A dark secret in America's medical community...... (attorneys, carry, money)

[pommysmommy]

Anyone in the medical field knows that the technical component (interpretation) of a radiological study pays poorly. Why would any doctor not trained as a radiologist risk a malpractice suit for a few dollars?

[Flem125]

Originally Posted by sol11

Very few physicians interpret their own MRIs alone. That is left to a trained technician/radiologist who bills you/your insurance company separately for that service.

Close...but not quite.
ONLY a physician can interpret and bill the professional component of a radiologic study. A technician can perform the exam but not interpret the image and bill for.
Additionally...you wouldn't want them to. They have 0 training in that.

[sol11]

Originally Posted by Flem125

Close...but not quite.
ONLY a physician can interpret and bill the professional component of a radiologic study. A technician can perform the exam but not interpret the image and bill for.
Additionally...you wouldn't want them to. They have 0 training in that.

I've NEVER been billed for x-rays or MRIs by a physician. It has always been billed by a radiologist who interprets the procedures.

[Flem125]

Originally Posted by sol11

I've NEVER been billed for x-rays or MRIs by a physician. It has always been billed by a radiologist who interprets the procedures.

A radiologist IS a physician.
The MD or DO after their name is the give away.

[sol11]

Originally Posted by Flem125

A radiologist IS a physician.
The MD or DO after their name is the give away.

That is true,...but I didn't make my point clearly. I've never been billed by my ATTENDING physician for interpretation of a MRI or an X-ray. That billing is separate,...from a radiologist.

[suzy_q2010]

Originally Posted by Cavaturaccioli

The other thing is to move your practice to a hospital (where the paper pushing can be centralized and done affordably). This is pretty much part of the Obama plan, eliminate the family doctor and substitute her/him with a government paid and controllable doctor at a nice government controlled hospital.

When that happens, unless there is some incentive for productivity, doctors will see fewer patients. If they are paid the same for seeing 20 patients per day or 40, how many do you think they will want to see?

Originally Posted by Xanathos

The average doctor in this country makes over $300,000 per year. If a 25% drop in what Medicare is giving them is what's causing them to go broke, they should re-evaluate their business model.

I don't think so.

For the math majors, these are median salaries, not "averages":

Physician Salaries - Average Physician Salary - PayScale

For a family physician: $142,506; for a plastic surgeon: $204,235: for an OBGYN $183,445.

Originally Posted by Factsplease

I am related to some and also work in the Healthcare IT field so I deal with quite a few too and they are doing fine. The ones I know work less than 40 hours per week.

What specialties? Salaried employees or private practice? Most docs in private practice who take night call work far more than 40 hours per week, often 60 hours for something like OBGYN.

Originally Posted by ovcatto

Wait, wait...wait. Can I believe what I am reading???

Doctors are going broke because the government subsidies, and that's what medicaid and medicare payments are, are becoming less and less??? In other words the free market doesn't support the number of doctors in the market and it is the government's job to infuse the medical economy with taxpayer money to keep these practitioners in business? Tell me this isn't the underlying reality of the arguments that I am reading???

The reality is that reimbursement by Medicare and Medicaid is so low that it barely covers expenses. These are not "subsidies." They are insurance plans, partially tax funded and partially premium funded (Medicare.)

Originally Posted by ovcatto

The real dark not so secret of America's medical community:

1. $1 billion dollars per year in research grants to pharmaceutical companies for drug development which they in turn are allowed to patent sole rights to.

2. FDA approval which certifies to the public that their products are both safe and effective much like the Good House Keeping award, or UL approval. No small thing when it comes to marketing.

3. $3.8 billion in grants from the National Institute of Health for medical research, again with the patents and profits going to the various grantees.

4. $10.3 billion in direct subsidies to medical schools.

5. $125 million to provide loan tuition loan forgiveness for medical students who accept positions in under served rural communities.

And that is without mentioning the $516 billion in payments to the medical industry.

