A pediatrician vent!!!!

[indygirl99]

I respect your opinion. Maybe I should have worded it differently, but the receptionist asked why I wasn't going to go in December, and I told her. I told them at her last appointment I didn't think it was necessary to go in when it was so close to her 5 year check up. They refused to have it any other way. Her blood tests came back normal, so the weight checks ARE a waste of time. I told her doctor I will watch what she eats. He's only doing it for the money. And for the record, this doctor has gotten a lot of bad reviews. He's NEVER on time. I remember interviewing him when I was pregnant with my first DD, but ended up going with another pediatrician who was a woman. She retired two years ago, so we went to him. I read the reviews online and thought they were absurd. He was so nice and professional, but only to my face. I realize I might have this problem if I do go to another provider, but no final decisions can be made until I get my new insurance under the ACA taken care of.

Okay I have not read all the posts so I apologize if someone has already made this point.

Insurance payments are now outcome based, meaning if you don't take your DD in for the weight check when you take her in for the 5 year check up they do not have to pay your doctor if her weight is not within "guidelines".

We are dealing with this in a big way in the hospital. If grandma comes in for a hip fracture, has surgery and ends up getting a urinary tract infection the hospital does not get paid for the ENTIRE hospitalization.

This is one of the new rules with the new ACA law.

You are saying you don't want to pay a $30 co-pay for a weight check, you may find if you don't comply with the medical care plan that you will be responsible for more than just a $30 co-pay. My medical insurance requires we comply with a health plan set up by a health coach, our doctor and our self. If we don't agree to the health coaching and make an effort to comply then our insurance coverage drops to 20% and we pay the other 80% out of pocket.

 

[Lisa loves Pooh]

Actually, she is at the 98th percentile for weight (assuming she is roughly 4 years and 10 months old, since OP says she is having her 5 year check up in January). Yes, height does make a difference. However, I'm going to give the doctor SOME credit and figure out that if he's concerned, the child is not extremely tall for her age. Could be, but I'll be any doctor worth anything knows that connection.

Per this chart, if she gained no weight in 2 months , she would be 90th percentile. Not sure where you get 98.

Based on doc saying she is 7 pounds overweight, that would place desired weight at 75th percentile.

Not that huge of a disparity of that is where her height is percentile-wise and it does not warrant the constant weight monitoring.

http://www.cdc.gov/growthcharts/data/set1clinical/cj41c022.pdf

 

[Lisa loves Pooh]

Okay I have not read all the posts so I apologize if someone has already made this point.

Insurance payments are now outcome based, meaning if you don't take your DD in for the weight check when you take her in for the 5 year check up they do not have to pay your doctor if her weight is not within "guidelines".

We are dealing with this in a big way in the hospital. If grandma comes in for a hip fracture, has surgery and ends up getting a urinary tract infection the hospital does not get paid for the ENTIRE hospitalization.

This is one of the new rules with the new ACA law.

You are saying you don't want to pay a $30 co-pay for a weight check, you may find if you don't comply with the medical care plan that you will be responsible for more than just a $30 co-pay. My medical insurance requires we comply with a health plan set up by a health coach, our doctor and our self. If we don't agree to the health coaching and make an effort to comply then our insurance coverage drops to 20% and we pay the other 80% out of pocket.

That is INSANITY if true.

Not sure what outcome based is--the term confused me. But if grandma gets a UTI while she is hospitalized for something else, it is illogical for them to not pay the hospital bill because she has an illness running concurrently with her surgical recovery.

Asinine!

 

[lsyorke]

That is INSANITY if true.

Not sure what outcome based is--the term confused me. But if grandma gets a UTI while she is hospitalized for something else, it is illogical for them to not pay the hospital bill because she has an illness running concurrently with her surgical recovery.

Asinine!

Its been like this for years(2007 I believe), nothing new. Hospital acquired complications don't get paid for...hence the hospital has to be diligent on prevention. Not always a bad thing. The original surgery would still be paid for, just not the extended time/treatment for the complication.

http://www.medicareadvocacy.org/InfoByTopic/Reform/Reform_08_09.25.NeverEvents.htm

 

[missbrooke06]

Okay I have not read all the posts so I apologize if someone has already made this point.

Insurance payments are now outcome based, meaning if you don't take your DD in for the weight check when you take her in for the 5 year check up they do not have to pay your doctor if her weight is not within "guidelines".

We are dealing with this in a big way in the hospital. If grandma comes in for a hip fracture, has surgery and ends up getting a urinary tract infection the hospital does not get paid for the ENTIRE hospitalization.

This is one of the new rules with the new ACA law.

You are saying you don't want to pay a $30 co-pay for a weight check, you may find if you don't comply with the medical care plan that you will be responsible for more than just a $30 co-pay. My medical insurance requires we comply with a health plan set up by a health coach, our doctor and our self. If we don't agree to the health coaching and make an effort to comply then our insurance coverage drops to 20% and we pay the other 80% out of pocket.

