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Message
re: Defeat the Nurse Practitioner scope of practice expansion - Louisiana SB 187
Posted on 5/19/16 at 3:54 pm to WaWaWeeWa
Posted on 5/19/16 at 3:54 pm to WaWaWeeWa
quote:
Can someone please explain how this bill will save money?
C'mon, you already know this, but I'll explain the THEORY behind the perceived cost savings.
Access to primary care to manage chronic conditions on a maintenance basis decreases ER/hospital admissions and the associated costs.
It's "professionally" managing the type 1's sugars instead of just paying for the amputation and physical therapy.
Again...THEORY. And oversimplified at that.
quote:
Let's be real clear, it's a RURAL access to care problem.
Really? Urban inner cities aren't medically underserved? And do you realize how much "rural" there is in this country? Do we just dismiss that as "flyover country" like a certain portion of our population does?
quote:
There are a few shotty studies that suggest NPs would be more willing to practice in rural areas, but the studies seem biased to me.
Well, they can fail on their own in a competitive market with physicians, or they can practice in an MUA where they can be of most use. Their choice. But you shouldn't legally restrict one for fear of the other.
quote:
My prediction is that all you will see happen from this bill is there will be triple the amount of urgent care facilities all over new orleans, Metairie, etc. All of which are profit driven machines designed to order as many tests they can and give everyone a steroid shot. The cost of a NP visit is $85 vs $100 for a MD. Those savings will be easily offset by just a HANDFUL of unnecessary tests and referrals that will be ordered.
Probably.
This post was edited on 5/19/16 at 4:07 pm
2
Posted on 5/19/16 at 4:12 pm to MSMHater
quote:
Access to primary care to manage chronic conditions on a maintenance basis decreases ER/hospital admissions and the associated costs
While this is true, this bill doesn't do much to solve it. It's just like Obama's recent bill on overtime wages. It has the appearance of adressing the issue.
Why isn't this bill directed specifically at the problems? Why doesn't it require NPs to practice in undeserved areas, atleast for some amount of time? Why do >75% of MDs who VOLUNTARILY apply to rural loan forgiveness programs get denied?
These are the questions you should be asking.
I'll tell you why they aren't being addressed. BECAUSE IT'S NOT ABOUT ACCESS TO CARE. But I will say yall are damn good at making it look like it. It's all smoke and mirrors for a certain group of inadequately trained individuals to make a power grab.
I have a solution. Why not keep the current system and give a subsidy to any MD or NP that is willing to practice in underserved areas. There has to be an incentive for people to practice in these places. It's human nature to avoid them. In that scenario you don't sacrifice quality of care and if your THEORY is correct the savings should offset the cost.
You act like this is some new phenomenon that NPs can magically solve. People living in rural and poor areas have always had less access to ALL resources since the beginning of modern civilization. Most highly educated professionals (NPs and MDs) don't want to live in a rural or poor setting. I wouldn't hold my breath waiting for nurse practitioners to solve this problem
This post was edited on 5/19/16 at 4:20 pm
Posted on 5/19/16 at 4:25 pm to WaWaWeeWa
quote:
But I will say yall are damn good at making it look like it. It's all smoke and mirrors for a certain group of inadequately trained individuals to make a power grab.
Dude, I manage you...doctors. I don't employ a single mid-level and don't plan on it. I benefit in absolutely no way from this bill. But while your post graduate education was dedicated to practicing medicine, mine was dedicated to figuring out how to deliver it...everywhere. Your denial of a peer reviewed conclusion (i.e. physician shortage) doesn't mean it doesn't exist. Legislators are going to act on it. And instead of being bitter, and taking your ball and going home, get with your chosen physician lobby to propose alternatives. Like this...
quote:
Why not keep the current system and give a subsidy to any MD or NP that is willing to practice in underserved areas. There has to be an incentive for people to practice in these places. It's human nature to avoid them. In that scenario you don't sacrifice quality of care and if your THEORY is correct the savings should offset the cost.
I have ZERO problem with this. Sounds great. Work towards getting it proposed WHILE screaming about the proposed bill being unsafe.
