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(Buzzfeed)   Doctor in Kentucky needs to close his small medical practice due to the crushing requirements imposed by the brutal dictatorship known as Obamacare. That crushing requirement: Using computers   (buzzfeed.com) divider line 192
    More: Asinine, obamacare, Kentucky, electronic records, electronic health records, incentive programs, Reinvestment Act, medical practices, Centers for Medicare  
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2824 clicks; posted to Politics » on 10 Dec 2013 at 4:06 PM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-12-10 09:03:50 PM  

bintherdunthat: machoprogrammer: There is a reason they are forcing small doctors offices to either close or to retire...

In 2009, the HITECH act was passed as part of the stimulus. Part of that is using an electronic medical record (EMR) in a "meaningful way", called "Meaningful Use". If the physician/hospital chooses not to partake, they do not get extra free money from taxpayers right now... In a few years, those tax payer dollar incentives turn into no medicare reimbursement penalties.

The problem is that EMRs are very, very expensive and the cheaper, smaller ones do not handle Meaningful Use very well. The nice ones are for bigger healthcare organizations and are tens of millions of dollars to just install (not counting support from the vendor, which is also in the millions).

The reason? Well let's just say EMR vendor CEOs know who to donate money to

It was NOT the ACA, but the HITECH Act that is causing it.

Fancy, expensive equipment is one of the things that has contributed to the U.S. Post Office's problems.


No. A congressional mandate to pay for the pensions of workers who haven't even been born yet is the USPS's problem.
 
2013-12-10 09:16:02 PM  

xxcorydxx: bintherdunthat: machoprogrammer: There is a reason they are forcing small doctors offices to either close or to retire...

In 2009, the HITECH act was passed as part of the stimulus. Part of that is using an electronic medical record (EMR) in a "meaningful way", called "Meaningful Use". If the physician/hospital chooses not to partake, they do not get extra free money from taxpayers right now... In a few years, those tax payer dollar incentives turn into no medicare reimbursement penalties.

The problem is that EMRs are very, very expensive and the cheaper, smaller ones do not handle Meaningful Use very well. The nice ones are for bigger healthcare organizations and are tens of millions of dollars to just install (not counting support from the vendor, which is also in the millions).

The reason? Well let's just say EMR vendor CEOs know who to donate money to

It was NOT the ACA, but the HITECH Act that is causing it.

Fancy, expensive equipment is one of the things that has contributed to the U.S. Post Office's problems.

No, being forced, by republicans in congress, to carry an unreasonable amount of future funds for pensions has caused all of the post offices problems, but thanks for playing!


Wrong again.
 
2013-12-10 09:20:18 PM  

bintherdunthat: xxcorydxx: bintherdunthat: machoprogrammer: There is a reason they are forcing small doctors offices to either close or to retire...

In 2009, the HITECH act was passed as part of the stimulus. Part of that is using an electronic medical record (EMR) in a "meaningful way", called "Meaningful Use". If the physician/hospital chooses not to partake, they do not get extra free money from taxpayers right now... In a few years, those tax payer dollar incentives turn into no medicare reimbursement penalties.

The problem is that EMRs are very, very expensive and the cheaper, smaller ones do not handle Meaningful Use very well. The nice ones are for bigger healthcare organizations and are tens of millions of dollars to just install (not counting support from the vendor, which is also in the millions).

The reason? Well let's just say EMR vendor CEOs know who to donate money to

It was NOT the ACA, but the HITECH Act that is causing it.

Fancy, expensive equipment is one of the things that has contributed to the U.S. Post Office's problems.

No, being forced, by republicans in congress, to carry an unreasonable amount of future funds for pensions has caused all of the post offices problems, but thanks for playing!

Wrong again.


Allow me to speak for everyone when I say [citation needed]
 
2013-12-10 09:21:12 PM  

phalamir: Nope. We want them to have decent doctors - that is why non-rural people tend to be quite happy to subsidize doctors who will work in rural areas. But, there is a certain segment of rural doctors who are there precisely because they have no competition. Either they are inept hacks who know they have a captive audience; or, they become inept hacks because no competition means they can slide by, and they atrophy. I've met some perfectly fine rural doctors - but I have met far more that would actually make me suggest that their patients visit the vet. The vet doea have competition, and so is on top of his game, and he probably has a better understanding of medicine than Doc Peckerwood.


