What's Your Doctor Worth?

American Thinker ^ | January 25, 2007 | Linda Halderman, MD

[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.

That's where my office gets involved.  Five or ten faxed pages arrive on my assistant's desk.  She calls the Gynecologist's office to request additional material, including copies of the mammogram report, the patient's contact information and insurance data-if the patient is insured.

As it happens, like more than 60% of the women I care for, this patient is either uninsured or underinsured by Medi-Cal or BCEDP, the State of California's breast cancer detection program for low-income women.

The paperwork piles up.  Now my assistant must confirm eligibility in addition to scheduling the consultation, creating a chart and retrieving x-rays for me to evaluate.  Prior to the visit, I review the chart and create an electronic medical record.

Next, the visit.  Your neighbor arrives at my office.  I speak with her for about 15 minutes, learning her medical and surgical history, asking about symptoms and risk factors, and answering questions.

I examine her carefully, assessing not only for breast abnormalities, but also for swollen glands in eight regions of the body.  A heart and lung exam is done to identify problems that would make her a higher surgical risk, and the neurological, abdominal and musculoskeletal evaluations provide evidence for or against tumor spread.

After my patient is dressed, she asks me to bring her sister and husband in for the discussion of my recommendations.  This is often the most time-consuming part of the visit, requiring patience, repetition and reassurance for a frightened patient and her concerned family.

Although our first visit has ended, the work has not.  I fill out a form ordering testing to further characterize the abnormality seen on my patient's mammogram.  I'll pore over a list of codes required by Medi-Cal to identify the visit, choosing the most appropriate ones and hoping they don't merit automatic rejection of the bill (a frequent occurrence, prompting up to nine months of back-and-forth debate with Medi-Cal).  Because the necessary biopsy requires a Radiologist's assistance, I'll communicate with him as well as the Pathologist who examines the specimen provided.

The diagnosis is Breast Cancer, and it's my job to break the news.

Our second visit is very different.  Not only do we talk about her diagnosis, we review all of the options for treatment, alternatives and their possible outcomes.  There may be tears and anger, self-blame and fear, and the inevitable, impossible question: "Why?"

This visit is the most difficult one for my patient and her family.  I, too, find it the hardest part of being a Breast Cancer Surgeon.  Some wounds cannot be healed with sutures and sterile bandages.

Back to the question at hand: How much is your doctor paid?

What payment will be made for the initial consultation and exam?  What dollar amount is assigned to the time spent with my patient and her family, explaining and encouraging, counseling and comforting? 

Every doctor who practices independently must be not only a medical expert but also a good enough business owner to keep the doors open.  No amount of compassion, however critical to successful treatment, will pay the bills. 

Payment for a visit must cover the rent and utilities to keep the office open.  Office staff needs to be paid, their health and dental insurance premiums covered.  There are additional payments to be made for Worker's Compensation, malpractice and liability insurance.  Office supplies, medical supplies, biopsy equipment and disposable instruments are essential and expensive.  There are also laundry and cleaning expenses, postage and biohazardous waste service.  Your doctor must also pay the 24-hour answering service, the billing company, as well as the bookkeeper, accountant and attorneys.   And, like everyone else, your physician must pay Federal taxes, State and local taxes, payroll, income and unemployment/disability taxes.

Here are the actual Medi-Cal billing codes and payment schedule for central California breast cancer Surgeons in 2006:

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.

This is what your doctor is paid.  Now ask yourself what she is worth.

Dr. Halderman is a Board-Certified General Surgeon practicing in rural south Fresno County, California.

[neverdem]

Thanks for the links & comments.

[cardinal]

"back to patient-doctor relationship".....A M E N!

Away with middlemen (ins. companies) injecting control and add-on fees to health care costs..

[CharacterCounts]

You have summarized my point very well. I make very little on these cases but, I am really just putting in extra time.

[CharlesWayneCT]

And I wasn't trying to minimize your work or attack you or anything -- I re-read my post and it could have been seen that way and I wanted to apologize for the inference....

[djreece]

Thank you for the in-depth post and the link to the Cato article.

[neverdem]

97 Reasons Democrats Are Weak On Defense And Can't Be Trusted To Govern In Wartime If you haven't heard LBJ on audiotape explaining why he had to commit to increase the number of troops and the fighting in Vietnam when he had no hope for winning, you need to listen to that link. LBJ makes Carter and Clinton look great.

Talking Ourselves Into Defeat

Facing the Islamist Menace [Hitchens reviews Steyn]

From time to time, I’ll ping on noteworthy articles about politics, foreign and military affairs. FReepmail me if you want on or off my list.

[Alamo-Girl]

Thanks for the ping!

[Chode]

looks like Medi-Cal still pays more than Medicaid here in NY. $6 bucks for a 99212.

and they get THEIR FRIGGIN GAS MONEY PAID BACK TO THEM by NYS tooo!!!

tell your insurance company you want your gas paid for when you go see your Dr. and they'd laugh to death.

[Chode]

my bad... i meant to post to #1.

[WV Mountain Mama]

Whatever. I had an ultrasound the my insurance refused to cover. The bill was $303. After months of the hospital claims department and my insurance company going back and forth, they covered it. Their cost-- $105 with their discount. I like how even though I had insurance that denied the claim, I would have paid the full price to help cover the cost of some non-paying, uninsured person wo goes to the ER for a cold.

[freespirited]

What if surgery wasn't needed?

A good question.

I think that is a real problem with some kinds of surgery, hysterectomies being the first that come to mind. Would be surprised though if breast cancer surgery is abused in the same way.

At least I hope it isn't.

[Arizona Carolyn]

This doctor is absolutely correct. I work for a California MD and know this is no exageration. It's one reason I get so angry when I read some of the posts right here on FR about overpaid doctors.

[Arizona Carolyn]

They would have rejected it or perhaps even triggered an audit, which even if proven to be billing legitimately would chew up weeks of valuable time that could be spent tending to patient care and records.

[Arizona Carolyn]

The anesthesiologist received more because the anest... literally holds your life in his hands while you are under the knife for the knee operation. For sure this may not be fair to your doctor because you depend on his expertise to walk properly after surgery.

These things are all weighed out and many times the person making the decisions on whether the doctor delivered proper care isn't even another doctor, but a RN hire by your insurance carrier.

[Fairview]

You are absolutely right. And that's why many or most doctors' practice managers have to become experts in delicate conservative coding. (I believe that in general they are dismissive of the physician's ideas about the proper code anyway.)

[Arizona Carolyn]

Well, what you do is go over the bills with a fine tooth comb and ask questions if something seems out of line. ICU is expensive, the level of care is extraordinary and the personnel working there is as well. The real key to lower healthcare costs is a healthy lifestyle and diet which will keep you out of the doctors office and/or hospitals.

[STD]

Most Fire Departments are made up of Volunteers

[Arizona Carolyn]

Let me ask you this. Does this hospital care for a lot of indigent people? Illegals? If so you have the reason the bills are so high, they are not a not-for-profit center and have to make up the short-fall to the bottom line with people like you or I who have insurance... and this is totally different from the subject of this article which is what doctors really earn.

[Popman]

This a bit disingenuous

The fine Dr makes a boat load on the actual surgery.

Yes, he bites the bullet in the office, but makes it up in the OR

[Fairview]

She provides no data on compensation for surgery. It's a good bet that there is a reason.

Medi-Cal compensation for surgery is just as pathetic as for office visits. I'd be amazed if she made as much as $300 for the procedure. She is basically giving charity care here.