This post was edited on 5/19/16 at 4:27 pm
Posted on 5/19/16 at 4:31 pm to MSMHater
How many NPs on this site or their significant others that come out in droves to stand up against "doctor oppression" have ever once said anything like..
"I really want to practice in the 9th ward or Cutoff, but no doctors will supervise me out there"
Guess what. They don't want to work there either. There has to be incentive.
"I really want to practice in the 9th ward or Cutoff, but no doctors will supervise me out there"
Guess what. They don't want to work there either. There has to be incentive.
Posted on 5/19/16 at 4:39 pm to MSMHater
quote:
Dude, I manage you...doctors. I don't employ a single mid-level and don't plan on it. I benefit in absolutely no way from this bill. But while your post graduate education was dedicated to practicing medicine, mine was dedicated to figuring out how to deliver it...everywhere.
Man I love this kind of shite. I know you think you bring alot to the table, and that doctors just don't know business, etc. I hate to break it to you but your job brings absolutely zero to the table. ZERO. You job is solely the result of government intrusion and unnecessary oversight involving the healthcare system.
Nowhere in your post did you respond to the fact that this bill does not specifically address the problem you are masquerading it to address.
I've already described the "physician shortage" and I'm not denying it. But it is misrepresented. There is a shortage in the places you previously described (rural and poor) and there is no indication that this bill will address those issues. So, logically, I would conclude that it does not address the access to care issue that you say it will.
So what healthcare crisis issue does it address?
This post was edited on 5/19/16 at 4:43 pm
Posted on 5/19/16 at 4:48 pm to MSMHater
quote:
Work towards getting it proposed WHILE screaming about the proposed bill being unsafe
Don't even try to make it sound like we aren't trying hard enough. The politicians know the issues. There are plenty of people arguing the case. They care about lobbying dollars, and their next election cycle. That's an entirely different problem.
The fact that the majority of the population other than physicians on this board can't clearly see the issues is what is disturbing
Posted on 5/19/16 at 4:57 pm to WaWaWeeWa
Yet, I can find a job at the drop of a hat, and every single person that has hired me is an MD asking me to run his entire practice. Nor just their regulatory affairs. They even are nice enough to pay me a nice salary. What they feel I bring to the table is all that really matters.
You really gotta wear that insecurity better. Most of my physicians are normal, nice guys, but there is always your type around to further the stereotype. I hope you grow out of that before practicing for yourself, if you don't already.
You really gotta wear that insecurity better. Most of my physicians are normal, nice guys, but there is always your type around to further the stereotype. I hope you grow out of that before practicing for yourself, if you don't already.
Posted on 5/19/16 at 4:59 pm to WaWaWeeWa
quote:
The fact that the majority of the population other than physicians on this board can't clearly see the issues is what is disturbing
I'm shocked that you believe only the physicians have a legitimate understanding of the issue. Shocked!
Posted on 5/19/16 at 5:10 pm to MSMHater
quote:
Yet, I can find a job at the drop of a hat, and every single person that has hired me is an MD asking me to run his entire practice. Nor just their regulatory affairs. They even are nice enough to pay me a nice salary. What they feel I bring to the table is all that really matters.
That's all you really care about right? Getting yours.
How long have doctors been around? How long has your field of practice been around?
I see a pretty strong correlation with you business folk and the government getting involved and the disaster that has become our healthcare system.
Go ahead and say "I fit the stereotype" and I'm a narssasitic a-hole, etc. That's fine. But YOU were the one who said you manage people like me... Because we need you. Your expertise.
Just realize why your job exists. Because the government has turned my job into 20% medicine 60% paralegal and 20% insurance adjuster.
Stating the above does not make me better than you, even though that's how you are going to spin it so that I look like the big bad doctor that thinks he's better than everyone else. In fact I think you are a very intelligent person who could probably succeed at a number of things. But to deceive yourself into thinking that you are an integral part of the healthcare system is a farce. 2 wrongs dont make a right.
quote:
I'm shocked that you believe only the physicians have a legitimate understanding of the issue. Shocked!
