Has this question been answered?

Medical care in our country gets more and more expensive on an annual (and sometimes three or four times per year) basis. But from my perspective as an MD, it's not because the physicians are profiting from it. Every year my reiumbursement (as someone who generates the majority of my income from procedures, as opposed to seeing patients in a clinic setting) goes down 1 or 2%. It's not much, but it's cut by a percentage point or two every year. So if medical care costs more, the money's going someplace other than my pocket.

I'm a hand surgeon. My father was an internist. If you believe in the pecking order of entitlement, a hand surgeon should make more than an internist. I make the same amount today as what my father did when he retired...about 15 years ago.

yes

Thank you.

That's one of my peeves re: medical reimbursement, the "while you're there" concept. For those that don't know, when performing multiple procedures simultaneously (at one sitting), insurance companies will pay 100% of the fee schedule for the first procedure, and then 50% for the second, 25% for the third/fourth/fifth/etc, and then eventually just stop paying for stuff after awhile. (Or some variation on the above theme.) The insurance perspective is that you should get paid less for subsequent procedures done at the same time because you're already there.

OK, sometimes that makes sense. If we're doing two things through one incision, for example. If we're going to take out a gallbladder and a piece of liver, that's through the same incision. But if we're doing things on two different limbs? How is that "while you're there?" I certainly wish I could walk into a restaurant with my wife and order two specials, pay full price for the first, and 50% for the other meal because the chef's already in the kitchen and the oven's already fired up. Maybe I could buy one tire from Goodyear at full price and expect the other three at half price. Or order one lugnet from Pelican at full price, expect to pay half price for the next 9, and get the other 10 for free.

But there's no discrimination in medical billing. And IMO that originates from Medicare, as almost all medical billing in America is derived from Medicare rules.

Soooo many issues here. Insurance co execs making billions, who is paying for that? Breast implants for 85 year olds after mastectomy. No reasonable end of life care. Under billing is fraud just as much as over billing accd to CMS. Barely useful drugs costing thousands per dose for cancer treatment. Almost nothing for kids, no limits for elderly pts with dementia in a nursing home with no quality of life. It all makes my head hurt.

My dr wife (a pathologist) was just telling me that they (her group) are expecting the govt to reduce medicare payments by 30%. Which is a large portion of the groups income. Her income has going down every your since she became a partner. :rolleyes:

Any other md's have any insight on the reduction?

Food for thought... I work at a large institution, and we ran some numbers...

Every time a patient CALLS for a refill, it costs us about $25-30 to do it. Silly, right? But thats what it costs.

1) Someone has to take the message, thats about 2-3 minutes of phone time.
2) Someone has to enter it in the computer, and relay this to the doc, 1 minute
3) Someone has to pull the old chart , which is on another floor (several minutes)
4) Doc has to review the records, pray there is no issues (2-3 minutes)
5) Someone has to call, fax pharmacy, which takes a couple minutes (1-2 minutes)
6) Heaven forbid there is a prior auth, or pharmacy suggested changing to generic- add 15 minutes.

When patients call asking to be treated over the phone, thats a 10-15 minute conversation. Most docs just don't do it anymore. There is no "flex" in the schedule for it.

Right now this work is all "free." Some practices now charge for it. Medicare is in the process of trying to figure out how to reimburse for it. When they do, I suspect they will only pay for a bit of it- the rest will fall on the patient...

Just for frame of reference, the portion a doc gets for doing a physical in a patient with commercial insurance, is about $50-60. Thats it. If you are medicare, cut that number down...

And if anyone reacts like thats a lot of money, please go to med school and join us. Apparantly very few folks think its worth it...

Most folks will shell out $700 for a cars brake job, $1500 for a plasma TV, but a $200 medical bill is an outrage...

sigh

Medicare has been threatening 30% cuts each year for the last 5. But they realize that NO ONE wants to see medicare pts. Most in private practice will not accept new mediacre pts. Why would you? At best you break even on overhead.

There is some serious pain coming. The future will include health rationing, limited care after a certain age, etc. Its unavoidable.

That is a problem for both the physician and the patient.

It's probably even higher. You need to factor in the cost of your practice management software, computers, etc...

Dialysis? Didnt we do this already?

Yeah, it seems like a rip, if your wife didn't waste his time. Let the pharmacist call it in next time, and move on. BTW, you Doctors; We work for our money too, and pay high premiums for insurance. Paying 200.00 to renew a prescription that requires NO diagnosis or extra time IS a rip, and the OP probably isn't going to get over it.

We all need money, but seriously, 200.00 for less than a minute is a rip. If I replaced a door in your house, and you asked me to replace a receptacle in the wall and it cost me two minutes and 2.00, would you be happy if I charged you 75.00 ?

The OP wasn't charged $200 for a refill. That is incorrect, and there is lots of info missing. Docs do so much for free, its unbelieveable. Your anger is displaced. Try calling a lawyer with a quick 5 minute question...in most cases, its BILLABLE. And usually in 15 minute increments.

You take your car to an oil change place. They charge $60 to do a synthetic oil change. $150 for a trans flush. $100 for a radiator flush. DO you complain that you were charged for the oil change? They were already "in there." It took them several minutes...

Folks will pay $300-400 for the above, and its fine. Many jiffy lube places do this with high school kids as staff.

Yet, you go to a doctors office, who has 30 plus years training, highly paid staff, massive over head ($40-50,000 malpractice), huge liability, and is taking care of your health, and $300 for a half our visit is an outrage...

Your cell phone and cable bill are likely $300 or more per month. But if folks have to pay the same for health care, its an out rage...

Ok, I've waited long enough. i'll keep this short. My wife was in the hospital for 7mo and passed away, She had 10 different doctors working everyday to help her get back to health, it didn't work out, but I will say the Doctors are fricken heros in my book, the hospital was running the bill up at a rapid rate and the doctors didn't care, they kept working, out of the 1.8, they charged about 180. Most people see doctors as elitist type's, it's all about the money, I can tell you thats wrong, i've seen doctors show up at 8am, 9pm, weekends, with family, without family, all to help my wife, a few of them never got to speak to her. Moses, noah, who ever else is a MD on here, Thank you for what you do, you guys are heros in my book


And for the guys wondering, Delivered a baby and got Pancreatitis, then finding out she may have had Lupus.....zero symptoms before delivery

Scott

Scott, very sorry for your loss. That's a very nice story, though. In my opinion, docs should be making much more than they do. There is not much DIY when it comes to medical care, so we have to rely upon them heavily. They are worth it.

I am sorry about your loss, Scott. I wish you strenght.

Bo

Thank you so much for your kind words. I'm sorry for your loss.

The other day at our hospital we had an uninsured patient in the operating room bleeding internally after a car accident. During the surgery I found unexpected cancer. At 5 AM I called a cancer surgeon I barely know and asked for help. He arrived and operated for 4 hours, saving the patients life. He had to cancel his scheduled surgeries to do this. He left the operating room never having met the patient. The patient is poor and uninsured and will never get a bill of any kind from this surgeon. The surgeon's only questions to me were about the patients condition. This is how it is.

In 20 years I've never had a doctor refuse to help in an emergency and I've never had one ask me if the patient had insurance or was able to pay a medical bill.

This happened coming up on 20 years ago, seems like yesterday.

Motion moses and Bo, thank you, I'm doing fine, when i start to feel bad about it is when the fine cuban cigars come out and a nice glass of the oldest Tequila I can find, it seems to get me back on track



How did the Baby turn out?

She would be proud, I know I am

Cheers Boys

http://forums.pelicanparts.com/uploa...1319848899.jpg

fantastic!! I'd bet Mom is skating right along.