Posted on 01/26/2007 12:36:12 AM PST by neverdem
How much money does your doctor earn? If your doctor is a Surgeon practicing in rural central California, you're about to find out.
First, some background: Perhaps your 51-year-old neighbor's screening mammogram this year showed a suspicious area. She is called back by the Radiologist for more testing, including additional mammograms and an ultrasound. She then receives a call from her Gynecologist explaining that the x-rays are "non-reassuring," and she'll be sent to a specialist in breast surgery.
For the initial consultation and exam of the lady with the abnormal mammogram:
CPT#99243 $59.50.
For the visit in which she is told she has Breast Cancer and is prepared for surgery:
CPT#99213-57 $24.00.
I will add that it becomes dangerous for the public to have people with a licence to practice medicine and privileges to perform major invasive surgery who are financially 'strapped'. I have seen those people perform proceedures which were unncecessary, or spread out a breast biopsy which was positive and a followup mastectomy more than 14 days later because the government would not pay for 2 proceedures within the 14 day period. That is unconscionable, but it happens all of the time.
There are much worse things going on out in the country that are winked at by the medical establishment.
Most health cost perversions are done by the hospital. 1 aspirin - charge 5 dollars. 1 box of Kleenex -17 dollars. and on and on.
All of this is leading to a 17% medical share of the gross domestic product. That is unsustainable. I have been in the buisness since 1975 and have seen many changes. The changes to come under Hillary will be made, they will be extremely detrimental to health care provision to the public, and once accepted will never be turned back to the free market forces which should determine hospital costs, physicians fees. The governments micromanaging the health care industry has lead to harsh developements in the delivery of health care to patients with many unintended consequences. But, the road to hell is paved with good intentions.
I guess it's charity, but it's not like she LOSES money treating these people, she loses her TIME.
If she had a business where she was turning away paying patients, then she could suggest she was losing money.
If not, she might actually come out ahead taking these patients in her down times, because otherwise she'd be sitting around making nothing.
Private practice no doubt?
Yes, but nothing fancy. Not a concierge practice. No idea what those guys make, but it's gotta be a lot.
These charges are not (obviously) to cover the cost of the asprin, but to cover the overheads and costs of the 60% who don't pay. Not that I think it's a good thing, but hospitals are not allowed to turn anyone away. Case in point, Ambulance picked up a bum (heavy drug and alcohol user) with some lower limb problems. when they got him to the ER they took off his shoes and his feet came with them. He had basically dead legs and the maggots were eating their way into his lower abdomen. Both legs amputated. Urology called because of invasion of urinary bladder and surrounds by cellulitis and maggots. Guy went into intensive care and died several days later.
This doesn't even look at the Mexicans who get their "free" health care at the expense of the rest of us. Everyone who pays their bills picked up the tab for this guy. The problem is that too few people pay for too many indigents and deadbeats Health care is a commodity, not a right.
I write a column for a local newspaper. I might spend 2-6 hours on the column. They pay me 30 bucks. My real work pays me a bit more than that :-). But I don't consider my writing "charity work" because I'm not really GIVING anybody something, I am getting paid to perform a service, just paid relatively poorly.
It doesn't COST me anything but my time, and I give my time to writing because I enjoy writing, and because I like having the opportunity to pursuade others of my opinions.
A doctor who treats patients and gets paid less for it isn't doing "charity", unless she specifically is turning away paying patients in order to treat the charity cases.
I suppose the same is true for you and your indigent work. It costs you your time, but you do get paid, just very little relative to your normal compensation. If you turned down paying clients because you don't have time because of this work, you did lose money. But if you took those clients, whoever ended up NOT taking those clients would have more free time to work cheaply for the indigents.
The only way the "cheap lawyers for poor people" actually can be considered "charity" is if there are so few lawyers in the world that there are paying customers who never get a chance to have a lawyer because the lawyers are too busy doing "charity work".
Otherwise, it's just a business which already is operating and realises that making less money is better than making no money. Like a store that does a sale.
Typically private pays more than hospital, and rural pays more than urban. I'm not saying that there aren't plenty of doctors who make a lot, but there are also a lot of doctors who don't make plenty. (considering what hell residency is and the time spent before being about to practice)
Then why is there a shortage of rural doctors?
Even with the financial incentives they prefer the city life.
Because of the lifestyle, professional opportunities or medical infrastructure available? Or all three?
probably all three
Thanks. This has been a very informative exchange. I'm off to work. Take care.
