Comments on: Employers as Doctors

By: Dr Bob

Dr Bob — Tue, 14 Oct 2008 19:58:42 +0000

TI has had a clinic at their headquarters facility for years. It was (and probably still is) staffed on a sublease to Baylor. They provide full outpatient services to employees.

The difficulty of seeing one’s PCP on a same day need, is what drives it and what makes TelaDoc such a viable alternative. No time lost from work, less expensive and quality consult service.

By: Marti Settle

Marti Settle — Tue, 14 Oct 2008 13:16:22 +0000

As the owner of a Laser Hair Removal Center I am forbidden to employ a physician by law in Texas. Although the state has attempted over and over to restrict the use of lasers for hair removal to any practice where a medical doctor is on site and immediately available. They make no provisions as to whether the physician is trained for laser hair removal or that the hair removal technician be trained in any manner whatsoever. The only requirement is that the physician be on site. This nonsense has in its sight that only physicians be allowed to reap the financial benefits from the use of lasers for hair removal which has always been a relatively lucrative business. For years needle electrolysis was the only method for removing unwanted body hair. Since the late 1990′s lasers became available and people in the hair removal business recognized the changing paradigm and bought the more expensive lasers and trained to use them. In the process the industry headed up mostly by women exploded the market. Doctors who would never behoove themselves to remove hair took notice of the profitability and started an ad hominem attack on the unwashed and the dermatological societies moved like vultures going from state to state using facetious lies about unsubstantiated injuries to state boards of medical examiners to put these very excellent people out of business. In Texas we have spent hundreds of thousands to maintain our stake in the industry. In the meantime manufacturers of lasers are taking a direct hit in the belly because of loss of sales of lasers and high dollar equipment because people are scared to expand their business. With the sword of damacles hanging over our heads we have not expanded nor have we replaced aging equipment because of a group of greedy doctors who would put us out of business. In fact, a great number of the dermatologists and plastic surgeons who fought against the independents do not even offer laser hair removal services. They just join in because their professional associations tell them to. They have no dog in the fight.

So, in short. it’s illegal for a non-physician to hire a physician. I have witnessed this turf war growing and imploding since 2001. Know what? Doctors are hurting bad. They are hanging on by their fingernails. The insurance reimbursements they receive are a pittance. So, where is all the medical money going? I don’t know. I am presently paying $958 a month for private insurance. I have 4 more months before I go on Medicare. At the age of 64, I just watched my meager retirement fall to nothing. I pray the state won’t shut down my business I will not run out of money before I run out of life.

By: Nevena Puhova

Nevena Puhova — Tue, 14 Oct 2008 09:58:33 +0000

Hi John,
i have all knowlidge of mine about healthcare almost from you and your blog.It was very dificult to me to understand the american system of care.i always compare.So as I am in Britain now I have learn its care.
I saw how it isfine to a pencioner here !
The care for old people is the most profitable industry here.And so and corporate compliance is investing into it.
They offer 24 hours care according LIFE-TIME-INSURENCE EQUITY instead the property of the homeoner.

Then all busness step on the Risk Assessments of patient, the clinic paths and paid care and the professional diseases.
If somebody got assessed as a patient they take money from the Social Servises and the Health Care Funds.
WWWWhat is wandering that the average fee of a person in a Nursing Home is from £450 to 800 a week ?

There is 23 000 homes across UK.You can count the profit.But the property that they covered equities stay unsaleseble on the market.Only that everione house probably has coused a big family tragedy before…

The businessmen in that industry finely speculate with deteorated relations home – they aggressivly offer residental hone care instead the part of ownership, that the old people have got.It is absolutely nonacceptable !
to be continued…

Cheers : Nevena

By: Chris Ewin, MD

Chris Ewin, MD — Mon, 13 Oct 2008 20:18:37 +0000

Doctor SH is correct. Employers shouldn’t “steer” patients to a medical home if it’s not portable. Patients need access to a trusted physician that they select to provide long term follow-up care. I have no problem with employees seeing an on-site physician as long as the patient agrees.

By: Phil Pfeiffer

Phil Pfeiffer — Mon, 13 Oct 2008 19:59:53 +0000

John your comments are right on! The first thing to do is abolish the existing fee-for-service Medicare and Medicaid programs than develop the reform of our Medicare, Medicaid and private health -insurance system. With the continuing watershed movements in our global finanical system, decline form power both military, and economicially its allows us to hopefully refocus on our problems in the USA( energy, entitlements, social security, education, infrastructure, proliferation and health care).

The main sticking point is that now the consumer wants to save( really needed) and cut spending but the politicians will want the consumer to continue spending and not save!!! Have a good day. Phil Pfeiffer

By: DoctorSH

DoctorSH — Mon, 13 Oct 2008 18:08:39 +0000

What happens to these employees when they no longer work for the employer. While this may help cut costs for employers, it still does not help with the issue of portable healthcare coverage. It also keeps the employer as the responsible entity for healthcare instead of the patient.

By: David Marcus

David Marcus — Mon, 13 Oct 2008 17:48:13 +0000

The big problem of opening these internal practices to outside patients is dilution of mission. The practice location at the worksite makes it convenient for patients to obtain primary care and should encourage early intervention/prevention. Cerner gains when its employees receive medical care quickly. I also doubt that Cerner–whose business depends heavily on physician customers–wants to become in a very visible way with those customers by opening its clinic to nonemployee patients.

By: Mike

Mike — Mon, 13 Oct 2008 16:25:05 +0000

Stark is not a problem here as the physician is a bona fide employee and is not making referrals to the employer for one of the designated health sevices, i.e. radiology. Could be a corporate practice of medicine problem, as Greg says, if service is opened up to non-employees. State laws control on that point.

By: Joe S.

Joe S. — Mon, 13 Oct 2008 13:29:53 +0000

The key here is a dysfunctional third-party reimbursement system. When the employer pays the bills, he can escape from the traditional payment schemes and pay for different and better bundles of care.

Patients and doctors on their own cannot do this. They are trapped in a reimbursement system they cannot escape from.

By: Nancy

Nancy — Fri, 10 Oct 2008 16:28:05 +0000

The problem with the employer as doctor is that the interests of the employer and the employee/patient are not the same. The doctor cannot be a reliable agent of the patient if he is on someone else’s payroll.