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Poll: Healthcare, specifically Surgeon costs.
My Dr was telling me today that some time ago Obama has said that Surgeon's make decisions for surgery based on the fact that they will get paid more then just treating the problem. I googled and came across this youtube video http://www.youtube.com/watch?v=rm9jdDHdFV0&feature=related
I'm seriously annoyed at this, and so is the American College of Surgeons. The link is to an article that the ACS posted on the website in response to Obamas accusations. They also send out a letter to Surgeons regarding the issues,my Surgeon received the letter.
This conversation came up after a patient told us that the hospital charged her 60k for the surgery and a 2 day stay.
So, I want to know: Do you think that surgeons really get paid thousands upon thousands of dollars for surgery?
Appendectomies are a common surgery my Doctor does. He's probably done 20 in the last 6mths. What do you think he gets paid for an appendectomy, from Medicare. We'll use Medicare as the example since they are the standard that most insurances base their payments off of.
I'm sorry this is kind of a rant. It just totally irks me.
[Poll]
Re: Poll: Healthcare, specifically Surgeon costs.
I should add that i am not complaining about the amount the Dr. gets paid. I am just annoyed that, a very public figure, the president, is going around saying that they get paid an insane amount of money for surgeries. When it's not true.
Obviously I don't know the cost of brain surgeries or more serious surgeries, but I can find out.
All surgeons i don't think get paid through the roof however i'm sure there are some that do and probably rightfully so. I know when my mom had knee surgery the surgery itself wasn't expensive it was everything else, I know for my c section the doctor recieved about 200/300 for the surgery the hospital stay and everything else came well over $200,000.
Yes, it is the hospital stay that increase the cost. In the video Obama says that an ENT would rather take out tonsils because he will get paid more than just treating whatever is causing the tonsilitis. in the ACS article they said that Obama said in some other meeting that a surgeon would rather amputate because he will get paid 50k..the ACS came back and said that the Surgeon would actually only get paid a little over 1k for an amputation.
The Surgeon does not see any of the money that gets paid to the hospital. I just think its a big misconception. It's just frustrating.
I can't see the video since I am at work. Is it a video of P.O actually saying that?
Let me add a little to this....
I worked an attorney about 10 years ago that was defending a doctor who was charged with insurance fraud and I learned way too much about the way insurance companies function (atleast in the state of NJ). It was a troubling and yet eye-opening experience and because of it was one of the reasons I believe our health care system needs a rehaul.
Anyway - without going into the details of the case, I can tell you that doctors don't have a clue as to what they are going to get paid for procedures and treatment performed. Each insurance company has a fee-schedule, that is not published, which indicates a range of what they will pay for every billable medical code. This fee schedule fluctuates throughout there year and is based on a myriad of data.
Doctors "blindly" bill the insurance companies based on a guestimate of what they think they insurance company will pay them in accordance with their fee schedule. If you ever look at your statement from the insurance company, you'll notice that the doctor may have billed the insurance company $200 for XYZ procedure, but the insurance company only paid him $43.
It doesn't start out at the beginning of his speech but the first thing he says when the video starts is, "forced to make decisions based on the fee payment schedule."
Then he says, "if you have repeated sore throat, or your child has repeated sore throats then the dr might look at the reimbursement system and say you know what i make a lot more money if I take this kids tonsils out. Now that might be the right thing to do but I'd rather have that dr making those decisions based on whether they actually need their tonsils out.... {he starts to stutter here like he can't think of what to say} .... or maybe your kid has allergies.
So, normally, most Doctors won't just go start cutting unless they've exhausted all other options. In all honesty, the Dr will get paid more if he continues to just see the kid rather than doing surgery.
Reimbursement for a tonsilectomy is about $310.. Again, we'll use Medicare fee schedule. The Dr. gets paid $101 for the intial visit, then $64 for every visit after that... So if he continues to see the patient @ $64/visit then he's going to make more. Once he takes the tonsils out the problem is gone and he doesn't need to see the patient anymore, right?