Go look at the posters who regularly respond in objection to this bill, they are openly known as physicians. Don't try to spin my statement into narcissism. That's your only defense, and it's weak. Let me be clear. They can't understand the issues because they are being deceived about the facts, not because they aren't intelligent enough.
This post was edited on 5/19/16 at 5:37 pm
Posted on 5/19/16 at 5:32 pm to MSMHater
"Managing doctors". Haha you're one of those people...
Posted on 5/19/16 at 5:33 pm to WaWaWeeWa
(no message)
This post was edited on 5/19/16 at 5:43 pm
Posted on 5/19/16 at 5:42 pm to LATigerdoc
Per the NPs, they pulled it today at the advice of their lobbyists and will bring it back up next Wednesday the 25th. They are pushing their members to call all the reps. Email or call representatives to oppose this. Don't let a bunch of lobbyists put patient safety at risk
Posted on 5/19/16 at 5:49 pm to LATigerdoc
MsMhater has some Damn good advice when it comes to business, you might actually learn something if you listen...he helped me grow my consulting business on money talk.
This post was edited on 5/19/16 at 5:50 pm
Posted on 5/19/16 at 5:59 pm to L S Usetheforce
No one is denying that he is a successful businessman, is intelligent, is a nice guy, etc. He is trying to spin my words to make me seem like a self righteous a-hole just because I am a physician, when I have done nothing but try to present facts that I believe are true.
The argument was whether he is a necessary cog in the healthcare machine or a product of prior screw ups. Since, as he claims, he is "our manager, and we are lining up to hire him".
The argument was whether he is a necessary cog in the healthcare machine or a product of prior screw ups. Since, as he claims, he is "our manager, and we are lining up to hire him".
Posted on 5/19/16 at 6:07 pm to MSMHater
Pretty sure you are an exception. Just from a little viewing of the thread.
Would like to hear your opinion on starting smaller practices at this point, specifically OBGYN.
5 person group at women's in BR just joined the super group because they weren't "doing well". Good doctors too.
Would like to hear your opinion on starting smaller practices at this point, specifically OBGYN.
5 person group at women's in BR just joined the super group because they weren't "doing well". Good doctors too.
This post was edited on 5/19/16 at 6:09 pm
Posted on 5/19/16 at 6:12 pm to GetBackToWork
quote:
Someone needs to file a bill allowing optometrists to perform cornea transplants.
Yes, because the world needs more blind people
Posted on 5/19/16 at 6:21 pm to LATigerdoc
quote:
Per the NPs, they pulled it today at the advice of their lobbyists and will bring it back up next Wednesday the 25th. They are pushing their members to call all the reps. Email or call representatives to oppose this. Don't let a bunch of lobbyists put patient safety at risk
67 pages and the first time i noticed this thread.
I'm not familiar with the bill in question and it could be that it's not written effectively
but generally, we need to try to break the monopoly that doctors and hospitals have on medical care.
There is too much anti-competition and restrictions to care. We have the internet now, we can do more to treat ourselves.
The medical field does a lot to restrict the flow of people into the field thus making doctor services more scarce which allows them to charge the enormous fees they charge and all live millionaire lifestyles.
From an education standpoint, it's gotten so expensive that only doctors can afford to send their kids to med school.
I got a "free" colonoscopy last year under my ACA plan and got three separate bills totaling $450.
The medical industry is the only industry that performs services, sometimes without your permission, and then charges you whatever they feel like charging. They rarely disclose the cost of a procedure or test.
Our American medical industry is not a free market industry.
It needs to be moved more in that direction. More drugs need to be designated OTC.
More people need to be allowed access to practice medicine without 8 years of college and $150,000 in tuition or whatever it is. That's probably low.
Americans need to be given the freedom to choose a less qualified and much less expensive option for the more routine issues.
We need to blow the shite up and start over. ACA is not the problem, certainly not the entire problem.
Posted on 5/19/16 at 6:46 pm to PygmalionEffect
quote:
monopoly that doctors and hospitals have on medical care.