You can often spot the hacks because they're also the local "coroner" if they managed to win the post away from the local funeral home director.
 
2013-12-10 09:21:52 PM  
There always are other options.  The simplest would just be to stop seeing Medicare patients or see fewer of them - for a one-doc practice, if you're any good, you should be able to choose your patients to a fairly high degree.

Another obvious thing would be to join a physician's group that either owns an EMR or partners with a local hospital to extend an EMR to their affiliated providers.  There's a number of both economic and patient care reasons why joining a larger group would be a good move even without the HITECH act.

Third, even if you don't want to go with an open source option, there's always Practice Fusion and the like that offer solutions at no cost.  You don't even really need to abstract your old charts, either, though there's benefit to doing so.  You could scan the charts and reference the scans, or you can just keep paper charts for historical data and electronic records for new data.
 
2013-12-10 09:22:47 PM  

Dafatone: bintherdunthat: xxcorydxx: bintherdunthat: machoprogrammer: There is a reason they are forcing small doctors offices to either close or to retire...

In 2009, the HITECH act was passed as part of the stimulus. Part of that is using an electronic medical record (EMR) in a "meaningful way", called "Meaningful Use". If the physician/hospital chooses not to partake, they do not get extra free money from taxpayers right now... In a few years, those tax payer dollar incentives turn into no medicare reimbursement penalties.

The problem is that EMRs are very, very expensive and the cheaper, smaller ones do not handle Meaningful Use very well. The nice ones are for bigger healthcare organizations and are tens of millions of dollars to just install (not counting support from the vendor, which is also in the millions).

The reason? Well let's just say EMR vendor CEOs know who to donate money to

It was NOT the ACA, but the HITECH Act that is causing it.

Fancy, expensive equipment is one of the things that has contributed to the U.S. Post Office's problems.

No, being forced, by republicans in congress, to carry an unreasonable amount of future funds for pensions has caused all of the post offices problems, but thanks for playing!

Wrong again.

Allow me to speak for everyone when I say [citation needed]


Yes, exactly. Please, show your work, we're all waiting.
 
2013-12-10 09:23:48 PM  

machoprogrammer: artifishy: machoprogrammer: There is a reason they are forcing small doctors offices to either close or to retire...

In 2009, the HITECH act was passed as part of the stimulus. Part of that is using an electronic medical record (EMR) in a "meaningful way", called "Meaningful Use". If the physician/hospital chooses not to partake, they do not get extra free money from taxpayers right now... In a few years, those tax payer dollar incentives turn into no medicare reimbursement penalties.

The problem is that EMRs are very, very expensive and the cheaper, smaller ones do not handle Meaningful Use very well. The nice ones are for bigger healthcare organizations and are tens of millions of dollars to just install (not counting support from the vendor, which is also in the millions).

The reason? Well let's just say EMR vendor CEOs know who to donate money to

It was NOT the ACA, but the HITECH Act that is causing it.

Where are you getting your information?

This EMR is popular and free.

In small doctor's offices, they install an EMR on a laptop on a roll stand and wheel it from room to room. I've helped to install them and they certainly don't cost anywhere near 10s of millions of dollars.

The major vendor EMRs are very expensive, is what I meant. There are exceptions, but the "big boys" are tens of millions.

The problem with OpenEMR is that if there is a problem, you either hire a developer to fix it or you wait until it is fixed.  Also, did you miss the big, red bold letters on that website about Meaningful Use Stage 2 not being done and needing funding? MU Stage 2 is pretty damn important right now.

I have worked in healthcare IT for quite a few years.


The big boys also come with guarantees that they will help you install, train you, offer to store your mountains of data offsite, etc etc.  Not to mention the guarantee that comes with having all the credentials.  I worked on one of these behemoths back in the middle of the 00s and the big issue was being able to promise that our customers would be compliant with whatever new regulations or protocols are in place.

