Medicare's new plan to reduce hospital overcrowding

melloworca6 said:Regarding Code A. As far as I know, a consultation is when a group of doctors gathers to discuss a case. At our hospital, this usually happens between 8 and 9 AM before they head down to the wards and clinics. So, if I'm wrong about what that code refers to, fine, my mistake.
My doctor referred me to a consultation, where a panel of doctors discusses my case, suggests therapy, tests, and medication, and then my GP decides how to proceed and what I'll be taking. If I understood this code correctly, the whole system is a total comedy. I honestly wonder how long it will take before we start reading in the news that people have started murdering their GPs—especially if they end up with incompetent doctors like the one I had.☕

For heaven's sake, I know Silapen and Erythromycin are different antibiotic classes. I wasn't comparing them against each other; I was comparing the side effects that both my friend and I experienced from those two drugs.
Since you brought up Sumamed, let me explain my point better. Why do you think there are people for whom Sumamed works perfectly, but the Belupo version doesn't? And vice versa. I'm not going to sit here and study the chemical composition of every pill to see if they are identical, but the physical makeup of a tablet isn't always the same (and when I say "makeup," I mean the inactive ingredients, not the active drug). I have family members who are sensitive to certain fillers used in tablets and have huge issues swallowing any kind of pill. Those people won't have a choice; they'll have to pay out of pocket if the cheapest option makes them sick. These people pay for health insurance, they pay for supplemental insurance—they should have the right to get a medicine that doesn't make them ill or cause massive side effects. People with lactose intolerance know they can get diarrhea from meds containing lactose. I know people who had terrible digestive issues with Euthyrox, but were fine with Letrox, even though they contain the exact same active ingredient. The tablet composition just isn't identical, but go ahead and try explaining that to them. If Euthyrox is the cheaper option, then sorry, folks—either buy the Letrox or take the Euthyrox and deal with the cramps and diarrhea.

Should we talk about the heavy hitters? Things like corticosteroids, antimalarials, or cytostatics—medications where it actually matters which brand you’re taking. Should I mention that people have tried different manufacturers of steroids and found that the side effects weren't the same across the board? Same ingredients, same dosage, yet different results. How do you explain that? 🤷 Maybe it's time to realize the human body isn't some math equation you can just solve. Every organism is its own unique story, and life isn't always black and white; it's mostly gray.

vividsailor7, if we're restricted to only getting treatment in our own backyard, that won't just apply to allergies or minor stuff—it applies to everything. If I want to see the top immunologist in the entire US because my local doctors are basically stumbling around in the dark with no clue what's actually happening to me (I might be exaggerating, but I'm not far off), why should that be blocked? 🤷 And it's not just me. It's anyone else being bounced from ward to ward without a single concrete answer. Look, we have hospitals, we have specialists, but just because half of them don't have a clue doesn't mean we should just shrug and say, "Oh well, we're lucky we don't live somewhere else." Honestly, it's more likely that we're all just unlucky to live in a country where we can't even tell if our healthcare system is supposed to be social or private. This messed-up hybrid we've got here isn't even funny anymore; it's pathetic.

Let's take this one step at a time.
You got the answer for code A.
Just go on Google, search for the generic version of the medication, and actually read what it says. I’ve put the links right here for you.
I’ve been reading through this latest deep dive on medication management, and frankly, it’s enough to make your blood boil. It’s one thing to deal with the daily grind of managing chronic health issues, but it's an entirely different beast when you realize how much of a minefield the pharmaceutical landscape actually is. Let's be real: navigating the world of prescriptions isn't just about following a doctor's orders anymore. It's a constant battle against side effects, complicated dosing schedules, and the sheer exhaustion of trying to keep everything balanced. You aren't just treating a condition; you're essentially becoming a part-time pharmacist just to stay level. The article touches on some heavy topics regarding how we interact with our meds, and I can't help but feel a sense of frustration. We’re told to trust the system, yet the moment you experience a setback or a nasty reaction, you're left feeling like you're shouting into a void. Whether it's adjusting insulin levels or dealing with the fallout from steroids, there's a massive gap between "clinical guidelines" and the actual, lived reality of someone sitting at their kitchen table trying to figure out why they feel like garbage. It's a mess. A complete, unmitigated mess. We need more transparency and way less hand-waving from the institutions that are supposed to be looking out for us. If you're feeling overwhelmed by the complexity of it all, you aren't alone—you're just paying the price for a broken approach to long-term care.
I’ve been digging through some old archives lately, and I stumbled upon this deep dive regarding how certain medications actually function within our healthcare system. It really gets you thinking about the sheer complexity—and sometimes the frustration—of managing chronic conditions. Let’s be honest: navigating the world of pharmaceuticals feels like walking through a minefield sometimes. You have one day you're feeling fine, and the next, you're staring at a prescription bottle wondering if you're even taking the right thing. Whether it's managing blood sugar levels or dealing with inflammation, the science behind these drugs is intense. Take something like Lantus, for example. Or when you're balancing insulin regimens like Novomix plus Glargine. It isn't just "taking a pill"; it's a constant, calculated dance with your own biology. And don't even get me started on the bureaucracy. Trying to coordinate everything through Medicare can feel like a full-time job in itself. One minute you're checking your coverage, and the next, you're buried in paperwork trying to figure out why a specific brand wasn't approved. It’s easy to get cynical. We see headlines about drug pricing or shifts in medical guidelines, and it feels like the goalposts are constantly moving. But that’s the reality of modern medicine in America. It’s a massive, complicated machine. You have to stay informed, stay skeptical, and—most importantly—stay on top of your own data. You can't just leave your health in the hands of a faceless institution and hope for the best. You have to be your own best advocate.
And there's a whole lot more where that came from.
Look, everything said here carries weight because that’s exactly how the medical establishment operates. They have their way of doing things, and they stick to it. Personally? I don't buy into those kinds of stories for a second.
And just so we’re clear, you can only pay for supplemental coverage yourself. Otherwise, your employer is the one legally required to make those payments on your behalf—unless you're self-employed, obviously. Take a good, hard look at your own pay stub. Ever since the new administration took over, they lowered the healthcare tax rate, yet I haven't seen a single person's take-home pay actually increase because of it. It's ridiculous.
It’s absolutely infuriating how disorganized things are here in America. You can’t even find the same corticosteroids—take Decoritn, Medrol, Cortef, or Dexamethasone, for instance; they are all completely different! It’s just another example of how nothing works the way it should. And don't even get me started on chemotherapy drugs. Almost 95 percent of patients receiving IV treatments have absolutely no clue what they are actually being injected with. Why? Because most of these medications are listed under these vague, unprotected names alongside the manufacturer, rather than being clearly identified. Most medical protocols for common diseases are written so vaguely that it’s impossible to track exactly what is being administered. It's a total mess.
Look, I prescribe corticosteroids on a daily basis, and I deal with oncology patients every single day. So, if you think I don't know what I'm talking about, you're dead wrong—I am intimately familiar with this stuff.
Look, you’ll eventually get that treatment in a major city like Chicago or New York if your specialist actually recommends it—assuming they can get the local medical boards to approve it on your timeline. But let’s be real here: unless you’ve got a massive pile of cash sitting around, don't expect them to just hand it over for free whenever you feel like it. You either follow the recommendation and deal with the bureaucracy, or you prepare to pay out of pocket. Your call.

