A HOLE IN MY LIFE: BATTLING CHRONIC DIZZINESS – BY PHILIPPA THOMSON
Originally published in FORBES.com
http://www.forbes.com/sites/theapothecary/2014/07/29/a-hippocratic-tragedy/
In the unfolding drama that is Obamacare, the current scene focuses on the law’s looming premium hikes. State insurance commissions are currently analyzing and releasing their expected premium rates for 2015. The early diagnosis isn’t good: Premiums are increasing almost without exception, with some states seeing spikes as high as 20 percent.
But from my perspective as a doctor, there’s another Obamacare storyline that deserves top billing. This subplot involves potentially radical changes to how doctors choose patients—changes that may even violate the Hippocratic Oath.
At the end of 2014, the Centers for Medicaid and Medicare Services will start penalizing doctors, hospitals, and other health care providers for not participating in the Physician Quality Reporting System. Originally introduced in 2007 as a voluntary program, PQRS asks providers to report on their compliance with pre-approved treatment paradigms for their Medicare patients. Doctors must obtain various health data on at least 80 percent of patients, which they must then submit to CMS. Until 2014, providers who met this goal received a monetary bonus.
This is a dagger aimed at the heart of medicine—it can perversely encourage doctors to limit the number of patients with complex medical problems they see. Why? Because those patients may need treatments that fall outside the program’s cookie-cutter protocols or they may require lengthy and frequent attention. This may jeopardize a doctor’s ability to meet the PQRS quota. Potentially affected patients may have conditions including diabetes, cardiovascular disease, etc., all which can make the management of a patient’s other medical conditions more difficult to treat.
This is wholly incompatible with a doctor’s promise to put a patient’s needs above our own. It turns a doctor into a practitioner of data extraction, when we should instead be focused on our patients’ well-being. Thankfully, the vast majority of doctors, myself included, refused to participate in this farce.
Enter Obamacare. It forces the majority of doctors to join PQRS by levying a penalty on non-participating doctors. (It also eliminates the bonus). The penalty starts in 2015 at a 1.5 percent cut on a doctor’s Medicare reimbursement rate, rising to a 2 percent cut in 2016 and beyond. While the program is still technically voluntary, Medicare’s low reimbursement rates give most doctors little choice but to give in to this financial coercion.
Every doctor who works at a hospital or anything but a private practice—a percentage that increases by the year—will have no choice but to participate in PQRS reporting. The only way to avoid it will be to refuse to accept Medicare—something that a growing number of doctors, including myself, have done.
Unfortunately, this isn’t the only example of an Obamacare regulation that potentially leaves some patients out in the cold.
CMS recently began assessing a penalty for hospitals that readmit too many Medicare patients within 30 days of their initial treatment. While the reasoning behind this is straightforward enough—doctors must not be doing their job if their patients frequently return with the same problems—it fundamentally misunderstands that every patient has unique medical needs. This simple truth means that some patients may require more frequent treatment, particularly if they have a recurring or rare medical issue.
Yet absent any nuance, the CMS rule leaves doctors with a financial reason not to see the patients who need help the most. In the future, patients with diabetes, high blood pressure, heart disease, and other serious medical issues may find it increasingly difficult to find doctors willing to take care of them.
It’s a similar story with Obamacare’s January 2014 revamp of the Evaluation and Management Coding system, the billing process used for Medicare patients. Prior to the law, E&M utilized five different codes for hospital clinic visits, which scaled reimbursement rates based on complexity.
In January, CMS replaced the five-code system with a single code and a single reimbursement rate for all hospital-employed physicians. In my field, for instance, a doctor who spends a few minutes getting wax out of someone’s ear gets paid the same as a doctor spending an hour evaluating, planning surgery and counseling a patient with an extensive skull base tumor.
This is little different than the changes to PQRS. It incentivizes doctors—and the hospitals that employ them—to prioritize quick and simple patient visits over long and complex procedures. As elsewhere, the government is placing financial incentives over patient well-being. This, again, punishes doctors that take care of patients who need medical care the most.
