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Re: New HCFA guidelines for teaching physicians From: Paul Prior MD (pprior@fast.net) Tue Jul 16 17:19:51 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: mborn: "Re: New surgical instruments" Previous message: ENDODOK@aol.com: "Endometrial Ablation" In reply to: DoctorJoe@aol.com: "Re: New HCFA guidelines for teaching physicians" Next in thread: R. Daniel Braun: "Re: New HCFA guidelines for teaching physicians" On Sun, 14 Jul 1996 09:40:36 -0500 (CDT), you wrote: ><<The amount of work expected from attendings has gone up dramatically in our >program, and given that sometimes our covering attending must come from a >private office and lose his/her own practice billing during that time, I can >see significant problems down the road.>> > >To throw a little perspective on this: > >Since the attending is BILLING, then this IS his practice and he SHOULD be >there. The real problem is not money per se, but the possibility that the >hands-on training of residents (AND medical students) will be diminished by >requirements that the attending's hands should be in the case, presumably >displacing the hands of a trainee. It is not his practice - although we may see many residency programs dissolve for financial reasons as clinic patients get picked up by HMOs and private practices...this sort of financial system has in the past provided quality care to a large portion of our population while also allowing attendings to maintain a private practice. What is going to happen here is attendings are NOT going to be supervising because they will decide it is easier just not to be involved at all. After all, if it takes so much time away from private practice, then they are suffering and we all know the margins are not there like they used to be. Therefore, I fear, the longterm outcome from this will be LESS supervision (at least less -quality- supervision) from attendings, and problems with coverage like never before. >The hidden disingenuity (if that's a word) in all of this is the lamenting of >the fact that an attending can't bill for the public patient at the same time >he's billing for a private patient... We stand to lose money from the >prohibition of a sort of DOUBLE BILLING... I think we should be "happy" that >we've gotten away with this for so long and be thankful if we can just >convert over to the new system without having to pay, like U of Penn. Again, the attending is not getting paid (directly) for billing this, and IMHO putting his name on the chart is enough - one is testifying to the quality of care when one sign's the chart and if quality is not being provided then we (the residents) hear about it and it changes. That is how it has been, and how it should continue to be, but it clearly will not. NSVDs used to be chief residents teaching lower years here, now with the attending IN the room, that sort of interaction is rapidly decreasing, which is a negative. I doubt very much all this is being driven by concerns about quality of care. It is about money and the government trying to cut it's cost by increasing the hassle factor (hoping that hospitals will have to write off a significant portion of charges). Sigh... > >************************************************* > >doctorjoe@aol.com > "All things are connected. >Joseph Pastorek, MD Some things are just more >Department of OB-GYN connected than others." >LSU Medical Center - Dirk Gently >New Orleans, LA >U.S.A. > >************************************************* -- Paul Prior MD pprior@fast.net Home deliveries: PGY-III Ob/Gyn ok for pizzas TRHMC-Reading, PA not for babies Next message: mborn: "Re: New surgical instruments" Previous message: ENDODOK@aol.com: "Endometrial Ablation" In reply to: DoctorJoe@aol.com: "Re: New HCFA guidelines for teaching physicians" Next in thread: R. Daniel Braun: "Re: New HCFA guidelines for teaching physicians"

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