The following is an actual fictional conversation that took place in the doctor's lounge at a local hospital. Internist - Dang, these Medicare cuts are coming and I doubt that congress has the wits to avoid them.  I am not sure I can go on practicing if they cut them any more.

Family Physician - Yeah, we already get paid so little by Medicaid and the private insurers, we have had to start to look for other sources of revenue.

Int - Really?  We have been looking into that as well.  What are you thinking about doing?

FP - We thought about doing cosmetic procedures, but we have an especially good-looking population, so we really can't make it work.

Int - Bummer.

FP - Yep.  Instead, we have decided to open a kiosk for Krispy Kreme donuts.  We figure we can make money off of the donuts, plus we can get more of our patients obese.  Then we can treat worse diseases and code a higher level for each visit.

670px-Krispy_Kreme_10 Int - Genius.  Plus, you can get all of the kids hyperactive on the sugar and treat their ADHD.

FP - And the "Hot Donuts Now" sign along with the scent of fresh-baked donuts will really draw in new customers...I mean patients.

Int - One of the GI doctors in town is doing the same sort of thing, opening a Starbucks in his office.  He figures he gets walk-ins, gets people with worse dyspepsia, and gets free WiFi to boot.

FP - Brilliant.  What have you been thinking of?

Int - We have noticed the interest our patients have in holistic medicine, and thought we should capitalize on that.

FP - So you are hiring a homeopath?

Int - No, they wouldn't set foot in our office because of the "evil" immunizations we use.  We tried to get all sorts of alternative providers, but they would always sneer at our practices.  And so we finally opted for two things: first, we are doing aromatherapy, which has our staff so relaxed that they don't seem to have noticed that we cut their pay by 50%.

FP - Great.

psychic Int - Second, we have a psychic who goes around in our lobby doing palm reading and tea leaves on our patients as they wait.  There are two positive outcomes from this: the patients who get bad fortunes told are so anxious that their blood pressure is up and they are ripe for anxiety treatment; the ones with good fortunes are happy enough that we can order all sorts of tests on them and they don't seem to care.

There is a downside, however.

FP - What's that?

Int - My partner now thinks that we should take our entire budget for next month and invest it in Power Ball lottery tickets.  He says it is a "sure thing."

Hospitalist - Hey guys, what's up?

FP - We're just discussing what we are going to do to offset the impending Medicare cuts.  Do you have plans?

Hos - Oh yes.  I don't like the idea of increasing the load to 70 admissions per day.  50 is plenty.  Instead, we are capitalizing on the fact that our patients are a "captive audience."

Int - This I've gotta hear.

Hos - We figured that we have enough turnover that some sort of direct marketing scheme to our patients could be quite lucrative.  We are now certified Amway sales representatives.

FP - I love it!

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Hos - Yep.  We have these patients in a position where they can't move, and we sell them cleaning solvents, vitamins, and skin care products.  Instead of taking cash, we just add it on to their hospital bill, so they usually buy a bunch.

Int - As an added bonus, the families of your patients will be so scared that you will try to sell them Amway products, that they steer completely clear of the hospital.

Hos - Bingo!  It works like a charm.  We got this idea from the intensivists who were holding Tupperware parties in the ICU.  The patients were sedated "just enough" so that they left the hospital with all sorts of cups, jugs, and bowls.

FP - Any complaints?

Hos - Not yet.  You figure, what we charge for the solvents is 1/4 of what the hospital charges for an Aspirin.  The patients really don't notice a little more charge.  We have even had some insurances mistakenly pay for some of our Amway products!

Int - You know, maybe this Medicare cut may just be a good thing.  Look at how it has pushed us to open new frontiers in medicine.  Our children will look back on this time as being one of the real turning-points in American healthcare.

FP - Yeah, today Amway...tomorrow....

Hos - Healthcare reform?  Higher reimbursement?  A fair payment model?

FP - Used Cars.

Int - I am so glad I went into medicine.

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