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| Home Front: Politix |
| How Government Killed the Medical Profession |
| 2013-04-23 |
| My current project, and several that I've worked on before, lie squarely in the middle of this, and the writer is spot on, as I'm sure Doc Steve will attest. Medicare and Medicaid compensation drag physicians' income down, for which they compensate by over-coding. Some claims or practice management systems have space for up to eight ICDs (diagnoses). Others allow as many as the practice can think up. The CPTs--treatments--are paid based on an allowed amount, which is not the amount that the practice actually bills. The allowed amount in other than Medicare/Medicaid cases are usually a percentage of the Medi/Medi rates. If you're going to get paid at half rate for doing something, it makes sense to claim you did two things and get your full rate or close to it. If your practice is primarily Medicare/Medicaid you might have to claim you did four or five things to be fairly compensated for one. All of this managed by interlocking bureaucracies of HMOs, PPOs, utilization managers, case managers, risk managers, and who the hell knows what else managers, plus claims processing. The feds, in the name of economy, try to keep the compensation per CPT down, the docs have to "perform" more procedures to pay for their own increasing overhead and the overhead of the institutions. And there's always political hay to be made when anybody makes a move toward changing the system. If you just keep squeezing his neck a little harder that goose will lay a few more golden eggs. |
| Posted by:DarthVader |
| #4 KiloBravo grew up in England and is very familiar with where we are heading. You'll wait all day to see a GP and then if you're lucky he will schedule a EKG to take place six weeks from now with the results back six weeks after that. The last report on England's National Health was that the Government wanted to get the wait time to see a specialist down to an average of 16 weeks. And, beware of the Liverpool Care Pathway. |
| Posted by: GolfBravoUSMC 2013-04-23 17:09 |
#3 This is a Mom & Pop business approach... No, it's a professional providing a service. |
| Posted by: Rob Crawford 2013-04-23 17:01 |
| #2 In the meantime he has to pay for the clerk that enters the patients info into his system, bills for the charge and possibly follows up on that billing. In addition to the time he spends interpreting the EKG he must dictate and have typed up a report for the Hospital client. Of course he has rent, utilities, payroll, equipment, etc. etc. to pay for at ever increasing amounts. This is a Mom & Pop business approach which is simply doomed, even without Obamacare. |
| Posted by: Anguper Hupomosing9418 2013-04-23 15:16 |
| #1 KiloBravo an I have been in the HealthCare computer business for almost 25 years. Before that I was a hospital IT consultant specializing in computerized billing. Having that background I read the article with great interest. Jeffrey Singer has highlighted every woe we witnessed in our interaction with our client Physicians. We cater to solo practices and small groups. Since the passage of ObamaCare we have experienced a rapid drop in customers as they retire or join large groups like Kaiser. There just isn't any significant number of new physicians starting independent practices to replace our losses. Just one anecdotal case of what independent physicians are facing: We have a solo practice Cardiologist who reads EKGs for a local hospital and other entities. He has charged $35 for over 15 years that he has been our customer. I was recently doing some work with the practice, cleaning up their Receivables. I noticed that when Medicare reimburses him they pay about $7.50 and Medi-Cal, California's version of Medicaid, pays about $1.70 if at all. He has to write off the balance. In the meantime he has to pay for the clerk that enters the patients info into his system, bills for the charge and possibly follows up on that billing. In addition to the time he spends interpreting the EKG he must dictate and have typed up a report for the Hospital client. Of course he has rent, utilities, payroll, equipment, etc. etc. to pay for at ever increasing amounts. My suggestion was to discontinue reading the EKGs or if he must don't bother to bill for them, especially to Medi-Cal/Medicaid. |
| Posted by: GolfBravoUSMC 2013-04-23 15:09 |