THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: February 23, 2009 09:47 AM Monday; Rod Welch

Call Russ for estimate replace tooth #2 from Steve's office.

1...Summary/Objective


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CONTACTS 
0201 - Steven K. Olsen, DDS.
020101 - Mr. Russell S. Harris, DDS; General and Cosmetic Dentistry
020103 - Dentists

SUBJECTS
Default Null Subject Account for Blank Record

0603 -
0603 -    ..
0604 - Summary/Objective
0605 -
060501 - Follow up ref SDS 11 0000, ref SDS 5 0000.
060502 -
060503 -
060504 -
060506 -  ..
0606 -
0607 -
0608 - Progress
0609 -
060901 - Background on repairing tooth #2 is reported on 090220. ref SDS 11
060902 - FQ5G
060904 -  ..
060905 - At that time on 090220, Christi advised that Russ would review the
060906 - chart, and call to discuss scope and price.
060908 -  ..
060909 - Russ called this morning to follow up the request for proposal on
060910 - 090220. ref SDS 11 F066
060912 -  ..
060913 - Russel indicated today that repairing a filling that failed in tooth
060914 - #2, and which resulted in part of the tooth breaking off, will require
060915 - an implant procedure.  Initialy the existing root is drilled out, and
060916 - a new foundation is constructed similar to a root canal.  This
060917 - "foundation" has to stay in place for several months.  At the end of
060918 - that time, Russ would take over and build a new tooth.
060920 -         ..
060921 -        [On 090223 1053 2nd opinion Richard indicates implant for tooth
060922 -        #2 often is not done because many people function well without
060923 -        this tooth, and because of risks doing implants for tooth #2.
060924 -        ref SDS 12 KU4L
060926 -  ..
060927 - Russ thinks this might cost $5K - $6K, similar to the root canal on
060928 - tooth #19 located on the lower left side, and which was performed by
060929 - Doctor Hasse on 050519. ref SDS 2 C476
060931 -  ..
060932 - Russ advised he will authorize charging "insurance rates" for this
060933 - work, based on long-standing relationship.
060935 -         ..
060936 -        [On 090302 0815 excellent meeting with Doctor Graham 2nd
060937 -        opinion concurs extraction may be adequate for tooth #2,
060938 -        ref SDS 14 H68W, and citing risks from complications doing
060939 -        implants for tooth #2. ref SDS 14 H664
060941 -         ..
060942 -        [On 090306 0800 Russell reports observing some contact with
060943 -        tooth #2 and tooth #31, despite tooth #2 having been degraded
060944 -        for several years; this may account for tooth #31 having been
060945 -        stable; removing tooth #2 presents a risk of #31 beginning to
060946 -        extrude into the open space, which can be solved by doing an
060947 -        implant to replace tooth #2, ref SDS 16 O13H; based on
060948 -        Russell's examination, decided to do the extra work today that
060949 -        prepares tooth #2 with bone grafts to perform an implant, if
060950 -        tooth #31 later extrudes. ref SDS 16 J55O
060952 -  ..
060953 - Actually, on 050519, Olsen's office performed a root canal,
060954 - ref SDS 2 MM5O, and also installed two crowns for $5K, reported on
060955 - 050520. ref SDS 3 6194  The implant of 1 tooth at this time seems
060956 - priced much higher, even for inflation.
060958 -  ..
060959 - The list of pending work on 050707 does not include tooth #2.
060960 - ref SDS 4 S43H  The original proposed scope was listed on 050518.
060961 - ref SDS 1 ZZ4M
060963 -  ..
060964 - Russ explained that billings for health care costs have greatly
060965 - escalated in part because of insurance practices.  Most customers have
060966 - health care insurance through their employer.  This is very convenient
060967 - by creating a large pool of customers for insurance and health care.
060968 - Increased demand for, in this case, dental care causes upward pressure
060969 - on prices.  Additionally, new technologies and methods in health care
060970 - increase the cost of care required to pay for very high development
060971 - expenses.  Examples include xrays, CT, and PET scan technologies, new
060972 - types of blood tests for cancer markers, and so on.  In dental work
060973 - new procedures and refinements, for example the 9 steps for root
060974 - canals, explained on 050519, ref SDS 2 YO3G, use very expensive tools
060975 - and skills.
060977 -  ..
060978 - At the same time, insurance companies are under pressure to audit