When I became a doctor, I swore to uphold the Hippocratic Oath. So did every other doctor. In so doing, we promised to put our patients’ needs above our own. Yet under Obamacare, bureaucrats in Washington are trying to make us break that promise.
This isn’t health care reform—it’s a tragedy. For our patients’ sakes, I hope it ends soon.
Dr. Gerard Gianoli is a private practice neuro-otologist from Covington, Louisiana.
What Our Patients Are Saying
When I leave here after a visit, I always do so knowing I have answers to my questions, and I’m confident in what I learned. There is a plan that works for me!
He saved my hearing after I was struck by lightning in 1997. Excellent physician and great bedside manner.
I have nothing but wonderful things to say about Dr.G and staff. I have been coming for 10 years now and they have always taken excellent care of me and seen to my every need. I was in a desperate way when I first found them, after seeing so many doctors who never could diagnose me. So very grateful that he was able to help me. Just the most professional group of people and the most caring I've ever come across. Love them all.
Amazing experience with Dr. Gianoli and his staff. They have been helpful and supportive at every step. Our son couldn't walk without assistance and after surgery, he can walk on his own again!
Traveling from Michigan to Louisiana after 2 years of various doctor visits was definitely worth it! My inner ear issue was finally discovered after thorough testing. A treatment plan was set up and I'm on my way to recovery. For 2 years I lived with dizziness that was unexplainable and undiagnosed - even after several visits to my local ENT and a handful of visits to the emergency room.
I have been searching for answers for two years and spent tens of thousands of dollars trying to figure out why I have all of these symptoms. Dr. Gianoli and his staff have spent so much time with me, testing, talking, and trying to find the root cause and we finally have a plan. I am in tears knowing that someone believes me and actually can SEE what I am feeling.
I am very satisfied with Dr. Gianoli's professionalism. I would recommend him to anybody who has ear problems without hesitation. He is a good hearted man that truly cares about his patients.
The obvious concern for the patient is overwhelming. Everything thoroughly examined and explained. Dr Gianoli ended my 3 year search for what was going on. All other health care systems gave up or said It was in my head, they are right, it was in my ears. Dr Gianoli and his ENTIRE staff worked diligently and nonstop for all the tests. He went thru results, concerns, and solutions. I was truly at my wits end and didn't know what I would do next. Don't delay like I did, listening to others... Go see the center.
Worth the trip from Michigan. Very kind, caring and compassionate. Listen to me and my symptoms. I have been struggling in the dark for 20 years and 11 months.
After 25 years of seeing 50+ Physicians/specialist connected to 3 hospital systems I’ve had my first success in diagnosing and curing my balance issues, one issue cured and one to go. I have come to appreciate what Dr Gianoli and his staff can do for people like myself who struggle with inner ear issues, an answer to prayer.
Wish he could Take insurance I wanted to do my surgery but With him not taking insurance Im out of luck I will continue suffering from Non Stop Dizziness due Superior Semi Circular Dehiscence 😞
I am so very very grateful for Dr. Gianoli’s medical knowledge and care! My life has been greatly improved with his treatment and will continue to get better!! Dealing with vestibular challenges are so very difficult, Dr. Gianoli is the doctor I had been wishing for. So grateful he studies and is an expert in the specialty he does, it has changed my life. We happily travelled from Michigan to his office, very worth it!! He is a kind man and an excellent doctor. Just so very grateful. Thank you.
The staff is professional and kind. Testing is explained. Everyone takes their time, which is nice. Dr. Gianoli is very professional, takes his time when with you and explains everything thoroughly. Much different then other practitioners I've seen. They care about my health.
Dr. Gianoli is one of a kind! 10 stars!! He truly cares about his patients, he takes the time to listen to you, and explains all results thoroughly. He has performed tests that other doctors had not done, nor even offered as an option. Instead of throwing an inaccurate diagnosis at you just to get you out the door as fast as possible so he/she can get to his next patient; Dr. Gianoli and the amazing staff, takes the time to invest in your care, getting you healthy again. (edited to add this after going through treatment) Finding Dr. Gianoli has been life changing. Before seeing him I was having to use a walker to walk, could not drive, could not look up, fell constantly....my quality of life was non-existent. Now I am back to functioning like normal! Dr. Gianoli gave me my life back and my entire family and I are forever grateful for his awe-inspiring knowledge and dedication.