How so? Doctors reimbursement medicare/Medicaid is decided mostly by the government. Doctor salaries aren't even the tip of the iceberg of medical costs.
quote:
There is too much anti-competition and restrictions to care. We have the internet now, we can do more to treat ourselves.
Is this a troll?
quote:
From an education standpoint, it's gotten so expensive that only doctors can afford to send their kids to med school.
Almost all medical students have massive debt. It's a huge problem.
quote:
Americans need to be given the freedom to choose a less qualified and much less expensive option for the more routine issues.
You can see any NP you want as of today. No one is stopping or restricting you. It's $85 vs $100 cost to you to see a NP vs a MD. But realize that the NP is more likely to send you to a specialist or order unnecessary tests that you would have to pay for.
I'm struggling to find any sense in your entire post. This is what is so frustrating. The system is broke and they want you to believe it's a doctor's fault.
There are more businessmen, coders, etc. at Ochsner hospital than doctors. There are hundreds of people hired to make sure that every piece of paper is in exact accordance with the ever-changing rules of government oversight. Then there are people hired to oversee those people. Who do you think pays for this? You do when you get that bill.
Posted on 5/19/16 at 6:54 pm to donRANDOMnumbers
Starting, and successfully running, any small practice that's not a niche specialty is basically your path of most resistance at this point. You're required to comply with so many administrative hurdles and federal incentive programs that hiring the appropriate staff and maintaining the IT infrastructure becomes a huge strain on your revenue.
We're also experiencing a huge cost shift to patients b/c of ballooning deductibles, so accurate, up front collection is more important than it has ever been. So your verification has to be timely, correct, and you HAVE to collect it at the time of service. You are working much harder now to collect your reimbursement. Add in that you are trying to actually build up volume while facing these issues. There is a high chance of failure, which may force you to sell out to a larger system in a position with no leverage. Conversely, if you're successful, those same systems will still be looking to buy you, but you will be in a position to decline or negotiate.
OBGYN, IMO, would seem more difficult than other specialties. Aren't you pretty saturated in general? If you start a practice, what makes you stand out in BR? Why are patients choosing you? Unless you're starting with an existing client base, the first few years will be very challenging.
Signing on as a health system employee means you don't have to deal with that shite, other than the extra work flow steps it causes you. No hiring, paying taxes, paying employees, w9s, 1099s, pqrs, meaningful use, payer contacting, hospital credentialing, etc, etc, etc...
That's worth it to some people.
We're also experiencing a huge cost shift to patients b/c of ballooning deductibles, so accurate, up front collection is more important than it has ever been. So your verification has to be timely, correct, and you HAVE to collect it at the time of service. You are working much harder now to collect your reimbursement. Add in that you are trying to actually build up volume while facing these issues. There is a high chance of failure, which may force you to sell out to a larger system in a position with no leverage. Conversely, if you're successful, those same systems will still be looking to buy you, but you will be in a position to decline or negotiate.
OBGYN, IMO, would seem more difficult than other specialties. Aren't you pretty saturated in general? If you start a practice, what makes you stand out in BR? Why are patients choosing you? Unless you're starting with an existing client base, the first few years will be very challenging.
Signing on as a health system employee means you don't have to deal with that shite, other than the extra work flow steps it causes you. No hiring, paying taxes, paying employees, w9s, 1099s, pqrs, meaningful use, payer contacting, hospital credentialing, etc, etc, etc...
That's worth it to some people.
Posted on 5/19/16 at 7:22 pm to MSMHater
quote:
We're also experiencing a huge cost shift to patients b/c of ballooning deductibles, so accurate, up front collection is more important than it has ever been. So your verification has to be timely, correct, and you HAVE to collect it at the time of service. You are working much harder now to collect your reimbursement. Add in that you are trying to actually build up volume while facing these issues. There is a high chance of failure, which may force you to sell out to a larger system in a position with no leverage.
True. I'd hate to be starting a practice now. It's hard enough dealing with this shite in a existing clinic much less trying to start from scratch.
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