That means that when Aetna changes what row 35 column 12 stands for in their claims form, the software needs to be updated...

The free ones are nice for small practices, but there are reasons that the major vendors are charging so much.
 
2013-12-10 09:26:37 PM  

InmanRoshi: ox45tallboy: If this guy resisted learning about computers, which have been pretty ubiquitous business practice for the past 20 years, imagine what other technological advancements he has resisted learning about regarding the practice of medicine.


This.

One can romanticize the archetype of  the folksy rural doctor, but there's probably a reason why many of them plant themselves to a captive pool of patients who don't have many accessible alternatives (and far, far away from the nearest malpractice lawyer).


Actually, I'm willing to believe he's trolling and he actually has a high-speed fiber to his room in the back he uses to check WebMD.
 
2013-12-10 09:34:46 PM  

NeverDrunk23: mrshowrules: From wiki: "Doctors who fail to use EMRs by 2015, Medicare reimbursements will be reduced by 1%. The deduction rate increases in subsequent years by 2% in 2016, 3% in 2017, 4% in 2018 "

In other words, he has no reason to close now and very little reason to close later.  Article already indicates that he was close to retirement.  So Obama is now responsible for doctors retiring.

Obama said I could keep my doctor. Now my doctor wants to be a dancer and I need a new doctor now. Thanks Obama.


LOL.  I love it.
 
2013-12-10 09:37:19 PM  

spongeboob: mrshowrules: From wiki: "Doctors who fail to use EMRs by 2015, Medicare reimbursements will be reduced by 1%. The deduction rate increases in subsequent years by 2% in 2016, 3% in 2017, 4% in 2018 "

In other words, he has no reason to close now and very little reason to close later.  Article already indicates that he was close to retirement.  So Obama is now responsible for doctors retiring.

You missed the part where if he had went to EMRs earlier he would have received bonuses for several years, the government would have literally paid for his transition to Electronic health care records.


I didn`t notice that part.  I choose to ignore that part now anyways because my head will explode otherwise.
 
2013-12-10 09:41:47 PM  
1.bp.blogspot.com
 
2013-12-10 09:45:43 PM  

Katie98_KT: I am so okay with this it if not even funny.

I want EHRs. You know why I want them? I'm have a drug allergy. Luckily its not a serious allergy, but it could develop into one if I'm given the drug regularly.

If I end up in the ER due to a car accident, and I'm unconscious/delirious/etc, I want the doctors to be able to pull up my medical history by contacting my insurance company/my doctor and getting all my records. I want e-prescribing, where the system screams bloody murder if they try to prescribe me the medication I'm allergic to.
No human is perfect. No machine is perfect either, but its much better at this stuff than the average human. And before you say that this kind of stuff doesn't happen- I was in the hospital to get my appendix out, wearing a bright orange medical bracelet saying I'm allergic, its in all my records, and when they went to discharge me the doctor wrote a prescription for it, and the nurse handed it to us. Luckily my parents were with me and caught it before we left, but jeez.

EHRs are an important upgrade to our medical system, and any doctor not willing to see the benefits should be done practicing medicine.


Yep. A friend of mine was rushed to the ER after a car accident. She's allergic to a couple of medications and wears both a medicalert bracelet & necklace, but both were overlooked in the rush to treat her. She was given one of the medications while still in the ER and started going into anaphylaxis.
 
2013-12-10 09:56:35 PM  
Really dude?   either adapt , grab on to new tech which ypu should have started doing like  a decade ago or get out of the way.
 
2013-12-10 10:16:32 PM  

Serious Black: urbangirl: Serious Black:

How the hell is every single person in his office computer illiterate in 2013?


Somerset, KY

Yes, yes, it's a small backwoods town, but still, nobody in their office is even remotely computer literate? And there HAVE to be technically literate people in the area given that there are huge centers for SAIC and Blackboard nearby.


I used Blackboard in college. I'm pretty sure the people who designed it were computer illiterate.
 
2013-12-10 10:46:46 PM  

vicioushobbit: Even my shiat-splat town growing up in LA had doctors with electronic records.


