Posted on 07/24/2008 5:28:12 AM PDT by shrinkermd
Medicare pays doctors for specific services. If a patient has a checkup that includes an X-ray, a urine analysis and a physical, Medicare pays the doctor three separate fees.
Each fee is meant to reimburse the doctor for the time and skill he or she devotes to the patient. But it is also supposed to pay for overhead, and this is where the problem begins. To Medicare, a doctor’s overhead (or “practice expense”) includes such items as rent, staff salaries and the cost of high-tech medical equipment. When the agency pays a fee to a doctor who has performed a CT scan, it is meant to cover some of the cost of buying or leasing the scanner itself. Services using more expensive equipment generate higher fees.
Any first-year business school student can see the profit opportunity here. The cost of a CT scanner is fixed, but a doctor earns fees each time it is used. This means that a scanner becomes highly profitable as soon as it’s paid for.
In contrast, the doctor-patient visit, which involves no expensive equipment, offers no significant profit opportunity. So the best way for a doctor to make money in his practice is not to spend time with patients but to use equipment as much as possible. That means moving the maximum number of patients through the practice, and spending the minimum amount of time with each one.
(Excerpt) Read more at nytimes.com ...
"...For their time, doctors should be given a stipend for each of their patients. It should be larger for patients with complicated medical conditions and smaller for those who are healthy, and it should not be influenced by the number of services or tests a doctor orders.
For overhead, doctors should be paid an amount that covers the typical cost of tests and treatments needed to address a patient’s condition. This strategy — known as “case rate” or “prospective” payment — is standard in American hospitals. The hospital receives a payment for dealing with a patient’s underlying condition rather than individual payments for each test and treatment. This approach offers no incentive to run unneeded tests, and it has been credited with substantially slowing the growth in Medicare payments to hospitals.
ping
Carolyn
Where I live, if you need a cat-scan or other hi-tech x-ray, you go to an imaging center. I’ve never been to a doctor who has this sort of equipment in his office.
Maybe so, but the fact remains that the “reimbursement” scheme leads to poorer patient care, which costs the individual and the system much more (on several scales) in the future.
You don’t run the tests, they complain. You do run the tests, they complain.
Obama Care, coming soon to a facility near you.
“”I’ve never been to a doctor who has this sort of equipment in his office.””
Just another case of a journalist not letting facts get in his way. Your thought was the same as mine on reading that. I think I’ll send a copy of my Explanation of Benefits to him...he wouldn’t be able to buy lunch on the amount paid by Medicare for an office visit. Multiplied over the course of a day, maybe dinner!
Tell them how long you have to wait for the almost lunch money, too.
You are paying a licensed official to do what only a certified number of people can do.
In NYC there is an artificial limit on the number of taxi cabs in the city as well. They use a medalion system to determine who can operate. Those medalians are auctioned off for those who want to get into the business by those who want to retire.
Meanwhile corporate America keeps offshoring high tech development work to India and importing the goods through the internet without paying import duty.
Some workforces have job security and some don’t.
Not if the urinalysis is done in an outside lab and the x-ray is referred to an outside radiology department, which is the common situation where I practice. Then the fees are paid to three seperate facilities. And in New York the primary care physician is not able to charge for work done in an outside facility. I'm sorry, I stopped reading after this sloppy opening.
I was in the doctor’s office last month. One of the front desk people had a cat that escaped into the outer waiting room for a brief moment.
The cat came over to where I was sitting and rubbed up against my leg a couple of times, while giving me that look that only cats can give.
I received the bill for the office visit yesterday. It was for $2000 !!
When I called to ask why it was so much, the lady said:
(drum roll, please)
“You had a cat scan!”
But there are three separate bills. I think that is the author’s point. Improper editing left the impression the doctor got three different checks—true in some parts—when this is not true in most parts.
my heart doctor has everything in his office. If he needs a test, you get it right now with results before you can get dressed......
The place IS ALWAYS jampacked with patients. Yesterday I sat outside and I noticed a fellow carrying out heavy cardboard boxes of ,(I assume boxes of blood). He must have put 2 or 3 dozen boxes in his van and drove away. From the way he was carrying them each one must have weighed around 25 lbs.
She gets her results the next day and dosage recommendations. I am curious as to why in the world was that much blood being moved to another facility?
Presumably the lab where the blood is being analyzed is in another location, perhaps even another state in these days of Fedex and the internet. Some basic tests are often done in labs in physician offices but more sophisticated testing usually requires specialized facilities.
I assumed as much, but I just don't have the patience for sloppy writing that I used to have, particularly when the source is The Newspaper of Record ;-)
I recently had a colon X-ray where the radiologist not only read the X-rays, but performed the procedure. The procedure from start to finish took almost an hour not including the time to read and interpret the X-rays. The radiologist billed my insurance $125, but due to negotiated fees with my PPO, discounted the price to $80 for which the insurance paid all but $17. The radiologist was in essence paid less than what you might pay for a plumber or electrician doing an hour and a half of work and from this had to pay not only the physician's salary but all the overhead cost of filling the paperwork, malpractice insurance etc. I hardly see this as a lucrative business.
Yes, I agree and, especially so, since I am a Medicare consumer.
FFS made sense when people paid all or most of their bills. Physicians, as well as other providers, collected t his money and discounted fees according to ability to pay.
But FFS does not work when payment is divorced from service. In this instance, even a small minority, can access the system with unrealistic demands while providers are encouraged to do more and more procedures since this is the only way to get out of the billable hour trap.
I think physicians, as well as other providers, are going to discover FFS is too easy to discount and cut at the whim of some politician who has promised what he cannot deliver.
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