Ok - when I say "current affairs", this has nothing to do with Tiger Woods.  It has everything to do with the current state our economy is, the problems we are facing with healthcare, the idiotic decisions by physicians, and the problems being faced by Medicare patients and those that will be faced by those that are 63 and 64 years old today.

First - let me say that we're all in good health and we had a very fun family reunion on Angie's side of the family.   Current news includes the fact that we have our house for sale (special pricing at shop.donself.com ) for anyone wanting to spend $225,000 on a beautiful home within walking distance to 4 schools with a great pool, guest house and more...  Ok - a little shameless sales plug doesn't hurt.   Angie's parents (Jim and Ann) are looking to buy a place close to us (they have their home for sale in Early, Texas) and last - but not least is that we have a contract on 20 acres about 20 miles southwest of where we are now - literally on top of a mountain.  Ok - the mountain is only 200 feet high but it is the close to the highest elevation in Cherokee County and if we get the property - we'll build a house facing the southwest with a panoramic view of at least 12 miles in about 3 directions - so it's the closest thing that I'll ever get to living on a mountain.  The town is called Mount Selman - so it's legal for me to say it's a mountain. <grin>

Ok - business is slow and part of that is due to the absolute moronic decisions being made by Congress (I'm ready to get rid of 534 members today if I could - but I do want to keep Louie Gohmert as he is the ONLY one there that I trust - and that includes Kay Bailey and Cornyn!).  It's also due to the ignorance of physicians and their staff that are hurting them by telling them to get rid of Medicare patients.  Ok - Perhaps "get rid of" is not the right term to use.  Many office managers, billers and even short sighted administrators of national and state medical and osteopathic physician associations are hurting the physicians with their bad advice.    I'll give you a little background first.

Prior to 1987, Medicare would follow whatever the private insurance carriers were doing, but that changed in 1987.  That was when Medicare took advantage of the STUPIDITY of the AMA and instituted for the first time in this country - a limit on how much a physician could charge.  The government doesn't limit what any other private business in this country can charge - but they effectively set the stage with physicians and the AMA let them do it because it didn't hurt them one bit.  I am of the belief that the AMA looks out for the AMA and doesn't give a dang about the physicians or the members or the patients in this country.  If it puts more money in their own pocket - halleluja and screw everyone else.    So - in 1985 the AMA asked for a "voluntary" fee freeze by all physicians and the physicians complied and then in 1987, Medicare came out with limits on how much physicians could legally charge - based on the previous 18 months history of fees charged by each physician.   Tadaaa!   So - the private carriers saw the government do it and then they started in 1989 sending out letters to their policyholders saying their doctor had "overcharged" or charged more than the Usual, customary and reasonable amount for the services they did"  It did not matter that the patient had no idea that there was no such thing as a uniform UCR - as every carrier made up their own.  They just heard "your doctor is screwing you" so they got upset.  As a result in 1991, those same patients voted in someone who was going to "reform" healthcare and make the doctors accountable and honest.  So - that unscrupulous jerk put his wife in charge of revamping healthcare and making it into socialized medicine.   Fortunately - the way he did that caused people to wake up and stop her - so she didn't accomplish anything.   So - then we had a couple of terms of Clinton that really didn't hurt our country too much - other than businesses paying more in taxes and our military that was stripped - but the healthcare arena stayed the same during his term with carriers slowly convincing physicians to sign contracts that anyone with a business degree would have torn up.   What many did not see happen in 1996 was the fact that Clinton - along with a republican led Congress passed a law that required a "sustained growth rate" of Medicare payments - which in fact - actually meant a budget neutral growth rate.  Congress knew that in 2011, we would start having the baby boomers (those born after our soldiers and sailors returned home from World War II) hit Medicare and that would be a huge influx into the Medicare program.   So - they designed something to slowly reduce the amount Medicare was spending and that would begin in the future president's term.  That took place in 2003, and Bush and the Congress felt the pressure - so they 'forestalled" the reduction of the 1.3% that year.  Then in 2004 - they again did not want to upset the doctors and hospitals, so they did it again.   Each year - the reduction was not eliminated - but delayed - so it started accruing.   So - the first year, the Medicare allowed conversion factor was supposed to reduce by less than 2% and then next year when they delayed it - that meant that when it took effect it would be over 2% and over 3% the following year, etc... By this year - by federal law, the Medicare allowed (how much the physicians are paid) was supposed to reduce over 21%.   Congress was terrified that if they allowed this to happen that at least half of the physicians in the country would no longer see Medicare patients.  But - since they couldn't get their heads out of their butts while they were pointing fingers at the BP people for spilling oil in the gulf (never let a good catastrophe go to waste when it comes to press time), they couldn't come up with a solution that made everyone look good. 

