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Dear Lawmaker Why Aren’t Doctors Involved In Health Care Reform?

By admin | In blog | on March 5, 2014

KevinMD.com 12/16/2013

First, older doctors will retire early fed up with the system. These older doctors feel that the loss of a patient-physician relationship and the burdensome regulations (ie. paperwork) will choke off their ability to provide good care. In addition, their expenses are increasing with these new regulations. Add in the projected cuts in reimbursement up to 26%, and their livelihood will be threatened. These cuts could force these doctors out of practice or force them to stop seeing Medicare patients simply because their expenses (which rise yearly) are exceeding their declining reimbursement, which has declined steadily over the past several years already.

…. Unfortunately, the medical billing is unique, confusing, and wrong. The charges (bills) that patients see in the mail are not what doctors get paid. These are inflated numbers derived from contracts between hospitals or groups and insurance companies. A recent New York Times article headlines read “As Hospital Prices Soar, a Stitch Costs $500.” Sadly, these inflated numbers have nothing to do with what the doctor gets paid. In fact, those bills do not go to the doctor at all, but rather to the hospital.

…. This situation I describe above is not understood by our leaders as verified in this video of President Obama discussing foot amputations in diabetics. President Obama claimed that surgeons get paid “30, 40, 50 thousand dollars” for a foot amputation. Looking at the Medicare Fee schedule, CPT code 28805 states that the surgeon would get paid $738.90, which is the fee before his expenses are considered. This $738.90 needs to cover his office space, staffing, medical liability, and years of training to have the privilege of performing this life saving operation. Thus, the doctor actually gets paid 1.4% ($738.90/$50,000) of what President Obama claimed he got paid. Our leaders are clearly confused and have no right attacking physicians’ reimbursement.

Another example of confusing costs of medical treatment hits closer to home as my own mother presented to the ER with sudden blurry vision a few weeks ago. Concerned for serious causes for this symptom, several tests were run to rule out causes such as stroke or tumor. Thankfully, her diagnosis was nothing life threatening and is recovering. She then received the following bill two weeks later in the mail explaining her charges. I have attached a copy of the bill.

She was shocked at how high the charges were and could not decipher this bill. Referring to my explanations above, under “professional/physician charges,” it “appears” a physician gets paid $450.00 to interpret a CT head and $580.00 to interpret a MRI of the brain. As I described above, this is far from the truth. Looking at the fee schedule, code 70450, a CT head would pay a doctor $29 for a Medicare patient. This is far different than the $450 shown on the bill. In fact, it is only 6% of what the bill states! Likewise, an MRI brain, code 70558, would pay a radiologist $109. Way off from the charge of $580. There are other inflated fees for the hospital as you can see in this bill totaling over $11,000, but these are not related to a doctor’s compensation.


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