sneaking 4-6 on weekends.  My wife doesn't know this...I have nearly wrecked my car coming home from overnight ER work on at least 6 occasions.  I take too much Provigil.  I am addicted to "Energy Drinks."  I know they are bullshit, but I'm hoping for a placebo effect.  Liquid Hope, I call it.

But I don't want to whine or ramble.  I just want to make sure no one else ends up like this. 

I vow to you, my fellow Sermoans, to describe my upcoming closing of a solo family practice.  A lot of posts have talked about it in generalities.   There is much more press about opening a solo practice.  The thought of opening another solo practice makes me want to vomit.

My practice currently has over 5,000 patients in a growing suburban metropolitan area.  Most have insurance.  The main lesson I have learned: I can't be the product of the business AND the manager of the business.  I reached out to a company to help, and now they are my pimp.  This ho just can't ho no mo'.  Not on 3 hours sleep a night.

My next question: Anyone else going through this?  Contemplating this?  Have anything to offer?

Stay tuned, as I will add to this post as events change.  I am expecting a flood of calls from recruiters after my many emails about jobs...

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FTC - Refusal to accept Medicare pricing = Price fixing


From Daniel Palestrant, Founder & CEO of Sermo
More than 500 physicians participated in a discussion focusing on a Complaint from the FTC that the Roaring Fork Valley Physicians IPA, by refusing to accept federal Medicare price controls, is violating anti-trust laws. The announcement prompted a strong reaction among physicians who want to accept or decline payment terms, like any other profession.

Originally Posted to the Sermo Community
By: Whatagas, Anesthesiology

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Today the FTC announced a consent agreement effectively killing the Roaring Fork Valley Physicians IPA. A major point of the FTCs contention was that the IPA's refusal to present contracts to members based on medicare payment rates represented price fixing by the IPA! In other words, if you don't accept medicare's fixed pricing, you are price fixing.

Here's a brief analysis:

http://blog.mises.org/arch...

and here's the actual FTC complaint:

http://www.ftc.gov/os/case...

Are dentists better off than physicians?


From Daniel Palestrant, Founder & CEO of Sermo
Physicians on Sermo weigh in on the differences between physician and dental practices. Physicians have plenty to learn about how dentists run successful practices. Click below to scroll through the physician comments and view the survey results.

Originally Posted to the Sermo Community
By: happysign, Physical Medicine and Rehab

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Are dentists better off than physicians?

It seems to me that the dentists I come across do very well financially. I would venture to say that they fare better than physicians and work very reasonable hours. It also appears that they get 100% of what they charge for ( insurance will pay but almost always patients pay the rest of what insurance does not cover). Why is it that patients seem more willing to pay their dentists?

Why do politicans not interfere as much with dental practices? Is is because most dental services are not covered by medicare?  Dental care is also expensive, my sister had to pay for $27,000.00 cash for a few implants. How do dentists get away with this? What is their secret? Are the dentists more united? Does the American Dental Association have stronger lobbying?

My daughter is a sophomore in college and wants to be a physician, with the current climate of the practice of medicine, I have been encouraging her to go into dentistry instead. I do not want her to  go thru the anguish , that we are all going thru.

Is there something we can learn from the dentists? What are they doing right?

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Humping Toddlers


From Daniel Palestrant, Founder & CEO of Sermo
Nearly 50 physicians on Sermo recently discussed the commonplace occurrence of humping in their pediatric patients. In most cases, this is normal behavior that parents can learn to address with their children. Click below to scroll through the physician comments.

Originally Posted to the Sermo Community
By: chinita, Pediatrics

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How do you counsel parents with toddlers who "humps?" Here are 2 recent cases:

2 year old boy living with both parents, only child. Since about 6 months old, he "humps" pillows and other objects mostly before he falls asleep. The humping seems to be soothing to him.  Parents initially thought it was funny and video taped it but stopped showing them after someone commented on it being perverted. I counseled them it appears to be a soothing behavior and to teach him to do it in private. No shaming. He now only does it occasionally in private in his own bed.

