Medicare's new plan to reduce hospital overcrowding

Nicholas Myers said:I don't think the new model will change much regarding referrals in your situation; essentially, your primary care physician will likely still be sending you to a psychiatrist.

From what I understand, family practitioners aren't trained to perform psychotherapy—at most, they might handle some surface-level therapeutic interventions. There may be rare cases where a doctor has pursued extra training specifically in psychotherapy, which isn't strictly a field reserved for psychiatrists.

The only gray area is the detail about hospital access. I haven't seen any clear guidelines outlining the specific criteria for which facility a patient can be sent to. So, as for whether you'll be able to receive treatment in Washington, D.C. via a referral, I can't say for sure.

But, as I've mentioned before, under this new model, I doubt anyone is going to force a primary care doctor to stop referring patients to specialists.

There’s also the option of having psychiatrists available through the PZZ—just like we already have gynecologists and dentists. It’s a safe bet that we'll see more of them once some of those specific psychiatric wards in general hospitals are eventually restructured. Right now, there are roughly 500 psychiatrists in the US, and honestly, a huge number of them are just stuck in hospital bureaucracy without actually doing much of anything. Their specialization takes four years, after all—and let's face it, severe psychoses are typically handled via hospitalization anyway, or through outpatient care if they're in remission. For everything else, day hospitals are right there. BTW—just give private psychiatrists a shot at the capital, and you'll see how quickly things start moving.😉

neonnomad21 said:I was wondering if anyone could clarify how long those current referrals for Category C specialist appointments actually remain valid—specifically, will they still be honored once we hit September 1st?

The old referrals will probably stay valid for about another year, depending on the specific service and type.

All referrals are valid for 30 days, during which you need to contact the facility and actually book the appointment listed on the referral. If you end up being scheduled six months out, don't sweat it—the referral will still be valid.

The main thing is just making sure you place the order within 30 days of it being issued. 🙂

Morgan Morgan5 said:There’s also the option of having psychiatrists available through the PZZ—just like we already have gynecologists and dentists. It’s a safe bet that we'll see more of them once some of those specific psychiatric wards in general hospitals are eventually restructured. Right now, there are roughly 500 psychiatrists in the US, and honestly, a huge number of them are just stuck in hospital bureaucracy without actually doing much of anything. Their specialization takes four years, after all—and let's face it, severe psychoses are typically handled via hospitalization anyway, or through outpatient care if they're in remission. For everything else, day hospitals are right there. BTW—just give private psychiatrists a shot at the capital, and you'll see how quickly things start moving.😉

What exactly is the PZZ?

restlesspanther42 said:If anyone actually cares, this explains what the new guidelines mean and how you're supposed to handle them.

@vividsailor7
Sure, you can tell a patient they have a right to a specific drug, but you're required to include a clause on every single one of your findings stating that Medicare has the authority to issue a different drug of equal strength from the same class.

Here’s the directive as well.

That "clause" is just another ridiculous fabrication.
As for that memo, I don't recall reading it myself, but back then (early March), my colleagues and I were basically making fun of Varga and the American Medical Association, so that was probably what we were talking about.
And as for the actual document? It’s probably been shredded or used as a coaster by now.

Kyle Lee7 said:1. She admitted herself that she doesn't know certain things; when I ask her directly, she looks me in the eye and tells me she doesn't know. Even regarding Vitamin D and its impact on MS, I had to find all that information online myself. When I brought it up, she told me she'd never heard of it and wasn't even sure if Vitamin D testing was even performed anywhere in the US...
Since I'm living with MS, I'm personally invested, so naturally, I dig deep, read up, and educate myself from every possible angle—which means I'm at least one step ahead when it comes to new research and developments. Of course, I don't know everything better than she does; I'm certainly not an expert on brain anatomy, but it really bothers me that if she treats patients with MS, she should at least stay current on the latest news...

2. Given that asthma either stays quiet or results in an acute attack, the question becomes: when and why should you go to a pulmonologist? When it's dormant, I stick to the regular prescription I've had for over 12 or 13 years; when an attack hits, then it's an emergency.

When it's quiet, I don't need a specialist, and when it's active, I'm physically unable to make it to a specialist's office.