At first I was wondering which town in Los Angeles you were talking about...
 
2013-12-10 10:53:37 PM  

Hagbardr: Serious Black: urbangirl: Serious Black:

How the hell is every single person in his office computer illiterate in 2013?


Somerset, KY

Yes, yes, it's a small backwoods town, but still, nobody in their office is even remotely computer literate? And there HAVE to be technically literate people in the area given that there are huge centers for SAIC and Blackboard nearby.

I used Blackboard in college. I'm pretty sure the people who designed it were computer illiterate.


Holy crap, isn't that the truth.  Putting articles up on that monstrosity was such a PIA.  Of course, it was one of the first very early on in the online classroom experience.
 
2013-12-10 10:58:03 PM  

xxcorydxx: Dafatone: bintherdunthat: xxcorydxx: bintherdunthat: machoprogrammer: There is a reason they are forcing small doctors offices to either close or to retire...

In 2009, the HITECH act was passed as part of the stimulus. Part of that is using an electronic medical record (EMR) in a "meaningful way", called "Meaningful Use". If the physician/hospital chooses not to partake, they do not get extra free money from taxpayers right now... In a few years, those tax payer dollar incentives turn into no medicare reimbursement penalties.

The problem is that EMRs are very, very expensive and the cheaper, smaller ones do not handle Meaningful Use very well. The nice ones are for bigger healthcare organizations and are tens of millions of dollars to just install (not counting support from the vendor, which is also in the millions).

The reason? Well let's just say EMR vendor CEOs know who to donate money to

It was NOT the ACA, but the HITECH Act that is causing it.

Fancy, expensive equipment is one of the things that has contributed to the U.S. Post Office's problems.

No, being forced, by republicans in congress, to carry an unreasonable amount of future funds for pensions has caused all of the post offices problems, but thanks for playing!

Wrong again.

Allow me to speak for everyone when I say [citation needed]

Yes, exactly. Please, show your work, we're all waiting.



Some people say all generalizations are false.  You made a generalization.  I did not.

If you ask for a citation, you should be prepared to provide a citation.  Since your  statement was a generalization you've got a lot more area to defend than I do.  I don't really need to provide a citation since what I stated was original thought.

I'm not on here parroting something I've read somewhere else, bashing Republicans, or trying to defend some technology I make a living from by squelching other people's opinions.  I made a statement from personal observations and from which people can take whatever usefulness they have the wherewithal to make of it.

As for the other fellow, no one speaks for everyone.
 
2013-12-10 10:59:54 PM  
I don't know why any doctor would take anything than self pay and private insurance patients or even go to a concierge service. Taking government programs is not worth the hassle of the regulations.
 
2013-12-10 11:12:29 PM  

machoprogrammer: There is a reason they are forcing small doctors offices to either close or to retire...

In 2009, the HITECH act was passed as part of the stimulus. Part of that is using an electronic medical record (EMR) in a "meaningful way", called "Meaningful Use". If the physician/hospital chooses not to partake, they do not get extra free money from taxpayers right now... In a few years, those tax payer dollar incentives turn into no medicare reimbursement penalties.

The problem is that EMRs are very, very expensive and the cheaper, smaller ones do not handle Meaningful Use very well. The nice ones are for bigger healthcare organizations and are tens of millions of dollars to just install (not counting support from the vendor, which is also in the millions).

The reason? Well let's just say EMR vendor CEOs know who to donate money to

It was NOT the ACA, but the HITECH Act that is causing it.


EMR is free for solo or small group practices.

http://www.practicefusion.com/

So, do we move on to the next scare tactic or do we dissect the Practice Fusion website looking for flaws in their model.  Subby's choice.
 
2013-12-10 11:22:17 PM  
www.quickmeme.com
 
2013-12-10 11:46:40 PM  

bintherdunthat: xxcorydxx: Dafatone: bintherdunthat: xxcorydxx: bintherdunthat: machoprogrammer: There is a reason they are forcing small doctors offices to either close or to retire...