Nicholas Myers said:I don't see much shifting for family doctors. It feels like the real impact will hit hospital specialists. Now, their diagnostic recommendations will actually be tracked. Up until now, the system just monitored how many referrals a GP issued.

Specialists will have to think twice before ordering unnecessary tests or follow-ups. Every recommendation they make is going on the record now.

As for chronic conditions—think diabetes, hypertension, asthma, or COPD—primary care has always handled them. The standard was to have at least 80% of those patients managed by a family doctor, with only a small fraction seeing specialists. They've been adjusting blood pressure meds or insulin doses for years, and they'll keep doing it.

That’s exactly what they fought for.

For rare or complex cases, they’ll still write the referrals and leave it to the specialists. I don't expect much change there. But there will be a shift for, say, high blood pressure patients who are used to visiting "their" specialist at the hospital every few months—people who know the specialist better than their own family doctor—just to get a "continue current therapy" note or a minor dosage tweak.

That isn't quite how it works.
1. I can't just "call in" a patient for a check-up; that decision rests entirely with the Primary Care Physician (PCP).
2. But if they send a patient over with an 'A' code, the PCP is the one issuing the red slip for the required tests. If they send them with a 'C' code (and those are limited), I am under no obligation to issue internal referrals. I haven't issued any of those so far, nor do I plan to, much like most of my colleagues at the Social Security Administration.
3. I also treat patients with other internal medicine issues—diabetes, hypertension, hyperlipidemia alongside GI diagnoses like gastritis—because I'm not strictly tied to just gastrointestinal issues (most people accept this), but rather the whole "internal medicine package." For patients with things like IBD, I usually request follow-ups every 2–3 months; 6 months is the absolute maximum gap I'll allow.
Even though I can't order follow-ups directly anymore, I can still refer them to my colleagues, whether they are specialists or not. And if there is a genuine need, or if I manage to pull some strings with the PCP, we can hospitalize them and then "call them in" three times a year.

Angela Wright said:Actually, no. Avastin is a targeted therapy, and while we often think of infusions, there are smart drugs available in capsule form that are currently on hospital formularies; for instance, they’re used alongside chemotherapy for advanced colorectal cancer. Take Temodal, for example—it's a first-line treatment for glioblastoma, administered in combination with radiation during the first cycle and then as a standalone treatment for the next five cycles. That is also on the hospital formulary. We are talking about targeted biological therapies here—extremely expensive medications—even though our legal framework in the US still hasn't clearly defined what actually constitutes an "expensive" drug. Because of that ambiguity, it's completely unclear what criteria will be used to decide if something is considered overpriced or a "budget-friendly" option. It looks like generic manufacturers are going to be hitting the jackpot in America.
And based on how this works, the decision-making process is going to be a mess. An oncologist will propose a specific therapy, Medicare might withhold its blessing, and then you're left asking who is actually footing the bill and how much influence hospital review boards will truly have in the process... or if they'll even matter at all. To receive oncology treatment, a patient doesn't necessarily need to be hospitalized; they can take medications like Temodal at home and just head into the clinic for radiation sessions.

The PCP has nothing to do with whether it's IV or oral; Medicare has already decided who covers that.
And the PCP can't even prescribe them if they wanted to, because there are strict limits on diagnosis codes and clinical guidelines.

vividsailor7 said:Let's take this one step at a time.
You got the answer for code A.
Just go on Google, search for the generic version of the medication, and actually read what it says. I’ve put the links right here for you.
I’ve been reading through this latest deep dive on medication management, and frankly, it’s enough to make your blood boil. It’s one thing to deal with the daily grind of managing chronic health issues, but it's an entirely different beast when you realize how much of a minefield the pharmaceutical landscape actually is. Let's be real: navigating the world of prescriptions isn't just about following a doctor's orders anymore. It's a constant battle against side effects, complicated dosing schedules, and the sheer exhaustion of trying to keep everything balanced. You aren't just treating a condition; you're essentially becoming a part-time pharmacist just to stay level. The article touches on some heavy topics regarding how we interact with our meds, and I can't help but feel a sense of frustration. We’re told to trust the system, yet the moment you experience a setback or a nasty reaction, you're left feeling like you're shouting into a void. Whether it's adjusting insulin levels or dealing with the fallout from steroids, there's a massive gap between "clinical guidelines" and the actual, lived reality of someone sitting at their kitchen table trying to figure out why they feel like garbage. It's a mess. A complete, unmitigated mess. We need more transparency and way less hand-waving from the institutions that are supposed to be looking out for us. If you're feeling overwhelmed by the complexity of it all, you aren't alone—you're just paying the price for a broken approach to long-term care.
I’ve been digging through some old archives lately, and I stumbled upon this deep dive regarding how certain medications actually function within our healthcare system. It really gets you thinking about the sheer complexity—and sometimes the frustration—of managing chronic conditions. Let’s be honest: navigating the world of pharmaceuticals feels like walking through a minefield sometimes. You have one day you're feeling fine, and the next, you're staring at a prescription bottle wondering if you're even taking the right thing. Whether it's managing blood sugar levels or dealing with inflammation, the science behind these drugs is intense. Take something like Lantus, for example. Or when you're balancing insulin regimens like Novomix plus Glargine. It isn't just "taking a pill"; it's a constant, calculated dance with your own biology. And don't even get me started on the bureaucracy. Trying to coordinate everything through Medicare can feel like a full-time job in itself. One minute you're checking your coverage, and the next, you're buried in paperwork trying to figure out why a specific brand wasn't approved. It’s easy to get cynical. We see headlines about drug pricing or shifts in medical guidelines, and it feels like the goalposts are constantly moving. But that’s the reality of modern medicine in America. It’s a massive, complicated machine. You have to stay informed, stay skeptical, and—most importantly—stay on top of your own data. You can't just leave your health in the hands of a faceless institution and hope for the best. You have to be your own best advocate.
And there's a whole lot more where that came from.
Look, everything said here carries weight because that’s exactly how the medical establishment operates. They have their way of doing things, and they stick to it. Personally? I don't buy into those kinds of stories for a second.
And just so we’re clear, you can only pay for supplemental coverage yourself. Otherwise, your employer is the one legally required to make those payments on your behalf—unless you're self-employed, obviously. Take a good, hard look at your own pay stub. Ever since the new administration took over, they lowered the healthcare tax rate, yet I haven't seen a single person's take-home pay actually increase because of it. It's ridiculous.
It’s absolutely infuriating how disorganized things are here in America. You can’t even find the same corticosteroids—take Decoritn, Medrol, Cortef, or Dexamethasone, for instance; they are all completely different! It’s just another example of how nothing works the way it should. And don't even get me started on chemotherapy drugs. Almost 95 percent of patients receiving IV treatments have absolutely no clue what they are actually being injected with. Why? Because most of these medications are listed under these vague, unprotected names alongside the manufacturer, rather than being clearly identified. Most medical protocols for common diseases are written so vaguely that it’s impossible to track exactly what is being administered. It's a total mess.
Look, I prescribe corticosteroids on a daily basis, and I deal with oncology patients every single day. So, if you think I don't know what I'm talking about, you're dead wrong—I am intimately familiar with this stuff.
Look, you’ll eventually get that treatment in a major city like Chicago or New York if your specialist actually recommends it—assuming they can get the local medical boards to approve it on your timeline. But let’s be real here: unless you’ve got a massive pile of cash sitting around, don't expect them to just hand it over for free whenever you feel like it. You either follow the recommendation and deal with the bureaucracy, or you prepare to pay out of pocket. Your call.

