Letters to the Editors

May 6, 2005

Medicare reimbursement clarification; raising patient satisfaction; misusing peer review; watch that apostrophe! medical costs foster high settlements; when faith is gone...

Medicare reimbursement clarification "Almost 65? What you need to know about Medicare" [March 4 http://www.memag.com/memag/article/articleDetail.jsp?id=148878], confuses readers by not making a distinction between a nonparticipating physician and a physician who has "opted out" of Medicare. A nonparticipating doctor can still see Medicare patients and bill the program for these services. The doctor simply has not signed a contract requiring her to accept assignment. The patient still receives the benefit of reimbursement from Medicare for the allowed amount. What's more, the doctor can elect to accept Medicare assignment for some patients on limited budgets.

This is very different from doctors who opt out of Medicare. Their patients are required to sign private contracts, there is no limiting charge imposed, and patients cannot recoup any part of the fee from Medicare.

Being a nonparticipating doctor provides me with the flexibility to serve patients who have varying financial resources, within a fee-for-service environment.
Rosalind Shorenstein, MDSanta Cruz, CA

Raising patient satisfaction

I agree with internist William Kornrich that enjoyable reading material in the waiting room has benefits ["How I connect with patients," March 18 http://www.memag.com/memag/article/articleDetail.jsp?id=151133]. When I decided to operate a satellite office full time due to increasing volume, I knew that at times patients would have to wait.

I decided to make the wait time as enjoyable as possible. I subscribe to a wide variety of publications in an effort to cater to different preferences, and I regularly visit a large-chain bookstore, where I can usually find a selection of discounted items for anywhere from $5 to $20. I've acquired more than 100 of these over a few years, and display them in bookcases in the waiting room. Topics range from WWII aircraft to the mysteries of history to the joys of chocolate. I've also included some brainteasers and crosswords. Copies of Life magazine from the '40s, '50s, and '60s are very popular, too-particularly the advertisements.

In addition, I have a fish tank, complete with colorful fish, that patients have told me is very relaxing.

I installed a small plasma TV, but found it's very difficult to get people to agree on what to watch. As a result, I leave it tuned to The Weather Channel with few complaints.

Patients tend to be in a much better frame of mind if their waiting time is enjoyable.
Robert R. Pavelock, MDOneida, NY

I not only leave photography magazines in the waiting room, but, being an avid MAD magazine reader and collector, I leave those in the exam rooms as well. I have the entire collection of MAD, and more often than not, I'll enter the exam room and find my patient reading one of the issues. Needless to say, this can sometimes lead to interesting discussions.
David Lubin, MDTampa

Watch that apostrophe! I appreciate the information about the physician assistant profession in the article "Adding a doctor? Ask these questions" [March 18 http://www.memag.com/memag/article/articleDetail.jsp?id=151138]. These health professionals can make it easier for physicians to expand services for their patients.

I would have appreciated the article more if you had gotten the professional title correct. The term "physician's assistant" is a descriptive phrase that can be used by anyone in an assisting role to the physician. The professional title "physician assistant" is legally protected by state and federal law, and may be used only by those individuals who meet the education and certification standards to be licensed to practice medicine with physician supervision.
Nancy HughesVP, American Academy of Physician AssistantsAlexandria, VA