My pulmonologist doesn't work out of a hospital and doesn't have a small clinic once a week; she works at a community health center in the pulmonary department where there are about ten of them, seeing patients five days a week during all working hours. Essentially, her entire job is seeing patients. So why can't she see a sick patient?
Naturally, I'll go wherever they are willing to see me. I tried once to see the pulmonologist when things weren't quite critical yet, because I wanted to understand why my stable condition had suddenly started worsening. She would have been the best person to tell me, but the people in the ER are just there to put out fires, and Urgent Care acts the exact same way in those situations.
The situation was such that she could see in "real time" how my lungs were behaving and hear it firsthand, rather than me having to recount everything that happened a month after the fact.
I truly don't understand why a pulmonary specialist would have an issue with someone coming in during a flare-up, instead of letting someone who *isn't* a pulmonologist deal with it by calling 911—is that how it works?

Or, if you mean the specialized pulmonary emergency units, like the ones at major city hospitals—unfortunately, I've had the chance to assist someone who was practically dying there a couple of times. I swear, I will NEVER set foot in that hospital or deal with those employees again, no matter the cost. What we experienced there, multiple times, was enough to warrant a lawsuit. The only reason I didn't pursue legal action was that I just wanted to forget the whole ordeal; otherwise, I would have ended up in a massive multi-year court battle. I'm drifting a bit from the topic, but I seriously believe those people are responsible for the death of someone close to me. The behavior of certain staff members, the lack of equipment, and letting a person who is suffocating wait in a hallway while the ER doctor and technician enter five times to literally beg the attending physician to start the exam... all while she and the nurse respond rudely, acting like they're just waiting to go paint their nails. Even today, it still makes me sick.😠
The worst part about it is that in NYC, Jordanovac is the only pulmonary emergency center, so...🙂

1. She DOESN'T have to know about Vit. D. As far as I'm aware, it hasn't been included in any official neurological society guidelines yet, even if the research exists.
2. An acute asthma attack is treated with two puffs of Ventolin, and if that fails, you go with 80mg IV Medrol. For severe cases, it's Aminophylline 250 IV along with Oxygen. Why on earth do you need a pulmonologist for that?? There's zero point in changing therapy over a single attack.
Furthermore, you don't go to the municipal hospital for emergencies; you go to the local hospital based on where you live for internal medicine or HS. Every time I'm on call, I have at least 2 or 3 asthma or COPD patients.

Jessica Chavez4 said:What exactly is the PZZ?

Primary health care.

restlesspanther42 said:The old referrals will probably stay valid for about another year, depending on the specific service and type.

All referrals are valid for 30 days, during which you need to contact the facility and actually book the appointment listed on the referral. If you end up being scheduled six months out, don't sweat it—the referral will still be valid.

The main thing is just making sure you place the order within 30 days of it being issued. 🙂

I appreciate the help. 🙂

Morgan Morgan5 said:There’s also the option of having psychiatrists available through the PZZ—just like we already have gynecologists and dentists. It’s a safe bet that we'll see more of them once some of those specific psychiatric wards in general hospitals are eventually restructured. Right now, there are roughly 500 psychiatrists in the US, and honestly, a huge number of them are just stuck in hospital bureaucracy without actually doing much of anything. Their specialization takes four years, after all—and let's face it, severe psychoses are typically handled via hospitalization anyway, or through outpatient care if they're in remission. For everything else, day hospitals are right there. BTW—just give private psychiatrists a shot at the capital, and you'll see how quickly things start moving.😉

It's not available in every city, though. In Sisak, there's only one (I repeat, ONE) psychotherapist working, and she's a psychologist, not a psychiatrist—which basically means you're screwed. And yeah, she works with kids and teens, so anyone over 18 is stuck choosing between Popovača or driving all the way to Washington, D.C., especially since there isn't even a bus running to Popovača. Figure it out yourself, buddy.😍
And don't even get me started on the smaller towns, because Sisak isn't even that small.

Brandon Lopez6 said:It's not available in every city, though. In Sisak, there's only one (I repeat, ONE) psychotherapist working, and she's a psychologist, not a psychiatrist—which basically means you're screwed. And yeah, she works with kids and teens, so anyone over 18 is stuck choosing between Popovača or driving all the way to Washington, D.C., especially since there isn't even a bus running to Popovača. Figure it out yourself, buddy.😍
And don't even get me started on the smaller towns, because Sisak isn't even that small.

From what I understand, there are five psychiatrists at the Sisak Hospital and one more in Petrinja—with at least three of them specializing specifically in psychiatry. My point was that it would be much better to have psychiatric services located at the PZZ (just like general medicine, OB/GYN, and dentistry) because there's really no reason for these clinics to be tucked away inside hospital buildings.