That isn't quite how it works.
1. I can't just "call in" a patient for a check-up; that decision rests entirely with the Primary Care Physician (PCP).
2. But if they send a patient over with an 'A' code, the PCP is the one issuing the red slip for the required tests. If they send them with a 'C' code (and those are limited), I am under no obligation to issue internal referrals. I haven't issued any of those so far, nor do I plan to, much like most of my colleagues at the Social Security Administration.
3. I also treat patients with other internal medicine issues—diabetes, hypertension, hyperlipidemia alongside GI diagnoses like gastritis—because I'm not strictly tied to just gastrointestinal issues (most people accept this), but rather the whole "internal medicine package." For patients with things like IBD, I usually request follow-ups every 2–3 months; 6 months is the absolute maximum gap I'll allow.
Even though I can't order follow-ups directly anymore, I can still refer them to my colleagues, whether they are specialists or not. And if there is a genuine need, or if I manage to pull some strings with the PCP, we can hospitalize them and then "call them in" three times a year.

The PCP has nothing to do with whether it's IV or oral; Medicare has already decided who covers that.
And the PCP can't even prescribe them if they wanted to, because there are strict limits on diagnosis codes and clinical guidelines.

We can note a three-month follow-up on an outpatient chart for a patient with an I10 diagnosis. There aren't any current restrictions on that.

The AMA can refer that patient for a check-up in three months, and the physician's ID number can be entered under the "specialist code" section on the referral.

Supposedly, Medicare is going to start monitoring how often specific codes appear on those referrals—basically tracking who is ordering what kind of diagnostic testing.

edit: my mistake, not follow-ups, but diagnostic tests. 🙂

vividsailor7 said:Let's take this one step at a time.
You got the answer for code A.
Just go on Google, search for the generic version of the medication, and actually read what it says. I’ve put the links right here for you.
I’ve been reading through this latest deep dive on medication management, and frankly, it’s enough to make your blood boil. It’s one thing to deal with the daily grind of managing chronic health issues, but it's an entirely different beast when you realize how much of a minefield the pharmaceutical landscape actually is. Let's be real: navigating the world of prescriptions isn't just about following a doctor's orders anymore. It's a constant battle against side effects, complicated dosing schedules, and the sheer exhaustion of trying to keep everything balanced. You aren't just treating a condition; you're essentially becoming a part-time pharmacist just to stay level. The article touches on some heavy topics regarding how we interact with our meds, and I can't help but feel a sense of frustration. We’re told to trust the system, yet the moment you experience a setback or a nasty reaction, you're left feeling like you're shouting into a void. Whether it's adjusting insulin levels or dealing with the fallout from steroids, there's a massive gap between "clinical guidelines" and the actual, lived reality of someone sitting at their kitchen table trying to figure out why they feel like garbage. It's a mess. A complete, unmitigated mess. We need more transparency and way less hand-waving from the institutions that are supposed to be looking out for us. If you're feeling overwhelmed by the complexity of it all, you aren't alone—you're just paying the price for a broken approach to long-term care.
I’ve been digging through some old archives lately, and I stumbled upon this deep dive regarding how certain medications actually function within our healthcare system. It really gets you thinking about the sheer complexity—and sometimes the frustration—of managing chronic conditions. Let’s be honest: navigating the world of pharmaceuticals feels like walking through a minefield sometimes. You have one day you're feeling fine, and the next, you're staring at a prescription bottle wondering if you're even taking the right thing. Whether it's managing blood sugar levels or dealing with inflammation, the science behind these drugs is intense. Take something like Lantus, for example. Or when you're balancing insulin regimens like Novomix plus Glargine. It isn't just "taking a pill"; it's a constant, calculated dance with your own biology. And don't even get me started on the bureaucracy. Trying to coordinate everything through Medicare can feel like a full-time job in itself. One minute you're checking your coverage, and the next, you're buried in paperwork trying to figure out why a specific brand wasn't approved. It’s easy to get cynical. We see headlines about drug pricing or shifts in medical guidelines, and it feels like the goalposts are constantly moving. But that’s the reality of modern medicine in America. It’s a massive, complicated machine. You have to stay informed, stay skeptical, and—most importantly—stay on top of your own data. You can't just leave your health in the hands of a faceless institution and hope for the best. You have to be your own best advocate.
And there's a whole lot more where that came from.
Look, everything said here carries weight because that’s exactly how the medical establishment operates. They have their way of doing things, and they stick to it. Personally? I don't buy into those kinds of stories for a second.
And just so we’re clear, you can only pay for supplemental coverage yourself. Otherwise, your employer is the one legally required to make those payments on your behalf—unless you're self-employed, obviously. Take a good, hard look at your own pay stub. Ever since the new administration took over, they lowered the healthcare tax rate, yet I haven't seen a single person's take-home pay actually increase because of it. It's ridiculous.
It’s absolutely infuriating how disorganized things are here in America. You can’t even find the same corticosteroids—take Decoritn, Medrol, Cortef, or Dexamethasone, for instance; they are all completely different! It’s just another example of how nothing works the way it should. And don't even get me started on chemotherapy drugs. Almost 95 percent of patients receiving IV treatments have absolutely no clue what they are actually being injected with. Why? Because most of these medications are listed under these vague, unprotected names alongside the manufacturer, rather than being clearly identified. Most medical protocols for common diseases are written so vaguely that it’s impossible to track exactly what is being administered. It's a total mess.
Look, I prescribe corticosteroids on a daily basis, and I deal with oncology patients every single day. So, if you think I don't know what I'm talking about, you're dead wrong—I am intimately familiar with this stuff.
Look, you’ll eventually get that treatment in a major city like Chicago or New York if your specialist actually recommends it—assuming they can get the local medical boards to approve it on your timeline. But let’s be real here: unless you’ve got a massive pile of cash sitting around, don't expect them to just hand it over for free whenever you feel like it. You either follow the recommendation and deal with the bureaucracy, or you prepare to pay out of pocket. Your call.

