Replies to This Discussion

Permalink Reply by Lois on December 23, 2012 at 10:14am

I am totally SHOCKED that your DR's office would do any such thing. Like money grubbing lawyers who are only looking at the "bottom line, your DR is only looking at his "bottom line." He wants credit for the successes but can't see to accept the inevitable failure. (Not that you're a failure, but you are just progressing at your own pace. By the way, I am told that an A1C under 7 is a good goal. I wish I was under that. My last A1C was 8.5!) My advice .... tell them to go to he** and that they are screwing YOU up!

I am so tired righ now that my hands keep slipping from the keyboard Better get going but, first, keep your head up high and keep doing what you can. o

Lois

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Permalink Reply by beechbeard on December 25, 2012 at 3:40pm

The doctors aren't asking for this - it is being forced on them by affordable care. Part of the "waste reduction" was to shift from pay-for-service to pay for outcome. So if a doctor has a patient with condition X he/she will get a fixed fee for treatment. If a patient's body and disease don't fit into the program, the doctor has to 1) treat you for no pay, and 2) lose performance incentives (which will not equal the payments they are getting now), or limit his practice to "perfect" patients.

This is a very complicated situation but I am in the business. It is happening. I'll give you another example. Hospitals have a percentage of post-surgery, cardio, etc. patients that have to be readmitted within 30 days of their first release for a variety of reasons like wounds not healing, infections, relapses, etc. Under affordable care that is a VERY BIG problem because the hospital gets no additional money (almost) and loses out on incentives. The good thing about this is that many hospitals are investing mucho money on pre and post-release case management to improve their cash flow and your quality of care. The bad thing about this is that if you are in day 20-day 30 after release, you are NOT going to get back into some hospitals no matter how sick you may be unless you break in with a gun.

For the most part, hospitals are not run by doctor's but by business people. Your doctor may be a shining example of the Hippocratic oath. He/She will not get to make this decision.

I am sorry if my comments upset some people. Doctor'e like us patients come in all shapes, sizes and personalities. But they are losing their right to choose. I attended a presentation last year by one of the zealot's in favor of this new medicine behind affordable care. His assertion was that 3/4 of doctor's today make their diagnosis not based on evidence or protocols approved by the "experts" and this leads to tremendous waste. To the uninitiated what he said seemed so plausible. To a trained scientist, the logical fallacies embedded in the arguments were staggering. But trained scientists do not vote in Congress.

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Permalink Reply by Natalie ._c- on December 27, 2012 at 1:14pm

+1 I wish more of the people who make policy actually knew what they were doing!

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Permalink Reply by Jonah on December 24, 2012 at 5:36pm

My endo tells me that if he doesn't check certain things, like cholesterol, my insurance company will send him a letter telling him that the ADA recommends testing cholesterol and he has a diabetic patient he's not testing it in. He and I both know that testing my cholesterol is dumb (my total cholesterol is never above 110 mg/dl and is often below 100, so the odds that it's gonna be above 200 the next time we test are negligible. But I'm willing to have it tested. If I wasn't, I don't think he'd push it.

My doc and I have had our disagreements, but mostly I like him and I trust him. I trust that he cares more about me and my health than he does about looking good or making money. Not that I think he doesn't want to look good or make money, it's just that I trust that when push comes to shove, he wouldn't endanger me for the sake of looking good for insurance purposes.
He has never said he'd stop seeing me for any reason.

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Permalink Reply by Lauren on December 26, 2012 at 12:26am

I have been kicked out of a practice before - a few years ago. It was just after college and up until then I had been making an hour long commute to see my hometown endo instead of seeing one in my college town. When it looked like I was going to be settling in my college town I did some research and found an endo in the area - she had gotten pretty good reviews online.

During my initial meeting with her I mentioned casually that I was interested in learning more about the pump. She told me that for my next visit I would be able to meet with their "pump educator" and see different models. Come the next visit I did meet with the pump educator...who showed me how one worked, went over my numbers, then sent me on my way. I didn't see the doctor at all which I thought was weird. The next visit I had the same treatment, except this time I told the pump educator that my insurance wouldn't cover most of the pump and I wouldn't be able to afford one and wanted to know what other tweaks I could do to my MDI treatment to get my numbers in a better range. She didn't have an answer for me.

About a week later I got a letter in the mail from the office telling me that they were letting me go for "non compliance". I felt, and still strongly feel, that it was because I wasn't willing to go into some serious debt for a pump. Annnd, as a result of some rather bad timing, my insulin prescription needed to be renewed right around the same time so I had hoped that the doctors office, while letting me go, would at least authorize one refill while I tried to find a new endo. Nope! The pharmacy called to let me know that the doctors office refused to refill my prescription.

I was able to find a PCP that was willing to take me the same day and get that doctor to write me a prescription for the insulin. I haven't had an endo that bad since then but I feel like a lot of the ones I have had since don't really know much about pumps or type one diabetics.

I don't know if you were being sarcastic with the "I thought this was America, where we have freedom to choose what medicine we want to take?" bit..but yeah. No. We don't. The insurance companies and the doctors get to decide for us. We can only chose to buy or not buy the things they tell us to use. Wee, let freedom ring (lol)!

I would start looking for another practice if you haven't already.

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Permalink Reply by Gerri on December 26, 2012 at 12:40am

Lauren,

Can relate to your experiences. Staggering to be labeled non-compliant for not having pump insurance coverage! Though I wasn't discharged as patient only because I quit him first, my first endo had no interest because I didn't want a pump. Clear I wasn't going to be another cash cow. Also had a similar experience with insulin Rx when I left an endo.

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Permalink Reply by Lauren on December 26, 2012 at 12:52am

I wish I had seen it coming. After the second meeting with someone in the office who wasn't a doctor or even a nurse practitioner I was planning on leaving..but it's hard to keep meeting with new doctors when you have to beg and plead with your employer to take a half day for an appointment. (Especially when you work in a "right to work" state and they watch your sick days and half days like hawks)

The insurance companies and big medical corporations certainly have us by the short and curlys. :-p

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Permalink Reply by Gerri on December 26, 2012 at 1:13am

They sure do! We're sitting ducks for whatever they dictate. Right to work--gotta love that:(

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Permalink Reply by Mayumi on December 26, 2012 at 6:12am

I am told that it is going to be very difficult after the 1st of the year to even find a doctor who will be willing to take me on as a patient. It makes me sad to know that I am now considered non-compliant and undesirable as a patient.

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Permalink Reply by Biomuse on December 27, 2012 at 11:57pm

Mayumi, fish oil pills (2x a day) plus regular moderate exercise will get you a long way towards where you don't need statins.

I also was prescribed and took statins for a while. I had a (rare) side effect involving memory loss. So I slowly went off the statin and I began running every other day and taking salmon oil pills, and it got my levels under control by raising my HDL to a very good level, no need for statins anymore.

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Permalink Reply by Mayumi on December 28, 2012 at 6:33am

Thank you for your kind advice. I have started taking fish oil liquid each day and also riding my stationary bike every day. I think I have a long way to go, but at least I've started.

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Permalink Reply by Howie767 on December 28, 2012 at 6:19am

I fired my Doctor. But when I phoned Doctor's who were accepting new patients, I got something like this:

"We are only accepting new patients who take their health seriously and are willing to work with their Doctor."

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