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The Water Cooler
Stupid Stuff
Prescription drug costs - let's hear your stories/rants
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<blockquote data-quote="tRidiot" data-source="post: 3222744" data-attributes="member: 9374"><p>What exactly did you DO in the doctor's office, can you tell me? Because I can guarantee you... the physician doesn't WANT to have to schedule 30 patients a day. I <strong>guarantee </strong>you that. Why do you think they do so? Do you have ANY idea at all?</p><p></p><p>Enlighten me.</p><p></p><p>Do you know how much the utilities cost? The insurance? The equipment? How about staffing costs? Paying insurance for your employees? How about even FINDING employees who are willing to work, and don't want to just sit on their phones surfing Facebook? Overhead is incredible in a doctor's office, how much do you know about that? How about how long it takes for insurance companies to remit checks? Or what percentage of what is billable (as determined by the .gov) actually gets paid? So... you see... they say, "This is how much you can bill." Specifically... and then... they don't pay that. And when they DO pay it, how much of that is written off, how much is 30, 60, 90 or even 180 days behind? Yet... the staff still needs to be paid. The bills have to be paid, or the lights will be turned off. The insurance and licensure fees... must be paid. And paid on time. Not 30 days behind. Certainly not 60, 90 or 180 days behind. Not at all.</p><p></p><p>So then... tell me what happens when the physician goes in to see the patient? Tell me How exactly the doctor can keep the patient on track, where they can talk for 10 minutes with the doctor in the room. And counsel them (again) about keeping their BP logs, watching their diet to keep their diabetes under control, the complications that come when they don't take their medicines appropriately, or exercise or a million other things. And then the patient wants to additionally talk about their gout, their sore back, complain they can't sleep, talk about what they read on Google about their condition, talk about how they don't want to take medicine, they just want to be fixed. And the doctor asks again and again for them to bring logs of their medicines, logs of what they eat, what medicines they actually are taking ("Oh, that little green pill, I don't know what it's called"), meds from other doctors, what happened at their Cardiologist's office visit, at their Neurologist's or Rheumatologist's office? But they don't really remember that. </p><p></p><p>Seriously... do this 20, 25, even 30 times EVERY. SINGLE. DAY. Then spend an hour or two after the office is closed doing all the charting required by the .gov - on the EMR system that cost you hundreds of thousands of dollars, that cost you hundreds of thousands in equipment to be able to run, that is slower than hell and is dependent upon your network and internet service, that is slower and less efficient than using old paper charts - but that you don't get any extra money from the government or insurers to implement - you just get reimbursed LESS if you don't do it. </p><p></p><p>And tell me how it's just a matter of respect, trying to make sure everyone gets seen within.... what? How long should it take? To walk in the door, to check in with the front desk, fill out your paperwork (which most people DO NO DO), sit down, be called back to the exam room, have a nurse check your vitals, go over your history and medications (again, on another cantankerous computer) - because you didn't bring your medicines OR a list of them, to go over what is being discussed today, and then the nurse goes back out and you wait for the doctor to come in. How long should that take? Seriously. 10 minutes? 20? 30? And when new patients come in, have ZERO records, don't bring their meds, want all their meds refilled, want several referrals and all these things done, when the doctor (and staff) is just trying to write in who they are, learn about their long, complicated, convoluted, confusing, poorly-recalled in scattered, sometimes conflicting history and reports... how easy is that?</p><p></p><p>Oh, and let's make some medicine and testing choices in there that are life-threatening, hmm? How about being terrified you might miss ONE, just ONE TINY, CRITICAL element that could cause a drug reaction, a complication, and potentially the DEATH of someone - all while you're stuggling to read through reams of papers that come in DAILY from Home Health agencies, from other providers' offices, take care of patients appropriately, document everything appropriately so you will be able to review it all when they come back - oh, and evaluating all the refill requests from people who don't want to come back in to discuss things, Home Health agencies that want to change people's medicines or dosages with little to no explanation - agents of Home Health agencies YOU DON'T KNOW. I know my nurses in the office. I don't know the nurses out there seeing people in their homes. Or at the nursing home.