Dr. Gripesalot retweetledi
Dr. Gripesalot
19K posts
Dr. Gripesalot
@pgipe
Private Practice IM doc, UofK alumi, wanna be foodie, college sports, pilot, not as angry as I sound in tweets
KY Katılım Haziran 2009
2.2K Takip Edilen2K Takipçiler
Foodnet is literally the surveillance program for cyclospora. This fucking idiot is a danger to Americans. Hard stop.
Headquarters@HQNewsNow
Q: Any response the criticism that the cuts under your leadership have slowed the response to the cyclosporiasis outbreak? RFK Jr.: Those criticisms are invalid. We had no cuts in the surveillance program. We did cuts in the FoodNet program
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I actually just don’t use clindamycin at all. (Few exceptions). Do people still really use it routinely?
Dr. Yonni@kiddiewise_
Clindamycin vs Metronidazole Why is clindamycin preferred above the diaphragm, while metronidazole is preferred below the diaphragm? Many people know this rule, but few understand the rationale behind it.
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Dr. Gripesalot retweetledi
The real reason Medicare for All never happens isn’t cost, ideology, or even system complexity (though those are real).
Current MACs already process 1.1BB+ claims/year for ~34MM fee-for-service beneficiaries. Universal coverage means orders-of-magnitude more volume. They’re not scaling that for free. There would be significant, exponential added cost.
Many “Medicare for All” paths in practice just expand Medicare Advantage-style managed care, which hands even more market power to UnitedHealth and the big payers.
But the actual deal killer is never mentioned by the unicorn riders or the unicorn killers. The actual deal killer is every, single, state government.
States won’t give up the ~$600B+ annual federal Medicaid flows (65% of ~$910B total spend). Let me change that: they aren’t able to give it up - there’s nothing that can replicate those revenues.
Provider tax schemes and supplemental payments already let them arbitrage extra federal dollars beyond statutory FMAP.
Kill Medicaid and that revenue engine - plus the hospital funding it supports - disappears.
State budgets and lobbies (red and blue) won’t allow it. That’s the immovable obstacle. Everything else is fun to talk about - but ultimately meaningless because it’s downstream from the state governments making hundreds of billions on the status quo.
Larry Levitt@larry_levitt
I see lots of mentions of the cost of Medicare for All. But, it wouldn't necessarily increase health spending, and could actually decrease it. What it would do -- which would be controversial -- is redistribute health care spending from premiums and out-of-pocket costs to taxes.
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@RepRoKhanna The profound ignorance it takes to ruin Americans healthcare then propose a complete takeover is impressive.
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Five things House Democrats are going to do once we have the majority:
Medicare for All
A living wage
Stronger union protections
$10 a day childcare
End aid to Israel
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@CyborgPeds What’s not to understand? Pete just says ‘woke, or leftist or radical or beta’ and knows the dumbs will gobble it up.
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I don’t understand this clip. VA Community Care is a current reality. No one has to drive 200 miles.
Mark Lucas 🇺🇸@MarkLucasUSA
Pete Hegseth and I have fought the Veterans Industrial Complex for years. The woke, leftist leaders at the VFW and DAV fight for budgets and access, not veterans. That's why they're siding with Democrats and unions against White House-backed reform. Pete and I have always stood by their members. They are our people. Their D.C. bosses left them behind.
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Dr. Gripesalot retweetledi
There is a lot of detail here, but let me Summarize it this way; in 1997, they decided to “balance the budget” into the future on the backs of physicians by FREEZING our reimbursement. Not any other Medicare cost, only physician reimbursement. So according to the law passed, we are frozen in 1997 unless some emergency “doctor fix” happens on a regular cycle. And congress has decided this is acceptable. Now….they want to tell patients to come back on a second day everytime we need to do a procedure because a visit and a procedure can’t be done on the same day. Patients pay attention, as you walk the halls of the beautiful hospital and wonder why you are so dissatisfied with the care the physician team provides, remember who is getting paid well and who is not. Think back to pre-1997, when I applied to med school. The brightest minds applied, it was very hard to be accepted. If you talk to college kids, they know…….the brightest minds are in engineering or science fields….but not medicine. We all suffer when our physicians are paid poorly.
Anish Koka, MD@anish_koka
Article that fleshes out post from yesterday on the new proposed Physician Fee Schedule rule. I urge all physicians to read it to understand the history of Medicare physician payment and why it came to be the way it is. Doctors should definitely read the take a valium paragraph.
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@ToughLoveMD @Cali_saloni As soon as somebody starts the ‘other country’ comparison they are not worth debating. It’s an adolescent and ignorant assessment of our healthcare finances.
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Because ensuring “health” is actually in healthcare is my fight. Because patient care is my fight. And because physician well-being is my fight. And yes, physicians are well compensated - but if you look at that compensation versus running a practice under increasing government regulations, those merchants become very, very slim.
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The new proposed CMS split scheduling physician reimbursement rule is especially devastating and harmful for rural patients - some of who wait months and travel hours for specialist appointments.
Now one visit turns into two, and months could turn into half a year or more for simple but potentially life-changing interventions or procedures.
This is despicable @DrOzCMS and more importantly, this will harm both patients and physicians. Like most clinicians, I am morally opposed to waste and fraud, but a blanket decision like this is like burning down the house to kill a cockroach.
