Dr. Gripesalot
@pgipe
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Private Practice IM doc, UofK alumi, wanna be foodie, college sports, pilot, not as angry as I sound in tweets
KY
Joined June 2009
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Well said
@mcuban
PBMs add NOTHING to the industry or patient. I’ve been doing this 20yrs-and the sacrifices my patients have to make to afford meds gets worse every year None of them benefit from forced mail order bullshit-or being confined to big box stores.
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Remember this bullshit when the “I chose and NP” commercials come on. Or they try to pass more legislation. Oppose 750 hours training? I got that by my 3rd month of intern year-and I didn’t know a damn thing at that point. It’s all about the $$$
🧵
#NurseTwitter
"The NLN continues to strongly oppose the increase in required clinical practice education hours to 750 from 500 for Nurse Practitioner (NP) graduate programs. This increase has created a burden on nursing programs that may cause some of them to close ... (1/4)
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Mom was admitted to hospital (lives far away) for a week (fine&home now)-despite her pleas & me leaving multiple messages I never got a SINGLE call from the hospitalists or consultants (one call from very kind NP). This is as a colleague. We wonder why patients get jaded
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@clavelluro
@UHC
As a PCP/Hospitalist of nearly 20yrs I can 100% say that doc has no idea what you were describing. The peer review process is a sham used to cloak a already decided denial.
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@propublica
@UHC
This is every day in my primary care office. And all of them around the country. It’s both allowed and protected by Washington. As long as UHC owns the politicians nothing will change.
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VA forcing my controlled diabetic to see local endocrinologist just to get approved for the same meds is another perfect example of just how fucking stupid the administrative class in healthcare and government is.
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Well that’s a wrap! After 20yrs our PCP group has stepped away from inpatient work. Doing both has been very difficult logistically, but mainly it’s mentally unsustainable given what hospitalist work has become at our facility. Bittersweet day-and I feel old lol
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Until you make them liable for causing bodily harm (a liability every other company in the country contend with) nothing will change.
UnitedHealth pressured employees to cut off payments for seriously ill patients in lockstep with a computer algorithm’s calculations, denying rehab care for older and disabled Americans as profits soared.
Read:
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@Jubilee4Jesus
Atelectasis is nearly always benign and seen on chest imaging routinely and typically has little to no symptoms unless there is underlying cause-which is rare.
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Specialist office consults are becoming more pointless every day-they never see a doc and just get every diagnostic study or procedure shotgunned by the NP anyway. I can do that and save the patient the time and hassle (I don’t of course bc I don’t think it’s appropriate)
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Yet DEA requires I do this on EVERY SINGLE CONTROLLED PRESCRIPTION. This system is ran by complete idiots.
UnitedHealth Group, one of the largest firms in the world by revenue, didn't have 2-factor authentication enabled.
lmao
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@sgremminger
@caseyadams360
And how exactly do I predict the size of that mound? Do I know ahead of time which patients will need imaging that requires a PA? Which ins co randomly changed their formulary-more unexpected PAs. You have such a minuscule understanding of the immense variables it’s embarrassing
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@JaymetheRN
Our hospital is running a ‘pilot’ program on certain floors with 8:1 ratios and a ‘virtual nurse’ at home. Hospital administrators do NOT care about patients.
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@jeff1uk
@RealFakeBlake
Help me out here. Exacely which one are we calling his pivot foot? First one or second one?
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To put into perspective, our little clinic takes $12-14K to operate PER DAY, nearly all fixed costs. This will end some practices.
🔥Cyber-takedown of Change HC forces practices to go without revenue for 12th day.
‼️AMA urges HHS Sec Becerra to use all available authorities to ensure physician practices can continue to function & patients can continue to receive the care they need.
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Academic medicine is not training docs to take care of the communities they will serve. They are training docs to take care of the hospital where their attending works.
🙋♂️ What’s your unpopular opinion in medicine that will get you in this position?
#MedTwitter
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Academic specialist with MPH has spoken yall. The rest of us in community medicine need to just ignore the danger we see on a near daily basis.
Medicine has a million problems and APPs are not one of them.
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So are we actually fixing the student loan situation (which we should) or just throwing taxpayer money at it to buy votes? Right out of the healthcare playbook?
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@tired_pa
Physicans aren’t opposed to PAs. Physicians are opposed to unsupervised practice. I trained PAs for years in residency and private practice. I employ a PA. She is awesome! But you’re not trained to our standard. Has nothing to do with intelligence, just training differences.