</p><p></p><p>And then the drug reps who all just want a MINUTE of your time - and you have to try to be nice and give them some time. You know why? Any idea? Not because you get a free lunch, not because you get a pen or a pack of sticky notes here and there, but because they leave SAMPLES of medicines. Expensive medicines. Things you can give to your patients to help them, because a lot of them are unable to afford the most effective medicines they really need. Like insulin. Blood pressure meds. Bladder control meds. How much does your 80 y/o woman want to talk about her blood pressure when she is leaking urine all the time, and you can't help her at all? Yeah, without samples, some of those folks would be screwed. Especially the diabetics.</p><p></p><p>And again, then people want to come in once every 3 months, or every 6, or fight about even coming in once a YEAR - but they need you do fill their meds, they don't want to do labs, they forget to fast, they skip appointments. How valuable is MY time? When people book appointments and just don't show, don't call, don't care? </p><p></p><p>So come now... tell me how simple, how easy it is to get in to see people in a reasonable timeframe? How it shouldn't be that hard, how it's just simply a matter of "respect". That's all, right?</p><p></p><p>Keep in mind, every 10 minutes I spend with a patient - I might have to spend another 10 or 20 minutes documenting what we talking about, putting in lab orders, sending in medications, even more time ordering tests or doing Prior Authorizations - you know, that time I have to physically get on the phone and sit waiting for some insurance schmuck to get on the phone (usually 10-20 minutes of menus and hold just to get them on the phone) so I can tell them why a patient needs a certain test. And you have to have patients scheduled pretty much every 10 minutes, 15 at the most. </p><p></p><p>How many hours of my evening and weekend time is it reasonable to expect I give up to do all the charting and paperwork? Just curious. 1 hour? 2? 3 hours a night, outside of the normal 7:30-5:00PM just to try to make ends meet.</p><p></p><p>Tell me how easy it is. Tell me why it shouldn't be so damned hard to see people in a "reasonable" timeframe. When they want to make a 3 month follow up to talk about their blood pressure, diabetes and heart disease. Then they want to add in their sore back, their bladder, their sleep, and all the other little aches and pains and irritations, and then get mad when you want them to come back for a different visit to talk about those things.</p><p></p><p>Tell me. <strong>Enlighten </strong>me.</p><p></p><p>I've scratched the surface of the things I have to worry about EVERY. SINGLE. DAY. And I glossed over the life-and-death stuff. Tell me how much sleep you lose over if you made the right decisions that day. When there IS no good answer, but you have to come up with SOMETHING to tell your patients. You can't just say, "Tough luck, you're old. Live with it." That doesn't work.</p><p></p><p>But the formula, boy it sure sounds simple, doesn't it? Make an appointment, show up, get your 10-15 minutes, and get everything you need done - DONE. IN TEN MINUTES.</p><p></p><p>Sounds simple.</p></blockquote><p></p>
[QUOTE="tRidiot, post: 3222744, member: 9374"] What exactly did you DO in the doctor's office, can you tell me? Because I can guarantee you... the physician doesn't WANT to have to schedule 30 patients a day. I [B]guarantee [/B]you that. Why do you think they do so? Do you have ANY idea at all? Enlighten me. Do you know how much the utilities cost? The insurance? The equipment? How about staffing costs? Paying insurance for your employees? How about even FINDING employees who are willing to work, and don't want to just sit on their phones surfing Facebook? Overhead is incredible in a doctor's office, how much do you know about that? How about how long it takes for insurance companies to remit checks? Or what percentage of what is billable (as determined by the .gov) actually gets paid? So... you see... they say, "This is how much you can bill." Specifically... and then... they don't pay that. And when they DO pay it, how much of that is written off, how much is 30, 60, 90 or even 180 days behind? Yet... the staff still needs to be paid. The bills have to be paid, or the lights will be turned off. The insurance and licensure fees... must be paid. And paid on time. Not 30 days behind. Certainly not 60, 90 or 180 days behind. Not at all. So then... tell me what happens when the physician goes in to see the patient? Tell me How exactly the doctor can keep the patient on track, where they can talk for 10 minutes with the doctor in the room. And counsel them (again) about keeping their BP logs, watching their diet to keep their diabetes under control, the complications that come when they don't take their medicines appropriately, or exercise or a million other things. And then the patient wants to additionally talk about their gout, their sore back, complain they can't sleep, talk about what they read on Google about their condition, talk about how they don't want to take medicine, they just want to be fixed. And the doctor asks again and again for them to bring logs of their medicines, logs of what they eat, what medicines they actually are taking ("Oh, that little green pill, I don't know what it's called"), meds from other doctors, what happened at their Cardiologist's office visit, at their Neurologist's or Rheumatologist's office? But they don't really remember that. Seriously... do this 20, 25, even 30 times EVERY. SINGLE. DAY. Then spend an hour or two after the office is closed doing all the charting required by the .gov - on the EMR system that cost you hundreds