In 2009, the HITECH act was passed as part of the stimulus. Part of that is using an electronic medical record (EMR) in a "meaningful way", called "Meaningful Use". If the physician/hospital chooses not to partake, they do not get extra free money from taxpayers right now... In a few years, those tax payer dollar incentives turn into no medicare reimbursement penalties.

The problem is that EMRs are very, very expensive and the cheaper, smaller ones do not handle Meaningful Use very well. The nice ones are for bigger healthcare organizations and are tens of millions of dollars to just install (not counting support from the vendor, which is also in the millions).

The reason? Well let's just say EMR vendor CEOs know who to donate money to

It was NOT the ACA, but the HITECH Act that is causing it.

Fancy, expensive equipment is one of the things that has contributed to the U.S. Post Office's problems.

No, being forced, by republicans in congress, to carry an unreasonable amount of future funds for pensions has caused all of the post offices problems, but thanks for playing!

Wrong again.

Allow me to speak for everyone when I say [citation needed]

Yes, exactly. Please, show your work, we're all waiting.


Some people say all generalizations are false.  You made a generalization.  I did not.

If you ask for a citation, you should be prepared to provide a citation.  Since your  statement was a generalization you've got a lot more area to defend than I do.  I don't really need to provide a citation since what I stated was original thought.

I'm not on here parroting something I've read somewhere else, bashing Republicans, or trying to defend some technology I make a living from by squelching other people's opinions.  I made a statement from personal observations and from which people can take whateve ...


Ah.  So you're trolling.  Carry on.
 
2013-12-11 12:30:16 AM  
Hey dumbass submitter!  It's not the computer that's the problem.  The problem is the systems that you have to buy.  They're incredibly expensive and private doctors are being forced out of business because they can't afford them.

Or as my boss is currently saying about our new system going online this weekend...it's only millions of dollars.  Doctors should not be expected to operate at a financial loss.

//works in medical billing.
 
2013-12-11 01:05:41 AM  

glassa: Hey dumbass submitter!  It's not the computer that's the problem.  The problem is the systems that you have to buy.  They're incredibly expensive and private doctors are being forced out of business because they can't afford them.

Or as my boss is currently saying about our new system going online this weekend...it's only millions of dollars.  Doctors should not be expected to operate at a financial loss.


Sure, a one-doc practice isn't going to buy Epic or Cerner, but athenaHealth or Practice Fusion are options. Hell, Practice Fusion is free.  There's not even any hardware requirements apart from an average Windows PC as they host as well.  athenaHealth is something like $3k per year I believe, including hosting, which is within reason for a small provider.

Nobody in the small practices is going to buy any of the multimillion dollar packages, nor should they - they would be packed with a massive amount of features the practice won't use.  A single provider practice has vastly different IT needs than a multistate health network with thousands of inpatient beds, hundreds of clinics, a full suite of specialties and ancillaries, etc.  There are good options at pretty much any point on the spectrum.
 
2013-12-11 01:11:42 AM  

TheGreatGazoo: Actually, many private practices are being scooped up by hospitals so they have a captive audience for referrals.

EMR (and related) software is super expensive.  A hospital near me has a 9 figure deal to have EPIC installed. Smaller hospitals can pay $40 million plus.

E

pic doesn't really bother with deals less than 9 figures these days, we're looking at about $1 billion over 10 years to them.  Not a bad business...
 
2013-12-11 01:35:47 AM  

natazha: I was speaking to a doctor last Sunday, who said the ACA was going to destroy her practice for exactly that reason. She doesn't use computers and her overhead is almost 70% of her gross. She's going to go to a cash practice, but that won't last very long. If most people have insurance, who's going to pay cash?


People who want decent treatment and not the assembly-line, one-size-fits-all version that's getting to be the norm. I have an HMO that I use for routine stuff, but I go pay out of pocket when I want more personalized service or when the HMO is reluctant to pursue a course of treatment that I think would work better for me. If, God forbid, I need the help of a top specialist for a serious problem, I'm fortunate to be wealthy enough to hire one if need be.
 
2013-12-11 01:39:20 AM  
One of my younger brothers is an MD who just opened a practice. Electronic records systems aren't that expensive. They even have SaaS options now (what my brother did).
 
