Thursday, November 30, 2006

Wal-Mart & Intel to establish a patient-controlled EHR?

Ok, as if it wasn't enough that Wal-Mart is planning to open its own brand of clinics (sound awfully similar to those HMOs that sprouted out in Florida in the late 1980's, then failed. Will quality suffer in the name of cost controls?). Now, they're planning to set up Electronic Health Records. These portable electronic records would be recognizable by hospitals, doctors and pharmacies. The idea -- have the patients coordinate their own healthcare among doctors and hospitals and their pharmacies. Intel and British Petroleum are also on the bandwagon, according to the article in the Wall Street Journal from Wed, Nov 29th. Should we be thankful or afraid?

On paper the ideas sound great! These companies will set up an electronic data warehouse, with of course the most top notch security, then house all private information there. This information will be used by employers and insurers to evaluate health spending patterns on millions of employees. Well, what would you expect? If the employers are paying for this, there's got to be some benefit for them. These e-records will perform the incredible task of eliminating duplicate tests and prevent erroneous information from being carried forward. It would also slash the administrative overhead that is making healthcare so costly in this country. Yes, and electronic prescriptions would help prevent the thousands of medication-related illnesses or deaths that occur yearly. Wow, that's amazing!

Who will be watching over the employers and the insurance companies these records are being shared with? What type of data mining will these records be subjected to? Will patient's privacy be respected, or will this data be used to deny job promotions or even health-care coverage? Who's going to be the watchdog to make sure this information is not misused by the companies that are providing this service for free? It seems too good to be true. Are there enough safeguards in place as of yet? The Patient Privacy Rights Foundation seems to think NOT YET. Ok, they're promising that the employee's information will be stripped off the record before the data is mined. Hmm, hmm!

I can just see it now: Wal-Mart will use its buying power to bully doctors to either agree to participate in these patient-controlled records, or else! If they don't, they will not be able to see these patients. Is it that Wal-Mart and Intel want a bite out of the healthcare spending pie? Intel chips are found in the hand-held prescription-writing PCs. Wal-Mart, with the third largest pharmacy chain in the country, now wants to open 60 "miniclinics." Are these plans to make back some of the money they spend in healthcare? Is there not some STARK II violation in there somewhere? Self-referrals in the case of Wal-Mart? And the union of Wal-Mart and Intel on this initiative was suggested by our very own Centers for Disease Control and Prevention? Wait a second, maybe this is a backdoor entry into a nationalized healthcare system?

Yes. It makes me nervous, because I don't have much faith in the individual consumer to protect their rights. We should have our antennas up and eyes wide-open on this one.

Wednesday, November 29, 2006

The ID Theft saga continues....

On Monday I placed a post about Identity Theft, because someone apparently got their hands on my credit card over the weekend, and charged up a storm. I thought it would have been over after the requisite phone conversations with my C/C company and the credit bureaus. But, yesterday I received a mysterious package in my office. It was one of those fraudulent purchases.

My staff found the contents humuorous, as they were shoes I would never be caught dead in. Were the prepetrators trying to tell me something? One was a plaid green tennis shoe, the other pair a plastic sky blue. They were asking me if I would keep them. Well, of course not! Would you keep something that was purchased with your own money? Fine, let's all poke fun at it, but I was freaked out that someone not only got my C/C info but also my mailing address. I was wondering what else might they have taken?

Well, neither the Citibank Identity Theft/Fraud Dept. nor were very helpful. The Sherlock Holmes in me was thinking that maybe could trace the IP of address from which the order was made and nail these thieves. Well, maybe I've been watching too many movies. I'm sure these thieves are probably sophisticated enough that they would be careful about traceable IP addresses. Citibank could not give me a direct answer as to how this could have happened. Oh well, I guess the case will go unsolved. But just in case, I've filed a report with the FTC (Federal Trade Commission).

Tuesday, November 28, 2006

Is Richer = Better?

Along the lines of my most recent post, I've brought attention to the idea of not just working to follow a dream, but to get rich. That is what my previous post was about -- doctors, Ph.D's, etc... letting go of their idealistic dreams of making a difference for the numerical remuneration on Wall Street. Are we in danger of losing more and more talented professionals for the lure of money? Are we really becoming a society fixated on financial wealth?