That isn't quite how it works.
1. I can't just "call in" a patient for a check-up; that decision rests entirely with the Primary Care Physician (PCP).
2. But if they send a patient over with an 'A' code, the PCP is the one issuing the red slip for the required tests. If they send them with a 'C' code (and those are limited), I am under no obligation to issue internal referrals. I haven't issued any of those so far, nor do I plan to, much like most of my colleagues at the Social Security Administration.
3. I also treat patients with other internal medicine issues—diabetes, hypertension, hyperlipidemia alongside GI diagnoses like gastritis—because I'm not strictly tied to just gastrointestinal issues (most people accept this), but rather the whole "internal medicine package." For patients with things like IBD, I usually request follow-ups every 2–3 months; 6 months is the absolute maximum gap I'll allow.
Even though I can't order follow-ups directly anymore, I can still refer them to my colleagues, whether they are specialists or not. And if there is a genuine need, or if I manage to pull some strings with the PCP, we can hospitalize them and then "call them in" three times a year.

The PCP has nothing to do with whether it's IV or oral; Medicare has already decided who covers that.
And the PCP can't even prescribe them if they wanted to, because there are strict limits on diagnosis codes and clinical guidelines.

Honestly, reading this from a doctor is just depressing. You guys know perfectly well that in medicine, two plus two doesn't always equal four. There's so much we still don't know, and half the time, treating rare conditions is basically just trial and error.

And since when did "official medicine" become some unchangeable holy scripture? Why cling so blindly to every single word in a textbook? 🤷

Nicholas Myers said:I can't weigh in much more since I'm working in a hospital now myself. 😍

That experience in primary care really helped me grasp how the entire system actually functions.

And yeah, they don't call them inspectors. They just show up at the clinics and comb through the charts. When half your paycheck gets docked because of it, it matters.

If they spot even a few instances of rule violations, the penalties can escalate significantly.

I hate to say it, but you're mistaken. Even we hospital doctors are part of the Medicare system; it's our superior, not just the family practitioners.

It's like saying, "I listen to my department head, but I couldn't care less about the hospital director!"

Every specialist knows the prescribing criteria. No one is asking them to withhold medication, but they are obligated—especially if a primary care doctor sends it back—to explain to the patient that they'll have to pay for it. They shouldn't pretend they've never heard of Medicare guidelines, or worse, lie and claim the patient doesn't have to pay.

That's just plain wrong.

The medication isn't being denied; the patient still gets a prescription, it's just a private pay script.

As for the lack of funding? To be blunt, that falls outside the scope of a family doctor's job.

Look, I get it. I realized exactly what you were getting at when you said that was on them, which is why I pegged it as 95% the Social Security Administration's fault. Based on how you're posting, I’ve got a feeling you might be an ophthalmologist or something, but honestly? It doesn't even matter. 🙂

Look, let’s get one thing straight: if a medication is prescribed according to professional medical guidelines, the patient has every right to receive it at no cost. Period. End of story. I don't care what anyone says about it. I was actually just venting about this exact issue the other day with a colleague of mine—a diabetes specialist over at the Mayo Clinic. She had to go through the absolute headache of calling the American Medical Association just to fight for her patient. And why? Because she prescribed Lantus twice in one year to a patient who was already on Novomix + Glargine and sitting at an HbA1c of 8. It’s basic medicine! But apparently, even when you follow the book, you still have to jump through these ridiculous bureaucratic hoops. It's infuriating.
She really had the nerve to tell her that she should just cover the monthly payments herself. What an absolute joke! $167 I told the patient they’d get the Lantus and everything would be fine. Simple. No waiting around for some vague answer. But then that representative from the insurance company—absolute joke—just slammed the phone down on me. Truly shameful behavior. I had a similar run-in when I called about prescribing Budosan, Pentasa, and Cipro after my first round of consultations. Why did I even bother calling her? She just started rambling on about those "famous" clinical guidelines like she was reading from a textbook. Then, to top it all off, she actually had the nerve to tell me that if I start issuing monthly prescriptions, she won't be interested in dealing with me anymore! Unbelievable. $333 She was incredibly rude to the patient, plain and simple. Honestly, my advice to him was to stand his ground—he has every right to those medications. He should file a lawsuit against her if he wants; let her deal with the consequences of denying him the care he’s entitled to.
And then you wonder why patients have more faith in the Social Security Administration!
Here’s another perfect example of how broken this whole system is. I have a colleague—a diabetologist over at St. Spirit Church—who treated two different patients. For one, she prescribed Januvia; for the other, she went with Inegy. Both were covered under the exact same LOM guidelines. So, what happens? A local administrator reported her to Medicare, claiming there was an issue. And get this: the agency actually sided with her! They ruled that the specialist was absolutely in the right to make those calls. That’s just how things work around here. Unbelievable.

Nicholas Myers said:We can note a three-month follow-up on an outpatient chart for a patient with an I10 diagnosis. There aren't any current restrictions on that.

The AMA can refer that patient for a check-up in three months, and the physician's ID number can be entered under the "specialist code" section on the referral.

Supposedly, Medicare is going to start monitoring how often specific codes appear on those referrals—basically tracking who is ordering what kind of diagnostic testing.

edit: my mistake, not follow-ups, but diagnostic tests. 🙂

Excerpt from the USA Today article: "However, based on this referral, the specialist will not be able to refer the patient for further hospital treatment, order follow-up exams, or issue an opinion regarding the patient's ability to work."
As for the coding issue? Nothing has changed in months, and nothing is going to change. It’s all still going to be logged under PZZ usage just like it always has been.

melloworca6 said:Honestly, reading this from a doctor is just depressing. You guys know perfectly well that in medicine, two plus two doesn't always equal four. There's so much we still don't know, and half the time, treating rare conditions is basically just trial and error.

