Friday, April 23, 2010

With a cluck-cluck here and a cluck-cluck there

Generally, I find my practice works best when I get paid in dollars. They're convenient. They can be transmitted electronically between bank accounts. Mary and Annie like them. I can spend them by swiping a credit card.

But, in a remarkable effort to win the "Let's See How Stupid I Can Sound" award, a Nevada candidate for U.S. Senate has proposed ditching the idea of paying doctors in money, and going to a barter system with them. Specifically, she suggested paying us in chickens or house painting.


Sue Lowden is the gem who hatched this idea. In fact, she was given a chance to explain it, on the assumption that she misspoke. But nope. When given the opportunity to clarify her point, she again clearly stated that medical services should be reimbursed by bartering goods, such as chickens, and not by paying money. She specifically indicated it was to pay doctors, and didn't say if it should be applied to other businesses (such as buying your meds at the pharmacy, or groceries at the store). She even said she wasn't going to back down from the idea.

Barter is not a bad thing. In some situations it works. Most civilizations used it before the advent of money. But the majority of human cultures eventually developed cash of some form. Because let's face it: It's hard to carry around enough chickens to buy a car. And they're messy. And, unlike coins, they require feeding.

This idea may work for some docs, but not me. I personally don't want to collect co-pays in chickens. Or goats. Or frying pans. Or anything other than money. This is also a matter of cleanliness: my migraine patients are sensitive to smells. I don't think they want to sit in a lobby filled with the livestock someone else brought to settle their bill.

And I don't have enough space in my yard to handle all those co-pays. Mary and Annie are also not going to be thrilled to be told that instead of money I'm now going to pay them in sheep and legumes. It's a baaaaaaaahhhhhhhhhd idea.

The logistics of making an ER co-pay become especially daunting, paticularly if you're now in a wheelchair but need to use the space in your car for bushels of corn and some turpentine.

And just try giving your kids a handful of chickens to spend at Chuck-E-Cheese's. Have you ever had to clean feathers out of a skee-ball machine? It's trickier than it looks.

We will also need to re-do medical school curriculum, to include care and feeding of livestock, as well as how to run your own slaughterhouse (for us non-surgeons) when turning your co-pays into dinner.

Ms. Lowden, to verify the usefulness of your idea, why don't you try a simple experiment- go into any large casino in Las Vegas. With a chicken. And try to bet it on any game. Or stuff it in a slot machine. And then see what casino security thinks about being paid in something other than money. I suspect they'll be as fond of the idea as I am.


Justin said...

You are so behind the times when it comes
to your thoughts about a modern day barter system. The only change you would have to make is turning one room into a giant walkin freezer for the 10 bags of Tyson boneless skinless chicken breasts each co-pay would cost. Or you could get really fancy an ask to be paid in racks of ribs.

Think about the benefits! You could open Dr Grumpy's Steak House With just your co-pays and current staff!

Maha said...

How is it that people like this have a public platform to voice their insanity??

Anonymous said...

But Doctor Grumpy, someone has already gone through the hard work of writing a chicken-to-medical-procedure converter program! This handy website will tell you how many chickens to charge your patients for.

Anonymous said...

it's a really foul idea and not a good eggsample of how to the get the economy running again.

WarmSocks said...

The staff at my doctor's office likes the fresh eggs I take them. That's in addition to money, not instead of it.

Leeroy Jenkins said...

At least I have chicken.

Mark In Mayenne said...

Lucky old surgeons, not needing special training in chicken disposal, eh?

Anonymous said...

yet another thing to make me feel sorry I am a republican. Still hope she kicks reids ass though

Anonymous said...

Just so you can plan for your future Dr. Grumpy, here is handy tool for you to base youre rates...

Nevada Bones said...

Thank you, thank you, thank you for bringing this up. I live in Nevada, and everything you say about multi-millionaire casino owner Sue Lowden, who is running for the US Senate, is true.

Unfortunately, she's got the most campaign money by far - I can only hope she keeps opening her mouth and proposing similar brilliant ideas!