Huh? Doctors do have an idea of what they will get paid. They are given a fee schedule. It's not published to the public but I can easily go on the Medicare website right now and find out what I will get paid for an appendectomy for a medicare patient.
BCBS bases their fee schedule off of Medicare. So, for a BCBS patient we may get paid 95% of the Mcare fee schedule.
If the Doctor is contracted with a certain insurance there is a set fee schedule. If they are out of network then you would be correct the Dr has no idea what they will be reimbursed.
Also, as far as charges being more then what is allowed; Most places set it up that way because all fee schedules are different as you said. My office bills everything out at a certain rate regardless of insurance and patient. This is much easier then adjusting all my rates based on insurance, this would take me effing forever to do my billing. It takes long enough as it is.
I can tell you right now what the Urgent care that I used to work for gets paid for every insurance patient that walks in the door.
Also, in the 4 years i was at the Urgent care our fee schedule did not fluctuate. It stayed the same until contract negotiations were done.
Obviously I don' tknow how it works in NJ since all my experience is in FL.. if that's the way it works in NJ thats horrible.
and Yes, healthcare needs a major overhaul, but my feelings on this will stay in my head because I'm not willing to start a huge debate about it on the internet.
Ok, so based on that and on Kissyfur's info, and based on FMIL's experience, I would say maybe he is just generalizing (which when you are the President, I would think that you would make it clear that you are generalizing, but if that is the case here, it doesn't seem like he made himself clear.) This may be a case of an anecdotal minority representing the majority.
My FMIL is on Medicare. She had an appendectomy done middle of last year-ish. She goes home (against the Dr.'s wishes) and while giving herself a sponge bath, she popped some stitches. She goes to her PCP, and he says, "Lady, you didn't need the apendectomy." I'm not sure what that tells, but it seemed fishy to me on all accounts.
Now she thinks she has a lawsuit.
Well, good luck w/ that lawsuit- Another reason why Drs are quitting, or can't make it in the first place. Malpractice insurance is insanely expensive.
I'm assuming the PCP was looking at the CT scan, and the pathology results when he told your MIL she didn't need an appendectomy?
Why would she go to her PCP and not the surgeon who did the surgery. It's his/her responsiblity for the next 90 days to take care of anything surgery related.
I also don't understand what you mean when you say he is generalizing? generalizing what?
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To answer your question, I currently work for one of the Largest Medicare/Medicaid managed care plans in florida. The amount that Medicare pays is minimal for services, however for our providers that are contracted with us, in their contracts certain doctors get 150% of Medicare/Medicaid allowable, so just because basic medicare will pay that amount, doesnt mean the managed care plans that take care of most patients will pay the base rate. Also, I have worked in private healthcare and some of these providers payments are based on a percentage above the customary allowable of Medicare.
I know you probably feel that providers do not get paid a lot for their services, but think about the providers that are capitated. That means we pay doctors a CHECK every month, regarldess if they 10 or 100 of our patients, plus other services rendered still are paid in excess. I do believe healthcare needs a complete overhaul, I am not able to watch Obama's speech at work, but I assure its a generalization, that has some factual proof. IMO
I couldn't agree more. Everytime I look at a bill that comes through I'm horrified what's being charged, and what insurance is paying. One bill I saw, they paid $14 for the equivalent of 3 Tylenols. Really? Not to mention the $450 my insurance paid out for three stitches in my finger that was done by someone who had just finished med school and took all of 15 minutes. It wasn't a complicated procedure, I don't care that it was done by a newbie - I was horrified the insurance company paid that much for a newbie for a simplistic procedure!
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I can't bold on my Mac so I wanted to just pull this.....
To make the $310 after the initial visit, a patient would need to see the doctor at least 3 more times. I personally would not see a doctor 4 times for a problem that still wasn't being corrected. Especially a sore throat.
