Wednesday, April 9, 2014

How Rich is Your Doctor?

Those damn rich doctors.  Bilking Medicare for billions a year.  Driving their Porsches and BMWs everywhere.  At least, that's what the New York Times and most media outlets would have you believe.

Today, to great fanfare, Center for Medicare Services (CMS) released the billing data of over 800,000 doctors.  This was done in the name of transparency.  Unfortunately, the data is anything but clear, helpful, or correct.

I looked up several doctors that I refer to.  There is no way their data is correct.  For example, one oncologist that I frequently refer patients to only had data for 10 patients.  I'd guess that I alone send her more than 10 Medicare patients a year.

I found my data somewhat depressing.  My reimbursement for an average visit with a Medicare patient is $47.  My reimbursement for a complex medicare patient is $73.  Those visits typically last about a half hour.  Keep in mind that that $73 has to cover my office's overhead, which runs...high.  Really high.  It also covers the work I and my staff do later on, like refilling meds over the phone, filling out the various forms that I'm always complaining about, reviewing lab and radiology results, consulting over the phone with other doctors...still think that doctors get paid too much?

Well, plenty of the commenters at the NY Times do.  What frightens me the most about the release of this data is that it is completely misunderstood.  For example:

What I learned about my opthamologist from this release is telling. That she alone in her practice of several was reimbursed close to $300K just for medicare reveals the tip of an iceberg. This is a small part of her practice, which suggests that her income is well into seven figures. While I’m all for her “right” to make as much money as you want, at what point does that become too much when it becomes an unreasonable burden on healthcare costs?

I recently switched to an ACA plan. I recently learned that this doctor’s practice is dropping two major insurers (including mine - all plans, not just ACA conforming.) I can only assume that the practice is gaming the system, pulling out to renegotiate compensation by these insurers, and in the meantime leaving their patients insured by these plans in the dark, not to mention in the lurch. All this for the sole sake of maintaining their very high compensation?

Many doctors have pulled out of ACA and Exchange plans altogether because the small percentage of patients seen under these plans have (relatively) low reimbursement rates. But, since this is fractional to their overall practices, they stand to lose little, if anything, considering some of these may be new patients.

Doctor’s carte blanche to opt out of these plans might well doom the independent insurance aspect of ACA altogether. Is it any wonder that the AMA was so staunchly opposed to the ACA?

Maybe I should bring a chicken to barter with on my next visit.
This commenter, like many, seems to think that her ophthalmologist actually was paid and got to keep  $300,000 from Medicare.  In fact, ophthalmologists have really taken a beating today.  However, one must keep in mind that most of these billings are for injections of Lucentis (I covered this in an earlier blog post).  The doctor has to buy the drug in advance, and actually only gets paid about 6% of the cost of the drug.  The rest of the money goes right out to the pharmaceutical company.  And that's before they even tackle their office overhead.

Then there's this one:

Medicine used to attract people who cared mostly about alleviating human suffering. The data has clearly shined the line on the lack of ethics among practicing physicians. Why the decline in ethics and medical ethics in particular? The profession's resistance to transparency, the false worship of technology, the lack of independent auditors to prevent or minimize fraud and waste, and the self-serving fee-for service practice. Can this nation ignore the threats of sickness-for-profit enterprises?
Ouch.  That hurt.

And this one:

I've been reading a number of responses here, allegedly from doctors themselves, that appear to care more about the billing and what they are paid per visit than patient outcome. (I'll bet they deal mostly with seniors too because the inevitable outcome is finite.) I have worked in the medical industry for years. This is a word of advice to all of the patients reading this column. The next time you go to your doctor, specialist or primary care, take a look at the car parked in the doctor's reserved spot n the parking lot, usually behind the office out of sight, then look at the doctor's trophies (photos, plaques, etc.) around his/her personal office. You'll be able to quickly determine what this doctor is really in the business for ego or patient outcome. You would not believe how many luxury cars and pictures of ski trips, fishing trips, etc. are out there.

These are the same providers who are also supporting the efforts to repeal the Affordable Care Act. Always follow the money trail. Those most fervently against reform are those profiting the most in the first place. 
Hmm.  Well, I don't have a reserved spot.  In fact, all of us who work in the building are told to park towards the back of the lot, so as to leave closer spots for patients.  I also don't ski.  Or fish. I seem to be doing everything wrong!

Now that we've thoroughly vilified physicians, I suggest we look at the bigger picture.  Payments to physicians were $77 billion.  Total Medicare expenditures were $600 billion.  That means the physician payments made up a measly 12% of total expenditures.  What about the other 88%?  Where is the transparency there?  Why have physicians been chosen as the scapegoat for out-of-control medical spending in this country?  If we want to have a true conversation about costs, lets look at the other culprits- pharmaceutical companies, medical supply companies, and hospital costs.

For the record- I drive a 2004 Honda with over 100,000 miles on it.

2 comments:

  1. 2000 Subaru Outback here. I'll admit I did go fishing over Memorial Weekend--at the local public boat launch where the kids and I fished for crappies. Did go skiing over Spring Break--drove 3 hours north, rented a cabin and took the kids cross country skiing. We live in 3 bedroom 1 bath house, but in a nice safe neighborhood with good public schools. I'm 43 and have finally paid off my education loans. We doctors, like all employees, park at the far end of the clinic lot.

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  2. Hey, paid off the loans at 43? Way to go! You're about 15 years ahead of me...

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