When this past election removed republicans, although the republicans were not much better at governing than dems, the public removed the few who kept their finger in the dike.
Here is an example of one such rule. If I went to see a patient who could not pay, but needed a cholecystectomy, I could not, NOT CHARGE them without violating medicare rules. If I was willing to extend the hand of charity ot anyone, that was the lowest bid and that is what the medicare requirements allowed for my billing medicare. Obviously I was not paid for that service to that person, but I could not do charity work legally. That is not reasonable.
The Mexican invasion will be the straw that broke the proverbial back of the camel. So the medical profession is about to be further conscripted into the army of Hillary, as are hospitals and providers of all stripes.
When this past election removed republicans, although the republicans were not much better at governing than dems, the public removed the few who kept their finger in the dike.
Here is an example of one such rule. If I went to see a patient who could not pay, but needed a cholecystectomy, I could not, NOT CHARGE them without violating medicare rules. If I was willing to extend the hand of charity ot anyone, that was the lowest bid and that is what the medicare requirements allowed for my billing medicare. Obviously I was not paid for that service to that person, but I could not do charity work legally. That is not reasonable.
The Mexican invasion will be the straw that broke the proverbial back of the camel. So the medical profession is about to be further conscripted into the army of Hillary, as are hospitals and providers of all stripes.
If in the next bed after that was a high risk pregnancy where the woman came here from some other country to have an anchor baby, now that half million dollars must be divided by three. some estimates say there are 15 million illegals in the country right now, so those numbers add up quick.
Then include the costs for malpractice insurance for the three doctors, the hospital, the anesthesia people, and the pharmacy staff and you're talking even less.
Doctors make a decent living, but nowhere near the windfall that costs would indicate. Most of that money (and in truth... a whole bunch more after that) is being given away to someone else in the form of "FREE" stuff, at the taxpayers expense.
Ummmm ... That would be the Hospital.
Years ago, I was asked by the Hospital ER staff to come to the ER at 2:00 AM to evaluate an ER patient. At the time, I had just developed an infection in a blocked tear duct and was in pain. I asked the ER staff, as long as I was coming in at their request, if I could pick up my antibiotic prescription at the time I saw their ER patient. I paid for the antibiotic and it was only a few dollars.
The following month, the Hospital sent me a $50 bill for "ER services" for having the ER hand over the bottle of antibiotics.
bttt
How to reduce Healthcare costs.
As a physician this topic is near and dear to my heart. I was a family practice physician for six years and have recently changed to occupational medicine. Probably the best article I have ever read on the costs and potential solutions for health care comes from the Cato Institute at http://www.cato.org/pubs/pas/pa211.html.
The greatest cause of increased Healthcare costs is simply over utilization. This is due to a dissociation between the consumer and the product. When someone else pays your Healthcare bill whether it be your employer or the government you naturally will over utilize those services because you do not see the direct cost. Of course we all actually pay for our own Healthcare either in the form of taxes (of coarse some pay more than others aka Socialism) or decreased wages but we do not directly see this and therefore it does not influence our healthcare decisions. (See John Stossel’s excellent article at http://www.townhall.com/columnists/JohnStossel/2006/10/25/getting_medical_insurance_from_your_boss_is_a_bad_idea) The solution to this is simple. Employers should stop offering health insurance. The only reason that employers offer health care is because of antiquated tax laws. If everyone had their own individual insurance over utilization would be reduced. Think about it. Almost everyone driving has automobile insurance. You very well know what happens if you get a speeding ticket or in an accident that was your fault: you're rate will go up. If you know that you're rate will increase if you go to your doctor excessively or demand expensive services you naturally will become wiser when it comes to utilizing these services. Also if everyone has their own individual policies competition will increase among providers and innovation such as Healthcare savings plans will increase. What about the Medicare crowd? I see two possibilities to improve over utilization. One would be to stop paying the doctors directly. Roll the clock back to the time when the doctor simply gave the patient the bill and the patient submitted the bill to Medicare. This way the consumer actually sees the cost of the care. Since Medicare obviously would not pay the entire bill the consumer would be responsible for the deference and this alone would be reduced over utilization. The other option would be to make an average payment to each Medicare recipient in the form of a health savings account for them to spend on their health care. Talk about the sudden resurgence in frugality!
The next cause of increased Healthcare costs is technology. Here I will take to task my colleagues. We love the latest and greatest pills and tests. Many physicians enjoy pulling out the latest and greatest drug despite how much it costs or recommend the newest test without much thought to its cost. The only solution to this is better education for the physicians (I actually did get quite a bit of instruction in family practice residency on how to make the most cost-effective decisions) and making the consumer more aware of the costs. Part of the drive for the newest and best technology leads us to our next topic: risk of malpractice.
