319 | Tragedies of Medicine
So I’ve finally started to get my thoughts on paper, well at least on my blog of some “simple” ways to change medicine and the current system for the better (See this photo for the first part of the story). I know I’ve teased all of you long enough. I figured out that it was too much to write all in one sitting. I’ve divided my thoughts into a 4-part blog series. The first is on my blog (linked here) and also below.
And it seems this comes in a timely manner, especially for primary care, given the results of the survey released in the news on Nov 18th: Many Primary Care Doctors Plan to Quit or Cut Back.
And I’m not doing a peace sign here; it was supposed to be a “2” since this is my second Flickr shot about this. Kinda looks more like a crude English gesture, though…appropriate for FGR today.
These are fictionalized stories, but based on true practices. You'll get my opinions on each over the next few weeks. Thanks for reading.
Tragedies of HealthCare Reimbursement
This is the first in a four part series about some disparities in the
current health care system in the United States that I personally have
a passion for. This part will present to you three scenarios that each
will be addressed in later posts. For each area I will later suggest a
"fix" or possible solution to the problem that essentially
will save many payors money and reward nonuse of services. However, I
know my ideas will strike an angry chord in many health care
professionals because it may hit them in their pocketbooks. And I am
prepared for the criticism. Please read along and check back for my
updates.
Scenario One:
Doctor “A” gets up at 6am. Makes it to the hospital by 7am; sees
around 8 patients there. She stops by the cafeteria for a coffee and
bagel before heading to her office to start seeing patients at 9am.
She has a half hour at noontime to grab a quick lunch and start back
up seeing patients until 5pm. Then she works on the messages, charts,
and insurance paperwork and is lucky to get out of the office by 7pm.
But she is on call tonight and the hospital already started calling an
hour ago. She may get to bed by 11pm, but the pager keeps her up all
night. And then the cycle begins again in the morning. This doctor
earns about $150,000 a year.
Doctor “B” gets up at 7am. He makes himself coffee and nice breakfast at home. At around 8:30 he enters his home office and fires up his computer. He logs in and views pictures all morning. He talks about them into a record, which later someone else will transcribe. When he finishes around noon, he goes out for a nice lunch at the country club and makes it to his tee time at 1:30pm. He never actually talks to a patient; he never gets a phone call from patients or a hospital. He is never “on call.” He can go to bed whenever he wants, not bothered by a pager at night. And then the cycle begins again in the morning. This doctor earns about $500,000 a year.
Scenario Two:
Person “C” has wanted to help people all his life. He decides to
become a doctor, specifically a pediatrician. He goes to college and
begins his studies: 4 years of undergrad, 4 years of medical school
and 3 years of residency training before he can be a physician,
working on his own. He was trained by other physicians and PhD, top
researchers in their fields. He works around 80 hours a week. He
barely makes $100,000 a year.
Person “D” has wanted to help people all her life. She decides to be a nurse, specifically a nurse anesthetist. She goes to college and begins her studies: 4 years of undergrad, 1 year of work as a nurse and then 2-3 years of nurse anesthetist school. She was trained by other nurses and nurses who are PhD’s in nursing. She works two or three days a week only. She easily makes just under $200,000 a year.
Scenario Three:
A primary care doctor sees a Medicare patient for an office visit. She
thinks her patient has heart failure, starts the initial management.
She orders labs and a echocardiogram. The echocardiogram is read by
the cardiologist who recommends the patient come and see him. The
primary care doctor spent around 15 minutes with patient and gets paid
around $50 for the office visit. The patient’s pharmacist later calls
and says the medication that was prescribed must be changed due to
insurance formulary restrictions. The doctor spends a minute or two
reviewing that patients chart before deciding on an alternative
medication. The doctor does not receive any additional reimbursement
for this service. She was still only paid $50 total. Later, the
patient drops off some paperwork for the physician to fill out for the
medical insurance. The doctor spends around 10 minutes filling out
that paperwork and having his nursing staff fax the complete forms to
the insurance company. The doctor does not receive any additional
reimbursement for this service. She was still only paid $50 total.
The patient arrives at the cardiologist’s office. The cardiologist is running late and spends around 10 minutes with the patient. The bill for his office visit, since he is a consultant for this patient comes to around $150. However, he wants to be sure of the primary care physician’s findings. So he orders a stress test be performed in his office. This doctor, since he can perform procedures in his office can receive additional reimbursement for this service. He is paid an additional $200. That combined with the fee for reading the echocardiogram earlier reaches a total of $500. The results of the stress test, read by this cardiologist, are “inconclusive.” He suggests the patient have a cardiac catheterization, which he can also perform. For this procedure he is paid an additional $2000. The cardiac catheterization reveals that the patient had heart failure. He recommends continuing the medications the primary care physician started.