But what is being rich? Is it your net worth? Is it your cash flow? Is it what your financial statement says or is it a feeling inside? If you lose everything tomorrow, are you rich or are your poor? On paper, you would be poor; but if you have retained a thinking of abundance in the broader context of a world full of possibilities, you are still rich beyond belief. Again, I ask: is richness what dollar value you show on paper, or what's in your mind? The stock market, your business, and taxes could take away what's in your wallet, but they can never take away what's in your mind. The skills and expertise you acquire in life are what make you rich, not the dollars you have acquired.

On that note, I wonder why there weren't any financial management classes in high school? I don't use the calculus I learned, but I sure could have used learning about how to manage my own finances. Why don't they teach practice management in medical school? Is it because most doctors are going to work for somebody else? After leaving the employed world for the self-employed world, in spite of the initial nauseous feeling that not having a paycheck ever again gave me, I have come to enjoy life without a paycheck. In fact, not living for a paycheck sets you free to think about money in a more responsible way. You can't sit by passively not managing your money when you don't have a paycheck to lean back on.

I wanted to share some books I have read recently, which deal with managing money and wealth. If you plan to work for the next 40 years of your life, slowly building your retirement account over time, hoping you'll have enough to retire, don't read any further. Go back and play with your Lego set. This is not for you. In order to proceed, you must first shatter your view that life is about working as hard as you can so you can save as much as you can until that one day you have enough to retire. Personally, I don't plan to wait around till I'm 70 to retire so that I am worrying about medications, and blood pressure, and who knows what else when I should be enjoying my life.

Here are some guides for you:

Rich Dad, Poor Dad, by Robert Kiyosaki

Multiple Streams of Income, by Robert Allen

Millionaire Maker, by Loral Langemeier

If you do not think that you have to actively manage your wealth; instead, thinking that Social security, your 401(k) or IRA are going to take care of you -- WAKE UP and smell the coffee! These books are a wake-up call into a world of abundance that should be for everyone. Fine, be a doctor or other healthcare professional, but manage your money so that you can live the life you want to live, not the life you have to live to "pay the mortgage".

Monday, November 27, 2006

Doctors shunning Medicine for Wall Street....

An interesting article in the NY Times today talks about how doctors, and other professionals, including academically trained Ph.D's, are shunning their chosen fields for high-paying business consulting positions on Wall Street. The article points to the widening chasm between the rich and the really rich. Apparently the proportion of high net-worth individuals and households in this country has grown in spite of the rocky economic Wall Street rollercoaster these last few years. They use the case study of one physician, formerly a hem-onc specialist, who left his "low-paying" 150K job for the more lucrative now likely 7-figure position in a marketing consulting firm.

Medical schools are even recognizing doctor's interest in business with 40 schools adding an optional 5th-year M.B.A. program in the last 20 years. The doctor in the case study's critical role is to evaluate new drugs from start-up biotechs for his employer, Merrill Lynch, to see if they live up to their claims. Paying the bills and creating a financially secure future for their children to live out their dreams seems to be a prime-motivator for making the transition from their chosen careers to these high-paying positions. Many of them will also start charities, or give enormous sums for their cause of choice. I have no disdain for them, as long as they do good with their money. Charity in the hands of the privately wealthy, in my opinion, like the Bill & Melinda Gates Foundation, is more accountable to the dollars. If the funding is private and in large amounts, they want to know that their money is being put to good use. Andrew Carnegie felt that philanthropy was the obligation of the wealthy. Perhaps we should be teaching that to our children....

Hey, wait a second..... Am I defending the wealthy here? Hell, I'd love to be a part of the richy, rich. But only so that I could direct my money to causes that do good for society. That's part of what motivates me to make more money than to just subsist, as many of us do, skimming by at our cost of living. I'd like to be able to afford more of a contribution to society than just paying my taxes and those $100 checks here and there to charity.

