Do more work and make more money. It’s the American way right? Of course it is. In Medicine regardless of what you may hear from experts we make our money one of just a couple of ways.
We get paid by “fee for service”. In this model, the more complicated the medical problem is, and the time spent, the more money is paid. Sounds reasonable right? Not so fast though. Insurance companies base reimbursement to us medical folks on what Medicare typically will pay for, so safe to say Uncle Sam is setting the price. This payment also differs depending on if you are a new Patient versus someone you have previously treated. I guess they figure things get less worthy the more you know your Provider. Over the years the payments to us has fallen off dramatically and the result?
You wait in an office waiting room for God knows how long, finally see your Doc and he or she can only spend 7 minutes with you. You can’t share how you really feel, your concerns, worries, questions about tests, medications and so on. You leave the office and feel like you spent half your day for what? Then you walk past the parking lot and see nothing but BMWs, Mercedes or Lexus (you get my point).
How do they do it? Numbers. Most Practitioners are forced by non-medical budgeteers to increase output during the day to make up for lost revenues and make a profit. After all, can’t keep the lights on and pay the person who ignores you behind the front desk can we?
This may work well for healthy folks with limited medical issues, but for the rest of us, we need more time and attention. As a result complicated issues are not given the treatment they deserve and folks drive away disappointed.
The other type of commonly provided care is the large non profit type companies that have one stop shopping. These HMO type places are large and I refer to them as “industrial” medicine.
These places you have multiple practices including most of the specialties in one place. Specialties such as orthopedics, cardiology, neurology and the like. Check in, put on the gown that opens in the back and go from place to place getting the care as indicated by your primary care person. Remember to always wear clean undies. The only issue with these types of facilities?
Choice. You have none. If you belong to such a practice model you must go to their Docs, their specialty clinics. If you move away, forget about it, find new insurance and care. If you go on a vacation overseas and something happens, open your wallet. I am sure you have heard of folks having an accident and their insurer won’t cover due to “out of network” status. Maybe you needed medical airlift service. Take out a loan to pay for that.
There is a growing trend for so-called concierge practices but most of us average folks cannot afford such expensive care, so insurance paid care is the only option. These practices will usually charge a set monthly or annual fee to supposedly give you exclusive access to your Doctor, even if he or she is on the golf course or ski hill. Not sure about that. Some of these plans will also bill other insurances if you have that as well.
In the meantime, we continue to chase the dollars. The government and insurance companies will continue to set the standards for medical practices as to what they will or will not pay for, how much they will and what they require to be documented. The focus becomes less on what is actually done for the patient and more on the proper coding and meeting standards and guidelines set forth so we can squeeze as much pay out of them as possible for our services. You would not believe some of the silly nonsense we go through just to get you the care you need. This is what detracts from doing what we love to do and care most about. Taking care of our patients. Instead, we’ll have to continue to chase the money so we can keep the lights on.