I don't think that's unilaterally true. We have a new "outcomes based" insurance. The coverage isn't affected but if you don't meet your guidelines or opt out of the exam, your deductible is higher. Ours also doesn't have requirements for children.

And actually, if your insurance requires you to meet guidelines, they are required to cover weight management programs as well.

 

[Lisa loves Pooh]

Its been like this for years(2007 I believe), nothing new. Hospital acquired complications don't get paid for...hence the hospital has to be diligent on prevention. Not always a bad thing.

http://www.medicareadvocacy.org/InfoByTopic/Reform/Reform_08_09.25.NeverEvents.htm

Then that would be part of their contract and they don't get paid should they fail.

Also-- that article cites for Medicare covered patients. I forget about that when it comes to elder patients.

Where it would be bad if there are expected complications that could occur rated to a medical event.

I don't think a 5yo could be on Medicare, though. With no lab tests supporting a medical need for a weight check, there does not seem to be a reason to deny anything.

 

[Lilliputian]

Insurance payments are now outcome based, meaning if you don't take your DD in for the weight check when you take her in for the 5 year check up they do not have to pay your doctor if her weight is not within "guidelines".

I'm not an expert so don't know if this is true, but if it is, the guidelines would not be for her to have lost the extra weight. When young children are slightly-to-moderately overweight, the ideal situation is that you make them stop gaining or slow down their gain as they grow up into their weight. Only obese children (especially preschoolers!) are recommended to actually lose weight.

I think that going to another doctor if you have issues with this one is a good idea. However, I do think that you and the new doctor need to have a conversation and be on the same page. Your post "sounds" like you think that since there isn't a medical problem and you're working on diet and exercise, it's all fine. It sounds like the doctor thinks that even though there's no known underlying medical condition, exercise and diet need to be monitored with regular weight checks to ensure that the efforts are taking her in the right direction.

I also wouldn't expect weight checks to cost money. Usually a diagnosis that requires follow-up bundles the cost into one copay. My son recently had surgery, and it required several follow-ups. None had a copay because they were covered under the surgery payment. Likewise, broken bones with multiple trips usually have one copay, and going in a few days later to remove stitches that the same doctor did shouldn't have an extra payment. Those are all considerably more work for the doctor and his staff, so I'd expect weight checks to be similar.

 

[mnrose]

Per this chart, if she gained no weight in 2 months , she would be 90th percentile. Not sure where you get 98.

Based on doc saying she is 7 pounds overweight, that would place desired weight at 75th percentile.

Not that huge of a disparity of that is where her height is percentile-wise and it does not warrant the constant weight monitoring.

http://www.cdc.gov/growthcharts/data/set1clinical/cj41c022.pdf

I got it off the CDC BMI calculator for children. I did make assumptions as follows: Birthday late January, current weight taken now (it would be even worse if the 47 pounds was a weight taken in 4 months ago), and average height for a female child of her age. Equals BMI of 98 percent, and a label of obese. Now, if my assumptions are incorrect, and she is significantly taller than the norm for female children age 4.5 years, then the calculation is subject to change. Again, however, I'm assuming her doctor is at least as competent as us amateur doctors here on the Dis, and knows that tall children weigh more than average or shorter children. There must be a reason the doctor is concerned enough to ask her to either keep the appointment or find a new doctor. We are hearing one side of it only.


As someone else said, the goal for an obese young child is NOT to lose weight, but to stop the rate of gain. I'm certain that is what the doctor was interested in checking. If the rate of gain has not stopped, or is even increasing, there would be reason for ADDITIONAL medical testing to see if there is an issue that wasn't covered by simple blood testing.

 

[lsyorke]

I also wouldn't expect weight checks to cost money. Usually a diagnosis that requires follow-up bundles the cost into one copay.

Surgeries have "global periods" where a copay isn't required, usually 90 days for anything other than a minor procedure(those are 10 days). This doesn't apply to a medical diagnosis. There is no global period, so copays would be collected at each visit.

 

[MaryLovesPoohBear]

Surgeries have "global periods" where a copay isn't required, usually 90 days for anything other than a minor procedure(those are 10 days). This doesn't apply to a medical diagnosis. There is no global period, so copays would be collected at each visit.

That sounds like it would make sense, but it doesn't.

I know that I don't pay a co-pay when I go in for a follow-up, regardless of the reason.

It doesn't matter if it is for a recent surgery or a few weeks ago and it was for a pulled muscle.

 

[Skippy918]

OP - what's her height percentile?
If she's also at 98% for height, then I don't see an issue, but if she's only on the 10th percentile, then I can see why the doctor is concerned.
My son is 6 and there is such a huge range of heights/ weights of kids in his class. He's always been between the 10th -25th percentiles. An old friend of his who was actually 4 months younger was at the 99th for both and was nearly a whole head taller and at least 10lbs more than DS.