of thousands of dollars, that cost you hundreds of thousands in equipment to be able to run, that is slower than hell and is dependent upon your network and internet service, that is slower and less efficient than using old paper charts - but that you don't get any extra money from the government or insurers to implement - you just get reimbursed LESS if you don't do it. And tell me how it's just a matter of respect, trying to make sure everyone gets seen within.... what? How long should it take? To walk in the door, to check in with the front desk, fill out your paperwork (which most people DO NO DO), sit down, be called back to the exam room, have a nurse check your vitals, go over your history and medications (again, on another cantankerous computer) - because you didn't bring your medicines OR a list of them, to go over what is being discussed today, and then the nurse goes back out and you wait for the doctor to come in. How long should that take? Seriously. 10 minutes? 20? 30? And when new patients come in, have ZERO records, don't bring their meds, want all their meds refilled, want several referrals and all these things done, when the doctor (and staff) is just trying to write in who they are, learn about their long, complicated, convoluted, confusing, poorly-recalled in scattered, sometimes conflicting history and reports... how easy is that? Oh, and let's make some medicine and testing choices in there that are life-threatening, hmm? How about being terrified you might miss ONE, just ONE TINY, CRITICAL element that could cause a drug reaction, a complication, and potentially the DEATH of someone - all while you're stuggling to read through reams of papers that come in DAILY from Home Health agencies, from other providers' offices, take care of patients appropriately, document everything appropriately so you will be able to review it all when they come back - oh, and evaluating all the refill requests from people who don't want to come back in to discuss things, Home Health agencies that want to change people's medicines or dosages with little to no explanation - agents of Home Health agencies YOU DON'T KNOW. I know my nurses in the office. I don't know the nurses out there seeing people in their homes. Or at the nursing home. And then the drug reps who all just want a MINUTE of your time - and you have to try to be nice and give them some time. You know why? Any idea? Not because you get a free lunch, not because you get a pen or a pack of sticky notes here and there, but because they leave SAMPLES of medicines. Expensive medicines. Things you can give to your patients to help them, because a lot of them are unable to afford the most effective medicines they really need. Like insulin. Blood pressure meds. Bladder control meds. How much does your 80 y/o woman want to talk about her blood pressure when she is leaking urine all the time, and you can't help her at all? Yeah, without samples, some of those folks would be screwed. Especially the diabetics. And again, then people want to come in once every 3 months, or every 6, or fight about even coming in once a YEAR - but they need you do fill their meds, they don't want to do labs, they forget to fast, they skip appointments. How valuable is MY time? When people book appointments and just don't show, don't call, don't care? So come now... tell me how simple, how easy it is to get in to see people in a reasonable timeframe? How it shouldn't be that hard, how it's just simply a matter of "respect". That's all, right? Keep in mind, every 10 minutes I spend with a patient - I might have to spend another 10 or 20 minutes documenting what we talking about, putting in lab orders, sending in medications, even more time ordering tests or doing Prior Authorizations - you know, that time I have to physically get on the phone and sit waiting for some insurance schmuck to get on the phone (usually 10-20 minutes of menus and hold just to get them on the phone) so I can tell them why a patient needs a certain test. And you have to have patients scheduled pretty much every 10 minutes, 15 at the most. How many hours of my evening and weekend time is it reasonable to expect I give up to do all the charting and paperwork? Just curious. 1 hour? 2? 3 hours a night, outside of the normal 7:30-5:00PM just to try to make ends meet. Tell me how easy it is. Tell me why it shouldn't be so damned hard to see people in a "reasonable" timeframe. When they want to make a 3 month follow up to talk about their blood pressure, diabetes and heart disease. Then they want to add in their sore back, their bladder, their sleep, and all the other little aches and pains and irritations, and then get mad when you want them to come back for a different visit to talk about those things. Tell me. [B]Enlighten [/B]me. I've scratched the surface of the things I have to worry about EVERY. SINGLE. DAY. And I glossed over the life-and-death stuff. Tell me how much sleep you lose over if you made the right decisions that day. When there IS no good answer, but you have to come up with SOMETHING to tell your patients. You can't just say, "Tough luck, you're old. Live with it." That doesn't work. But the formula, boy it sure sounds simple, doesn't it? Make an appointment, show up, get your 10-15 minutes, and get everything you need done - DONE. IN TEN MINUTES. Sounds simple. [/QUOTE]
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