Stanley Feld M.D.,FACP,MACE
I feel compelled to dwell on Alex Berenson’s article Sending Back the Doctor’s Bill because it is wrong and distracts from the main problems with the healthcare system. In fact, I find it an insult to our intelligence. I want to include some of the demoralizing examples that are widespread among the physician community. I will start by quoting Dr. Uwe Reinhardt.
“The low lying fruit in cost-containment (ie. physician reimbursement) was strip mined by the HMO movement and Medicare over 15 years ago. There is wide-spread disenchantment and lack of job satisfaction among physicians that threatens to split wide open over further aggressive pay cuts. You don't have to be a Nobel prize winning economist to understand the inevitable brain drain and service problems you'd create.”
If you review my blog entries on how this all started in the 1980’s you will understand how the easiest stakeholder to attack were physicians.
They are disorganized, individualistic, and political when necessary, and very competitive with each other. In fact, most of the competition has been directed toward and against each other in their local communities. When they perceived that their medical organizations did not represent their interests they walked with their feet and dues, weakening major organizations, that potentially could have aborted the mess our healthcare system is in.
It was very easy for the insurance industry to dominate the practice of medicine. They started dominating the access to care and the price of care. It is only a matter of time before the entire healthcare system implodes because of the insurance industry’s arrogance and greed.
Some physicians have just walked away from their medical practice as conditions worsen and the physician shortage increases. Below is the story of a much beloved physician in Summit County Colorado who practiced there for 25 years. He was at one point chief of staff at the hospital and has served on the Frisco Town council.
Throughout the past 25 years, he’s delivered more than 300 babies, handled countless emergencies, practiced family medicine and conducted altitude research. But soon, he will be moving on.
And even though he loves living in Frisco and will always call it home, in recent years insurance companies have become hard to deal with, making private practice increasingly difficult, he said.
“It makes the financial side impossible,” Bachman added. As a result, working for a company where he will not have to deal with that aspect of the business appealed to him.
He said he feels bad about leaving is patients, but knows he is leaving them in capable hands.
“I’ve always enjoyed the quality of the medical care in the community,” he said.
Sid Schwab M.D. a surgeon nearing retirement said...
“I saw Dr. Reinhardt’s letter (in the New York Times), too. What's depressing -- in addition to everything else in the world -- is the misconception people seem to have about what doctors (surgeons especially) do. Hey, cut their pay, put 'em on a salary, or (as one recent commentary suggested) hire a bunch of doctor/moms who'll be glad to fill in the gaps with part-time work, flood the market --problem solved!”
Snafu Suz a cancer survivor said.
“The American health crisis is many-fold (is that a word? anyway...). There is not one answer to the problem. The whole thing needs a serious overhaul. I agree that cutting doctor's salaries will hardly help and yes, it will demoralize our health professionals which is NOT a good thing. Personally I have a huge beef with insurance companies and think that would be a better place to start. Health care should not be a for-profit business. Doctors need to be paid just like everyone else, but insurance companies don't need to be running the show. Maybe we should start there? Maybe we should start with campaign reform so that our politicians are not for sale to drug and insurance companies? Maybe we should start with making higher education universal so that doctors and other professionals don't have to carry such astronomical debt? Maybe individuals shouldn't be running to their lawyers hot to sue for things that are unproven? (The silicone implant fiasco comes to mind.) As I said, this problem has many aspects and there is a lot of corruption. Doctor's salaries are not one of them. The guy who wrote that article is smoking crack. (Alex Berenson)
Susan”
I could go on forever but I think you get the point. We are all in search of the truth. We are all in search of the best way to Repair the Healthcare System. Mr. Berenson’s solution is not the way to repair the healthcare system.
The following is based on a letter I occasionally send to patients of Mr. Berenson's ilk:
Dear Mr. Berenson:
Over the past few years several patients, like you, have asked me "Why is my medical bill so high?". It is a very good question that needs to be answered in the context of our current health care system.
When I was growing up and went to my family doctor, my parents or I paid around $10 for a typical minor problem visit (in 1966). With inflation, that would be around $62 today (in 2006 dollars) (http://www.westegg.com/inflation). Today Medicare reimburses me approximately $33 to $45 for a similar patient visit. When I was a teenager the overhead costs of my physician’s medical practice were low. My family doctor did not make appointments and thus did not need a receptionist. When you were sick you simply went to his office and waited your turn to be seen. If it was a busy day with lots of patients, I sometimes waited several hours before I was seen. He did not employ nurses nor did he have a transcriptionist (typist) write his notes. He worked by himself, but did have a part-time bookkeeper. He called me back from the waiting room, evaluated me and usually jotted down a sentence or two and that was it. I paid cash at the conclusion of the visit. He did not deal with insurance companies so he had very few phone calls and paperwork to deal with. He did not have high malpractice costs and he worked from his home office.
Over the past few decades, things have changed radically. The overhead costs for a physician are astronomical compared to the good old days of my family doctor.
My overhead costs are many. I pay the equivalent of 5 full-time employees: 1 ¾ transcriptionists/receptionists, 1 office manager/receptionist and 2 ¼ registered nurses. I need a receptionist to make and change appointments, call and remind patients of their appointments, collect co-pays and to answer phone call questions. I need a transcriptionist to thoroughly document all that I do, as insurance companies periodically audit my work to see if my billing level is justified by the work I have performed. The transcriptionist also makes copies of patient records and types letters that I send to other doctors regarding their patients that I see. I need a manager to oversee the scheduling, billing, and other operational activities. My office manger spends much of her time tracking down payments owed to us from insurance companies and answering billing questions from patients. I need nurses to help with patient care. The nurses also answer phone questions, call patients with lab test results, deal with getting approval for medications from insurance companies, educate patients, and engage in other patient care-related activities.
I have medical licensing fees and ever increasing medical malpractice fees, even though I have never been sued. Medical equipment and supply costs, and building, utility and additional insurance fees add to my overhead costs.
Dealing with insurance companies adds other costs, including payments to a billing service that electronically processes and mails my bills, that cost thousands of dollars a year. It is unfortunate that insurance companies do not pay my practice for the extra work and hassle factors they create for my patients and me. When dealing with insurance companies I am at the mercy of their fee schedule. I document what I do, and I accept what they pay. If I feel that they are cheating me, or my patient, I will write a letter of protest to contest any denial of payment. Some insurance companies pay better than others. Some insurance companies are sensitive to the high cost of providing medical care today and some are not. A given insurance company may pay well for some services but poorly for others. There is one health insurance that I no longer accept because it paid too little and caused too many aggravations.
I provide free telephone advice to patients, and to physicians who call me with questions on patients I have never seen. I provide free care to charity cases and sometimes receive no payment from patients who can afford to pay me for my services (at a loss), including late night or weekend consultations at the hospital emergency room.
All the costs of running my medical practice, including the services provided by the transcriptionist, receptionists, office manger and nurses are paid for from the fees I collect for the services that I provide. When you receive a bill from me, it is important that you understand that only a portion of the bill actually pays me for my time, the rest goes to cover my overhead expenses of practicing medicine in today’s complicated health care system.
Occasionally there is a patient who is uninsured, or under-insured, who does not have the financial means of making payment for the services I have provided. If you feel you are such a patient, please call my office; explain your circumstances and we will work out a reduced payment plan that will help you.
Sincerely,
Your Physician
Posted by: Mr. Berenson's Overpaid Physician | August 20, 2007 at 07:12 PM