Sunday, May 11, 2014


1 + 1 + 1 = 0


In search of a decent medical practice


I'm beginning to think finding a decent Medicare Advantage plan with decent practitioners AND office staff is an impossibility.

For a number of years I had what I considered a good general practitioner, a/k/a PCP. The doctor was great and I credit him with saving my life (by correctly diagnosing a 7-cm abdominal aortic aneurysm or "Triple A" and quickly getting me into the hands of a surgeon to fix the problem).

Unfortunately, his office staff is clueless; a total disaster. Complaints, even repeated complaints, fall on deaf ears.
Despite the office staff's absolute incompetency my Spouse, on a different insurance plan, won’t abandon the doctor.

In any event, AvMed, for many years my Medicare Advantage provider, cancelled the practice. In talking with other practices, the opinion is that AvMed was "bleeding money" in my county and had to cancel practitioners who were failing to contribute as much to AvMed's ROI as it desired/required. Part of the blame might be laid to AvMed's allowing patients to self-refer to specialists. The was a two edged sword for the patient: On one edge, the patient could see an AvMed-listed specialist without waiting for authorization. The other edge is that the PCP and the specialist might never connect, and that is to the patient's disadvantage.

AvMed has since eliminated self-referrals and now is in line with most other Medicare Advantage HMO plans.

For whatever reason, AvMed cancelled my PCP. (It previously cancelled my long-time ophthalmologist. He was "reinstated" the following year.

AvMed's cavalier cancellations tend to prevent any long-term patient/doctor relationship, and even AvMed admits that relationship is critical for it's client's well-being.


Good bye AvMed, hello Humana

In a fit of pique, I went looking for a Medicare Advantage provider to replace AvMed. I looked at several and settled for Humana

Once I settled on Humana I went in search of a new PCP.

I found one who seemed agreeable and seemed to have a decent office staff; I notified Humana that when the 2014 calendar year rolled around, this gentleman would be my PCP.

January arrives and I visit the new PCP. During the course of the appointment I ask for referrals to my AAA surgeon (annual follow-up) and to my ophthalmologist. Both specialists are on Humana's provider list so there should be no problem.

But there was a problem.

The new PCP told me I had a choice: I could go to the ophthalmologist he preferred or I could find a new PCP.

No contest. I looked for a new PCP.

I was told that the reason the first Humana PCP would refer me only to someone on his personal list was due to "capitation." "Capitation" somehow relates to the PCP's bottom line. The truth of that is beyond my ken.

So I went searching for a new PCP - again.


New PCP Number 2

I checked out several and settled on one with what seemed to be a knowledgeable office staff. I thought this was a multi-physician practice; I was disabused of that idea today when I was told the person I thought was an MD/DO was actually a PA, albeit, the office staff told me, a "really good PA."

I made an appointment to see the MD and he seemed "OK"; off-shore degree, but conservative in his approach to medicine. So-so sign (off-shore degree) with positive sign (conservative approach).

My follow-up visit was pushed back two weeks - no reason given.

Meanwhile, I visited the local medical lab for blood work. The triglyceride results were off the charts.

I get a call from someone at the practice - not the doctor - who tells me to double a certain medicine. No one asked me for my history or if an anomaly occurred. Since I have had this test performed four times a year for many years, I knew the off-the-charts results were a fluke.


Strike 1

When I finally got to see the doctor, I tried to tell him that the lab results were not accurate and that I would like to retake the test. He arrogantly informed me that HE would decide if I could retake the test. The patient be damned. Even my surgeons are not that arrogant! It turned out his concern was not for my results but for an impact on Humana's and the practice's bottom line.

I did walk out with scripts for my four meds.


Strikes 2 and 3

Unfortunately, despite telling him I take two tablets-a-day of one med and four capsules-a-day of another, his prescriptions called for one tablet-a-day and two capsules-a-day.

I discovered this situation the other day when I started running low on the two-a-day pills. My first thought was that Publix, where I get most of my meds, shorted me. Then I looked at the script and saw that my now "previous PCP #2" ordered 30 pills for 30 days. Publix was fine; the now former PCP was not.

The the four-a-day meds arrived (they come from a mail order pharmacy). I received two (2) bottles of 120 capsules/bottle (and was charged for three bottles). If you do the math. 120 capsules divided by 4 (capsules-a-day), you have 30 days' worth of medicine. The delivery of 240 capsules would last 120 days (four 30-day months) on a two-a-day consumption.

I take my health seriously, but doctors and office staffs have put it in jeopardy for too long.

I hope the PA that works with a good office staff and who can refer me to my specialists "prn" (as needed) will work out. If not, I will be interviewing PCP candidates again.

Just for the record, both of my former Humana-listed PCPs also are listed with AvMed.

Time will tell.

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