 

[Pea-n-Me]

American Academy of Pediatrics Position Statement on Prevention of Pediatric Overweight and Obesity

American Academy of Pediatrics Recommendations for Prevention of Pediatric Overweight and Obesity

 

[DebbieB]

Okay I have not read all the posts so I apologize if someone has already made this point.

Insurance payments are now outcome based, meaning if you don't take your DD in for the weight check when you take her in for the 5 year check up they do not have to pay your doctor if her weight is not within "guidelines".

We are dealing with this in a big way in the hospital. If grandma comes in for a hip fracture, has surgery and ends up getting a urinary tract infection the hospital does not get paid for the ENTIRE hospitalization.

This is one of the new rules with the new ACA law.

You are saying you don't want to pay a $30 co-pay for a weight check, you may find if you don't comply with the medical care plan that you will be responsible for more than just a $30 co-pay. My medical insurance requires we comply with a health plan set up by a health coach, our doctor and our self. If we don't agree to the health coaching and make an effort to comply then our insurance coverage drops to 20% and we pay the other 80% out of pocket.

Its been like this for years(2007 I believe), nothing new. Hospital acquired complications don't get paid for...hence the hospital has to be diligent on prevention. Not always a bad thing. The original surgery would still be paid for, just not the extended time/treatment for the complication.

http://www.medicareadvocacy.org/InfoByTopic/Reform/Reform_08_09.25.NeverEvents.htm

Bush was President then, so it's not ACA.

 

[Tozzie]

Okay I have not read all the posts so I apologize if someone has already made this point.

Insurance payments are now outcome based, meaning if you don't take your DD in for the weight check when you take her in for the 5 year check up they do not have to pay your doctor if her weight is not within "guidelines".

We are dealing with this in a big way in the hospital. If grandma comes in for a hip fracture, has surgery and ends up getting a urinary tract infection the hospital does not get paid for the ENTIRE hospitalization.

This is one of the new rules with the new ACA law.

You are saying you don't want to pay a $30 co-pay for a weight check, you may find if you don't comply with the medical care plan that you will be responsible for more than just a $30 co-pay. My medical insurance requires we comply with a health plan set up by a health coach, our doctor and our self. If we don't agree to the health coaching and make an effort to comply then our insurance coverage drops to 20% and we pay the other 80% out of pocket.

I have stayed out of this debate until this absurd post. What you post is correct for some things, it is largely incorrect and are equating apples and zebra, The issues with hospital admissions and contracting illnesses in the hospital is what were targeted however most if not all things that occur in a dr's office are not under this mandate. In fact since the doctor can't control things people do in life they can only offer advice, it is the patient that pays dearly in the form or higher premiums and deductables the dr still gets paid.



There is a lot of short sightedness in this thread the OP isn't trying to duck the doctor, she feels and rightly so imo, that the weight check can be acomplished in one visit in January, and if the doctor had a reason that he wanted the check in December, he should have conveyed that to the OP not reacted with find another provider, I think his ego got in the way when he felt someone actually questioned him and instead of explaining why it needed to be done in December he reacted rather strongly and that is very telling IMO.

 

[MrsJackSparrow4Life]

I have stayed out of this debate until this absurd post. What you post is correct for some things, it is largely incorrect and are equating apples and zebra, The issues with hospital admissions and contracting illnesses in the hospital is what were targeted however most if not all things that occur in a dr's office are not under this mandate. In fact since the doctor can't control things people do in life they can only offer advice, it is the patient that pays dearly in the form or higher premiums and deductables the dr still gets paid.



There is a lot of short sightedness in this thread the OP isn't trying to duck the doctor, she feels and rightly so imo, that the weight check can be acomplished in one visit in January, and if the doctor had a reason that he wanted the check in December, he should have conveyed that to the OP not reacted with find another provider, I think his ego got in the way when he felt someone actually questioned him and instead of explaining why it needed to be done in December he reacted rather strongly and that is very telling IMO.

They are actually moving towards a "pay for results" model in clinics now as well as the hospitals. Our clinic has been preparing for this for the last 3+ years and I think my manager said we have two different insurance companies switching to it as of 2015.

Because of this we have been switching our clinic to Patient Centered Medical Home over the last few years. There have been some "growing pains" but it is going to make the switch in insurance payments easier in the long run.

 

[indygirl99]

I have stayed out of this debate until this absurd post. What you post is correct for some things, it is largely incorrect and are equating apples and zebra, The issues with hospital admissions and contracting illnesses in the hospital is what were targeted however most if not all things that occur in a dr's office are not under this mandate. In fact since the doctor can't control things people do in life they can only offer advice, it is the patient that pays dearly in the form or higher premiums and deductables the dr still gets paid.