2013-12-11 01:46:56 AM  

FormlessOne: In other news, ancient, obstinate coot, forced to put up or shut up, shuts up.


In still other news, long-time physician who was doing just fine serving his patients put out of business by bureaucratic horseshiat, fark statist assholes kick the body in celebration, because that's how they handle those who speak truth to power when the power happens to be one they like.
 
2013-12-11 03:43:53 AM  

jjorsett: FormlessOne: In other news, ancient, obstinate coot, forced to put up or shut up, shuts up.

In still other news, long-time physician who was doing just fine serving his patients put out of business by bureaucratic horseshiat, fark statist assholes kick the body in celebration, because that's how they handle those who speak truth to power when the power happens to be one they like.


Yeah.  That 1% of Medicare reimbursements he'd lose in 2015 would totally put him under.
 
2013-12-11 04:14:26 AM  
My god, you can't get doctors in New Zealand off a computer.  They get downright angry when they have to go back through written records to find notes you need (assuming they haven't already scanned them).

Optometrists and dentists, though.  No.  They will continue to handwrite their notes on A5 cards until Armageddon comes.

/Also physios, chiropractors and osteopaths
//Computers not new age and holistic enough for you bastards?
 
2013-12-11 08:41:43 AM  

if_i_really_have_to: My god, you can't get doctors in New Zealand off a computer.  They get downright angry when they have to go back through written records to find notes you need (assuming they haven't already scanned them).

Optometrists and dentists, though.  No.  They will continue to handwrite their notes on A5 cards until Armageddon comes.

/Also physios, chiropractors and osteopaths
//Computers not new age and holistic enough for you bastards?


Admittedly I haven't been to a dentist in a while, and now that I have dental insurance I need to suck it up and go, but I've got shiate vision, and go to the optometrist pretty regularly, and they are ALL ABOUT the computers in there. Laptops and tablets just flying around, leaving gross photos of my eyes on the screen while I'm waiting for the doc to come back. *shudders* I've got this thing about eyes, and I have panic attacks at the eye doctor pretty regularly. Especially the glaucoma test. Still haven't managed to take one. Though I've heard they have a new digital way of testing that doesn't require the air puff or touching my eyeball. Most practices charge a bit extra for it, and most insurances won't cover it, BUT I DON'T CARE. GO TECHNOLOGY! (There's a history of glaucoma in my family... not being able to get the test without panic attacks is a big deal to me.)
 
2013-12-11 08:58:38 AM  

natazha: I was speaking to a doctor last Sunday, who said the ACA was going to destroy her practice for exactly that reason. She doesn't use computers and her overhead is almost 70% of her gross. She's going to go to a cash practice, but that won't last very long. If most people have insurance, who's going to pay cash?


That's why I changed doctors (before ACA was even voted on); she announced she wasn't going to accept health insurance and charged a flat $100 fee for initial visits (followups were free). When I asked her why, she said that health insurance providers were always on doctors to keep patient visits to as short as they could (15 minutes was the goal) and to treat only one illness/problem in each visit (to maximize insurance payments). By refusing to accept insurance, she could then spend as much time as she needed with each patient and try and address all their concerns in one visit. She had only two employees besides herself; a receptionist (who doubled as the initial visit nurse) and a physical therapist/dietician.

My wife still goes to see her but I switched to the practice she used to be a part of; sure enough they try to keep the visits as short as possible and won't try and deal with multiple problems in one visit; "just schedule another visit for those things" they say...
 
2013-12-11 09:00:20 AM  

Dwight_Yeast: TheGreatGazoo: Actually, many private practices are being scooped up by hospitals so they have a captive audience for referrals.

EMR (and related) software is super expensive. A hospital near me has a 9 figure deal to have EPIC installed. Smaller hospitals can pay $40 million plus.

That's what big east coast hospitals have done for years.  But they should have been constantly building and updating their systems.  With the doctor I see (he works for PennHealth here in Philly),

I can make appoints online, access my medical records, etc.  I even found out recently that he actually checks his email at the end of the day, every working day, which is probably a requirement.