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Had a switch to different GLP denied by
@AnthemBCBS
today bc they don’t have “records” the patient is diabetic-even though they’ve approved and been paying for their other diabetic meds. I hate it here.
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@TimBarounis
@drcarroll
Nearly every experience that every clinician I have known in my nearly 20 years of practice would disrespectfully disagree. Enjoy your kool aid.
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Narrow specialties like primary care. Lol. Dude. It’s the ONLY specialty that’s specifically designed NOT to be narrow. JFC, these are the idiots working to destroy patient safety.
APRNs are trained to provide quality care in a narrow specialty such as primary care, women’s health, or mental health. By allowing APRNs to do the work they already do, we can address Texas' healthcare workforce crisis.
#HEALTexansAct
#SB1700
#txlege
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@mcuban
@costplusdrugs
Primary care and Hospitalist doc here: ANY long acting and mealtime insulin, literally life threatening profiteering by PBMs for such a large % of population.
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If they will replace docs with NPs why wouldn’t they replace nurses with nurses aids? UHC doesn’t care if you die as long as stock $ goes up-and your government doesn’t care what they do.
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When Washington spends 25yrs writing laws to remove physicians from your healthcare decisions so MBAs can pocket more $ this is exactly what you get.
HCA, The hospital system that owns over 180 hospitals and 3200 sites of patient care, responding to Stein lawsuit, says it never committed to quality care at Mission • Asheville Watchdog
Another reminder that consolidation is a bad trend in medicine
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@KySportsRadio
You should check out this fools FB page. It’s not just a costume for him. I live in Owensboro and the community outrage was quite obvious last night. It’s unfortunate he has reproduced.
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@jbcarmody
@NBMEnow
We are the only profession that has worked this hard to give away this much governing of our standards.
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How bad is $70M Epic emr? Every day all day I give patient typed out instructions printed from MS Word on significant med changes bc computer generated handout- “after visit summary”- is complete trash.
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@olsonplanner
@gruntdoc
Practice? So this was written by an independent practice trying to recruit docs? May I ask what specialty? 🤯
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By law (ACA MLR rule) insurers can keep up to 20% of all healthcare dollars. ALL physician salaries TOTAL in US accounts for ~7% of HC $. The fix is in folks. This admin doesn’t give AF about fixing the system.
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@Ocasio2018
So the solution to obvious government ineptitude is more government ineptitude? Got it. She basically makes the case against the financial feasibility of this disastrous idea.
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Clueless. Drs have been begging for years to increase residency #’s. 15,000 grads went unmatched last year alone.
This pandemic makes it clear how dysfunctional our healthcare system is. Not only do we pay the highest prices in the world, we can’t even produce the number of doctors and nurses that we desperately need. Let us not give up the struggle for Medicare for All.
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Great video. If a group of docs want to open a radiology service they can be fined and jailed for STARK law violation-but UHC is protected from any anti trust since our legislators have been bought.
The Justice Department has launched an antitrust case against UnitedHealth, owner of the biggest health insurer in the U.S. and Optum health-services.
UnitedHealth had $372 billion in revenue last year. Its insurance arm covers 53 million people, and Optum has 90,000 doctors.
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So parents are losing it at about somebody with minimal training teaching their kids…BUT nobody gives a second thought about somebody with minimal training and no oversight providing them health care??
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@SamFromUpNorth
@JaymetheRN
@K3LLYB33N
@PlumberManTed
Ummm….is this for real?? You do understand that the urethra does not connect to the kidneys right?
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One tough weekend in our small town. If you haven’t told those close to u that u love them do it. (But start w u don’t have covid or ur mom may panic for a sec...just sayin)
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I mean is there ANY surprise here.
@CMSGov
willing to bail out hospital systems-who have cash reserves-and fine to let physicians and pharmacists go bankrupt. From a problem the government created! Could these f’n people be any more obviously corrupted and captured?
damn damn damn damn it
I can't believe that hospitals -that have vastly more resources- are getting liquidity help from CMS but medical practices are left out
I can't believe it
we will be fighting this
"Physician groups press HHS for more relief following Change cyberattack"
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“Premiums will go down by $2500” -Barack Obama. Up nearly 100%. Our company premiums have increased 200% since ACA-and reimbursement has decreased. Don’t forget he also pointed the finger right at Dr’s. Insurance industry simp.
Average US family health insurance premium...
