Friday, January 30, 2009

Frivoulous Medicine?

One of the things that I love to rant about are what seem to be frivoulous lawsuits filed to drive the economics of the legal profession. I cant help but think that we in medicine are just as guilty. I mean, when I look at the surgeries that we do, only a small proportion are life and death in the sense that if the surgery is not performed, the patient will die as a direct result of their disease process. In fact, most of the surgeries are for pain or impairment in some way. The OR schedule if full of cataracts, elective hysterectomies, carpal tunnels and knee scopes.

The economics of this are amazing. We get paid more for the elective stuff than we do for the emergency life and death stuff. A 30 minute elective case pays more than the 4 hour cancer operation. I dont even want to go into the economics of all the medical tests! I guess the silver lining is that it is the elective stuff that generates the revenue that keeps the medical practices and hospitals financially afloat and the insurance companies flush with cash. I wonder what would happen if elective stuff had to be paid for in cash and not in insurance money? The problem with this stuff is the same as frivoulous lawsuits. They are not frivoulous for the person who wants the surgery or is filing the case.

1 comment:

SeaSpray said...

Hi Throckmorton -you said, "The economics of this are amazing. We get paid more for the elective stuff than we do for the emergency life and death stuff."

I do NOT understand that! I don't. How is it that they can devalue a surgery that SAVES A LIFE?

The 1st EOB I received with my urodoc's reimbursements for the 1st time he worked on me in the OR...I was sure they had made a mistake and promptly called the company. They said it was correct. I was still sure they were wrong and so ran it by my doctor. He thanked me for caring but said that is how it is.

I couldn't help but think there had to be a coding error. And even now..when I look at these...I still wonder. Of course reading so many medblogs...I do have insight into how shady some ins companies are with reimbursements, etc. As far as I know... mine is not shady though and they do pay.

I have had to get on them for an additional 15% payment to the non PPo docs I have because they are my only option in the PPO hospital I use.(anesthesia,radiology and ED)

My company has a 2-3 week turn around provider payment time and I know that is good. But I see on my EOBs exactly what you are talking about with surgery reimbursements.

I don't know if this is universal with ins companies but it seems he is paid proportionately better for any procedure in the office. It is better for me financially too because then I avoid all the hospital costs... but I am a wimpette.

But that 1st day... I was very sick, he had to try to open a completely closed ureter and then stent me and I don't remember everything involved now. He was successful. :)

But I couldn't believe the difference in what they said they would pay. And here he spends how many years in school/training and has the responsibility using his skills to help a patient.. a sick patient in ways that most people can't. AND... if he couldn't do it... it would cost the company even more money down the road.

You said, "A 30 minute elective case pays more than the 4 hour cancer operation."

How can that be. How do they justify that? I don't understand. The older surgeons must flip out when they see how they are paid!

I was wondering...if we do go to a national insurance..would that eliminate in Canada?

I know at our little hospital, they said it was the ED and SDS keeping the doors open. Their SDS schedules were always full.

Knee pain can hinder quality of life and I have been the grateful recipient of meniscal repairs. :)

The surgeries may not be frivolous but some of those lawsuits are.
I have a friend who worked for a local doctor's billing group and from the things she has told me... there were probably errors perpetuated (for various reasons in different areas of the billing process)and given the work ethics of some staff (nice people but always talking, all day long)I am not surprised that work is backed up and the doctors are not getting paid. Not only because of companies but because staff is slow. They did not care if they got all of the information.

Evidently these doctors put too much stock in an office mgr who is not up front with them or doesn't know what she is doing or is misrepresenting the facts somehow.

I am saying this because... unless docs have a conscientiously stellar staff/billers...or is possible that they are losing money because things are not.coded/billed properly and/or timely.

This isn't my area of expertise..but know of these things and have seen how shoddily information can be gathered and mistakes perpetuated at the hospital too... which also directly affects doctors who relied on hospital staff.

After reading medblogs for so long, I think doctors need to add business and law degrees to their training. :)