Comments on: We have socialized payments with free market expenses.

By: brian

brian — Wed, 24 Jun 2009 20:56:21 +0000

As another quick point…

NPR recently ran a story on Medical Advocacy.

http://www.npr.org/templates/story/story.php?storyId=105161828

When did Primary Care Doctors stop being their patients advocates? maybe thats the problem?

insteed of looking to “others” to be patient advocates. shouldnt we just pay our primary care doctors to do that job? seems awfully important to me…..

By: brian

brian — Wed, 24 Jun 2009 20:42:58 +0000

I commented this on your “what’s wrong with healthcare” blog on June 8th.

I dont need or want any recognition… just makes me happy to know you see and understand my point. I’ve said this a few times in the Doctor’s lounge at the hospital and got blank stares… LOL.

keep up the good work. love your blog.

brian

By: JPB

JPB — Tue, 23 Jun 2009 14:41:55 +0000

Good question solo dr! I have wondered the same thing about my family’s insurance premium – but wait, could it be that it goes to profits for the insurance company?!?! Until we take the profit margin out of medical care (and I am not talking about salaries), we won’t be able to change anything.

By: solo dr

solo dr — Tue, 23 Jun 2009 01:43:14 +0000

A full premium for a young family of 4 is running over $8,000 a year, even if the children are past most immunizations and the family takes no chronic medications. For all the visits, assuming the adults each come in twice and the kids come in once a year, I would get between $200-$300 for the visits. Where does the rest of the premium go?

By: Bohdan A. Oryshkevich, MD, MPH

Bohdan A. Oryshkevich, MD, MPH — Mon, 22 Jun 2009 16:18:20 +0000

We also have free market tuition charges for medical students making it difficult to accept socialized payments. Hence the migration from primary care.

Bohdan A. Oryshkevich, MD, MPH

By: JPB

JPB — Mon, 22 Jun 2009 14:08:12 +0000

to solo dr: I have made this point many times – office visits should be the responsibility of the patient. Most of us could afford to pay $55-60 and get the insurance companies out of our business. This would also hopefully allow the companies to lower insurance rates (yes I am hopelessly naive). If all doctors would do this and abandon the 2 tier fee schedule (i.e. accepting a lower fee from insurance but charging self-pay patients a much higher fee), that would be a start on real medical care reform!

By: solo dr

solo dr — Sun, 21 Jun 2009 19:34:48 +0000

Likely half the US population is covered by Medicare, Medicaid, Tricare, civilian Federal jobs, state jobs, and/or other government related plans.

In my area a level 3 routine office visit from Medicare is 59.98, public knowledge and available on their website. Medicare is fair in that it pays all FP and IM physicians the same fee in my zone. Unlike private plans, where 10 different doctors will have 10 different fee schedules for the same code from the same insurance plan, Medicare is fair. As a solo doctor I receive a take it or leave it fee schedule from each insurance plan, with 80% of my private insurance plans at fee scheduels that are 10-20% below Medicare.

The current system encourages more frequent office visits to make up for the low fees and more patients to see daily to maintain overhead and profits. Quality is rewarded through Medicare with between a 2-4% bonus on certain meausures, which often comes out to about $1-$2 a patient. Since Medicare is less than 25% of my visits, this means that I can make a massive $2,000-$4,000 bonus by spending hours going through quality measures.

A true free market would eliminate office visit coverage and good doctors could charge more for good care and poor doctors would get paid less for each office visit. Insurance and government coverage would be limited to hospital care and large studies only. I would be willing to see cash patients for about $55-$60 a visit, just to not have to deal with the insurance companies.