Pricing your practice.
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Biomedical subjects
Publications and source records attributed to L BeSaw.
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If Laredo pediatric allergist Gladys Keene, MD, and her husband, otolaryngologist Roger Keene, MD, had their druthers, they would maintain the solo practices they have had for the past 20 years. But they know changes in the form of managed care are coming to the border city, and medicine as they know it will never be the same again. Preferred provider organizations have already captured about 20% of the Laredo market in the past 2 to 3 years, and health maintenance organizations (HMOs) and capitation are not far behind.
There is a widely held belief that big trouble often starts with a simple declaration: "Now here's what we'll do." It's a variation of the one about hell and good intentions. During the most recent session of the Texas Legislature, lawmakers decided that what they would do is authorize the conversion of the state's Medicaid program to managed care. Otherwise, Texas faced a projected shortfall of up to $2 billion in state funds over the next biennium for the program that provides health care for about 2 million low-income Texans a month.
Ask most folks if they would trade the crime, high taxes, traffic nightmares, and general hassle of big cities for the pastoral setting of small-town life, and their first question may be what time the moving van arrives. Life in a small town can be peaceful, quiet, and relaxing: just the tonic for the headaches of modern urban life. Then reality in the form of illness intrudes, and the services of a doctor are needed. Unfortunately, in many rural areas of Texas, one may not be available.
Let's take a walk down memory lane. Think real hard. Remember the good old days when patients came to your office, you diagnosed their illnesses, and you prescribed courses of treatment that your training and experience told you were necessary? Either patients paid you directly or you billed their insurance companies. And, if you decided hospitalization was needed, your patients stayed there until you decided they were well enough to go home. You and your patients made the necessary decisions.
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Imagine medical schools faced with applicants who know or care little about science because they are the products of an educational system that did not motivate them to take an interest in the subject. Now imagine what kind of physicians they would be if they managed to get into medical school and graduate. John Burnside, MD, has imagined it, and it scares him.
For many Texas physicians, the workers' compensation system represents a bureaucratic tangle of regulations, guidelines, and forms; frequent payment hassles; and a cumbersome dispute-resolution process. If it were not for their concern for their patients' welfare, many of them would choose not to participate.