Over a year ago I had nasal polyps removed and a deviated septum fixed. I had Cobra insurance so my responsibility was 50%. I ended up paying 6K for the surgery out of pocket to the hospital, and a little over 1K directly to the doctor's office. So I can see that not all of the money goes to the doctor, but I wouldn't doubt some doctors suggesting more expensive procedures in order to get paid more. Some doctors probably prefer to do surgery and get the problem taken care of immediately vs. dragging it out with other options.
Oops. Sorry. I wrote some more stuff in there and edited it, because I thought it was superfluous. Guess not. Maybe it was a generalization of surgeons?
I have no idea- He's been in practice 6mth.
I agree, healthcare is outrageous, but the Drs aren't the ones who dictate how much they get paid. The insurances are.
I understand that some plans pay above that.. None of the ones we are one, but they do.
My whole point to this is that Obama is making speeches about Drs doing surgery when it's not necessary to make more money.
I'm not here to argue about whether or not I think My Dr gets paid enough, that is completely irrelevant. I think the general public has no idea what Drs/Surgeons actually get paid and then you have Obama going around saying they get paid 50k for one amputation which is simply not true.
Right, I also understand about capitated services.
I also know that some Drs will not order things for patients because it gets into their incentive/bonus money... I hear a lot of things with various reps that come in and out.
I think the capitated thing sucks for some providers, and some providers bank with it.
I'm not saying that our healthcare needs an overhaul. That is blatantly obvious.
The point of this post was not how incredibly high healthcare costs are.
The only rates that Doctors set are for their self-pay patients. Everything else insurances dictate. You can ask for whatever rates you want, but the end result is the insurances will give you what they are willing to give you.
LOL.
Okay.. I wanted to say more about that law suit business, but out of respect I just shut it.
Also, from what I've heard from my Dr. appys are rare in elderly people, so maybe that is why your FMIL pcp felt she didn't need one...
True the doctors arent the one's who dictate their payment. But they do dictate which insurances they sign a contract too. So if the provider thinks he doesn't get paid enough by a particular insurance company, when its time to renew the contract, the doctor has the ability to not renew.
Good point! And if you are an established patient you either have to find a new doctor or pay out of pocket.
This is true, they do have the option of opting out.
If they do not contract with insurances then who pays for health care services that are given?
Again, I was not complaining about how much, or little Surgeons get paid.
I go to the Doctor the same as everyone else. I have to pay my copays and I gripe about the fact that I have to pay $25 for the ortho to spend 5 minutes with me and say good luck.
I feel like this is getting turned into something it initially wasn't.
Maybe it was misinterpreted- I honestly just wanted to know what you thought a surgeon would get paid for a surgery. If you thought it was thousands of dollars, or not. I'm not saying I think they should get paid more. I mean, really, an appendectomy is an hour long surgery. Hardly worth thousands of dollars.
I've been on the ginormous surgery bill end. Chris has had heart surgery, and he had surgery on his ankle. Trust me, when we got the bills i was like jimminy cricket 20k for a stupid ankle surgery? That surgeon is banking... not so much. His heart surgery was even more nuts.
I dont' have time to read all of these post right now, but I wanted to add that Dr.'s do get a fee schedule, like you said. Before I was a teacher I worked for about 5 years at a Dr's office as a receptionsist. The Dr.'s sometimes wouldn't see patients with certain insurances or perform certain procedures on them because they knew how much the insurance company would pay and they didn't think it was enough.
In my experience working with cardiac/thoracic/vascular surgeons for the past 5 years, what drives them to do surgery after surgery is ego-driven and always wanting to be the first to try something new. The type of surgeons I deal with on a daily basis have very large egos. And they make a crapload of money. Yes, they are very passionate about their patients for the most part, and are really good at what they do (most of them), but I don't think they do all the surgeries they do just to make more money.