Who’s Killing Our Goose?
By O&P Edgy The older I get, the harder I try not to get too upset about
things. Doc* says the stress will kill you--let it go, chill out. I
was doing pretty well too--until last week, that is. I got a call
from a friend who's been making limbs and braces since Hector was a
pup (Southern for "a long time").
George* tells me he's putting his business up for sale and
thinking about getting out of the field. He is the last person I
ever expected to hear that from. He loves working with patients,
and they love him. "Ol' George has the patience of Job," his staff
would say. Seems his patience has just about run out.
So I asked George what was going on, and I got an earful. He
started telling me about spending more time trying to get paid for
his work than actually taking care of his patients. Sure, he has
lots of staff; he has someone to check that patients have
insurance, someone to get approval for what Doc already says they
need, another person to submit the bill, then someone to try to get
the bill paid, and finally someone to manage the whole crew. George
says they know their jobs but still need his time to answer
questions from payers--questions that many times seem more like
ways to slow down or refuse payment than real clinical
questions.
 Of course his staff needs to get paid too, and
that means more work for him. That's where we really got to the
root of George's frustration. He says he finds himself thinking
about profit and making ends meet more than about how to best take
care of his patients. George said it reminds him of the story about
the farmer and goose that laid the golden egg.
Golden Eggs
A farmer goes out to the coop one day and finds a golden egg
under the goose. Then, the next day to his surprise, he finds
another golden egg. This continued every day, and as the farmer
grew rich, he also grew greedy. And thinking of all the eggs that
remained inside the goose, he figured that if he cut the goose
open, he could have all the eggs at once. He did this, and when he
killed the goose, he found it empty.
O&P: Farmer or Goose?
Like I told George, "Nice story, but what does it have to do
with your wanting to give up your practice?" He explained it this
way: "I remember when I could just take care of patients, and I
didn't worry about money and making ends meet. But lately, I can't
decide if I'm the farmer or the goose in the story--and I don't
want to be either."
 That conversation made me ask myself, "Who's
killing our goose?" The way I see it, our goose is a victim of a
few circumstances that have caused healthcare costs overall to
rise. Folks are living longer; since 1960 life expectancy is up 53
percent, and the fastest-growing segment of our population is
people over 80.
My punk nephew said, "Geeze, who wants to live to be 80?"
I shot back, "Someone who's 79 and a half!"
On top of needing more care as we get older, technology is also
improving, providing a higher quality of life and higher prices to
match. As Pogo said to Porky, "We have met the enemy, and he is
us." Modern medicine is great; we've just got to figure out how to
pay for it. Trying to cut costs only goes so far, and withholding
reimbursement from providers or denying technology to folks who
need it is just wrong.
You don't have to be a farmer to understand that not long after
our goose is dead, it will be cooked too! I guess that's why,
despite Doc's orders to the contrary, these days I'm a little too
"Edgy." *
* Names have been changed to protect the provider
status. 
Table Of Contents - March 2005
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