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Showing posts from 2017

Parable of the Pizza Shop

One day a man decided to open a pizza shop.  The first week he sold pizzas, collected money from his customers; the happy customers ate hot pizza and business was good.

The next week many of his customers who came in had pizza insurance, and had already paid Blue Wall Insurance for their pizzas.  Since so many of his customers had purchased pizza insurance, the man signed a contract with Blue Wall agreeing to discount his pizzas in return for a larger volume of customers.  And so it went with United Pizza Insurance, PizzaNet and Pizzaetna.  

Pretty soon the man started having trouble getting the pizza insurance companies to pay for the pizzas he sold, and he had to wait a few months for his payment.  They also started meddling with his cooking and trying to dictate what toppings he could use.  They even restricted the use of some of the more expensive ingredients.  He had to hire extra employees to fill out forms and paperwork they required before they would reimburse him.  This all cos…
California's Managed Care Medi-Cal
I thought if I wrote about  “Medi-Cal Managed Care” that my readership may run screaming in the opposite direction.  But hey, what is life without risk?  Anyway, look at this--you’re still here.  Kudos to you for your determination and tenacity.  Here we go:  

CAPITATION
In 2013 California decided to change the way Medi-Cal reimburses primary care providers from fee for service to capitation1,2.  Lots of private insurance Health Maintenance Organizations (HMO’s) also reimburse under this model.  For those of you lucky enough not to understand capitation, here’s the quick and dirty:  Traditionally physicians have been paid a set amount for each service rendered:  aptly named fee-for service. Under capitation, a physician is assigned a number of patients and gets paid a monthly fee, generally a few dollars per patient per month (PPPM), regardless of whether the patient receives services or not.  In theory, this is supposed to motivate physicians to ke…

The Slow Demise of the Private Office

Doctors have been bemoaning changes in the practice of medicine for years, and with good reason.  It’s harder and harder to make a go of it in private practice.  In recent years our area has lost several small practices -- Hal Grotke’s Redwood Family Practice closed*, Dr. Garcia retired, Teresa Marshall’s solo office shut its doors, Eureka Internal Medicine transitioned to Humboldt Medical Specialists (which then became St. Joseph Hospital Medical Group), and  Beverly Copeland relocated to Ashland.  As I was writing this, Dr. Windham announced that he is ceasing the provision of primary care at his small office.  Unfortunately, young, freshly trained physicians are not arriving here to take their places.  Most recent graduates take positions with large organizations that can offer loan repayment funds, regular hours and steady salary. It’s no wonder new physicians want to be employees with reasonable pay and limited hours.  If you are not working for yourself, there is no reason to be…