This is what the doctor in the article says,

“I wasn’t sure that I was willing to take the risk of spending many years applying for grants and working long hours for the very slim chance of winning at the roulette table and making a significant contribution to the scientific literature,” he said.

I say: "Is he a sell-out?" I'm not going to be the judge of that.

I do have this to say, though. Is something wrong when money is luring doctors from the skilled trades they were trained to perform? I put it out there for you to ponder. Does something need to change in our society to keep talented professionals in their initial chosen field? Or is it that the most important thing in human nature, as the movie Thank You for Smoking so poignantly points out is a "paying the mortgage"? Does one justify the other? Maybe paying the mortgage is what life is all about. The rest is just fluff.

Identity theft! Arrrggh!

Well, yet another joy of being a small business owner....yesterday afternoon I was leaving the gym when I got a text message on my PDA phone:

Re: Citibank alert/Business card/suspended right now/Fraud dept.

Someone had apparently gotten their hands on my Business credit card number and charged up $8,000 in a number of a few hours on Sunday. Wow! Glad Citibank picked that up in time. I wondered why they didn't flag it before they passed the credit limit? A slew of online purchases at >$200/each within 2 hours of each other are not my usual behavior; but hey, it's the holidays, perhaps they thought it was within the realm of possibilities. I spoke to their Fraud department, and there wasn't much they could tell me in terms of how I could have avoided this. They said, basically, there's no way to avoid it. Are we all at risk just by having a credit card? I asked if I could have set my credit card to only allow a certain amount of charges per day, but Citibank doesn't offer that. I also asked the representative if having Fraud and Identity Theft protection, you know that service they're always trying to get you to buy, would have prevented this, and the rep said "NO." (I guess that rep doesn't work in the sales dept.). Wouldn't setting a daily use limit make logical sense? I know that I don't exceed a daily amount under normal circumstances. OK, yeah, yeah, I know what you're thinking -- at least it's not as bad as getting robbed, because you can dispute the charges on the next statement, but I couldn't help but feel a bit violated. You've got to wonder how these people are able to do this with a card that is barely used? And why didn't Citibank flag this sooner? Is it because the purchases were made online?

I found this website with useful tips on how to deal with Identity Theft:

The FTC site for Fighting Back on Identity Theft

And here's what the Citibank website recommends one do in case of Identity Theft:

Identity Theft Checklist
When identity theft happens, prompt action can help limit the negative consequences. Here is a checklist to follow in the event you or an employee of your business is the victim of identity theft.

  • Contact the credit bureaus. For personal identity theft, you should contact the three major credit bureaus: Equifax, Experian and TransUnion. For business identity theft, you should contact Experian and Dun & Bradstreet.
  • Contact your creditors, i.e. credit card companies, mortgage companies and other finance companies with whom you have loans, credit cards or lines of credit.
  • File a police report and contact the Federal Trade Commission at 1-877-IDTHEFT (1-877-438-4338).
  • Stop payment on any stolen checks.
  • Remove fraudulent phone charges by contacting your state's public utilities commission and remove fraudulent cell phone charges by calling the Federal Communications Commission at 1-888-CALL-FCC (1-888-225-5322).
  • Report the theft of your Social Security Number to the Social Security Administration at
  • Notify the local department of motor vehicles to ensure that someone doesn’t take out a driver’s license or register a car using your identity.
I guess one of the most important things to take care of is call the Credit bureaus and file an Fraud Alert, just in case someone tries to open a bank account or take a loan with your stolen identity. Here are the numbers:

Equifax: 1-800-525-6285;; P.O. Box 740241, Atlanta, GA 30374-0241

Experian: 1-888-EXPERIAN (397-3742);; P.O. Box 9532, Allen, TX 75013

TransUnion: 1-800-680-7289;; Fraud Victim Assistance Division, P.O. Box 6790, Fullerton, CA 92834-6790

Once you place the fraud alert with one, they should notify the other two credit bureaus, and you're also entitled to a free copy of your credit report to review.

Now all you have to do is type Identity theft protection on Google and you'll come up with a whole bunch of companies that promise to: "scour the black market for the use, trade or sale of your identity-related information, alerting you instantly to potential fraud."

Does one incident warrant this? I'll have to investigate further.....