I haven't been outside their network for medical care for 25 years, as I've had no need to.

/If we'd been allowed to set up a national medical database, everyone in the country would have the options I have.


Me too.  I love that feature of my care.  Prescriptions are sent while I'm in the exam room, from their tablet, and waiting for me by the time I drive the 10 mins from the doc's to the pharmacy after my appointment. Appointments for things outside the office like xrays/mammograms and such are made right at the same time as well.  I have access to my medical records, test results, can schedule/reschedule/cancel my own appointments, and of course email non emergency questions and get answers within a couple hours.  They also offer free in office advice on how to set up a living will, and will help you make arrangements for who can call the shots on your care if you are incapacitated.  (I'm single & no kids, so it does not default to my spouse/kids).

All in all, a huge improvement over the old days of pen and paper.
 
2013-12-11 09:00:43 AM  
If, in 2013, you don't even have computers in your office, there is no way that you are current on the medical profession.
 
2013-12-11 09:10:24 AM  

Close2TheEdge: HAHAHA.  I knew it had to be somewhere down around Somerset before I even clicked on the link.  This is the county that has racked up thousands of dollars in legal fees fighting the ACLU over the right to post the 10 Commandments in all the courthouses.  It's a freaky religious area.  There are honest-to-God snake handling Christian churches in that shiathole of an area.


My wife has some extended family in that town. When we were visiting a couple years ago, her father in law and I were making jokes about finding and going to a snake handling church since we were in the area.

...decided against it. Don't *really* want to be surrounded by psychos with venomous things.
 
2013-12-11 09:12:57 AM  

xxcorydxx: machoprogrammer: There is a reason they are forcing small doctors offices to either close or to retire...

In 2009, the HITECH act was passed as part of the stimulus. Part of that is using an electronic medical record (EMR) in a "meaningful way", called "Meaningful Use". If the physician/hospital chooses not to partake, they do not get extra free money from taxpayers right now... In a few years, those tax payer dollar incentives turn into no medicare reimbursement penalties.

The problem is that EMRs are very, very expensive and the cheaper, smaller ones do not handle Meaningful Use very well. The nice ones are for bigger healthcare organizations and are tens of millions of dollars to just install (not counting support from the vendor, which is also in the millions).

The reason? Well let's just say EMR vendor CEOs know who to donate money to

It was NOT the ACA, but the HITECH Act that is causing it.

Bolded the part that I'm replying to.

I work for a cheaper, smaller EMR company, and we're one of the leaders in our state (ny) / region (northeast) when it comes to meaningful use.

We cater to small practices. we do not deal with hospitals. I've been here for 10 years, and in that time, we've grown from 100 employees to nearly 300, mostly due to the

ARRA and Meaningful Use.

The other thing that I want to clarify for the threadshiatters that will be here shortly because the title of the thread has "Obamacare" in it, the ARRA and the ACA (0bummercare) have nothing to do with each other.

/making money right now to be on fark, thanks a lot, Obama!


Read that as ABBA, wondered when they got into the medical industry.
 
2013-12-11 09:16:53 AM  
 
2013-12-11 09:59:40 AM  

www.hollywoodrepublican.net

 if your doctor likes his antiquated and borderline dangerous means of keeping your medical records, he can keep it.

 
2013-12-11 11:59:00 AM  

StokeyBob: Seems kind of a shame throwing away a perfectly good doctor.


- Rand Paul
 
2013-12-11 01:25:28 PM  

Dafatone: bintherdunthat: xxcorydxx: Dafatone: bintherdunthat: xxcorydxx: bintherdunthat: machoprogrammer: There is a reason they are forcing small doctors offices to either close or to retire...

In 2009, the HITECH act was passed as part of the stimulus. Part of that is using an electronic medical record (EMR) in a "meaningful way", called "Meaningful Use". If the physician/hospital chooses not to partake, they do not get extra free money from taxpayers right now... In a few years, those tax payer dollar incentives turn into no medicare reimbursement penalties.