Dr Gianoli its Great Doctor and understands his patients very well He is very Good With SSCD (Superior Semi-Circular Canal Dehiscence) he is very professional and the staff are very helpful
Dr. Gianoli took me from bed ridden from Vestibular issues to working again! He is personable, professional, experienced and dedicated, in my opinion to helping every person who walks theough the door as are his whole staff! I highly recommend him and Dr. Soilleu !
Dr. Gianoli has a unique and exceptional technical capacity at diagnosis and treatment of neuro-otology related conditions. At the same time he has amazing "bedside manner" and ways of working with patients and their families. He is down to earth and makes very complex issues understandable. He is patient and compassionate from the moment you meet him. The doctor and staff at the Ear and Balance Institute in Covington, LA did intensive comprehensive evaluation that shed light on a condition I have been struggling with since a traumatic brain injury 2.5 years ago. They were all kind, compassionate, and professional and spent many hours with me. Other specialists told me my condition was not treatable and that I would need to just live with it, unable to do many simple things I used to be able to do. I am confident that with Dr. Gianoli I will have great improvement in functioning and quality of life.
Dr. Gianoli and his staff are always prompt, professional and cordial each and every time we have appointments. My wife would not let anyone else touch her ears. Thanks for such an excellent practice.
The office staff and medical professionals are all wonderful. The Audiologist is very knowledgeable and properly prepares the patient for testing. Dr. Gianoli provides results of his examination and tests in a very thorough and understandable manner and takes the time to answer any questions and/or concerns. I always feel I am in very capable hands in dealing with my medical issues.
dr. gianoli changed my life quality in a very positive way!! ..after first SCDS surgery method in johns hopkins all the bad symptoms came back! dr. gianoli did in a revision surgery a perfect work! seemed to me like a wonder.. i come from switzerland in europe. nobody else was able to do this great job!!!
After 3.5 years of chronic balance, vision and hearing problems and bouncing from one uncaring doctor to another, I traveled to the US to see Dr. Gianoli. I finally have a diagnosis and I know what steps need to be taken in order to get my life back. Dr. Gianoli seems to be far more knowledgeable and experienced than any other ENT I have dealt with. He is also very approachable, has great bed side manners and genuinely cares about his patients. His staff couldn't be more professional and welcoming. No wonder this place has the reputation it has and welcomes many foreign patients.
It has been a pleasure to be evaluated & educated by Dr. Gianoli. His staff is professional & very friendly. We are thankful we were referred to him. I highly recommend him!!
I’ve had a great experience with Dr. Gianoli and staff, he is very thorough and spends a good deal of time answering your questions and explaining his diagnosis. My PLF was treated and I’m feeling much better. Highly recommend Dr. Gianoli.
Absolutely the best and most caring doctor I've seen since my TBI 8 years ago. He will not settle for Occam's easiest and simplest answer to any balance problem. Dr. Gianoli is determined to find the answer, not simply the most likely answer. Vastly different in the field of medicine. Having a diagnosis based on fact and not theory makes an immeasurable difference to my outlook on life. I am very thankful I found Dr. Gianoli. I now have a future in front of me.
Dr Gianoli is very thorough each and every visit. I am now 4 years a patient with him and have been more than pleased with the results I have achieved with Dr Gianoli.
We were very pleased with Dr. Gianoli. He was very accessible before our appointment, responding to my questions via email. It will be several weeks before we see if the treatment is effective, but we are very encouraged. Everyone we encountered was very helpful.
The amount of time with the doctor and his staff spends is a very big plus for me. I do not rushed. That is hard to find now-a-days.
I love DR. Gianoli and Kacey and the entire staff. I have been a patient for 11 years. Their kindness and compassion is just as much a part of their treatment as their high level of expertise.