Further, she's a staunch proponent of patients negotiating (haggling about) fees with their Doctors. How do you feel about that one, Doc G?

How'd you like to have her and like-minded legislators craft health care reform? (shudder.)

Brings a whole new meaning to "A Chicken in every (doctor's) pot...and maybe a goat or two."

Here's a scenario:

Savvy negotiator (SN): "So, Doc, how much for an initial visit to explore my migraine problem?"

Doc: "$xxx.00"

SN: "Is that the best you can do? Is that your best, rock bottom, can't go any further, cash price?"

Doc: "Yes."

SN: "How about .8 * $xxx.00...the Neurologist down the street will do it for .75 * $xxx.00, but I'd rather see you."

Doc: "Unless you're willing to pay my fee of $xxx.00, I suggest you go the other Neurologist, as I have patients to see and no more time to waste. Good luck."

SN: "Aw, c'mon doc...Sue Lowden (and many others, for that matter) say I should be able to haggle with you and negotiate a lower fee!"

Doc: "Is Sue Lowden a doctor?"

SN: "No."

Doc: "Too bad. Maybe you could have negotiated with her for services. Bye-bye now."

Seriously though, would you be willing to "negotiate" (downward, obviously) your fees for your services, or would you stick to your guns (and fee schedule)?

Finally, as an aside, 9 out of 10 photos I see of Sue Lowden in the newspaper makes her appear to be bombed on opioids. Not alcohol, not pot, not speed, but her eyes (and mouth for that matter) just scream, "Opioids!!!" I'm sure you know the look.

Weird shit, for sure.

Anonymous said...

What can I say? Take a look at this:

ER's Mom said...

Can you imagine what the waiting room the exam rooms would look like after 1 day of being paid in chickens?


Bad enough I have to deal with the occasional puker...

John Woolman said...

I'ma doctor. And I keep two happy hens in our back garden. There is a strong resemblance to politicians in that they make a lot of pointless noise, run round in clucking circles to little effect in a crisis, depend on me for their food and shelter and produce remarkable amounts of dung. Unlike politicians they produce something useful - about a dozen eggs a week of a quality you never find in stores. And those eggs do make lovely gifts, not barter.

Anonymous said...

but surgeons will be just fine?

Unknown said...

Isn't the lynchpin of a functional bartering system that you actually want whatever it is that your services are being traded for?

"Dr. Grumpy does not accept chickens, but requires payment of a fee of X dollars, or X dollars equivalent in fine wines, white coat cleaning and alteration services, or other goods as Dr. Grumpy sees fit. Diet Coke is an acceptable barter good."

Anonymous said...

What she really said was that she'd prefer we go back to a small private practice medical model, rather than corporate or government run healthcare (both models pushed by her opponent, Harry Reid). She used the example of her grandparents, who bartered for medical services by trading their farm goods. I think you're buying into the Reid campaign's bullshit completely. Personally, I think small private practice medicine works a lot better than government run healthcare, but hey, as long as you can tell jokes about chickens, who really cares about the actual issues?

Cthulhu Sashimi said...

Remember the dying words of one of the wisest men who ever lived, Socrates:

"Crito, we owe a cock to Asclepius. Please don't forget to pay the debt."

Asclepius was the Greek god of medicine, mentioned in the original version of the Hippocratic oath. We see here that paying for medical care with poultry has a long and distinguished history. Sue Lowden is merely following the great Socratic tradition.

Now, let's see if she drinks hemlock.

Anonymous said...

But don't you diagnose your patients by sacrificing a chicken and reading the entrails?

Anonymous said...

Here is a handy calculator to help your patients figure out just how many chickens to give you:

The Mother said...

Dare I ask what pathologists should be paid with? Body parts?

miss kitten said...

here's one that didnt get mentioned...

how do you stuff a chicken in an envelope to send it to pay those pesky student loans? in the words of bart simpson "aye caramba!"

hekates said...

