I suppose it's too much to ask for emergency (California)

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Re: I suppose it's too much to ask for emergency (California)

Postby jobmdpsych on Mon Mar 30, 2020 5:01 pm

If you've gotten a raise since 2005 you really need to sit out on any discussion of windfalls especially when we are talking about a small percentage of overhead.

I would more than welcome a free market to find a price point. Guess who isn't up for that? The carriers. Because they know what the costs are for comparable services. I know this personally because DBA/maritime cases are similar but less complex and pay more.

Proof that ML fees are not high enough to be worth it is in declining pool of new QME applicants and the geriatric demographic of the current pool. It's not worth it to be a QME if you're 35. They don't pay enough to jump through all the hoops. Older doctors stay with it because they understand it and there are barriers to entry.

What happened during the last days of disco is irrelevant to the current situation.

It's a little off topic, but if carriers were seriously interested in reducing med-legal costs, and by a lot, they'd instruct DAs to reduce unnecessary records. I've had many people here tell me that it's impossible yet it happens all the time in DBA/maritime. In those cases I'm not reading colds and flu records from the last days of disco like I do on comp cases. It's a waste of your money and my time.
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Re: I suppose it's too much to ask for emergency (California)

Postby jpod on Tue Mar 31, 2020 8:48 am

I am not saying QME's don't deserve a raise I was merely pointing out what actually happened when the initial M/L fees were set. The baseline was based on a small subset of M/L events. If QME overhead is reduced it is a good thing for QMEs and the consumer who pays for it all. That statement doesn't mean no raise, just that lower overhead should be considered in any adjustment if in fact there is a reduction in overhead costs. In past posts you railed against the sales tax Gov Brown imposed. at least that tax was known, not hidden from view. WC costs are a hidden tax on consumers. If you don't like known taxes, I would think you would dislike a hidden tax even more.

I don't work for a carrier, never have. Over thirty five percent of employees in the state are covered by self-insurance. There is no profit involved in self insurance, it is a cost that goes into pricing and is passed on to consumers.
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Re: I suppose it's too much to ask for emergency (California)

Postby jobmdpsych on Tue Mar 31, 2020 12:38 pm

Reimbursement for telehealth treatment is 29% percent less than office visit.

Let's talk about the windfall to the carriers. Satellite office bills are not 29% of overhead.

See how that works?
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Re: I suppose it's too much to ask for emergency (California)

Postby jpod on Fri Apr 03, 2020 10:15 am

The carriers make a profit of course, but the customers of their clients who pay premiums pay for the costs, the waste, and the profits.

That is how capitalism works.
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Re: I suppose it's too much to ask for emergency (California)

Postby jobmdpsych on Sat Apr 04, 2020 11:48 am

Oh yes, I'm sure the 29% percent reduction in medical costs will immediately and judiciously passed onto the policyholder because a carrier would never delay passing those savings on and keep their profits flat due to some invisible code of honor. Here's also how it works in capitalism...increase profits to the shareholders. Who take precedence over customers. Look at Zenith stock in 2005.
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Re: I suppose it's too much to ask for emergency (California)

Postby jpod on Wed Apr 08, 2020 9:42 am

Couldn't agree more.

It doesn't end with profits either; taxes a Corp. expects to pay are embedded in prices and in some casesnever passed on to governments b/c of deductions taken by the Corp when computing taxes (Look a Trump, hasn't paid Federal taxes in a decade or more yet collected them from his customers).

While I haven't gotten there yet, that is why some economists say it would be better to eliminate Corp. taxes altogether so consumers know exactly what taxes they are paying and to end the shell game that goes on.
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Re: I suppose it's too much to ask for emergency (California)

Postby jobmdpsych on Tue Apr 28, 2020 9:07 pm

Now they want to play with the billing codes and add additional duties. Our staffs are overwhelmed trying to get telehealth appointments arranged against all kind of resistance. Now we have to jump through more hoops and get paid less. I might call it quits.
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Re: I suppose it's too much to ask for emergency (California)

Postby Manila on Fri May 01, 2020 8:09 am

Latest news is the DWC has dropped its revision of procedure codes and payment schedule to be used during the pandemic and reverted to the usual 2006 MLFS. No doubt more surprises are in store. Kudos to CSIMS and Dr. Jacob Rosenberg, in particular, for their efforts.
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Re: I suppose it's too much to ask for emergency (California)

Postby jobmdpsych on Fri May 01, 2020 11:09 am

Yes, this new CSIMS and Dr. Rosenberg and his associates seem to be highly engaged and informed so lots of praise to them. I am impressed and I plan to rejoin and I was once on the board.

One thing that the DWC has to be aware of is that our staffs are stressed out to the max by trying to schedule telehealth over many obstacles and we don't need any more procedural changes at this time other than what it takes to facilitate completion of these exams. Otherwise we may have a terrible backlog by August. I can see a scenario where I would have a backlog of a hundred cases.

I'm not sure why they gave us more time. Thirty days is plenty of time to complete a report when 80 percent of your exams end up rescheduled. The priority needs to be getting the exams, not the reports done. With some of these claimants they might need a loaner iPad or phone.

After some initial success in getting four appointments scheduled via telehealth, I'm running into considerable obstacles. One thing that might help is to allow the claimants to do a telehealth exam with a shelter relative or friend who has a reliable phone or computer. As is always the case, having someone around under thirty usually solves IT problems.
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Re: I suppose it's too much to ask for emergency (California)

Postby DrDoc on Mon May 04, 2020 4:49 pm

Have any of these changes actually taking place? If so, where is the information please?
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