So - last December - they delayed the reduction for five months - giving them five months to fix it.   Of course, they did NOTHING for the first 4 months on it at ALL!  Then by May - when they started thinking about it -  they had a great catastrophe to get in the way.   So - the government department over Medicare  decided to help by holding all Medicare checks for the first 2 weeks in June to give Congress time to act.  But - those Congressional members had to take some extra time off for this or that and then they couldn't come up with a solution in time.  Once again, CMS (Centers for Medicare and Medicaid services) tried to help (help who???) by announcing they would hold Medicare checks for one more week.  then, towards the last part of June - both chambers of Congress finally finished their tug of war between Pelosi and Reid trying to prove who had the most power and passed something - delaying it another 18 months.    That would take time for the Medicare payers to get their computers right so they had until July 1st to start issuing checks to the doctors.    Think about this.

No doctors got any checks in June for any Medicare services done in June.  This doesn't mean  a big deal to the Pediatrician doctors - as very few of their patients have Medicare.   But - what does it mean for the family doctor or internal medicine doctor or the geriatrician or the doctors visiting nursing homes?   What if you owned a business with alot of employees and alot of expensive supplies (drugs, equipment, lab tests, etc) that you had to buy and your income stopped - but you had to keep paying everyone?    Now - you get a feel for what your doctors have been going through.     Did you hear about this on CNN or FoxNews or in your paper?  heck no! 

Now - while we've seen all of this coming, I've been a voice in the wilderness telling physicians to see MORE Medicare patients and trying to convince them that Medicare patients are the most profitable they have.   While I've been telling them this - they've been listening to their office managers and billers and associations tell them to get rid of Medicare patients as they believe Medicare is one of the lowest paying (Medicaid is definitely by far the lowest paying).    The doctors listen to their office manager explain that Don must be wrong or smoking something he shouldn't and they'll give them an example of a Medicare payment.    They will show the doctor that the doctor is paid $52 for a level 3 established Medicare patient visit and they are paid $67 for a Blue Cross patient for the same service.  The doctor looks at the $52 in one hand the $67 in the other hand and then doesn't take the time to let me explain why that is deceiving.  

Since 2001, Medicare has been trying to get physicians to change how they practice to achieve better medical outcomes.   To accomplish this, they have moved massive amounts of money from the areas of office visits and procedures into evidenced based medicine, such as clinical lab testing and diagnostic testing.   Unfortunately - they did not tell the physicians about this move.   They just put alot more money into select areas and expected the physicians and their managers to figure it out - but they didn't.   Physicians kept seeing reduced payments for office visits (when compared to the national inflation rates) and reduced payments for procedures and did not realize that Medicare was MOVING money instead of reducing it.  In fact, from 1996 to 2009, the federal government increased PHYSICIAN expenditures by more than $14 Billion per year.  it almost DOUBLED IN THOSE 14 YEARS.   Yet during the first 10 years of this century, physicians kept feeling the pinch and had to draw money out of savings, reduce their own salaries, cut back on employees, offer less benefits to employees, reduce hours, etc... trying to survive.    My partner Keith and I have, for more than 3 years, been showing the physicians that would listen to us how they could easily increase their income by $ Hundreds of thousands per year while improving patient outcomes by following Medicare's new guidelines - but the vast majority were not listening to us.   So - those that have listened would benefit.    Sometimes they would come back and admit that they waited too long before listening, such as Dr. Mike Benavides in Dallas, Texas.  Mike and his wife Cindy had been struggling for the first part of this decade like many other physicians and had to take out loans to cover payroll, lay off essential staff, reduce hours and sometimes go months without taking a personal paycheck.   After he listened to us, he increased his income by more than $150,000 per year by following Medicare's guidelines and he said "I wish I had acted on what you were telling me years ago instead of ignoring it".   Today - he's in great shape because he listened.

Last week I had a physician who I've known for about 20 years say "I had been reading what you've been saying for many years now Don, but when you said you could help me, I though you meant by $1,000 to $2,000 per month and did not realize you meant by $25,000 to $30,000 per month in increased profits.  Now it's too late for me since I can never work again due to this disability but i wish I had acted back then".   That is Dean Gafford, DO in DeSoto, Texas.  Dean had called me because he wanted someone to take over his practice since he can't practice anymore.   Another consultant and I put together a package for the doctor about to buy Dean's practice and in a 4 way conference call, Dean saw what we could actually do and he was surprised.

