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.
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.
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.
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
(for this scenario, all reimbursements were Medicare estimates; values slightly higher for third parties to primary care, greatly higher for third parties to cardiologists)