2000: $6k
2002: $8k
2004: $10k
2006: $11k
2008: $13k
2010: $14k
2012: $16k
2014: $17k
2016: $18k
2018: $20k
2020: $21k
2022: $22k
That's a 249% increase since 2000 (5.8% per year).
(Note: US CPI inflation has increased 2.5%/year)
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@abouttosynapse
Fuming? Cmon. Per the National coalition for the homeless 38% of homeless are etoh dependent. It’s not about stigma. It’s about developing an appropriate differential diagnosis.
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Holy smokes-read this pile of bullshit-I always wonder when docs sell out if they realize it and don’t care, or care and don’t realize it.
What role does private equity play in healthcare?
PE is significantly transforming the healthcare landscape, bringing much-needed capital and innovation.
But there's a growing debate about their impact on the quality of patient care and ethical considerations.
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@doctornontrad
Remind me of the time as an intern I intubated a pt who threw a HUGE mucous clot and coded (survived). Thought it was my fault until we pulled the plugged ET tube out. The pulm fellow calmly pulled me aside and reassured me. Moment I’ll always appreciate.
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Pain management refusing to fill out disability forms on a patient of over 10yrs and punting it to the PCP is some high level ‘look I’m just here for the rvu’s’
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@olgakhazan
“Nothing gets you as much hate as when you write a biased and misleading article attacking the livelihood of people that dedicate their lives to helping patients while middlemen profiteer off their work for decades”-corrected it for you.
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Read this disgusting article and remember Washington has made it illegal for your doctor to own anything but their practice. Who’s looking out for patients?
Corporate Giants Buy Up Primary Care Practices at Rapid Pace
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Hospitals get more money for multi million dollar CEOs and fancy lobbies-your doc keeps taking pay cuts year after year. Wonder why your visit keeps getting shorter?
@ZachJonesForTX
Hospitals got a few fixes/extensions like the elimination of the DSH cuts. Both inpatient and outpatient payment systems saw increases in 2024, albeit not significant increases. Unfortunately the PFS is the only payment system that sees year-after-year decreases to payments.
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@DGlaucomflecken
@jtrebach
All I know is I’m NEVER flying with this dude. Every plane crashes, and around poisonous delicious plants.
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@tafolabi_MD
There are people bankrupting the system right now-and none of them are treating patients.
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@PoleDoctress
Save the pearl clutching....c suites making 7 figures and ins co profits at all time high...your colleagues are deservedly frustrated.
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Again: there is NO reason for PBMs to exist. The system functioned better without them for decades. They only exist to siphon money for insurers off patients and employees.
@RepGuthrie
#pbmreform
Big Pharma rebates + PBM formulary
Pt: Why is my Symbicort so high ($243.66) must not be on ins
Me: it's covered that's your copay because you have a deductible
Pt: I can't afford that can I get a generic
Me: your plan only covers the brand
Pt: ?
Me:💡wait let me see
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@generalorthomd
@UHC
Report
@UHC
to your state board. Let your UHC rep know that you are. And also let their employer know who decides on which plans to buy yearly.
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@nickmmark
“I managed vents in surgical patients in training so I know better than the intensivists” seems about on brand
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Think vertical integration isn’t bankrupting patients while it kills private practice. This would cost about $100 at my independent office.
@SecBecerra
@RepGuthrie
Received a surprise medical bill yesterday for in-network specialty office visit, a routine follow up to renew a prescription. Despite 30 years working in healthcare--Medicaid, Blue Cross, med school, nonprofits--even I still can't comprehend the system well enough apparently.
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@jfulk25
@JaymetheRN
My mom was hospitalized half way across the country. Even as an MD who knows exactly how to navigate the system I couldn’t get any info, any call backs-whole thing was a disaster.
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Patients daughter (and dear friend) just gave me her recently deceased fathers bible, knowing I’m not very religious, and a message that he would pray for me. Y’all I’ve never been more touched by a gift from a patient in my entire career.
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@Gatordoc
@MidlevelCare
I don’t understand how TF the public and for that matter, the politicians dont see this for what it is. F’n race to the bottom in corporate health crisis w patients held captive
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Skyrocketing costs for patients and record profits for companies & CEOs. Denied care. Unaffordable medications. Medical bankruptcies. 30 million still uninsured. Bravo president.
I ran for president to protect and strengthen the Affordable Care Act – and that's exactly what we've done.
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Wait,
@CMSGov
changed the rules so insurance companies could rob more from physicians to ramp up their already-record profits? What a f*cking surprise.
