I really do not understand why so many colleagues, judging by the howling silence that pervades my travels both on foot and here at the net, really either do not care, do not see, or do not understand the consequences of the onslaught of disruptions in our providing care by non provider entities like insurance, big pharma, and government.
1. The problems with prescription authorizations. Yes, I spent a prior post on this issue, but think about this for one more minute, please? Medco, who is the most obnoxious company doing this almost on a DAILY basis to me of late, must think they are the biggest part of health care in this country to brazenly tell doctors that a patient cannot get a prescription the physician has written for a medical problem, because, …, well, because why? They don’t tell you why the patient can’t have it filled, they just tell you you have to justify it to them because, what, they are on a f—ing power trip and can disrupt care simply for the sake of being able to disrupt it? If it was about cost, then I would see the trends in just refusing meds that are prohibitively more expensive than generic alternatives. But, to refuse a patient Hydroxyzine HCl, who has been on it for months by me, that costs out of pocket about $20 a month, what the hell is this about?
I’ll tell you my two guesses: they don’t like physicians who challenge them on the authorization forms that these delays are disruptive to care, so the insurer will start demanding authorizations on just about any medication that is not plain vanilla drugs to split care between the doctor and patient; and/or the insurers want to maintain control and micromanage care so it can be made into template decision algorithms and then completely control the prescription process.
I think it borders on sociopathic interventions. It certainly does not make sense from a clinical point of view, and how interesting that bureaucracy rarely if ever has anyone with clinical skills managing clinical care decisions. Stuff that is in the above book as pictured.
2. CPT coding. It is now painfully obvious that this change in coding will decrease reimbursements further for psychiatrists, unless they want to risk fraud by over, or even under billing patient care documentation. The fact that the AMA and APA not only supported the development of this process, but is now profiting from it by holding seminars and insisting clinicians buy these ridiculous novels explaining the coding process is not just obscene, it really does border on treasonous for the profession.
Again, I see it as sociopathic. To prey on your own colleagues, I think it says volumes, pun intended, of what these organizations can and will do to the public they pretend to protect and treat. But, the silence by the profession as a whole, well, you know the adage of what happens when alleged good men and women lie silent. Don’t wait for the coming tread marks!!!
3. What PPACA (Obamacare) really will do to you as providers. The following link from the LA Times is painful to read, but, if you really care about what will result from this disgusting legislation, you gotta read this:
Think about what is hypothesized here: pharmacists and optometrists will be providing somatic care interventions most likely as solo providers, outside their trained disciplines. If this is not dumbing down the health care process, and I am not dissing the role of pharmacists or optometrists, because they are a specialty and important ones at that, but, how many psychiatrists really are happy with the States that have granted psychologists the right to prescribe? Yeah, that has really improved the state of mental health in those underserved areas, right?
Again, I see it as example of sociopathy run amok by the biggest group of organized sociopaths we put up with in this country. Our politicians. Who think that they know better how you should live. And by the rates of reelection of incumbents, I guess it does validate their point of view. Because being rewarded with another term in office for what they have done, or often as much as what they have actively chosen NOT to do, well, they love the proverbial slaps on the back. Ironic that I seem to remember lots of moments of late seeing Obama being slapped on the back by his minions.
Well, you all come to your conclusions as to what is making health care better and more functional, and if what I write about above is of no concern, well, I am sure your country is getting better every day, and your patients are improving so much you are becoming possibly irrelevant each week. The problem is, being silent, uninvested, and just plain ignorant of what these matters are doing to care only aids and abets the sociopaths among us. Hey, it’s not my opinion, just what author Martha Stout wrote about over 7 years ago.
If you haven’t read this book, and have the tolerance for some pain and tough introspection, you might just want to consider the read. You might see some patterns around you, and to miss them, well, it is your career.
How ironic I wrote this while the State Of The Union address was going on simultaneously.
Perhaps this could be viewed as my State of the Disillusioned! Cheers!