I watched the interview, Anonymous, up there, and part of her reasoning was that "Doctors are kind hearted people." Well some may be and some may not be but no doctor should have to go through a ton of bullshit to get paid. I don't care what the heck her grandparents did. My grandfather was an electrician that worked with exposure to asbestos. His doctors when he died of cancer didn't accept barter.
Sue Lowden is a giant tool - She fired people, eliminated a matching plan for her employees while giving her husband a $200k bonus Shes under SEC investigation. I suppose that it would be a continuation of Ensign's investigation.

And finally to the Anonymous up there that wants to get rid of Reid - yeah, sure, because a ridiculed jr senator from a small state is waayyy better than a respected Senior Senator with some clout. WHy not have two lousy senators to go with our lousy governor and lousy representives?
And fi

Gert said...

LOL....funny post!

I do agree with Anonymous 6:11, though.

I have 15 chickens, two are that enough for an office visit?

Unknown said...

Maybe she should be paid using the barter system.

Anonymous said...

haha does this mean that someday i will be able to pay my speeding tickets with prostate exams?

A Doc 2 Be said...

Rarely, if ever, caught speechless...

I am.

Wow. Really?


Matt said...

Hilarious. Can't believe this woman is a contender for the U.S. Senate. Can't they find someone who isn't a cook?

Poli-Woli-Doodle-All-The-Day said...


Q:"How is it that people like this have a public platform to voice their insanity??"

A: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

Ain't it Grand?

Texas Pharmacy Chica said...

Do you have to pay taxes on reimbursements paid in legumes, cheese or chickens?? Does the local county and school district take chickens instead of dollars come tax time? Valid questions that need answers.....

erer said...

First time on your blog.

Hmmm this is something I'm new to. Didn't know about this barter system coming up. The way you've talked about chicken is funny. But reading other comments, guess it makes some sense. Whatever the conclusion, I enjoyed the read.

Happy blogging!

Dr. McCoy said...

I know you hate politics and political bickering on your blog,
but, hey, You Started It!
I promise this will be my last (overtly) political post on this subject.

What Anon,4/24,06.11AM posted is true as far as it goes:
"She used the example of her grandparents, who bartered for medical services by trading their farm goods. I think you're buying into the Reid campaign's bullshit completely."

But, it's not the Reid campaign's bullshit, it's Sue Lowden at her out of touch with the non-wealthy (that'd be 99.99% of us, folks) best.

But more importantly, Suze has 1) said that bartering and negotiating for medical services IS applicable and practical TODAY, and 2) subsequently, her campaign has re-stated and re-iterated that the bartering and negotiating ideas are her ideas of health-care reform for TODAY, NOW, AS WE SPEAK. Not just in her grandparents time, not just in The Little House on the Prarie's time (damn, that was one cool medico on that show, wasn't he?) but NOW, TODAY - April 24, 2010, and going forward into the future.

Check the website - Las Vegas' right-wing newspaper if you don't believe me.

Outrider said...

Didn't you want to get started on Marie's dowry? Or are you holding out for goats?

Don said...

The batering system is nice, if used carefully and both parties understand and agree to the terms.
A few years ago, while I was on a consulting contract, our system administrator, a young mother, set up a fully functional network and web site for her pediatrician, who agreed to provide $XX amount of care for the children in exchange for her services. Both parties were pleased with the arrangement, from what I heard at work. The agreement was extended while I was there, and may still be active.
While Ms. Lowden's phrasing may be awkward, the barter system does work when both parties are informed and in agreement.

Grumpy, M.D. said...

I never said the barter system doesn't work. I pointed out that it does, for some people and circumstances.

ChemoQueenRPh said...

I think the IRS would expect taxes be paid on the chickens. Do you think they would accept eggs sent in with your 1040?

Anonymous said...

6:11- so wrong it suggests you have problems with reality cognition. you too gert.

NozDoc said...