Saturday, November 25, 2006

Welcome to my FEATURED MEDBLOGS list:

Friday, November 24, 2006

A little dose of humor this Holiday Weekend...

Imagine a world where the US computer industry ran like its biotech industry: I dug up a biologist's view on the matter. Where does drug development factor into the rising healthcare cost=equation?

Botox, anyone, with your martini?

Recently, I was invited to a friend's place for a get-together, except it wasn't just any get-together, besides drinks and good conversation, there was going to be a doctor performing free botox injections. This is not the first time I've heard of a botox party, but it is the first time I've been invited to one. Well, my friend's primary care doctor was the one who was going to be giving the botox injections. She told me it might be a good idea for me to talk to her. "She's been doing it for a year now, and it's been very lucrative for her," my friend chimed. So let me get this straight, her internist, with several weekend CME courses has started performing botox injections on her patients. About a year ago, that very same friend was telling me how her doctor was struggling financially. Let's be honest, more and more doctors, faced with insurance reimbursement cuts, are turning to other means to make more ching-ching. The self-sacrificial doctor that chose this profession to serve society is becoming extinct. But, then again, that same doctor used to make a good living doing what they loved 25 years ago. Everywhere I turn, doctors are trying to bite a chunk out of the cosmetic cookie: Dermatologists doing liposuction, ENT's doing 1-year "Plastics" fellowships to be able to do rhinoplasties and face lifts, and Ophthalmologists doing "Oculoplastics." A Dermatologist I know spends at least $5,000 in marketing to drive his cosmetics practice (I'm sure every cent well-worth it since he continues to spend it month after month without seeming to go broke), and he drives around in a Porsche.

Botox parties are a way of getting botox neovites to try it out, then get hooked. It sounds like what drug-dealers do. It's free the first time, but thereafter it's about $400 a pop. Wow! I never make that type of money in one office visit, no matter how thorough it is. But, trust me, in the name of beauty, women of all sorts will sacrifice their earnings for a little drink of the fountain of youth. I even had a male patient asking me about botox, because he was concerned that work colleagues were misinterpreting his expressions because he tends to furrow his forehead when talking without meaning that he is angry. Now that is a reason for botox if I ever heard one! What's next? Ok, botox does have a very useful application -- to stop excessive underarm sweating. This is a major problem for some people who don't want to be embarrassed at work by dripping armpits. Otherwise, are we really becoming such a wrinkle-phobic society? In my neighborhood, there are more plastic surgeons and dermatologists than primary care physicians.

I'd like to believe that I will never have to turn to botox to make the money necessary to meet the ever-increasingly expensive demands of modern living. I mean, common, we're living in a time when people are willing to pay $5 for a coffee. The real estate market has exploded recently. The ceiling is being raised on everything. And whereas the ceiling is rising, traditional medicine is being paid less and less. The hope that I could live a similar life (and I'm not talking about excessive luxuries, just essentials, like a home, possibly one or two nice vacations per year) like doctors did 25 years ago, are slim, but still there. Perhaps I am just deluding myself by sticking to my ideals. I became a doctor to help people in a certain (non-cosmetic) way, and that did not involve seeking the most lucrative treatments or procedures. I have an ideal practice I'm trying to create. I'd like to think that I can become successful and make a decent living doing just that -- by providing good integrative medicine to my patients. If I'm going to make extra money, I'd rather make it investing in real estate or the stock market -- something just won't let me go the cosmetic route (for now).

Thursday, November 23, 2006

Waking up to great business advice on Thanksgiving Day...

One of the toughest parts of being "the boss" is learning how to manage employees. This is a constantly evolving art, and one that I admit I'm not very good at. I'm much better at being a doctor, but I'm learning everyday how to manage and motivate my employees to do a better job and really care about the service they are providing to other people. They are each as vital a part of my practice as I am. Without them, I could never deal with the endless requests for pre-authorization for medications or billing issues or medication refills, etc... On this day of giving thanks, I am thankful for my employees, even thought I may gripe about them from time to time (in private).