Keith and I have helped one doctor after another increase their income by $100,000 to $400,000 per year - so easily - just by following the new guidelines when they listen to us.   From Dr's Gastorf in Durant OK, to Tasha Wallace in Lehigh Acres Florida to Hector Lopez in El Paso to Jeff Lindenbaum in Pennsylvania to Dr. Lomas in Florida to David Braunreiter near Houston, Texas to so many others.  I have dozens of letters from physicians showing what we did for them and every one of them point out that their patients are getting so much better care today than they did before.   Many of them reference patients who are ALIVE today thanks to what we taught the doctors - and while we could do so much more good - we run into the know-it-all office managers who are driving their physicians into bankruptcy.  We run into the physicians who want to save 5 cents so they totally ignore the $10 they would get.

As an example, in May, I did a diagnostic analysis with a doctor and I showed the doctor the guidelines that Medicare and other carriers have and how often they want the doctor to do specific tests.  Medicare and carriers have realized that it makes financial sense to pay $115 today to a physician to do an 8 minute test to detect peripheral arterial disease early enough so that the patient doesn't have to have an amputation of a toe or foot.  When you consider that 33% of patients  over 50 years old with diabetes have P.A.D. and that less than 10% of them are being diagnosed (per the National Institute of Health numbers), it makes sense to save the $7,000 they would pay for an amputation by paying $115.   So - I did with this doctor the same thing I've been doing for years with every one of the doctors I mentioned earlier and then asked the doctor "If you were doing this in your office, how many a day would you do and be conservative".  He gave me very conservative numbers.  Then, we looked at other diagnostics and some lab tests and he said that he needed to be doing these.   He agreed that it would be good for his patients and that these did meet the current guidelines (I showed them to him on the Medicare website).    As he gave me numbers, I would sometimes reduce them to be super ultra conservative.   When we finished, he agreed that after ALL expenses, by following the current guidelines, he would increase his net (net is after all expenses) monthly income by $17,312 per month.   He was excited about it and gave me his tax id and social so I could run it by the leasing agent and he could check with his CPA to make sure of the tax breaks and he wanted to start helping his patients.  I also gave him 7 letters from other physicians similar to his practice that had done the same thing and increased their income by more than $200,000 per year and saved lives.   I called him a week later.   He didn't return my call.  I called a week after that and sent an email.  No return call.   A week later, his office manager said he was comparing prices and thought he could get the pulmonary function test equipment for $2,000 less and he would check back with me.   Last week he said he was waiting on his bank to see if they could get a better interest rate than the leasing company and I know for a fact that the leasing company we went to has rates almost equal to any bank in the country.   Ok - do the math.  He has spent 2 months trying to save $2,000 and maybe save another $400 in the interest.   In that 2 months, using his conservative numbers he would have made another $34,624 but he hasn't because he's been busy trying to compare interest rates.  He'll probably wait another month and by then it will be more than $50,000 he lost due to ignorance.  yes - ignorance!   Forget the money for a minute.  He pointed out that he was NOT running ABIs on his patients and I wonder how many of his patients have P.A.D. that are undiagnosed and by the time he acts - will need amputations of toes?    He was not running PFTs - yet 20% of Americans suffer from pulmonary dysfunction and COPD is the 4th leading cause of death.  He is not performing heart rate variability tests and we KNOW that 30% of CHF patients are over beta blocked and 14% of Americans have orthostasis and between 11% and 14% of seniors with diabeteos suffer from silent ischemia.   I could go on and on but you get the idea.  It's doctors like that which drive me mad.

One of the letters that I received from a physician in Malvern, Arkansas points how much he has changed how he practices by following the national guidelines that I showed him.  He doesn't center on the fact that we've increased his net profits by $Hundreds of thousands per year over the past 2 years but he points out what his patients experienced as a result of it.    i give out these letters with the physician's phone numbers - yet so few of my prospects call them.  They would rather spend their time trying to save $100 on the price of the equipment or listen to their office manager tell them I'm wrong instead of calling physicians who have proved that I'm right.

So - this is me spouting off.    I'll keep fighting to get these doctors to listen and some will and their patients will do better and the arrogant fools who do not listen will continue to pull money out of their savings trying to stay afloat and the battle will continue.

have a great day!