Defensive medicine significantly drives up the cost for health care. My favorite example is the headache patient. There is really no good scientific evidence that helps a physician decide when to get a CT or an MRI. A good rule of thumb is the patient’s age and neurological findings. But what most often happens? We get a CT or MRI on everyone just to make sure we don't miss that one in a million brain tumor. I could go on and on: x-rays for minor trauma, cancer screening tests that are marginal at best, unnecessary C-sections, etc. etc. How do we improve this? First, a true loser pay legal system. Second, a government sponsored set of clinical recommendations. (I know I'm not really thrilled about the idea of the government being involved in anything in Healthcare but actually I think this would be of benefit, let me explain……) Using our above example of headache and MRIs: the government would issue a set of recommendations for this specific scenario stating that a physician should only order a CT or MRI for a headache patient if they are over 45 or have neurological signs or symptoms. If that physician follows these recommendations,(they would not really be law so they don't have to) and they miss the one in a million brain tumor they would have protection from litigation. These evidence based very specific objective recommendations could then be used by the insurance industry to either justify or deny a given test. If a patient insists on having any of these tests they simply would be on their own to pay for them.
Another major cause of high Healthcare cost is regulation. There is entirely too much time and money spent on paperwork and regulations that have nothing to do with the care of the patient. There are many potential solutions that are beyond my meager knowledge of economics but I have one solution that I believe would go a long way to reduce costs. Physicians as a group need to stop accepting payment from insurance carriers. If you come to see me as a patient I simply gave you a bill and you pay it at the time of service. It would then be your responsibility to haggle with the insurance company over reimbursement. This would actually have several effects. It would greatly reduce the overhead for the physician. It would introduce greater competition among the physicians. If you tried to charge more than your competitors you would be expected to provide greater service. Most people do not realize that physicians must accept a certain level of pay from the insurance carrier despite the actual level of care given. And again it would reduce over utilization by making the consumer more aware of the actual cost of care.
The last major cause of high Healthcare cost (at least that I can think of) is indigent care. I hear people discuss the idea of socialized medicine all the time. We already have socialized medicine either in the form of higher taxation or cost shifting. The solution to this problem is very simple and I know will be very shocking to many people. Stop providing indigent care. Stop forcing hospitals to care for those who cannot pay. Oh! horror of horrors you say, who will care for those who cannot pay for health care? First there is an underlying philosophy to be discussed. Is Healthcare a right or a privilege? Healthcare is not a right but a privilege. You and I should not be forced to pay higher taxes or higher Healthcare costs because someone chooses not to purchase Healthcare insurance. (Yes, I believe there is a sizable portion of the populace who spend their money on beer, cigarettes and lottery tickets instead of purchasing health insurance or saving it for a rainy day.) Stopping indigent care would make those who could be responsible for their health care responsible for it. What about those who truly are in need or those who are faced with emergency our tragedy? Simple: charity. I do feel that you and I have a responsibility to help our common man who is truly in need. The big difference is that you and I should do this privately and should not be forced by the barrel of the government's gun. Let's bring back the charity hospital. Let's encourage and support organizations that pay for health care of those who are truly in need. Let's stop our current wasteful system of socialized medicine.
I know this is a lengthy post. I've discussed this on various forums over the years and have finally (it's been a very slow Friday) decided to put these ideas together in one post.
Eric Roth M.D.
excellent post.
I had a stent put in last year, spending one night in the hospital. The bill came to $40,000.
I am self-pay, so I paid cash.
Because I paid cash, they knocked $10,000 off the bill.
What that tells me is insurance claim handling drives up the cost of health care by a third.
"I would imagine, but don't know for sure, that a private insurance company might pay quite a bit more than this."
You'd be wrong. Our average third party private insurance pays between 105-115% of Medicare for office visits in "big" city SC. This thread for more info: http://www.freerepublic.com/focus/f-news/1773796/posts
Medicare is such the dominate player now (anywhere between 25-60%) of the reimbursed fees of a practice, that the price is kept low (obviously, there are many more variables, such as doctors not able to strike, not able to organize collectively for rates, etc). This is why doctors were screaming this year about the scheduled 5% cut from Medicare this year. That would've been the point for many of the doctors (like the orig. posting) that a big portion would've said "SEE YA" to Medicare.
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