One of my favorite finance pages, Yahoo Finance, has an article today about creating a motivated work force -- Five Steps to Engaging Your Employees. Although it is written for the corporate world, the advice is general enough that it can be applied in any business setting. The gist is to remember to not lose your human touch on your employees. It's easy to forget. After all, everyday is very task-oriented, and medicine (probably more than any other field) has very little room for errors. But you can't let the focusing on each task cause your employees or yourself to lose the big picture of why you are there. You may also have to be the moderator of a fight between your employees, so managing a harmonious workplace is not just all about the boss-employee relationship.

One day I was attending to a patient in an exam room, and suddenly I hear two of my employees fighting, raising their voices at each other. I could not believe it! First of all, it is so not my personality. Feeling my skin curl and seeing the patient's eyes widen (thankfully she was a well-established patient of the practice that realized this was not usual behavior), I asked the patient to excuse me for a second. Sometimes immediate feedback at the moment of the incident is better than waiting for later. See The One Minute Manager. I reminded the medical assistants about what proper etiquette in our office is all about, then returned to my patient, knowing I would speak to each of my MA's individually as soon as I had a free moment that day. They both apologized later, and I merely asked them that it never happen again. But as the boss, I also provided them with a vision of what it means to work in our office -- that is, cooperation, a healing environment, resolution of disputes in a humane fashion (no yelling!). As the boss, you have to provide the big picture, to keep the ship steering in the right direction. If I had an office manager, that would be his/her job, but for now, being a small operation, I am the office manager.

For those bosses out there struggling to keep their employees in line, take the above advice to heart. I think you'll find the links very useful.

And Happy Thanksgiving to all!

Life from the perspective of a self-made business owner....

Yes, and that's basically what I am. I've created a medical practice from scratch. That's right, from maybe 2 patients in the first week, to a flow of 40-60 patients now after 2 1/2 years. It was no easy feat, and required a lot of faith that one day it would work. I had the privilege to build this in one of the most competitive markets in this country, because I wanted to live there and nowhere else. And after having worked for an insolent boss, I decided I never wanted anyone breathing down my neck again. Maybe that works for some, but not for me.

But as a self-made business owner (because no matter which way you cut it, a medical practice, especially nowadays, is a business) you find yourself connected with the struggle and hard work of other business owners. Never before did I really get how much sweat and hard labor it takes to be the head of a business, get if off the ground, and make it successful. You don't learn this sheltered working for a hospital during residency, nor taking on a job with a large group or for a hospital after residency (as most of my friends did). That may be for them, but not for me. And now, having experienced the creation of my practice, I would never go back. But what I truly have enjoyed this week is the shared connection with other business owners and managers I see getting their businesses to work. Whether it be the manager of the salon down the street who's involved in a legal mess because the new landlord is trying to evict probably to build a multimillion dollar condo, or the manager of the Jamba Juice around the corner who's there making shakes on a Wednesday afternoon before Thanksgiving with only one staff member at the registrar because she could probably not find employees who would work today (or possibly called in sick) even though it's fully staffed on other days -- I look into their eyes and feel a connection I never felt before. Underneath that connection, is a new level of understanding and appreciation of what they're going through, because I've gone through it (albeit in different ways) myself.

And, in truth, in spite of what has happened to the medical-legal-insurance-driven medicine machine in this country, I am proud to be a part of this community of small-business owners that make up the backbone of America's job market.

This was taken from the White House website (Disclaimer: Source does not imply agreement with political decisions of current administration. I'm merely quoting statistics, which I have no reason to believe were altered).
  • America's Small Businesses Are Thriving. Small businesses create two out of every three new jobs and account for nearly half of America's overall employment. They have played a vital role in helping our economy add more than 5.1 million new jobs since August 2003 and have helped reduce America's unemployment rate to 4.7 percent, below the average rate of the 1960s, 1970s, 1980s, and 1990s. Small businesses are also vital for supporting our communities.

  • Small Businesses Create New Opportunities - Especially For Women And Minorities. Women own more than a quarter of all businesses, and the number of women-owned businesses is growing. Hispanic Americans are opening their own businesses at a rate three times the national average.
I am particularly proud of this last sentence, because not only am I first-generation American, but I am also Hispanic. This is the spirit for which this country was created: to allow the individual to create his/her dream.