Electronic medical payments were supposed to save doctors billions and benefit patients.
Instead, payment processors convinced a federal agency that they were allowed to charge fees to doctors and pocket the profits.
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$25 BILLION in excess payments a year. Don’t forget Washington gave these insurance plans a raise for 2023 while cutting pay for your physician who actually takes care of you. They are all bought off. No other reason.
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@danielleofri
I bet she’s a lot of fun at parties. “Hissing” at a resident for doing their job while not realizing your own attempted conformational bias of errors when it sounds like everything explained here was appropriate medical care.
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@EdGainesIII
What does America need more: ONE clover health CEO or 1500 PCPs? Washington has already decided.
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Medicare taxpayer overpayment to insurance companies in 2024 estimated@ $88B. Governments answer? An extra $16B in 2025. Same people cutting your docs pay so you can barely get your 10 minute appointment if u see a doc at all.
The CY 2025 Medicare Advantage and Part D FINAL Rate Notice may be released later this afternoon.
As a reminder, here is a summary of the Advance Notice:
KEY TAKE AWAYS OF ADVANCE NOTICE
· Overall Payment Update: CMS estimates that the proposed policy changes in the Advance
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I enjoy the dichotomy of being trained to respect patient autonomy and simultaneously being penalized by ‘value based care’ systems for patient autonomy.
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Another day practicing medicine, and other day of Epic randomly changing interface layout. I f’n hate it here.
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Record profits ($11B-wtf) yet your premium and deductible soar-don’t worry they pay your doctor less every year too-all thanks to your leaders in Washington.
1/For Q1-Q3 2023, the top 6 health plans had over $11B in net profits. But don’t ask them about the costs of healthcare, or compliance w/
#NoSurprisesAct
IDR decisions against them or not taking high single or low double digit > in premiums—costs too much
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@KellyPe27341309
@gruntdoc
I do both still and have for 20 years and can confidently tell you that you have no clue what you’re taking about. Outpatient is much more diverse. You’re the perfect example of you don’t know what you don’t know.
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In case you forgot the healthcare system is functioning just like Washington designed it to.
Take note
GPOs and PBMs are the only organizations that are exempt from the federal anti-kickback statute
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Biden “They’re the only industry in the nation with that kind of immunity”….ummm, who wants to remind him about his buddies in health insurance industry??
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@B_Madden4
How many different big boxes gonna give this a go? You can ‘revolutionize’ all you want-end of the day people need relationships with their PCP.
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In healthcare everybody can be held liable for harming a patient-EXCEPT the insurance companies. Specifically excluded by our politicians.
@caseymross
These restrictions were low-tech: Send certain cases to MD reviewers for denial. But UnitedHealth’s algorithm was previously used in this prior authorization process. However, that stopped over the summer — again as our stories led to more scrutiny.
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If this doesn’t show the disconnect between the ABIM and those of us doing the work and cleaning up the messes daily I dunno what doesn’t. But I bet u still support MOC don’t u Yul?
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I can’t remember the last time I saw as much pulmonary involvement with influenza. This years strain is for real.
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The amount of mid level mess I’m cleaning up today is exponentially worse than usual-and complete waste of time taken away from what I should be doing. At least the weekend starts tomorrow.
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Unpopular opinion?: the time suck of EMR/admin + patient hoarding by health systems leading to explosion of hospitalist services worsened the death spiral of primary care access/shortage. (I’ve done both for nearly 20yrs-can’t keep it up much longer)
Anyone know any PCP taking new pts in Boston?
I just called
@BrighamWomens
& they said they’re not taking new pts. They had no recommendations who to call. They also told me to call back in Dec, which I’m not going to do
So yeah, I have no issues really. Just need a PCP lol
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@GPanisriR_MD
Sounds like somebody doesn’t value their referring physicians. Time for referrals to dry up.
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What makes this even more awesome is most MA plans are now trying to cut our practice’s payments to 15% less than Medicare. Cheating the docs doing that work for you while raking it in from taxpayers.
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Just found out several of the “large referral hospitals” use NP only Hospitalist teams for “easy” admits? Is this common? This is fucking insanity. Suits don’t give a damn about patient safety. JFC
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@B_Madden4
Just more PCPs to be owned by corporate entities. You’re doc doesn’t work for you anymore and the system wants it that way.
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@nandoodles
Happened to us last year googling delta customer service to change a flight. Top ad with delta insignia was a scammer.
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