So to blame the federal government of "forcing" doctors out business, despite the billions of dollars expended by the federal government, as small as the medical establish feels that it is, feel free to explain how many of them would be in the market if left to the sole vagaries of the free market.

By the numbers:

http://www.chcf.org/~/media/MEDIA%20...areCosts10.pdf

Payments to doctors have held steady at about 21 to 22% of total health care spending since 1988.

Doctors in private practice see none of the medical school money and none of the research money, unless they conduct clinical trials, which few do.

If someone is getting loan forgiveness for practicing in an underserved community, he is likely to be receiving a salary at the low end of the scale. A rural family medicine doc probably is not going to make the median salary noted above.

The article was about doctors in private practice. Decreasing Medicare reimbursement to family doctors and internists who have large percentages of patients in those plans would indeed put a lot of doctors out of business.

Medicine is not a free market. The doctor and the patient are not free to negotiate prices. The government and the insurance companies are in firm control of prices, and private insurance siphons off a significant percentage of the health care dollar for administration, including in many cases astronomical CEO salaries.

Originally Posted by Chango

I was just charged $5K to get a MRI done. HTF could doctors possibly be going broke?!

Did you pay the full $5K? If you are uninsured, you may have. If you have Medicare or private insurance, the bill was probably paid at a significant discount. Think of the billed price as the "Manufacturer's Suggested Retail Price." Medicare, Medicaid, and private insurance never pay MSRP.

A radiology procedure typically generates two bills: a facility charge (for the cost to use the machine and the salaries of the techs to run it and maintain it) and a bill from the radiologist to interpret the results. The doctor who ordered the test got nothing. It is illegal for the doctor who orders a test to benefit from it financially.

I had surgery last summer. The total bill from the hospital, before discounts, was about $32,000. That included all the surgery suite charges, room charges, medications --- everything. My private insurance negotiated that down to a little under $4,000, of which I ended up paying about half in deductible and copayments. The surgeon's fee was similarly discounted.

The bad news is that if you are uninsured, you are subsidizing the care of insured patients.

Originally Posted by ovcatto

Pardon the expression but you are speaking out of your anal sphincter. According to the Government Accountability Office the national average, as of 2009, was $4,000 per year for internal medicine; $10,000 per year for general surgeons; and $17,000 per year for OB/GYN's.

Both of you are wrong. $100,000 is too high for most specialties in most states, though premiums vary wildly with location and specialty.

Medscape: Medscape Access

The numbers in this article are over a year old, but rates in most places have been stable or slightly declining for the last two years. The variation is largely due to the presence or absence of limits on awards for pain and suffering and the particular legal climate in some regions.

For most OBGYNs, if rates were $17,000 per year, you would hear champagne corks popping from Puget Sound to Poughkeepsie.

Here are some premium numbers from 2010:

amednews: Medical liability premiums steady, but big extremes remain :: Jan. 17, 2011 ... American Medical News

Internal Medicine: $3,200 to $48,000
General Surgeons: $11,300 to $193,000
OBGYN: $13,400 to $192,982

Originally Posted by ovcatto

Actually shifting to electronic medical records part of the AHCA, will save the medical industry some $142-$371 billon.

Don't expect EMRs to save you money at the doctor's office. All that data entry takes time, and actually interferes with patient care. Do you want your doctor's eyes on you while he is talking to you or on a computer screen?

For some specialties which do a lot of testing and generate a lot of numbers that need to be tracked carefully, it is helpful. For many others, not so much.

Take a simple visit to the pediatrician to see if your child has a strep throat. The old fashioned paper chart might look something like this:

Date: 1/6/2012

Subjective: sore throat since yesterday afternoon

Objective: age x, weight xx pounds; temp 100.2; pharynx red; tonsillar exudate present; a few tender cervical lymph nodes. Rapid strep test positive.

Assessment: strep pharyngitis

Plan: penicillin [dose appropriate for age and weight of child]
any instructions to the parent, including when to come back.