However, the truth is that in spite of how many small businesses are created, it is well-known that they have a high failure rate: 40% fail in the 1st year, and of those who survive 1 year, 80% fail in 5 years, and of those who survive 5 years, another 80% fail. Wow! My dad really did well then, not having even been born in this country, but having a strong command of the English language (which he learned as a child because his parents thought it was wise for him and themselves to learn the language of the world's most dominant country), his small business thrived year-after-after for 31 years, when it was sold (and continues under a different name). I could have taken my dad's business and built it into a national conglomerate, but instead, I decided to follow my dreams and become a doctor. 31 years? I wonder how many make it that far? I don't know.

America should support it's small business, because you know what, they might be creating a new job for that family-member that's been unemployed for 6 months. Small businesses should get additional tax breaks during the 1st 5-years when they most tend to fail, probably because of cash-flow issues. For any small business owners who need some pointers, connect with local business owners through your local chamber of commerce, or look up a BNI Chapter near you. You might even pick up a copy of The E-Myth Revisited: Why Most Small Businesses Don't Work and What to Do About It by Michael E. Gerber.

And remember, that no matter how tough the going gets, the tough get going. There is one true thing I've learned: the business market is tough (no matter what business you're in), but it will respect hard work and the genuine desire to bring a good product or service to society. After all is said and done, small businesses fill a void and provide a level of service that corporate America cannot. Who isn't tired of the multi-multi-multi-tiered phone answering services?

If you do have to call corporate America, which unfortunately we all do from time to time, use the GetHuman 500 Database to bypass all of those annoying "press this, press that" choices to get straight to a human being. Thank you!

Monday, November 20, 2006

Doctor beware...... your reimbursements rates may have been subversively dropped!

As if yearly reimbursement rate cuts were not enough, it seems that Aetna throws in a curve ball every so often just to see if I'm still awake. Last week, I received the EOB (Explanation of Benefits for those of you that may not know that dilineates how claims are paid) for some recent claims and immediately noticed a greater than 40% drop (aah!) in payments for given CPT codes. What? I couldn't believe it, but then again, they've done it before in different ways. See, I'm fee-for-service with Aetna, and the rates have been negotiated by an IPA (Internal Practice Associates) that I belong to, so Aetna can't go changing my rates arbitrarily. This protects me as a solo practitioner dealing with the big-wigs. However, it seems that Aetna tries to sneakily lower its payments when you're not looking. I've spoken to other physicians in my neighborhood and they've experienced similar behavior. In fact, one of them didn't even notice Aetna had lowered his reimbursements way below the negotiated IPA fees until it was too late. He lost 6 months worth of payments he could not argue for or retrieve. You see, he did not notice the infraction until a year after they had started, and they only allow you to request claim corrections for the 6 months prior. Interestingly, on the other hand, if an insurance company realizes that they overpayed you for a claim that is greater than 1 year old, there's nothing to stop them from putting that overpayment to collections from you or sending you threatening letters that if you don't return the overpayment, they will subtract it from your next payment. It's simple as that: Goliath against David.

Another trick Aetna has used is switching me from fee-for-service (which is how I have elected to be payed) to capitated, then paying me $2 for a visit. The story is always the same -- "Oh, we don't know how this happened...(with a batting of the innocent eyelashes)." Yeah, right! You're in the business of making money, not paying claims.

So doctor beware. Don't expect your biller to catch this. Here are some helpful hints:
1) Know what your reimbursement rates are for each insurer for every CPT code you use.
2) Even if you have a biller, review your EOBs periodically. Check that you are being paid the contractual amount. It's better to take the extra time than to find out too late you've been underpaid by $6,000.
3) If you discover an underpayment, call the Insurance plan immediately or if you are a member of an IPA, call them to help you with this matter. Have the EOBs at hand. The insurance plan needs to know you're on top of this.
4) Consider filing a complaint with your local medical society.

They didn't teach you this in medical school, but you have to be a shark to swim with the killer whales.