Cost Comparison of heart failure diagnosis:
Primary Care Physician: $50
Cardiologist: $2500
(for this scenario, all reimbursements were Medicare estimates; values
slightly higher for third parties to primary care, greatly higher for
third parties to cardiologists)
Comments and faves
JOE MARINARO [deleted] (55 months ago | reply)
I thought it was a "piss off" photo, lol!
Interesting scenarios!
Scenario 2 is the one I am most familiar with. My wife is a critical care nurse at a leading teaching hospital. Although her work is quite stressful and she has "interesting dealings" with many residents and interns, she makes over $100,000 working just 3 twelve hour shifts per week.
They are also paying for her schooling 100%. She is well on her way to being "person D".
The last scenario makes me want to pull my hair out.
Black wolf (55 months ago | reply)
now you look like a british consultant(they don't like being called doctors).
we could do with some of your honesty in the nhs over here.
all the good hard working docs put in ungodly hours and are on call all the time, get paid poorly for their effort, yet self centered "specialists" do their best to never actually see patients get paid fortunes and half the hospitals staff are scared of them.
sorry rant over
Jeff__M (55 months ago | reply)
This is a really great shot.
Your story illustrates various points
1 The system is far from perfect, and I do think it's tragic.
2 It isn't what your position is per say, as it is what the person in a particular position knows, and the value of that position in a particular area.
JoeRocketh [deleted] (55 months ago | reply)
Cool shot. The scenarios have got me thinking...
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Seen in a discussion of the group "Flickr Group Roulette" (?)
SAMBoddy (55 months ago | reply)
as soon as I saw this I thought this was the "English" Rude sign you were flashing. we see it a lot at our house since my hubby is British.
Interesting scenarios - I can't wait to read the rest of this.
Olga_Greece (55 months ago | reply)
Oh my, you look so pissed. I like it!
The Doctr (55 months ago | reply)
Thanks, all. More to come!
beccaplusmolly (55 months ago | reply)
your healthcare system sucks. i'm sure there's problems with ours but i think you guys have so many problems with insurers that we don't have.
Τϊζζ¥ (55 months ago | reply)
Due to the fact that I'm a lazy bitch and don't want to read that right now, I'll just let you know that your shirt kicks ass.
And I might come back later and read that stuff. Might. lol
☼Anastasia☼ (55 months ago | reply)
Wow, this is pretty SICK and SAD, SAD, SAD :(
The photo does rock, however!!
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El_Sol added this photo to his favorites. (54 months ago)
hybridvigour (53 months ago | reply)
Hey, interesting. I am a primary care physician (GP) from London. I am gong to have a more detailed read of this post and your stream later. T
marcusgomez (47 months ago | reply)
Hello,
A short note to say that we love your shot and have used it for an article on ChickTimes.com, "The Great Workout Pretenders."
jessbair (46 months ago | reply)
Ok, I'm interested in Scenario Two for obvious reasons. What makes you think all Nurse Anesthetists work 'two or three days a week only' and the pediatrician works 'around 80 hours a week'?
Not to pick at the details but I have never in my life met a pediatrician who works an average of 11.4 hours a day, 7 days a week?! Perhaps you mean in a 2 week pay period? And if that's the case, in most hospitals there is no need for pediatricians to be on call for emergencies 24 hours a day (or at least not more than one at a time), and pediatric emergencies that are beyond the scope of the ER doc are relatively infrequent. Compare that to a Nurse Anesthetist who works all hours and is frequently involved in emergencies at all hours of the day/night. I would imagine the pay difference is largely due to the shift differentials for late nights and the call pay for being tethered to the hospital and unable to have much of a life. Again, the pediatricians I know of work 8-5, they don't work weekends, they don't work holidays and they are rarely called in for emergencies if they take call.
I know my situation is not the same as all CRNAs but for Pete's sake, me and my colleagues work an average of 80 to 104 hours per pay period. Two or three days only huh? Maybe I should come to your hospital.
jessbair (46 months ago | reply)
And while we're on the subject of affordable healthcare, how about we compare apples to apples, instead of anesthesia to pediatrics?
Anesthesiologists make about double what a CRNA makes. They can charge for 4 ORs at once, all that have CRNAs actually doing the anesthesia, under the 'physician supervision' rules. That doesn't mean they have to even enter the OR. We're extremely cost effective and safe. In fact, we've been doing anesthesia since before anesthesiology was even a specialty.
I think if you strip away all the junk in your scenario what you're really saying is that you're offended that a nurse in any capacity could possibly make more money than a doc in any capacity. Why? You see this phenomenon all over a free market. There are kids that didn't go to college at all in the software industry making more than you OR me.
savorologist, Possibilism, taranoel, and joshuawdavies added this photo to their favorites.