That can be hand written in far less time than it takes to go through a dozen levels on an EMR, entering the age on one page, the vital signs on another, the physical findings somewhere else, the test results on another screen, the diagnosis on yet another, and finally creating the script, which can be printed and handed to the patient or sent electronically to the pharmacy (perhaps the most useful part of the process.)

However, from the EMR we now have all sorts of facts that can be counted. How many cases of strep did this doc see this week? this month? last year? the same months this year and last year? Useful for epidemiology perhaps, but at a cost to the doc in terms of time --- time not spent with the patient.

The EMR is being pushed hard, but the bottom line is the insurance companies want that data. The systems are expensive, will be designed so that expensive, frequent upgrades are necessary (earlier versions will not be "supported"), and will not be cost effective for a lot of offices.

I have good friends who are pediatricians, very savvy business people, and very savvy computer users. They recently started a new practice from scratch (after starting and selling a couple of practices and "retiring". ) Their practice was profitable within a very short time. But the EMR did not play a part in that. They find the click, click, click with the computer just a big annoyance. They are profitable because they are good docs who take good care of their patients. One of them was the one who diagnosed my older son's leukemia.

The EMR will not do a whole lot to improve care of the patient in most outpatient settings.

Originally Posted by Chango

Technicians run it, but a doctor interprets the images. I'm pretty sure he gets paid to do it, too.

But the physician's fee is only a fraction of the total cost. Most of it is the facility fee.

[pommysmommy]

Originally Posted by suzy_q2010

When that happens, unless there is some incentive for productivity, doctors will see fewer patients. If they are paid the same for seeing 20 patients per day or 40, how many do you think they will want to see?



I don't think so.

For the math majors, these are median salaries, not "averages":

Physician Salaries - Average Physician Salary - PayScale

For a family physician: $142,506; for a plastic surgeon: $204,235: for an OBGYN $183,445.



What specialties? Salaried employees or private practice? Most docs in private practice who take night call work far more than 40 hours per week, often 60 hours for something like OBGYN.



The reality is that reimbursement by Medicare and Medicaid is so low that it barely covers expenses. These are not "subsidies." They are insurance plans, partially tax funded and partially premium funded (Medicare.)



By the numbers:

http://www.chcf.org/~/media/MEDIA%20...areCosts10.pdf

Payments to doctors have held steady at about 21 to 22% of total health care spending since 1988.

Doctors in private practice see none of the medical school money and none of the research money, unless they conduct clinical trials, which few do.

If someone is getting loan forgiveness for practicing in an underserved community, he is likely to be receiving a salary at the low end of the scale. A rural family medicine doc probably is not going to make the median salary noted above.

The article was about doctors in private practice. Decreasing Medicare reimbursement to family doctors and internists who have large percentages of patients in those plans would indeed put a lot of doctors out of business.

Medicine is not a free market. The doctor and the patient are not free to negotiate prices. The government and the insurance companies are in firm control of prices, and private insurance siphons off a significant percentage of the health care dollar for administration, including in many cases astronomical CEO salaries.



Did you pay the full $5K? If you are uninsured, you may have. If you have Medicare or private insurance, the bill was probably paid at a significant discount. Think of the billed price as the "Manufacturer's Suggested Retail Price." Medicare, Medicaid, and private insurance never pay MSRP.

A radiology procedure typically generates two bills: a facility charge (for the cost to use the machine and the salaries of the techs to run it and maintain it) and a bill from the radiologist to interpret the results. The doctor who ordered the test got nothing. It is illegal for the doctor who orders a test to benefit from it financially.

I had surgery last summer. The total bill from the hospital, before discounts, was about $32,000. That included all the surgery suite charges, room charges, medications --- everything. My private insurance negotiated that down to a little under $4,000, of which I ended up paying about half in deductible and copayments. The surgeon's fee was similarly discounted.

The bad news is that if you are uninsured, you are subsidizing the care of insured patients.