Honestly, as a practicing otolaryngologist in rural KY, I have been predicting this would happen. I actually wouldn't mind taking the value of bartered goods and services that I might want. I can be thrown into federal prison and fined hundreds of thousands of dollars if I cut a break to a hard working farmer that doesn't have insurance and not charge them in cash what I charge for my services. I cannot even do something for free because I would be breaking my contract with the feds. If someone paid me in 2 chickens and I ate them at least I wouldn't have to give them back like I just did with a check for 800 dollars four months later because they found out that they had "overpaid" me 10 dollars and couldn't just ask for 10 dollars back. Don't fool yourselves people, Medicare is to healthcare as Fannie Mae and Freddie Mac are to the housing/financial meltdown. Anyone who tells you otherwise is trying to sell you something...

Unknown said...

From the chicken calculator site:
*This site makes no guarantees regarding the correct number of chickens for your procedure. Chicken count is an estimate only based on current market value of typical live chickens and average costs of medical procedures gathered from multiple sources. Your doctor may require more chickens than specified. For your convenience, we recommend bringing at least 20% more chickens than specified to any doctor's appointment. For that matter, you should have at least 1500 chickens per passenger in your car in the event of an accident, so you could just use those if you're a little short on chickens, but then be extra careful driving home from the doctor because you will have used up some of your accident chickens. Do not mail your medical chickens as payment. Please barter medical chickens in person. Chickens should be secured in your trunk or truckbed if possible. Any chickens riding in the passenger compartment on the way to the doctor must wear seat belts. Chickens should not drive you to the doctor, if you are unable to drive you should dial 911 for an ambulance. Ambulances may not accept chickens for payment, you should have at least 4 goats or an adult pig for such cases. Your healthcare provider may not accept chickens for payment, but many accept other livestock. The Chicken Calculator can not convert medical procedures to sheep, goats, pigs, ducks, cows, llamas, ostriches, etc. Check with your local livestock association for current exchange rates and providers.

Pure gold.

Gert said...

Awwwww, Anonymous 4:49...don't be hatin'!

GB, RN said...

But, but...what if they paid in Diet Coke????

Money is useful, but I will admit, if someone wanted to hire me as a private duty nurse for a set time, in exchange for siding on my house, a new roof, windows, or something of that nature, I think I would seriously consider it.

tia n, rn said...

No,no, she's got it wrong. You raise the hog, kill it and cure the meat and pay the doctor in hams. They are much easier to transport. My mother grew up knowing that the first hams each year went directly to the doctor. Only after my grandfather decided he had "banked" enough advanced payment for the next year's potential medical needs did the family get to eat ham.

RehabNurse said...

Aw, Doc, it sounds just like Little House on the Prairie.

Maybe she doesn't get out much and use computers, eh?

Walter Cronkite said...

@John Woolman: I see you possess a keen and accurate understanding of Politcal Science, the Political Process, and Politicians. My hat's off to you, good Sir.

@Cthulhu Sashimi:

"Crito, we owe a cock to Asclepius. Please don't forget to pay the debt."

As we are talking about the Greeks, are you sure it's poultry Socrates is referring to?

Next, to all ya' homies and homettes hatin' on Harry Reid (especially those of you who live and vote in Nevada), hekatesgal makes an excellent point. Anyone who has taken an introductory political science class knows that when it comes to the US Congress (and probably every other legislative body) SENIORITY=POWER.

Let me give it it's own line:


Freshmen congresswomen/men are lucky to be allowed by the party leadership to scrub the congressional toilets!

So, Nevadans, if you can put down your ideological blinders for a moment (yeah, yeah, I know - when pigs fly...) who do you want as an advocate for your interests in the US Senate? Someone who has 30 years SENIORITY in that august body and therefore has a tremendous amount of power and wields a tremendous amount of clout (Reid), or someone who has ZERO seniority and therefore ZERO
power and clout (anyone else)?
Think about it.


@NozDoc: your plaint is disingenuous at best.

As you yourself say, "I would be breaking my contract with the feds... Don't fool yourselves people, Medicare is to healthcare as Fannie Mae and Freddie Mac are to the housing/financial meltdown. Anyone who tells you otherwise is trying to sell you something..."

Your 3 telling words: 'contract', 'feds', & 'Medicare.'