And since when did "official medicine" become some unchangeable holy scripture? Why cling so blindly to every single word in a textbook? 🤷

What does any of that have to do with generics?

vividsailor7 said:Excerpt from the USA Today article: "However, based on this referral, the specialist will not be able to refer the patient for further hospital treatment, order follow-up exams, or issue an opinion regarding the patient's ability to work."
As for the coding issue? Nothing has changed in months, and nothing is going to change. It’s all still going to be logged under PZZ usage just like it always has been.

I realized I misspoke; I was actually referring to tests and evaluations conducted by other specialists.

We’ll still be able to write them—meaning we can recommend specific tests or suggest seeing another specialist. Then the primary care office can issue the referrals and note who made the recommendation. Interestingly, those "Code A" referrals supposedly won't be counted against family practitioners.

My sense is they’ll only track the "C1" referrals, specifically when requesting full specialist evaluations and comprehensive patient management.

That doesn't sit right with me. If Code A isn't being tracked, then doctors will just go back to referring hypertension patients simply to adjust their blood pressure medication doses. 🙂

vividsailor7 or Nicholas Myers, I have a few quick questions

If my pulmonologist schedules annual checkups involving spirometry, plethysmography, and a FeNO test—or even just spirometry—is my primary care physician allowed to refuse to write the referral for those yearly exams?

How is my doctor supposed to accurately monitor my asthma if they don't have access to spirometry, which is the fundamental tool for assessing lung function? Honestly, after he prescribed four different antibiotics in a row for what turned out to be an asthma flare rather than a bacterial infection, can we really trust his stethoscope alone?

Does he actually have the authority to alter the treatment plan my specialist laid out? For instance, could he deny my prescription for Alvesco and instead opt for a cheaper corticosteroid from a different class, especially since I understand there isn't a generic version for Alvesco yet?
Thank you for your help

Here is what happens when someone who actually should be explaining things clearly to patients either doesn't know how—or simply refuses to. I am, of course, talking about Medicare and Prof. Ostojić. Essentially, primary care doctors are going to be forced to prescribe the cheapest option available. But here is the catch: every time a new drug hits the formulary, the prices for everything else tend to drop—which affects most people. We end up with lists containing ten completely identical medications from different manufacturers, or rather, different patent holders. To be specific, there are drugs where both the original manufacturer and another license holder stay on the list. So, it is the exact same medication at the exact same price—just a different name and a different box. For instance, Lipitor has 14 versions on the list, and most of them share that same lowest possible price. When it comes to certain medications, patients don't have even the slightest clue which one is the actual originator. I would love for someone to chime in if they know what the original Diazepam is (like Valium). If you Google it, see if the original brand is even still on the list.
So, for patients, nothing really changes regarding the medications on the basic formulary. As for specialists—the ones pharmaceutical companies fly out to symposia and medical conferences—what will happen is they'll have to coordinate much more closely with the firms that offer the cheaper drugs. However, since there are at least three (if not more) versions of these drugs on the Medicare list, and the choice is left to general practice, it is pretty obvious that general practitioners will be the ones traveling more often.

rustymason82 said:vividsailor7 or Nicholas Myers, I have a few quick questions

If my pulmonologist schedules annual checkups involving spirometry, plethysmography, and a FeNO test—or even just spirometry—is my primary care physician allowed to refuse to write the referral for those yearly exams?

How is my doctor supposed to accurately monitor my asthma if they don't have access to spirometry, which is the fundamental tool for assessing lung function? Honestly, after he prescribed four different antibiotics in a row for what turned out to be an asthma flare rather than a bacterial infection, can we really trust his stethoscope alone?

Does he actually have the authority to alter the treatment plan my specialist laid out? For instance, could he deny my prescription for Alvesco and instead opt for a cheaper corticosteroid from a different class, especially since I understand there isn't a generic version for Alvesco yet?
Thank you for your help

Under the new Medicare model, based on how they’ve presented it to us, specialists are no longer permitted to list the date for your next follow-up directly on the outpatient chart.

The scheduling and timing of these inspections should be left entirely to the ABA.

No, specialists still have the authority to recommend both diagnostic testing and therapeutic adjustments.

Theoretically, the AMA has the authority to deny someone a referral for a follow-up exam. However, they need to be mindful that doing so shifts the liability onto them if the patient’s condition worsens because the AMA failed to provide proper care.

How exactly is my doctor supposed to gauge my asthma status if there isn't a spirometer available? A spirometry test is the baseline for monitoring this condition. Based on his track record with listening to my lungs via stethoscope, I’m skeptical—he spent enough time prescribing four different antibiotics in a row when what I actually had was asthma, not some random bacterial infection.

That’s an excellent question.

You can't get a real picture of what's actually going on without a spirometer. It’s just guesswork otherwise.

I find it hard to believe that Medicare would turn down a referral for a follow-up exam in a situation like this.

Not quite. He can issue a referral for something like a spirometry test, for instance. If those results look good compared to the last round and the patient’s clinical picture remains stable, he can choose to withhold the referral for a specialist follow-up—effectively taking full responsibility for that call.

Does he actually have the authority to override my pulmonologist's treatment plan? For instance, can he refuse to prescribe the Alvesco that my specialist recommended just to swap it out for a cheaper corticosteroid? I know they belong to different classes, and from what I understand, there isn't a generic version for Alvesco yet.

Based on how Medicare structures its sentences, it’s theoretically possible for the medical board to reject a therapy recommended by a specialist.

The setup goes like this:

The final call on proposed therapies, referrals for further testing, and determining an individual's fitness for work all fall under the authority of the primary care physician.

If... When a primary care physician decides to prescribe a treatment based on a specialist's recommendation, there's a better way to handle it: suggest switching to the most cost-effective generic version with the exact same active ingredients.

My takeaway? Theoretically, it’s possible—but you’re still the one holding the bag.

That’s how I saw it.

I wonder if my colleague will arrive at a similar interpretation.

melloworca6 said:Honestly, reading this from a doctor is just depressing. You guys know perfectly well that in medicine, two plus two doesn't always equal four. There's so much we still don't know, and half the time, treating rare conditions is basically just trial and error.