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@STzorfas ACA has been the worst thing in my lifetime to happen to healthcare. But neither party cares about independent practice and cost or access to patients. They are both corrupt.
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I was humming along quite nicely until Obama came into the office. With the Affordable Care Act, the HITECH ACT , MACRA, MIPS, and the killer of them all the Misvalued Code Initiative, life in my solo private practice changed dramatically. I will never forgive the democratic administration for what they did during this time.
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Any party that would do this would get my vote. Unfortunately we know they are all compromised by the endless lobbying money and spineless against corporate PR.
Charles Lutz@CharlesLutzMD
Agree with you. Maybe the Democratic Party should get back to its roots and defend free market small business capitalism. In healthcare that means defending private practice medicine which has been utterly destroyed by the big corporate shills in both parties.
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Dr. Gripesalot retweetledi
Congratulations Epic EMR!
You did it!
Now even the most trivial or inconsequential information can be instantly transmitted at all hours of the day or night. And repeated tirelessly if you don’t act.
Every chat response is followed by a thank you which once again chirps endlessly on your phone until acknowledged.
This will improve care beyond anything we could have ever imagined.
Sleep is for the weak.
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@HEALTHCOSTtruth @HeathVeuleman It was this way when I started medicine. Better care. Less expensive. Easier access. @CMSGov and Washington has ruined the healthcare of our citizens. @RepGuthrie
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Remember when you had a local doctor that wasn’t owned by a hospital?
Remember when you could get access to care?
Remember when hospital didn’t charge facility fees?
Remember when it didn’t bankrupt people to pay for insurance and not go bankrupt because insurance didn’t cover their services?
Remember when a PBM didn’t decide who pays what for the same Rx?
Let’s try remembering those things for a change.
A lot of us still have local butchers. Few of us have freedom in healthcare.
ⁿᵉʷˢ Robert F. Kennedy Jr.@RobertKennedyJc
Remember when every town had a local butcher? You knew who raised your food. The meat came from local farms. Not a giant factory. No mystery ingredients. We've traded trust for convenience. Bring back local butchers. Bring back real food. Support real people.
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Dr. Gripesalot retweetledi
@LivingstonMD @DutchRojas @realdocspeaks @DrBobBasu @AmericanCancer @DrRodRohrich @AAHS @ASPS_Members @ASPS_News @MaryBowdenMD See the graph above. We are getting beyond screwed. Adjusted for inflation, doctors are earning 30% less than they did in the year 2001. Please go to @STzorfas call and email CMS. I tell you how.
saveprivatepracticemedicine.org
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@DrCasteelEM You’re gonna rile up the peptide bros if you’re not careful.
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@PaleoOnc @CMSGov @DrOzCMS @RepGuthrie The fact our local hospital has a reputation for monopolistic behavior doesn’t hurt.
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@pgipe @CMSGov @DrOzCMS @RepGuthrie That’s the best. When you’re in practice long enough that you can be fair and honest with your patients and they reciprocate!
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This 💩 doesn’t work unless doctors are the good guys. And they *know* it even while badmouthing us
You can’t pay someone half and DARE them to send them home for better pay tomorrow
So … either we’re a sucker and do the right thing, accept a pay cut and treat the patient right (for an unfair discount)
Or … we send them home to get paid fairly the next day. And patient calls us the bad guy
Sucker or bad guy
That’s our lot.
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And you know why they don’t do it to the hospitals ?
Because they know they play dirty.
They don’t care.
We do
So they get raises and we get pay cuts.
While they bad mouth us and praise the hospitals.
Dutch Rojas@DutchRojas
I would like to thank Washington for finally finding the waste in American healthcare! It was a physician. I know. I was as surprised as you are. Specifically, a physician who evaluated a patient and treated her in the same visit. One trip. One parking fee. The efficiency of it makes me ill. So CMS are going to pay him half for the second thing he did. As they should. Now, I was not worried for a moment. I read which rule it was in. The cut lives in the rule that pays the physician. My facility fee lives in the other rule. My drug spread lives in the other rule. I collect three fees on one patient in one hour, and no one has ever once called me a duplicate. If duplication were a sin, I would be the cathedral. But the rule walked right past my tower and knocked on a dermatologist with a table and a light. Funny, how it knew the address. And they did it in the name of making America healthy again. There is a television doctor running Medicare and Medicaid now. I could not have written it better. I did not do this. I merely benefit from it. There is a difference, and the difference is beautiful. -Rojas out.
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CMS 2027 proposal to cut E/M payment by 50% when billed same-day as a procedure will badly hurt patient access.
Practices will of course split visits - E/M one day, procedure the next - leading to many more appointments, longer wait times, patients missing second visits, more fragmented care.
This really burdens elderly/chronic patients who due to health and transport reasons need same-day evaluation + treatment.
Urge CMS to reconsider.
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@jasonlofton @PaleoOnc @CMSGov @DrOzCMS @RepGuthrie Still getting cut $40 on that first knee. Just do both on return
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@pgipe @PaleoOnc @CMSGov @DrOzCMS @RepGuthrie I’m family medicine and have people frequently asked me for two shots, one in each knee. I just tell them I’ll do one shot one day and come back the next day for another shot and explain why. I have them pick which knee they want first.
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