If you want to barter for your services and be free of the Fed's restrictions, don't renew your Medicare contract!
In fact, I hear that's all the rage among doctors these days as the reimbursement rates have been/are likely to be cut.
If you were smart enough to get through med school and your specialized training, you should be able to understand the terms of the Medicare contract BEFORE you sign it.

No one is holding a gun to your head or in any other way forcing you to enter into a legally binding agreement with the Federal Government, so don't expect any sympathy or empathy from around these parts.

You want to have your cake and eat it too? Pissing and moaning about "what is" will get you nowhere. Gather a group of like-minded doctors who WANT the Medicare $'s AND want to be free of Medicare's restrictions (so they may barter, accept differential payments, cut patients breaks, provide free care, etc.) AND LOBBY THE SHIT OUT OF CONGRESS TO CHANGE THE LAW AND THE TERMS AND CONDITIONS OF THE MEDICARE CONTRACT!!!!!!!!!!!!!!!!

I believe that's known as the "American Way."

RSDS said...

ChemoQueenRPh said...
"I think the IRS would expect taxes be paid on the chickens. Do you think they would accept eggs sent in with your 1040?"

Eggs sent in with your 1040 would cause the IRS building to be evacuated. They might contain anthrax!

About ten years ago, when I was a Mail-extracter at the IRS, we were evacuated for several hours over some cookie crumbs in someone's return. They were terrified that the crumbs might be anthrax.

Word verification: eatterie = where to send the chickens.


Doris said...

What I want to know is...

How do you make change?


Outrider said...

>>How do you make change?

Eggs, of course!!!

NozDoc said...

Borrowing a brilliant individual's moniker does not add any credibility to your post and in fact you do an extreme disservice to his memory with your ignorant rant. I was going to ignore your inanity but I will respond to you.
First of all, I, like Grumpy, could drop Medicare out of Medicare but I work in an under-served rural area for the past 4 years and have taken Medicare and Medicaid patients BY CHOICE because I feel bad for them and wanted to provide first class ENT service to them so they would not have to drive 2 hours to a major academic institution and wait for hours especially when many of them are obviously poor or can't afford to drive.
Second, I do know how to read and when I signed the contract initially, at some risk, I never expected such an extreme abuse of power and breach of contract as I saw in one year. I don't mind a gradual decrease in reimbursement and expected it, but not a 20% decrease in one year plus a potential additional 20%. I am sure if I told you that you were going to get reimbursed 40% less next year for the same amount of work you would be outraged, perhaps you should go lobby your boss with your decreased income?
No one is holding a gun to my head but the "legally binding" contract is extremely lopsided in that one side makes the law and cannot held accountable to that contract when I feel they are in breach of it, which they are. I was not asking for your sympathy or empathy but actually pity your ignorance which leads me to my final point.
I AM doing something about it. I am CLOSING my practice, have to let three wonderful women go jobless and have had to go through hours of crying by my patients pleading for me to stay and it breaks my heart. My wife and I are taking academic positions in NYC because we can and are well respected in our field. So I am not pissing and moaning nor will I engage in a fruitless waste of time and resources with a "legislative body" that has no idea what they are doing. The only people who suffer in this situation are my employees and my present county. This is happening all over the country and will continue to happen. I was simply trying to educate you. Next time just shut up, do some research by what was provided you and post something constructive.

Anonymous said...

Imagine if chickens were the standard currency. The chicken feed sellers would be the richest people in the world.

TracyKM said...

THere is a lot of bartering going on in the US and Canada; happens all the time. You fix my car, I'll paint your kitchen. It's very popular in smaller communities here. And, it's by 'professionals' (like, a licensed mechanic, not a backyard grease monkey).
Being paid by chickens is not really bartering if you don't want chickens. Do none of your patients have a business or skill that you would be willing to exchange your services for? Although that would make it hard to pay your rent I suppose.
My parents built a house and barely had to use any cash/money.
And only one chicken was ever received, LOL.

Anonymous said...

OMG! I have 9 chickens but no health insurance. You mean my kids & I can see a doc when we need one now??

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