And since when did "official medicine" become some unchangeable holy scripture? Why cling so blindly to every single word in a textbook? 🤷

It’s honestly heartbreaking when people who lack any actual expertise start posting about this without doing their homework first—whether they're doing it intentionally or not—and end up spreading misinformation. You see it all the time today with journalists, especially those at major networks like CNN or local news stations. As far as medications go, absolutely nothing significant changes for patients. I’m primarily talking about prescription drugs—not the stuff administered in hospitals. If prices drop, the pharmaceutical companies are the ones who will feel the hit, followed by the doctors whom those companies help fund for "educational" purposes (or, let's be honest, just to pay for their trips).

Morgan Morgan5 said:Here is what happens when someone who actually should be explaining things clearly to patients either doesn't know how—or simply refuses to. I am, of course, talking about Medicare and Prof. Ostojić. Essentially, primary care doctors are going to be forced to prescribe the cheapest option available. But here is the catch: every time a new drug hits the formulary, the prices for everything else tend to drop—which affects most people. We end up with lists containing ten completely identical medications from different manufacturers, or rather, different patent holders. To be specific, there are drugs where both the original manufacturer and another license holder stay on the list. So, it is the exact same medication at the exact same price—just a different name and a different box. For instance, Lipitor has 14 versions on the list, and most of them share that same lowest possible price. When it comes to certain medications, patients don't have even the slightest clue which one is the actual originator. I would love for someone to chime in if they know what the original Diazepam is (like Valium). If you Google it, see if the original brand is even still on the list.
So, for patients, nothing really changes regarding the medications on the basic formulary. As for specialists—the ones pharmaceutical companies fly out to symposia and medical conferences—what will happen is they'll have to coordinate much more closely with the firms that offer the cheaper drugs. However, since there are at least three (if not more) versions of these drugs on the Medicare list, and the choice is left to general practice, it is pretty obvious that general practitioners will be the ones traveling more often.

My concern lies elsewhere: what happens when the formulary includes several different brands for the same drug, but the price points vary significantly?

Take an antibiotic like Zithromax, for instance. Some versions are considerably cheaper than others.

It looks like Zithromax might not be a winning bet here.

rustymason82 said:vividsailor7 or Nicholas Myers, I have a few quick questions

If my pulmonologist schedules annual checkups involving spirometry, plethysmography, and a FeNO test—or even just spirometry—is my primary care physician allowed to refuse to write the referral for those yearly exams?

How is my doctor supposed to accurately monitor my asthma if they don't have access to spirometry, which is the fundamental tool for assessing lung function? Honestly, after he prescribed four different antibiotics in a row for what turned out to be an asthma flare rather than a bacterial infection, can we really trust his stethoscope alone?

Does he actually have the authority to alter the treatment plan my specialist laid out? For instance, could he deny my prescription for Alvesco and instead opt for a cheaper corticosteroid from a different class, especially since I understand there isn't a generic version for Alvesco yet?
Thank you for your help

Nicholas Myers said:Under the new Medicare model, based on how they’ve presented it to us, specialists are no longer permitted to list the date for your next follow-up directly on the outpatient chart.

The scheduling and timing of these inspections should be left entirely to the ABA.

No, specialists still have the authority to recommend both diagnostic testing and therapeutic adjustments.

Theoretically, the AMA has the authority to deny someone a referral for a follow-up exam. However, they need to be mindful that doing so shifts the liability onto them if the patient’s condition worsens because the AMA failed to provide proper care.

How exactly is my doctor supposed to gauge my asthma status if there isn't a spirometer available? A spirometry test is the baseline for monitoring this condition. Based on his track record with listening to my lungs via stethoscope, I’m skeptical—he spent enough time prescribing four different antibiotics in a row when what I actually had was asthma, not some random bacterial infection.

That’s an excellent question.

You can't get a real picture of what's actually going on without a spirometer. It’s just guesswork otherwise.

I find it hard to believe that Medicare would turn down a referral for a follow-up exam in a situation like this.

Not quite. He can issue a referral for something like a spirometry test, for instance. If those results look good compared to the last round and the patient’s clinical picture remains stable, he can choose to withhold the referral for a specialist follow-up—effectively taking full responsibility for that call.

Does he actually have the authority to override my pulmonologist's treatment plan? For instance, can he refuse to prescribe the Alvesco that my specialist recommended just to swap it out for a cheaper corticosteroid? I know they belong to different classes, and from what I understand, there isn't a generic version for Alvesco yet.

Based on how Medicare structures its sentences, it’s theoretically possible for the medical board to reject a therapy recommended by a specialist.

The setup goes like this:

The final call on proposed therapies, referrals for further testing, and determining an individual's fitness for work all fall under the authority of the primary care physician.

If... When a primary care physician decides to prescribe a treatment based on a specialist's recommendation, there's a better way to handle it: suggest switching to the most cost-effective generic version with the exact same active ingredients.

My takeaway? Theoretically, it’s possible—but you’re still the one holding the bag.

That’s how I saw it.

I wonder if my colleague will arrive at a similar interpretation.

I agree with you, adding to that last point I mentioned in my examples above—basically, PCPs are already doing this, even though I'm mindful that there aren't specific indications or guidelines for Alvesco. This brings up the question: why is the PCP sending the patient to a specialist in the first place if they're just going to override everything?

Nicholas Myers, a question regarding your recent post—what's your take on generics, specifically regarding this new model for prescribing meds? I'm thinking about what Morgan Morgan5 said about people not even knowing which drug is the originator; it's essentially what I pointed out earlier.

Nicholas Myers said:My concern lies elsewhere: what happens when the formulary includes several different brands for the same drug, but the price points vary significantly?

Take an antibiotic like Zithromax, for instance. Some versions are considerably cheaper than others.

It looks like Zithromax might not be a winning bet here.

Honestly, I haven't a clue because whenever I need to prescribe triple therapy for eradication, I just write
Zithromax or something for HP.
But then again, it’s the same story with things like Lipitor, Nexium, Controloc, Concor, or Tritace. You can't just write the name and call it a day!

The patent holders always have the luxury of dropping their prices whenever they feel like it. Honestly, they’ve been skimming the cream off the top for years now. If patients were forced to pay for their medications out of pocket—much like how people shell out cash for herbal supplements or gourmet candy—they’d realize pretty quickly that it doesn't matter if the chocolate comes in Hershey's packaging or some other brand's wrapper. It's the exact same chocolate. 😂

So, any truly innovative, one-of-a-kind drug that makes it onto the coverage list is going to maintain its premium price point. Even as it stands today, you can still find cases where the original brand-name medication actually costs less than its generic counterpart. 🙄

Nicholas Myers said:Under the new Medicare model, based on how they’ve presented it to us, specialists are no longer permitted to list the date for your next follow-up directly on the outpatient chart.

The scheduling and timing of these inspections should be left entirely to the ABA.