Both of you are wrong. $100,000 is too high for most specialties in most states, though premiums vary wildly with location and specialty.

Medscape: Medscape Access

The numbers in this article are over a year old, but rates in most places have been stable or slightly declining for the last two years. The variation is largely due to the presence or absence of limits on awards for pain and suffering and the particular legal climate in some regions.

For most OBGYNs, if rates were $17,000 per year, you would hear champagne corks popping from Puget Sound to Poughkeepsie.

Here are some premium numbers from 2010:

amednews: Medical liability premiums steady, but big extremes remain :: Jan. 17, 2011 ... American Medical News

Internal Medicine: $3,200 to $48,000
General Surgeons: $11,300 to $193,000
OBGYN: $13,400 to $192,982



Don't expect EMRs to save you money at the doctor's office. All that data entry takes time, and actually interferes with patient care. Do you want your doctor's eyes on you while he is talking to you or on a computer screen?

For some specialties which do a lot of testing and generate a lot of numbers that need to be tracked carefully, it is helpful. For many others, not so much.

Take a simple visit to the pediatrician to see if your child has a strep throat. The old fashioned paper chart might look something like this:

Date: 1/6/2012

Subjective: sore throat since yesterday afternoon

Objective: age x, weight xx pounds; temp 100.2; pharynx red; tonsillar exudate present; a few tender cervical lymph nodes. Rapid strep test positive.

Assessment: strep pharyngitis

Plan: penicillin [dose appropriate for age and weight of child]
any instructions to the parent, including when to come back.

That can be hand written in far less time than it takes to go through a dozen levels on an EMR, entering the age on one page, the vital signs on another, the physical findings somewhere else, the test results on another screen, the diagnosis on yet another, and finally creating the script, which can be printed and handed to the patient or sent electronically to the pharmacy (perhaps the most useful part of the process.)

However, from the EMR we now have all sorts of facts that can be counted. How many cases of strep did this doc see this week? this month? last year? the same months this year and last year? Useful for epidemiology perhaps, but at a cost to the doc in terms of time --- time not spent with the patient.

The EMR is being pushed hard, but the bottom line is the insurance companies want that data. The systems are expensive, will be designed so that expensive, frequent upgrades are necessary (earlier versions will not be "supported"), and will not be cost effective for a lot of offices.

I have good friends who are pediatricians, very savvy business people, and very savvy computer users. They recently started a new practice from scratch (after starting and selling a couple of practices and "retiring". ) Their practice was profitable within a very short time. But the EMR did not play a part in that. They find the click, click, click with the computer just a big annoyance. They are profitable because they are good docs who take good care of their patients. One of them was the one who diagnosed my older son's leukemia.

The EMR will not do a whole lot to improve care of the patient in most outpatient settings.



But the physician's fee is only a fraction of the total cost. Most of it is the facility fee.

Kudos for the most informative post on this thread.

[Flem125]

Originally Posted by sol11

That is true,...but I didn't make my point clearly. I've never been billed by my ATTENDING physician for interpretation of a MRI or an X-ray. That billing is separate,...from a radiologist.

Yep...my point to your original comment was the technician does not interpret or bill only the radiologist (i.e. Physician).
Don't call a radiologist a technician...he'll get REAL testy!!!!

[Crossfire600]

Originally Posted by Xanathos

The average doctor in this country makes over $300,000 per year. If a 25% drop in what Medicare is giving them is what's causing them to go broke, they should re-evaluate their business model.

Do you have a clue? They spend 8 years of school and a min 5 year residency making next to nothing? If you want some hack cutting your chest open go to the hood if you want a skilled surgeon you pay for it! You people can't get past your envy. Unfreaking believable

[sol11]

Originally Posted by Flem125

Yep...my point to your original comment was the technician does not interpret or bill only the radiologist (i.e. Physician).
Don't call a radiologist a technician...he'll get REAL testy!!!!

Point taken!!