The problem is that EMRs are very, very expensive and the cheaper, smaller ones do not handle Meaningful Use very well. The nice ones are for bigger healthcare organizations and are tens of millions of dollars to just install (not counting support from the vendor, which is also in the millions).

The reason? Well let's just say EMR vendor CEOs know who to donate money to

It was NOT the ACA, but the HITECH Act that is causing it.

Fancy, expensive equipment is one of the things that has contributed to the U.S. Post Office's problems.

No, being forced, by republicans in congress, to carry an unreasonable amount of future funds for pensions has caused all of the post offices problems, but thanks for playing!

Wrong again.

Allow me to speak for everyone when I say [citation needed]

Yes, exactly. Please, show your work, we're all waiting.


Some people say all generalizations are false.  You made a generalization.  I did not.

If you ask for a citation, you should be prepared to provide a citation.  Since your  statement was a generalization you've got a lot more area to defend than I do.  I don't really need to provide a citation since what I stated was original thought.

I'm not on here parroting something I've read somewhere else, bashing Republicans, or trying to defend some technology I make a living from by squelching other people's opinions.  I made a statement from personal observations and from which people ...


You're projecting.
I use Fark a little differently than you do.  To me, it's a forum for learning.  Occasionally, I try to add something.
 
2013-12-11 01:57:22 PM  

mrshowrules: From wiki: "Doctors who fail to use EMRs by 2015, Medicare reimbursements will be reduced by 1%. The deduction rate increases in subsequent years by 2% in 2016, 3% in 2017, 4% in 2018 "

In other words, he has no reason to close now and very little reason to close later.  Article already indicates that he was close to retirement.  So Obama is now responsible for doctors retiring.


Reimbursement =/= profit.

If the doctor did a procedure that cost him $980 in man-hours and out-of-pocket costs, and was getting reimbursed $1000, he made a nominal profit of $20 on a patient. That's not very competitive, and doesn't make for a long-term successful practice.

Now if medicaid reimbursements are cut by 1%, his profit is cut by 50%. If it's cut by 2%, he's working for charity. If it's cut by 3%, he's losing money on each medicaid patient he sees.

In other words, another Obamacare supporter has the first clue about economics or running a business, and there's very little chance that any of them do.
 
2013-12-11 07:27:34 PM  

Dafatone: jjorsett: FormlessOne: In other news, ancient, obstinate coot, forced to put up or shut up, shuts up.

In still other news, long-time physician who was doing just fine serving his patients put out of business by bureaucratic horseshiat, fark statist assholes kick the body in celebration, because that's how they handle those who speak truth to power when the power happens to be one they like.

Yeah.  That 1% of Medicare reimbursements he'd lose in 2015 would totally put him under.


It may very well, because Medicare barely covers the cost of providing care in the first place.  Why do you think so many docs don't take Medicare?  But since liberals believe doctors are rich @ssholes, why do you care, right?  They just save lives & went to school for 10+ years to save those lives...taking on hundreds of thousands in debt in the process.  Why should they make any money?  Liberals expect them to operate at a loss anyway.
 
2013-12-12 12:24:46 AM  

iawai: If the doctor did a procedure that cost him $980 in man-hours and out-of-pocket costs, and was getting reimbursed $1000, he made a nominal profit of $20 on a patient. That's not very competitive, and doesn't make for a long-term successful practice.


The problem with that analysis is that, in healthcare, the vast majority of the cost is fixed - for a hospital, around 90%.  As long as the marginal cost incurred by the patient is less than the marginal revenue for seeing that patient, it's worth it to see them rather than let the bed / time slot go empty.

In general, seeing a privately insured patient is better than seeing a Medicare patient.  A Medicare patient is better than seeing a Medicaid patient. A Medicaid patient is better than seeing a self-pay patient.  A self-pay patient is better than seeing nobody.

And, while Medicare reimburses less, it's not unmanageable.  There are clinics that cater to only Medicare patients and they can be very successful.  Some of that are billing efficiencies as a result of dealing with only one kind of insurance, and some are just a different model of providing care.  While Medicare pays less than private insurance, it still pays more than any other nation in the world does for comparable care.
 
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