Saturday, November 18, 2006

How do you value yourself?

Ah, the quandary is the meeting of medical care with financial reality. As a solo practitioner, you are forced to attach a value to what you do. I never thought of that before opening my own private practice. Valueing, i.e. assigning a price to what I do, was a foreign concept to me. After all, in residency we never dealt with billing. There was no business of medicine course. But wait! Medicine is a business. It's a BIG business! So big that year after year the major health insurance plans are reporting RECORD and GROWING profits, whereas physicians' reimbursements are dropping. But, I digress. The dilemma is assigning a $ value to what we do then charging for it. Medical school didn't teach us this. But this is a concept that the street is very familiar with. After all, we live in a world of assigned and perceived values for all types of goods, both tangible and intangible.

So when you're running your own practice, and you're starting up, what do you do when someone comes to you in a supposed "bind" because they don't have a job or no insurance and they want to get a freebee from you? It's hard, because the resident in you may want to reach out with your heart and help this poor soul, but the growing businessman or woman in you knows that you need income to exist and provide valuable medical services to all of your patients. After all, if you don't value yourself, your patients won't either. Where does it end? Next thing you know, you're running a free clinic and have no cash to put a roof over your head. The problem is that with the onslought of the insurance-run world, people have come to believe that medical care is their right. Perhaps it is, but it's then up to the government to come up with universal healthcare for anyone who can't afford their own. Every other service business charges fees for its services which are standard and accepted, and in many instances (like in the case of lawyers) way higher than any private medical office fees.

What prompted this post is a patient I have never met asking me for free medical care and a prescription, without being an established patient in my practice. This patient wanted to get a freebee because they did not currently have health insurance or a job. My belief is that one's health is an investment. And that the service I provide, which goes beyond the single-problem single-solution type of Western medicine, as I like to address the whole individual, has far greater value than any price tag I can attach to it. However, I do help people out with discounted rates if they are insurance-less and have low or no-income. I believe in being fair, but I do not believe in giving out free medical care in the setting of my private practice (unless it is an emergency in dire circumstances), because often I've seen these very same people that are asking for free medical care going for facials, botox, hair-coloring, or carrying the latest ipod. I believe that if they can allocate finances for non-essentials, they can pay for a visit and in so doing show appreciation for the energy-exchange that has occurred to benefit their health. Even if it's only a small charge, if you give away your professional services, you're telling the world you don't value yourself, and in return you won't attract value to yourself. Perhaps my readers may have differing opinions? If so, do share.

Why do I think this way. Because I believe that if you do not value yourself, others won't value you, and you are bringing scarcity into your universe. The world has decided to operate with money. It is an energy interchange for services rendered. This was the way medical care was provided in the middle of the last century -- fee-for-service. I'm not saying everyone should have to pay for the their medical care, but having a person be directly involved (financially) in their medical care is a greater incentive for them to follow recommendations and improve their health. This is the reason that insurance plans came up with the concept of a copay, so that individuals would have a vested interest in their own care and their access to care. If along with a discounted rate, you can give the patient a bunch of samples, right there you've saved them a tremendous amount of money.

What people haven't realized is that physicians aren't necessarily the costliest part of medical care. It's prescription medications, monthly health plan premiums, and the waiting until a problem is too big to deal as an outpatient that the person has to undergo a costly hospitalization. In some ways those expensive monthly premiums are not insurance -- they are PRE-PAYMENT for health services. Perhaps if we started focusing on PREVENTIVE and PROACTIVE health care, the overall cost of providing care would go down.

Again, I believe one's health is an INVESTMENT. Exchanging something of value ($ or in the case of my country doctor grandfather in the middle of the last century, it may have been a chicken) for care is merely how the world works. Don't ask me for a freebee. It shows me that you do not value yourself nor me. Otherwise, when I don't have to worry about supporting my family and paying a mortgage and costly business expenses created by the medical-legal-insurance complex (i.e. malpractice insurance and a biller to chase after all of those forgotten, underpayed or incorrectly denied claims), along with the rising cost of living, I'll go do charity work in Africa or volunteer at a free clinic downtown. In the meantime, please value yourselves!
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