RE: Doin' it Right (Robert Rampino, DPM, Vincent
Gramuglia, DPM)
Nowhere in my prior posts have I insinuated that
1) I am happy with declining 3rd party payor
rates, 2) condoned the acceptance of those lower
rates and 3) failed to provide the most
comprehensive, innovative podiatric medical
possible. The main point, which seems
to have been missed, is that within any given
payor mix framework, health care providers still
bare the responsibility of providing the highest
quality, most cost efficient health care
possible. Those that do will ultimately survive
the long term. Ideally, that concept should
become the basis for any health care provider's
mission statement. Unfortunately, we don't live
in an idealistic society and medical decisions
are often made on the basis of profit margin
alone, rather than what is in the patient's best
interests.
Regarding Dr. Gramuglia and Rampino's comments
about declining payor rates, health care
providers are always free to attempt to
renegotiate their managed care contracts,
AND, if unable to do so, STILL have the option
of de-selecting/opting out of any non-profitable
contract and accepting cash for their services.
The concept of capitation has no bearing
whatsoever regarding my own personal sense of
fulfillment for the professional services I
provide. If I didn't feel I could maintain an
acceptable profit margin for the servcies I
provide within any given payor contract, I
wouldn't remain within that plan...end of story.
Hopefully, other podiatrists will wake up one
day, realize the value of their services, learn
what it costs them to provide them and then make
intelligent choices by refraining from giving
them away, or even worse, losing money providing
them.
If my tone came across as "holier than now"...so
be it. I can live with that because my attitude
is backed by my professional actions, including
my role as health care compliance advisor to the
AAPPM and compliance officer for my group's
practice. The challenge I put forth is for the
rest of the "herd" as you call it, to follow
suit. I agree with your 99.9% statistical
comments, with the exception of medical ethics.
To assume that 99.9% of your colleagues are
ethical is very naive...I also thought that
once, until I began to read posts
regarding "creative billing" scenarios, over-
utilization and medical inappropriateness of
diagnostic and therapeutic services, all the
while continually receiving monthly reports
regarding the fines and sanctions levied against
various health care providers in violation of
medical compliance regulations through my
affiliation with the HCCA(Health Care Compliance
Association). These statistics transcend all
medical disciplines, which is why podiatry and
its podiatrists, cannot be excluded. Further, I
fail to see how adopting strict adherence to
medical compliance guidelines, which govern the
way we should provide and bill for the services
we perform, segregates our profession. Frankly,
if one doesn't follow the guidelines, or is
incapable of change, why would I, or my other
ethical colleagues want anything to do with you.
That's a herd I'll gladly stray from.
Lastly...diagnostic ultrasound as just 1 glaring
example, since this was the topic that initiated
this dialogue...if MR is the diagnostic modality
of choice for occult, cryptic soft tissue
pathology of the lower extremity...AND, it
is...then exactly who is compromising their
medical care? The doctor who outsources his/her
patient to an MR center to obtain the diagnostic
study of choice, or the doctor who self performs
an ultrasound? Why then, would a health care
provider perform an inferior study...because
they can, because it's billable and because
within most financial frameworks, it is
profitable! THAT was the point of that post.
No...currently, there's still a few too many
black sheep within our "herd" for my liking.
Instead of "coming back to that herd" as you've
suggested, I'd rather go out on a limb and
attempt to lead a new "herd" consisting of other
health care providers who understand that a
health care crisis persists in our country, that
costs continue to spiral out of control, that we
can still make a decent living without
sacrificing our medical ethics if we have the
courage, the discipline and the patience to
attain the knowledge of how to adopt and
incorporate the efficiency concepts necessary to
maximize our profit margins for the services we
provide. Oh, it's most definitely about "doin'
it right" 100% of the time. If you do, you'll
never be sorry you did and you'll achieve the
ultimate professional fulfillment possible!
Thanks Dr. Shangold...wherever you are!
Barry Mullen, DPM
Hackettsown, NJ