I really appreciated the time Dr. Gianoli and his staff spent with me. There was no rush to get to the next patient. Thanks for the care and concern!
Great experiences with everyone, staff and Dr. Gianoli. Everyone was very professional and explained all procedures to me thoroughly.
I previously tried seeing several doctors and specialists in DFW for my vestibular neuritis without success. He is a expert in his field, easy to talk to and he has certainly changed my life.
Dr Gianoli and his staff have been wonderful to deal with in the diagnosis and treatment of my SCDS. I have had a complete resolution of my debilitating symptoms, and am back to living life without dizziness. Dr Gianoli is a miracle worker, in my opinion! He gave me back my life!
Overall, this has been the most thorough medical exam I have ever had for my symptoms. Dr. Gianoli and his staff have all been very understanding and compassionate throughout my appointments and testing.
Came for yearly check-up. As always, it was a pleasure to see Dr Gianoli. After almost 6 years of being a patient here, he has become a friend, as well as my doctor. I have made enormous steps back towards health, and I remain so very thankful to have found Dr Gianoli, who, in my opinion, is the best Neurotologist in the country...and I should know...he was the 37th doctor I went to in search for answers to my vestibular problems.
Dr. Gianoli is very thorough in running tests and making a diagnosis. He truly cares about his patients and takes a personal interest in their progress.
Dr. Gianoli and his staff were very thorough in their testing and diagnosis, and he spent as much time with my wife and I as necessary to explain their diagnosis, treatment options and to answer any questions we had.
When no other physician could accurately diagnose the cause of my hearing loss and dizziness, Dr. Gianoli not only diagnosed but performed a minor surgery that has eliminated the debilitating dizzy spells and nausea which accompanied them.
He has an excellent manner and is very detailed in his explanation of the problem. I felt very comfortable with him, as he is easy to talk to.
If you have an inner ear problem, this is the place to go. The Staff and doctor were very helpful and informative during the visit. All procedures were explained in detail. Doctor took time to explain results and most beneficial treatment.
Very professional I would recommend him to anyone with inner problems. Seems to be very knowledgable in his profession.
Dr. Gianoli was instrumental in helping me with my vertigo. I am still under his care but now only have to see him on a yearly basis as I no longer have problems with vertigo. I still have hearing loss but this is a permenent condition for me and that will be for the rest of my life. But I honestly feel that Dr. Gianoli has healed my vertigo condition. The entire staff is very friendly and helpful. They go beyond the call of duty to do everything they can to make you feel comfortable during your visit.
In 2000, I was diagnosed with Otosclerosis. Dr. Gianoli determined that the left ear was much worse than the right. He operated on my ear that same year. The results were immediate with a marked improvement in hearing. A few years later I began to notice the same gradual degradation in my ability to hear in my right ear with an increased level of tinnitus. I would go to Dr. Gianoli every few of years for testing and evaluation. We both came to the conclusion earlier this year (2014), that it was time I had the procedure done in my right ear. He operated on me on March 13th. Everything went well and my hearing is much improved! A positive side effect is that the level of tinnitus is greatly reduced to the point that I am most often unaware of it. Thanks Dr. G!!
Very thorough, patient, efficient. Wait time at a minimal. Staff and doctor make you feel comfortable.
Very professional and knowledgable. Honest and straight-forward. The treatment, ie surgery, from Dr. Gianoli changed my quality of life.
Dr. Gianoli and his staff are fantastic! Appointments are easy to schedule and you are always seen promptly upon arrival. Office visits are thorough and you are never rushed. I currently travel 1+hour to see Dr. Gianoli, however, I would easily travel 10 hours for care and treatment. He has quite literally saved my life by diagnosing and treating my condition. Thanks to Dr. Gianoli I am able to drive, work and have a family.
Dr. Gianoli's professional manner and medical expertise is exceptional. His treatment of my condition was life changing, I do not know what I would have done without him.
Contact
1401 Ochsner Blvd.
Suite A
Covington, LA 70433
Phone: 985-809-1111
Fax: 985-809-1119