Morgan Morgan5 said:From what I understand, there are five psychiatrists at the Sisak Hospital and one more in Petrinja—with at least three of them specializing specifically in psychiatry. My point was that it would be much better to have psychiatric services located at the PZZ (just like general medicine, OB/GYN, and dentistry) because there's really no reason for these clinics to be tucked away inside hospital buildings.

It's an insurance thing.
Hospitals have security—at least the Mayo Clinic does—whereas health centers pretty much don't.

Morgan Morgan5 said:From what I understand, there are five psychiatrists at the Sisak Hospital and one more in Petrinja—with at least three of them specializing specifically in psychiatry. My point was that it would be much better to have psychiatric services located at the PZZ (just like general medicine, OB/GYN, and dentistry) because there's really no reason for these clinics to be tucked away inside hospital buildings.

I was actually talking about the community health centers, since not every town has its own hospital. In Sisak, you're looking at an 8 to 9 month wait just to see someone at the Hospital.🙂

Here is the question I am trying to get an answer to.
I have schizophrenia and receive treatment at the Mayo Clinic.
I’ve completed four psychiatric evaluations following my hospital stays, as I have been working under a medication regimen prescribed by my psychiatrist at Mayo Clinic, which my primary care physician then implements.
I need to know if I will continue seeing specialists at Mayo Clinic starting September 1st, or if my primary care doctor will take over those follow-ups.

Is there going to be any shift regarding the other doctors in primary care? Basically, can my gynecologist still write me prescriptions or lab referrals, or is that all going to have to go through the AMA now?

vividsailor7 said:That "clause" is just another ridiculous fabrication.
As for that memo, I don't recall reading it myself, but back then (early March), my colleagues and I were basically making fun of Varga and the American Medical Association, so that was probably what we were talking about.
And as for the actual document? It’s probably been shredded or used as a coaster by now.

1. She DOESN'T have to know about Vit. D. As far as I'm aware, it hasn't been included in any official neurological society guidelines yet, even if the research exists.
2. An acute asthma attack is treated with two puffs of Ventolin, and if that fails, you go with 80mg IV Medrol. For severe cases, it's Aminophylline 250 IV along with Oxygen. Why on earth do you need a pulmonologist for that?? There's zero point in changing therapy over a single attack.
Furthermore, you don't go to the municipal hospital for emergencies; you go to the local hospital based on where you live for internal medicine or HS. Every time I'm on call, I have at least 2 or 3 asthma or COPD patients.

Primary health care.

1. Well, I guess they "don't" have to then...
In my case, a neurologist—Professor Brinar—actually prescribed the exact dose I had discovered myself online and started taking: 5000 IU. And yes, there is evidence suggesting that patients with MS seem to deal with Vitamin D3 metabolism issues.
So, clearly, neurologists do know what's up.

2. I know exactly how an acute asthma attack is treated because I've been dealing with this since I was six years old, and now I'm nearly forty. But as I mentioned before, this wasn't an acute attack; it was a flare-up of the underlying condition. It wasn't quite "emergency room" level, but it was certainly "pulmonologist" level. I wanted to know their take—was this a new allergy, maybe my medication isn't working anymore, could it be an infection, or something else entirely?
The problem was, I couldn't actually see a pulmonologist because the wait time is a month. By the time that month passed, I didn't need them anymore.

I should clarify: my asthma is very well controlled. The only Ventolin I have at home expired back in 2007, so that's useless. I don't even take Flixotide or Serevent anymore; I just take one Singulair a day. When I first started, I was on 2x Flixotide and Serevent in the morning and again at night. Eventually, we managed to taper down to just that single Singulair. And that entire process happened under the close supervision of a pulmonologist, not some general practitioner or an ER doctor. That's precisely why—because we reached such a great state through careful monitoring and tapering—it worries me when I notice things starting to slip. Naturally, I want to see the specialist who manages my care, someone who would find it useful to see and hear about the situation right when the decline begins—to understand *why* it's happening and whether I'll need to move back to a stronger regimen.

So, my question remains: who needs a pulmonologist, and when?
Because based on your comments, it sounds like I'll never need one again. 🤷

Amanda Chavez27 said:Here is the question I am trying to get an answer to.
I have schizophrenia and receive treatment at the Mayo Clinic.
I’ve completed four psychiatric evaluations following my hospital stays, as I have been working under a medication regimen prescribed by my psychiatrist at Mayo Clinic, which my primary care physician then implements.
I need to know if I will continue seeing specialists at Mayo Clinic starting September 1st, or if my primary care doctor will take over those follow-ups.

