[BITList] healthcare usa

CT's x50type at cox.net
Tue Mar 30 17:04:12 BST 2010


best healthcare in the world?

this may be of interest, it's the comments of a doctor [they always call themselves "physicians"] on a Porsche web site responding to a thread about changes in healthcare in the usa.

I think with most of them it's sour grapes now that their profits are under scrutiny. long ago it became open sesame for smart young men to make lots and lots of money as a "physician" in the usa. times seem to be changing.

money making and not patient care has been the goal for a long time now.

this poor guy, what a tough time they/he has, down to one Porsche and one Lexus.....................................!

ct

      fang911  
      Registered User   Join Date: Mar 2009
      Location: Chicago
      Posts: 110 
      Rep Power: 11 
     

Absolutely- it is NOT an insolated case, and illustrates why private practice family practitioners and internists who are not part of a large multi-specialty group and don't own their own diagnostics have to see so many patients a day to stay in the black. What's the biggest complaint about docs? "They don't spend enough time with me"- patients say. Well, here's why-

The average overhead for an internists office is enormous, averaging 50-70%- a good RN costs $25-30/hr + benefits, receptionist $12/hr + benefits, biller/paper pusher $10-12/hr + benefits + rent $20/hr + transcription services / IT / etc ($?/hr) + malpractice (40k/yr = $20/hr) = >> $120/hr EASY. Let's say you want to practice like Alan's brother-in-law and see 2 patients an hour. Medicare will pay you about $50-80 per patient (Medicaid far less) -> so you would AT BEST, break even with this model. So how do you make a living and avoid eating out of a dumpster? By seeing MORE patients- upwards of 4-5/hr. 

Seeing 4 patients an hour sounds reasonable- 15 minutes/pt- but that 15 minutes includes - the actual office visit (5-10 minutes) and documentation (5 minutes) + other (calling other docs, filling out disability paperwork, refilling scripts)- so the actual face time is very short. But unfortunately now, the documentation aspect is huge - Medicare/CMS are in process of sweeping MD offices across the US with subcontracted billing experts and giving them a commission to audit physician office and hospital charts to determine if enough has been documented to justify that $50-80/bill- so we can't just jot down a couple of quick notes- it must be COMPREHENSIVE- and that takes time. And most docs aren't going to wait until the end of the day to document on 30 charts (they would never go home) - they're going to squeeze that in as part of the patient visit. 

And if you're seeing a 70 year old with diabetes, heart disease, hypertension, gout, and hyperlipidema - good god - what can you really get accomplished in a (net) 5-10 minute visit? You can barely review labs results in that time. So what happens? The primary doc either asks the patient to come back frequently to discuss different things that can't all be addressed in a single visit- or they end up going to a bunch of specialists who are reimbursed at a somewhat higher rate who can take a little more time to focus on a single problem- and patients are unhappy about this- more copays, visits, etc. But patients, esp. Medicare patients, have to understand that crap reimbursement for non-procedural specialties mandate that docs do not have the luxury of time when taking care of them. 

So what happens if Congress doesn't fix the flawed SGR model of determining Medicare reimbursement (scheduled to lead to a 21% drop in physician reimbursement later this year)? It will lead serious access problems AND physicians who do take Medicare will be forced to see patients ever more quickly --->>> lower quality of care. Or we'll end up having a multi-tiered service model- Medicare and medicaid patients get 10 minute office visits, whereas insurance and private pay patients get 20 minutes or more- call it discrimination, but if you keep taking whacks at reimbursement while our overhead keeps rising- something's gotta give. So for Congress to come out and say that they can decrease reimbursement to providers and improve quality, and not affect access- that's flat out bull****. 
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