060979 - costs of care and demand discounts comensurate with their large
060980 - customer base.  This reflects general conflict in the health care
060981 - market demanding both expansion of care, and containment of costs.
060982 - Therefore, even though paying cash for services significantly reduces
060983 - transaction costs, providers are forced to charge customers more money
060984 - who pay cash in order to set a high enough price baseline that
060985 - insurance company audits will yield a discounted price at least
060986 - sufficient to cover the cost of services.
060988 -  ..
060989 - Millie encounterd distorted market pricing dynamics working with UCSF
060990 - in 2007.  On 070823 Bob Schwartz advised that Medicare insurance pays
060991 - less than other customers pay for cancer treatments. ref SDS 6 P28L
060992 - This creates pressure for UCSF to recover additional revenues through
060993 - creative billing practices, reported at UCSF on 080830. ref SDS 7 7X5G
060995 -  ..
060996 - Russ related personal experience that illustrates distorted medical
060997 - billings.  His son fell seriously ill, and was rushed to the hospital.
060998 - After 4 hours in the Emergency Department, mostly waiting to be seen
060999 - by a doctor (illustrated by Millie's many trips to Emergency at
061000 - Kaiser, e.g., on 080409, ref SDS 8 0R4H) the family was relieved when
061001 - the doctor found only minor stomach ailment from something the boy had
061002 - eaten.  Russ' son was sent home without needing any medical care,
061003 - excpet over the counter drugs that cost $20 at Safeway.
061005 -  ..
061006 - Russ said he later got a bill from the hospital for $17,000.
061008 -  ..
061009 - Mentioned Richard's experience being in the the hospital 10 days last
061010 - year in June or July for a heart attack.  He got a bill for $300,000,
061011 - reported on 081007. ref SDS 9 NY53
061013 -  ..
061014 - Millie's doctor reported on 081016 that her son was treated in a
061015 - hospital while the family was on vacation in Hawaii several years ago.
061016 - They got unreasonable billings, and attempted to resolve the matter,
061017 - but are still being harrassed for payments that are not owed.
061018 - ref SDS 10 7N7H
061019 -
061020 -
061022 -  ..
0611 -
0612 -
0613 - 1035
0614 -
061401 - Kristi called back.
061402 -
061403 - She has instructions from Russ to bill his time at reduced insurance
061404 - rates, per above. ref SDS 0 ME4L  She is billing for peridontist at
061405 - full rates, because he is not available for consultation on any
061406 - discounts.
061408 -  ..
061409 - Kristi said that the program Russ proposes is to meet on 090306 0830
061410 - for the following work....
061411 -
061412 -            1.  Examination and cleaning
061413 -                Russ 1 hour.................... $100.00
061414 -
061415 -                Xrays.......................... $188.00
061417 -                 ..
061418 -            2.  Examination to assess implant
061419 -                work
061420 -                Periodintist .5 hours........... 200.00
061422 -             ..
061423 -            Total first visit.................. $488.00
061425 -  ..
061426 - Kristi will call early next week to remind of the meeting on 080306.
061427 -
061428 -        [On 090223 1053 called Richard for 2nd opinion.
061429 -        ref SDS 12 SV8G
061431 -         ..
061432 -        [On 090223 1118 scheduled meeting for 2nd opinion from Doctor
061433 -        Graham in Danville. ref SDS 13 JW9O
061435 -         ..
061436 -        [On 090302 0815 excellent meeting with Doctor Graham 2nd
061437 -        opinion concurs extraction may be adequate for tooth #2,
061438 -        ref SDS 14 H68W, and citing risks from complications doing
061439 -        implants for tooth #2. ref SDS 14 H664
061441 -         ..
061442 -        [On 090303 2053 letter to Doctor Harris in Olsen Dental Offices
061443 -        confirming meeting on 090306 0830 and clarifying scope to
061444 -        perform extraction of tooth #2. ref SDS 15 O13H
061446 -         ..
061447 -        [On 090306 0800 Cindy calculated credit for charging "insurance
061448 -        rates" on invoice for apprximately $1,800 to clean teeth,
061449 -        extract a tooth, and perform bone graft. ref SDS 16 V440
061450 -
061452 -  ..
061453 - Asked Kristi to thank Russ for timely response.
061454 -
061455 -
061456 -
061457 -
061458 -
061459 -
061460 -
061461 -
061462 -
061463 -
0615 -
Distribution. . . . See "CONTACTS"