From what I gather:
1) If you have a specific specialist at Mayo Clinic = you keep seeing them.
2) If you don't = they shuffle you off to whatever local hospital is in your area.

Elizabeth Fowler46 said:Is there going to be any shift regarding the other doctors in primary care? Basically, can my gynecologist still write me prescriptions or lab referrals, or is that all going to have to go through the AMA now?

Man, I really hope not.

Elizabeth Fowler46 said:Is there going to be any shift regarding the other doctors in primary care? Basically, can my gynecologist still write me prescriptions or lab referrals, or is that all going to have to go through the AMA now?

It seems like OB-GYNs working in primary care are still stuck in the old way of doing things—just like the dentists. Honestly, they aren’t crazy enough to go around trying to change the system now.☕

Amanda Vaughn3 said:It's an insurance thing.
Hospitals have security—at least the Mayo Clinic does—whereas health centers pretty much don't.

Look, you can find psychiatrists in plenty of community health clinics across America. What do you mean, "insurance"?😲

I’m only asking because there’s some vague talk about whether it's actually true—this idea that you’ll only get four specialist consultations after being discharged from the hospital, and after that, everything falls back on your primary care physician.
My GP has always sent me to the Mayo Clinic for psychiatric evaluations, and they simply follow whatever treatment plan the specialists dictate, specifically applying the medication dosages prescribed by those experts.
I should point out that, as far as I know, my doctor only orders certain medications specifically for my case; I’m essentially the only patient in that entire clinic receiving this particular therapy.

Amanda Chavez27 said:I’m only asking because there’s some vague talk about whether it's actually true—this idea that you’ll only get four specialist consultations after being discharged from the hospital, and after that, everything falls back on your primary care physician.
My GP has always sent me to the Mayo Clinic for psychiatric evaluations, and they simply follow whatever treatment plan the specialists dictate, specifically applying the medication dosages prescribed by those experts.
I should point out that, as far as I know, my doctor only orders certain medications specifically for my case; I’m essentially the only patient in that entire clinic receiving this particular therapy.

Honestly, I believe they’ll still be referring you to specialists if there's even a slight suspicion that your medication dosage needs adjusting. I’m assuming you’re on a long-acting depot preparation (getting those injections)? It’s going to be incredibly difficult for a general practitioner to step into psychiatric cases (F.20-29), and the same logic applies to some of the more severe medical conditions. So, really... there's nothing to fear. Besides, things aren't actually going to change *that* much.

Pediatrics over at the Mayo Clinic has been pure chaos this week.
One doctor mentioned she’s been seeing a $233 25% pay cut since the start of the year because they cut back on call shifts.
They still haven't reached an agreement on whether they'll accept a cap of 48 hours per week or not.
If they don't budge, the Mayo Clinic director will likely just force them into a shift-work rotation.
🤷
The staff at the Mayo Clinic is pretty divided—some departments (like OB/GYN) couldn't care less about their government salary being slashed, mostly because they’re basically working private practice every other afternoon and Saturday anyway.

For context, a specialist's base salary without any call duties is $2400, which is exactly what people in clinics without call requirements—like the Dermatology Dept at Mayo Clinic—are pulling.
It seems a bit off that a dermatologist working a standard 40-hour week would pull the same paycheck as a pediatrician pulling all-nighters every third day.

I have a question... I'm based out of the NYC area, and I need to undergo a surgical procedure that can only be performed at the Mayo Clinic. When I tried to get my preliminary testing done locally in the city, they basically told me no... because they want everything handled within their own hospital system. I've been scheduled for an outpatient appointment at 9:00 AM to get all my tests completed. Today, I went to see my primary care physician to ask for the referral... she told me to just come back at the beginning of September when the actual procedure date rolls around, because who knows what will happen by then?! She refused to give me the referral now, even though any referral she issued would likely be valid for about 30 days anyway. What is the deal here? Was she allowed to act that way? I called the Mayo Clinic and the head nurse confirmed that I am indeed on the schedule for outpatient services for that date at 9:00. Does my doctor have the right to refuse to give me the referral right now... or perhaps even later in September if four different specialists from the Mayo Clinic insist on performing the tests themselves because the procedure is so specialized and only their specific team handles it?

If they don't even offer that procedure anywhere else—and you literally just said they don't—then there’s zero point in them shuffling you off to some local hospital near your house that can't even perform the surgery 🤷