May 2001 • Volume 7 • Number 5
Medicare drug coverage
To the editor:
Here's a better idea than giving all Medicare recipients drug coverage: The government should increase the proportion of Medicare costs that are paid by seniors based on an accurate means test and have all seniors eligible for benefits with a sliding scale approach to payment/coverage. Those with more resources would help pay into a pool of money that would be available for less fortunate patients to access. Patients and their physicians would have a set amount of money each year to utilize for Rx coverage, and beyond that amount the patient would be responsible for either paying cash or independently providing Rx coverage insurance.
Therefore, this system would encourage communication and joint decision making between the patient and physician regarding the patient's medication choices and prioritization each year.
Jon Parham, D.O., M.P.H.
Knoxville, Tenn.Members oppose sexual orientation coverage
To the editor:
I wanted to respond to the March FP Report special section on sexual orientation issues. The AAFP has done well in allowing for a great deal of diversity. I appreciate this and know that this is part of the culture in a group as large and influential as our Academy is. I do, however, take exception to the notion that a "gay/lesbian/bisexual/transgender-friendly office" is a desirable thing for family physicians. We are able to treat and maintain all individuals without needing to enter into a politically motivated and very divisive stance.
When step one to engineering a GLBT-friendly office is the exorcising of my own "demons" in regard to my personal view about homosexuality I find tremendous fault with the process being promoted. I would suggest giving fair time to a group that has had success in helping people escape homosexuality. I have maintained a professional relationship with those who have come out of the homosexual lifestyle and have been overwhelmed with joy in the relief they have found. I would refer the AAFP to The National Association for Research and Therapy of Homosexuality, 16542 Ventura Blvd., Suite 416, Encino, CA 91436, (818) 789-4440, narth3@earthlink.net.
Bruce Young, M.D.
Olathe, Kan.The choice to publish this, while many worthwhile subjects beg for publication, casts serious doubt on the moral integrity of those at the helm of FP Report. It is evidence of detachment from that which is real, enduring and important in our lives and the lives of our patients. Editors, please acknowledge that this set of articles was a worthless pursuit, and aim for subjects that will edify and transform.
John Humiston, M.D., Lt., U.S.N.R.
Keflavik, IcelandMy practice is very diverse, and I care for all my patients with the same care, skill and compassion. To suggest that I have to take special steps or precautions to make GLBT patients welcome is absurd; I take the same extra care with everyone. That I should put up special signs or should respond in some special way to some symbol (be it a rainbow or a star of David) is totally unnecessary. The tone of these articles was condescending and offensive.
Ron Stephans, M.D.
Tampa, Fla.Aren't there many more minority groups that comprise far larger segments of the population, and have serious issues in their lives which were not brought about by choices but by tragic illnesses or accident, to whom we could give the attention?
Paul Reay, D.O.,
Wichita, Kan.Reasonable compensation
To the editor:
It's impressive that the March 4 New York Times printed the AAFP's letter about health care coverage for all. But now that we have the public ear, perhaps we should say some other things. For example, are we insisting that doctors get a reasonable compensation for their work? Are we assuming that Medicaid is charity, and we are the donors? Have we taken a position on the onerous government regulation package that comes with accepting Medicaid patients? One of my local reps for a program, when confronted with the regulations holding doctors responsible for the behavior of parents of children on Medicaid, glibly told me not to worry, "we're not prosecuting doctors for that" -- of course, with the implication that they could if they wanted to.
I am not a malcontent. I have weathered 22 years in various compensation climates. I feel the nonfinancial rewards of long-term relationships with patients and staff have made my life full and rich. However, when I see local groups successfully recruiting primary care docs at $80,000 a year, I fear the decline of family practice will sadly accelerate.
Dennis Novak, M.D.
Forked River, N.J.Down with referrals!
To the editor:
I am trying to get managed care organizations to abandon the practice of requiring referrals. The referral system serves no real medical purpose -- but it is quite effective in driving a wedge between physicians and their patients and between primary care doctors and specialists. The system also is useful to MCOs in their campaign to deny or delay payments for services.
Today's average primary care office is processing so many referrals that it needs a special phone line and an employee dedicated to this process. We must create these referrals on a credit card type of machine, entering detailed CPT codes for the services the specialist may perform. Should these codes be incorrect, a denial of payment to the specialist occurs. The specialist and the patient call and gripe to the primary care office, which must intercede on their behalf and beg the MCO to pay, despite the "error."
If referrals were eliminated, the MCOs could use the positive press coverage that would result. The millions of dollars saved could be spent on patient care or quality assurance. Physicians should unite to dismantle the nightmare of referrals.
Roger Thompson, M.D.
Middletown, N.J.Kudos to the Academy
To the editor:
I think the Academy is on a roll! The Web site familydoctor.org has been extremely well received by my patients. I've also directed friends in other specialties to it, as an alternative to wacko chat rooms that permeate the Web.
American Family Physician continues to be of great help. I forwarded recent articles on end-of-life care to our social service department, and the patient handouts are being given to families faced with these decisions. Also, when students, NPs and PAs have rotated through our family medicine department, they are very impressed with AFP's content, mentioning how useful it was during their various rotations.
The Home Study program is more relevant than ever. Family Practice Management is filling a long-standing void. FP Report is better and more useful than ever, and the new AAFP This Week by e-mail is equally good.
I am sure that these things will show students how the Academy and family medicine have developed, and will counter some of the academic folks who continue to downgrade our specialty. I think that, apart from trying to make sense of billing and attempting to change the adversarial relationship between medicine and HCFA, my practice is satisfying -- and fun.
D.E. Peterson, M.D.
Inverness, Fla.Editor's note: We appreciate hearing from readers, even when they're not happy with coverage in FP Report. We believe, and we hope, the AAFP is seen as a place where all family physicians can come together to share their common concerns, learn from each other's special perspectives and respect each other's differences.
To the reader: Write us letters of 200 words or fewer (subject to editing), using the FP Report address pbinder@aafp.org or FP Report, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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