There is a lot of short sightedness in this thread the OP isn't trying to duck the doctor, she feels and rightly so imo, that the weight check can be acomplished in one visit in January, and if the doctor had a reason that he wanted the check in December, he should have conveyed that to the OP not reacted with find another provider, I think his ego got in the way when he felt someone actually questioned him and instead of explaining why it needed to be done in December he reacted rather strongly and that is very telling IMO.

Everyone is entitled to their own opinion but I can tell you what I have posted is not absurd at all.

Try doing a little research on medical homes and you will find that all the work that I have done in the last year to help our practice be compliant is not absurd. Gotta love that word.

There will be a lot of evolution to our current healthcare and I think people will be very surprised at some of that evolution. We will be required to actually take responsibility for our own health and not blame everything on the......... fill in the blank. And we will be expected to pay for the healthcare we receive instead of getting everything for free.

As a general rule we are usually more invested in something that we have to pay for over things we get for free.

 

[AnAmericanInDisney]

The biggest change I've seen with doctors lately is a tendency toward more testing and recommending more visits in a effort to recover their med school costs or maximize income to their corporations on the back of my "Cadillac" health insurance. If they're going to use Medicare/Medicaid quality measures as an excuse to have to see me every month, they better get some mobile van that will come to my house. I don't have time to go to the doctor's office all the time, neither do most working adults. Very sick of the churning.

 

[Lisa loves Pooh]

American Academy of Pediatrics Position Statement on Prevention of Pediatric Overweight and Obesity

American Academy of Pediatrics Recommendations for Prevention of Pediatric Overweight and Obesity

It has not been established that the child is obese or even close to obese.


7 pounds going by weight alone from a current weight of 47 pounds is 40 pounds--15 percent overweight.

But absent a height measurement--who knows?

Per your second link--child isn't even overweight--but at middle of the at risk range.

 

[Happy Snowman]

Its been like this for years(2007 I believe), nothing new. Hospital acquired complications don't get paid for...hence the hospital has to be diligent on prevention. Not always a bad thing. The original surgery would still be paid for, just not the extended time/treatment for the complication.

http://www.medicareadvocacy.org/InfoByTopic/Reform/Reform_08_09.25.NeverEvents.htm

This is a Medicare policy--based on hospitals and clinics pushing seniors out before they are ready to go home....to prevent return visits that would have been unnecessary if they kept patients longer.....but the flip side, Medicare also treats by diagnosis, not by the patient, so if you have a heart attack they pay for x number of days in the hospital and it's a fight to get more time...

It is also NOT in the ACA. Medicare is not part of the ACA.

I don't think that's unilaterally true. We have a new "outcomes based" insurance. The coverage isn't affected but if you don't meet your guidelines or opt out of the exam, your deductible is higher. Ours also doesn't have requirements for children.

And actually, if your insurance requires you to meet guidelines, they are required to cover weight management programs as well.

This is also a choice your company made, not so much an "insurance" decision.

Everyone is entitled to their own opinion but I can tell you what I have posted is not absurd at all.

Try doing a little research on medical homes and you will find that all the work that I have done in the last year to help our practice be compliant is not absurd. Gotta love that word.

There will be a lot of evolution to our current healthcare and I think people will be very surprised at some of that evolution. We will be required to actually take responsibility for our own health and not blame everything on the......... fill in the blank. And we will be expected to pay for the healthcare we receive instead of getting everything for free.

As a general rule we are usually more invested in something that we have to pay for over things we get for free.

Consumer driven health plans have been slowly evolving. I think they are a good thing and I agree, they remove the blame. People for too long have run into the doctor for every little cough and sneeze and it's driving up costs. I know people that have not been into the doctor for decades and all of the sudden they have a major medical condition, heart attack or whatever, that could have easily been prevented by going for a physical and taking a $4/month medication.

In the OP's case, I think there is still a back story we are unaware of.

 

[sam_gordon]

There is a lot of short sightedness in this thread the OP isn't trying to duck the doctor, she feels and rightly so imo, that the weight check can be acomplished in one visit in January, and if the doctor had a reason that he wanted the check in December, he should have conveyed that to the OP not reacted with find another provider, I think his ego got in the way when he felt someone actually questioned him and instead of explaining why it needed to be done in December he reacted rather strongly and that is very telling IMO.

Careful of assumptions...
1) The OP willingly made (or at least accepted) the weight check appointment after the blood results were known. It's not like the office called her and said "bring the child in on 'x' day."
2) We don't know if the doctor truly made the statement about the OP leaving the practice or if the receptionist did it on her own.
3) We don't know if the OP ASKED why the December weight check was needed. I would have assumed the proper time to ask that question would have been before the appointment was made, not after.