Texas Medicine Letters: May 2014

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Letters — May 2014

Texas Medicine Should Focus on Patient Advocacy

I just finished reading your latest issue of Texas Medicine (February 2014) and basically was appalled. Probably because I have been in the private practice of internal medicine for 33 years and have just announced that I am going to a cash-only practice. 

I wonder how much more of this we physicians can take. I thought by its title, "Secrets to Success," the cover article would give me some insight into what I am doing wrong, but it is exactly about what I am doing right. I have been doing for many years what the physicians in that article are doing. I have a great staff, a lot of experience, easy appointment availability, and excellent prescription turnaround, but none of that matters when it comes to reimbursement. Maybe it is because they [the practice featured in the article] are a pediatrics practice and not a Medicare-dependent practice like mine.

I have never seriously considered electronic health records, which are covered again in this issue, due to the cost, hassles, and lack of time saving. I have noticed that Medicare has continuously moved the incentive carrot, and meaningful use was really a joke. Most physicians in this area (or at least the optimistic ones) considered it just an interest-free loan. 

Now, I understand that Medicare plans to attach some HIPAA requirements to the electronic health record so the system cannot be hacked into. It seems to me that if people can hack into Target, they can easily hack into me, and I do not know who would want to know that "Grandma Baker" has a mole between her butt cheeks, except for Larry the Cable Guy.

An article on the Affordable Care Act exchange plan ("Untested Waters," December 2013 Texas Medicine, pages 37-42) gave no real answers at all. It was just another hint of the hassles to come -- who's on the plan, who's not on the plan, hiring staff to decide who is on and who is off. There is no fee schedule; it just goes on and on.

The last thing I noted, which I think is the only bright spot, is the Texas physician workforce numbers (see "Testing the Limits," February 2014 Texas Medicine, pages 27-31). In Texas, the active primary care physicians are ranked 47th among the 50 states, and we rank sixth among the most populous states. Certainly, we are in demand, and it is going to get worse. 

I read a previous article in which you stated how many primary care physicians in Texas are older than 60 years such as myself. If I remember the number correctly, it was more than 40 percent. That implies that many physicians are expected to retire soon, especially if things continue to go the way they are going. 

I think my point is that we certainly should have the clout to dictate our destiny more than the insurance companies do. I do appreciate the Texas Medical Association. I think it is the best medical association in the country. 

The insurers are obviously overwhelming us. I do not think we need all these articles on how to play the insurers' game. We need more on how to be advocates for our patients and defend them from the game. 

Richard L. Baker, MD

Food Fight

I was surprised to read the long letter about a McDonald's ad in Texas Medicine ("No McDonald's in Texas Medicine," January 2014, page 7). 

Weight Watchers plain oatmeal has 28 grams of carbohydrates. Its apple and cinnamon oatmeal has 35 grams of carbohydrates. 

Starbucks describes its eight-grain roll as a "wholesome multigrain roll with raisins." However, it has 380 calories and 67 grams of carbohydrates. 

Let us not get into a food fight! 

Barbara M. Hair, DO