3 year old girl with recently separated parents. Living with mom and 5 year old brother. Since she could crawl, she would also hump objects. Again, it appears to be soothing. Mom tried to ignore it. Also tried to encourage girl to do it in private without shaming. Since parents separated, things have gotten worse. She's now undressing herself in public to hump objects. Mom found her naked humping brother's Transformer toy. This one I referred for therapy. There was DV between parents. No physical or sexual abuse per mom. Genital exam and UA were normal.

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Do You Believe In Eternal Life?


From Daniel Palestrant, Founder & CEO of Sermo
Several hundred physicians on Sermo recently discussed their thoughts and beliefs about the human afterlife. 44 physicians responded that they categorically do not believe in an afterlife, while over 200 who responded that they whole-heartedly believe in one. Click below to scroll through the hundreds of physician comments and see the results of the survey.

Originally Posted to the Sermo Community
By: Wonposet, Pediatrics

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Carlos Eire's recent book, "A Very Brief History of Eternity," raises the eternal question as to whether God exists outside time or is indivisible and everlasting.   He begins this book by emphatically stating that every trace of our life will someday disappear forever.

Some say life after death does not exist but is programmed into us to help perpetuate our species and allow us to function even after we realize our mortality.

François-Marie Arouet, better known by his nom de plume, Voltaire,wrote, "Si Dieu n'existait pas, il faudrait l'inventer."  He understood the practical benefits of a generalized belief that the wrongdoings of humankind would be punished in an afterlife, the fear of which could get people to behave.

http://upload.wikimedia.o...

Even amongst Christians who believe that salvation and eternal life are rewards for faith as opposed to works, there is an underlying appreciation of the benefits of living a righteous life and doing good deeds and the feeling that charity can overcome a multitude of sins.

The early Catholic Church recognized this when it invented Purgatory and at one time carefully calculated the time one would need to spend in it.  One day on earth was considered to be equivalent to ten thousand years in Purgatory.

http://www.npr.org/templa...

http://online.wsj.com/art...

We physicians have a better education and more exposure to death and dying than many of our contemporaries. 

How do you feel about eternal life?

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Family Doctors, PLEASE don't prescribe Xanax or Klonopin!



From Daniel Palestrant, Founder & CEO of Sermo
Several hundred physicians on Sermo respond to one Psychiatrist’s plea to not prescribe Xanax or Klonopin. From the psychiatrist’s perspective, the addictive nature of these medications only serves to further exacerbate the patient’s ability to recover. Click below to scroll through the hundreds of physician comments and see the results of the survey.

Originally Posted to the Sermo Community
By: psychiatristnj, Psychiatry

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Family Doctors, PLEASE don't prescribe Xanax or Klonopin (or Valium or ativan)!   The next time someone comes to you and tells you they have anxiety or panic attacks give them an SSRI or give them vistaril or give them Buspar but PLEASE don't prescribe Xanax or Klonopin.   It's a big mistake.   These medicines are addictive.  Even the best intentioned patients find that one tablet works for a while and then after a while they need two because one stops working.  They don't relieve the panic attack or anxiety.  They are a bandaid for a larger problem.  
Would you give a bandaid for a severed limb?   The patients have to learn relaxation techniques.   They should go buy a CD on relaxation techniques.   They should exercise to reduce stress.   Patients end up taking these meds when they're angry to calm themselves down.   Then they go to a psychiatrist, maybe, and they're already hooked on these pills.   People, particularly young people in their 20s, take an extra pill or two when one doesn't work and then they go driving and they get pulled over for a DUI.  The police don't care if it is prescribed.  If they appear intoxicated they will lose their  license.  It's happened to my patients before I stopped prescribing these medicines.  When you give them Xanax or Klonopin, you're essentially telling them they should not work on their problems.   Panic attacks are over 90% curable by cognitive behavior therapy which in the case of panic attacks includes breathing and relaxation exercises in addition to positive self talk so they stop catastrophizing.   I know as a family doctor (or internist) you don't have time to tell the patient all of this, but you're hurting your patients by getting them hooked on Xanax and Klonopin.   Come on guys, you might as well tell them to drink a beer (if you're trying to hit the GABA receptors.)