No, specialists still have the authority to recommend both diagnostic testing and therapeutic adjustments.

Theoretically, the AMA has the authority to deny someone a referral for a follow-up exam. However, they need to be mindful that doing so shifts the liability onto them if the patient’s condition worsens because the AMA failed to provide proper care.

How exactly is my doctor supposed to gauge my asthma status if there isn't a spirometer available? A spirometry test is the baseline for monitoring this condition. Based on his track record with listening to my lungs via stethoscope, I’m skeptical—he spent enough time prescribing four different antibiotics in a row when what I actually had was asthma, not some random bacterial infection.

That’s an excellent question.

You can't get a real picture of what's actually going on without a spirometer. It’s just guesswork otherwise.

I find it hard to believe that Medicare would turn down a referral for a follow-up exam in a situation like this.

Not quite. He can issue a referral for something like a spirometry test, for instance. If those results look good compared to the last round and the patient’s clinical picture remains stable, he can choose to withhold the referral for a specialist follow-up—effectively taking full responsibility for that call.

Does he actually have the authority to override my pulmonologist's treatment plan? For instance, can he refuse to prescribe the Alvesco that my specialist recommended just to swap it out for a cheaper corticosteroid? I know they belong to different classes, and from what I understand, there isn't a generic version for Alvesco yet.

Based on how Medicare structures its sentences, it’s theoretically possible for the medical board to reject a therapy recommended by a specialist.

The setup goes like this:

The final call on proposed therapies, referrals for further testing, and determining an individual's fitness for work all fall under the authority of the primary care physician.

If... When a primary care physician decides to prescribe a treatment based on a specialist's recommendation, there's a better way to handle it: suggest switching to the most cost-effective generic version with the exact same active ingredients.

My takeaway? Theoretically, it’s possible—but you’re still the one holding the bag.

That’s how I saw it.

I wonder if my colleague will arrive at a similar interpretation.

Unless they start slapping on more restrictions—like strict mandates or tracking exactly how many times a doctor checks in on a patient—I highly doubt the primary care office is going to shoulder that much liability just to go against what a specialist recommends. 🤷

I don't see any reason why anyone would bother doing that unless Medicare is breathing down their neck and throwing penalties left and right—but hey, we'll see how that plays out.

Morgan Morgan5 Asks:
It honestly makes me sad when people who don't have a clue about the profession start posting their opinions without doing any actual research first. Whether they’re doing it on purpose or just being lazy, they end up spreading nothing but misinformation. You see it all the time with journalists today—the hacks at the local news stations and those big cable networks. As far as medications go? Nothing. Absolutely nothing important is actually changing. For the patients.I'm talking primarily about prescription drugs—not the stuff they just hand out to you in a hospital ward. If prices actually drop, the pharmaceutical companies are going to take the hit first. And that’ll ripple right down to the doctors, too, since those big pharma outfits are the ones footing the bill for their "educational" seminars (or, let's be honest, just paying for their trips).

Look, we patients all read the same sensationalist garbage in the papers. The way they write things makes everything sound so murky just because they need clicks. I’m not exactly an expert—I'm definitely a layman—but I know enough about how things work to realize I totally misread the text. What do you think it’s like for someone who hasn't a clue how any of this works, especially when their only source of info is some tabloid churning out the same nonsense?

We’ll just have to wait and see how much this new policy ends up crushing the patient. All this back-and-forth between specialists and the insurance providers—it’s the patient who ultimately pays the price. It’ll be interesting to watch once the insurance companies get the final word on everything. Truth is, plenty of things are already being swept under the rug. Terrible stuff that people mostly stay quiet about. You know how it goes: there are limits on certain tests and caps on specific medications. You end up waiting two or three months for a basic lab test because they ran out of reagents or blew through their monthly budget. Or you have oncology patients sitting around waiting weeks for their treatment because the monthly quota was hit and the funding for those drugs just ran dry. It happens.
You aren't going to convince me that we won't feel the fallout of this. Every single time they roll out some new reform or set of regulations, it’s the patients who end up paying the price.

Unbelievable. Apparently, this new regulation kicks in on September 1st, so let's just sit back and see what "wonderful" surprises they have in store for us. And look, I'm with you on one thing: I honestly don't care what a drug is called as long as it works and doesn't wreck my body. I couldn't care less if it's the brand name or a generic, unless that cheap version actually performs worse.

edit: And get this—over on the other thread, people are saying exactly what I've been hammering on about here. They're claiming Misar hits harder than Xanax or Helex. Yeah, I get it, it's the exact same medication under a different name, but clearly, for some reason, certain people respond better to one brand over another in the same class. How? Why? Is it a placebo effect, or are they lying to their doctors? 😁 I don't know, but it's not the first time I've heard someone swear that a version from a different manufacturer works significantly better.

vividsailor7 said:I have no idea what kind of "torture" by the medical board you're talking about. Up until now, everything revolved around issuing medications and referrals, which was clearly too much for some people. Let me repeat: there were cases where my colleagues or I had to call out "the gentlemen" in charge because they refused to issue medications that were clearly indicated. Every single one of those conversations ended with them nodding along while they spewed nonsense about guidelines that make zero sense professionally.
If a patient is indicated for Avastin, they will get it, just like they always have.

Exactly. They started shutting down labs in community health centers, diagnostic departments, and things like that. For instance, the lab at the downtown clinic just closed its doors. What is that even supposed to mean? Now everyone is being bounced around from one lab to another; they sent me all the way out to the Railroad district.
When I see an attending physician, everything they do boils down to antibiotics, referrals, or maybe some vague guidelines. Though, in my case, they actually put in some effort. There are plenty of doctors out there who won't even look at you; they just process whatever paperwork you bring them.

With all due respect, specialists sometimes go overboard with diagnostics and treatments. My latest headache is a CSR in my right eye that’s been dragging on forever. They literally ran me through the wringer: neurologists, head MRIs, optic nerve scans, vertebral artery imaging, visual field tests—you name it. They kept swearing it was a neurological issue. And all this happened without anyone performing a basic, and I mean basic, ophthalmological exam. They harassed me for two years, and then my primary doctor simply told me he wasn't going to dig any deeper because we weren't getting anywhere. I couldn't let it go, so I went to a private eye clinic. They did the basic diagnostics and I walked out ninety minutes later with a diagnosis and a treatment plan. It’s a perfect example of how aimless wandering hurts the patient, and how an attending needs to realize when a path is counterproductive and leading nowhere.

melloworca6 said:Unless they start slapping on more restrictions—like strict mandates or tracking exactly how many times a doctor checks in on a patient—I highly doubt the primary care office is going to shoulder that much liability just to go against what a specialist recommends. 🤷

I don't see any reason why anyone would bother doing that unless Medicare is breathing down their neck and throwing penalties left and right—but hey, we'll see how that plays out.

Morgan Morgan5 Asks:
It honestly makes me sad when people who don't have a clue about the profession start posting their opinions without doing any actual research first. Whether they’re doing it on purpose or just being lazy, they end up spreading nothing but misinformation. You see it all the time with journalists today—the hacks at the local news stations and those big cable networks. As far as medications go? Nothing. Absolutely nothing important is actually changing. For the patients.I'm talking primarily about prescription drugs—not the stuff they just hand out to you in a hospital ward. If prices actually drop, the pharmaceutical companies are going to take the hit first. And that’ll ripple right down to the doctors, too, since those big pharma outfits are the ones footing the bill for their "educational" seminars (or, let's be honest, just paying for their trips).

Look, we patients all read the same sensationalist garbage in the papers. The way they write things makes everything sound so murky just because they need clicks. I’m not exactly an expert—I'm definitely a layman—but I know enough about how things work to realize I totally misread the text. What do you think it’s like for someone who hasn't a clue how any of this works, especially when their only source of info is some tabloid churning out the same nonsense?

We’ll just have to wait and see how much this new policy ends up crushing the patient. All this back-and-forth between specialists and the insurance providers—it’s the patient who ultimately pays the price. It’ll be interesting to watch once the insurance companies get the final word on everything. Truth is, plenty of things are already being swept under the rug. Terrible stuff that people mostly stay quiet about. You know how it goes: there are limits on certain tests and caps on specific medications. You end up waiting two or three months for a basic lab test because they ran out of reagents or blew through their monthly budget. Or you have oncology patients sitting around waiting weeks for their treatment because the monthly quota was hit and the funding for those drugs just ran dry. It happens.
You aren't going to convince me that we won't feel the fallout of this. Every single time they roll out some new reform or set of regulations, it’s the patients who end up paying the price.

Unbelievable. Apparently, this new regulation kicks in on September 1st, so let's just sit back and see what "wonderful" surprises they have in store for us. And look, I'm with you on one thing: I honestly don't care what a drug is called as long as it works and doesn't wreck my body. I couldn't care less if it's the brand name or a generic, unless that cheap version actually performs worse.

edit: And get this—over on the other thread, people are saying exactly what I've been hammering on about here. They're claiming Misar hits harder than Xanax or Helex. Yeah, I get it, it's the exact same medication under a different name, but clearly, for some reason, certain people respond better to one brand over another in the same class. How? Why? Is it a placebo effect, or are they lying to their doctors? 😁 I don't know, but it's not the first time I've heard someone swear that a version from a different manufacturer works significantly better.

I've felt that tension myself—the back-and-forth between general practitioners and specialists, bouncing from one to the other and finally ending up at a Medicare commission.🙄
It’s certainly not going to get better. There's going to be massive scrutiny regarding medical leave. You truly realize drugs are identical when you're paying for one out of your own pocket, say $50 every month, and then you find out there's a generic equivalent (the same drug) that you could pay $20 for instead. Otherwise, you have to consider the nocebo effect. Patients can actually experience side effects from a "medication" that doesn't even contain an active ingredient.
In the US, some medications are dispensed by number (how antibiotics used to be handled) in plain paper bags. They list the generic name, not the brand name on the approval.
The media writes these sensationalist pieces, the journalists are unprofessional, and frankly, often even the people who should be providing accurate info don't know it themselves. In the end, neither the hospital specialists, nor general practitioners, nor even those in pharma—and I firmly believe most people at Medicare too—have any idea what is actually going to happen after September 1st. From experience, I know it won't be anything sensational.🤷

Could someone please clear this up for me? I've been managing my thyroid issues with an endocrinologist in another city for two years now. Moving forward, am I still able to keep seeing my current specialist, or am I going to be forced to handle all my checkups and tests at the local hospital?

Nicholas Myers said:It really depends on the specific diagnosis.

A primary care physician isn't going to call the shots when treating psychosis. That falls squarely within the domain of a psychiatrist.

Think of it this way: a family doctor handles mild to moderate depression. However, once you get into severe cases, treatment-resistant episodes, or depression involving psychotic symptoms, you're looking at a specialist's territory.

We don't expect a GP to act as a full-scale psychotherapist; patients will continue to see their own therapists for that level of care.

But given how mental health issues are surging—some even predict depression will soon be the most prevalent condition out there—it makes sense that not everyone needs a psychiatrist. It should be reserved for those facing moderate to severe struggles.

If you ask me, there’s no such thing as "psychotherapy in the full sense of the word"—nor is there any such thing as "semi-psychotherapy." You either perform it, or you don't.
Given that becoming a licensed psychotherapist requires years of specialized training and practice, and considering that a standard therapy session lasts 45 minutes while the waiting room at my local clinic is packed with 30 people (my doctor sees anywhere from 60 to 90 patients a day!), I just don't see how any kind of "partial psychotherapy" (like simple talk therapy) could possibly happen in that setting.

I’m sharing this from the perspective of someone who has been in psychotherapy for several years now.

I have a follow-up question regarding this whole "residency" issue.
I live in Brooklyn, but I see specialists at various different hospitals depending on what I need—sometimes it's an appointment, sometimes it's just where I end up needing care.

For example: Neurology is at Mayo Clinic plus some private doctors; Neuro-ophthalmology is at Mayo Clinic; Pulmonology is over by Barun Filipović; Ophthalmology (for contacts and glasses) is at Vinogradski; Gynecology involves my records being kept in Silicon Valley plus a private specialist; and my dentist is in Savica.

Does this residency rule mean I’m suddenly going to be kicked out of Mayo Clinic where I've been a patient for years, or from my dentist's office too?

Regarding the idea of primary care physicians taking on more work—it isn't a bad concept in theory. However, after decades of them writing prescriptions and referrals while juggling upwards of 90 patients a day, how can we honestly expect them to suddenly transform overnight into Renaissance doctors who know and manage every single niche detail?

My own doctor is actually really nice, but she honestly doesn't know nearly as much about MS as I do! Just a few months ago, she didn't even know where in NYC one could get Vitamin D tested or what specifically to write on a referral. I ended up looking it up online for her, including finding the location where I could go (at Vinogradski, without an appointment, where they email the results a few hours later, versus waiting three months for an appointment at Mayo Clinic and then waiting even longer for the results). She basically just waits for me to show up with a list of tests—tests that I track myself, because if I don't remember them, she won't either...