frustrated and confused...

[Fritz]

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Recently I have been reading about the whole malpractice insurance issue, and honestly it freaks me out. I was reading that the insurance premiums in some states were in the 200k for OBGYN and 300K for neuosurgeons. Now if a doctor has pay 200K for malpractice insurance, it means that they have to make at least 500 K gross income, so that they can afford to pay the insurance premium, their student loans and to be able to live decently. How many patients do you have to see to make that kind of money? Isn't this impacting the quality of care that you provide to your patients, since if you have to see a lot of people, you end up spending less time per patient?
I am looking at these numbers and for me simply they don't make sense. I think that the medical system in this country is going to hell, and lately I have started to question almost daily my decision of going into medicine. I don't know why but I feel that the lawyers and the insurance companies are going to decide what type of treatments I am going to provide and what kind of medicine I am going to practice. It's really not about the patient anymore, it's only about the money. Is there anyone else out there who feels the same way?

Fritz.

 

[terpgirl]

I definately feel you. I want to go into OB for the fact that if people shy away from it, in conjunction with many practices dropping that and only doing GYN, we're not going to have people to deal with all of these women. My intention is academic medicine, so that I have my behind covered quite well.... I know private practice can be much more lucrative but not everyone is going to make a boat-load of money with premiums so high and insurance reimbursements being just enough to cover the bare essentials.

Some places are very efficent when it comes to spending time with patients yet being able to make money. Hopkins specialists bill my insurance company around $300 for a visit--I pay a $30 copay (some it's $20, all dependant on who I'm seeing), and my insurance pays out around $110. $140 for a basic visit isn't bad. For surgery, they'll see 90% of what they charge. I know some complain reimbursements are low, but some aren't too shabby. But when you can negotiate with a an insurance company as a hospital I'd think you'd have more leverage than say a group of 3 doctors in private practice. Right?

CNN.com recently had an article about US not being the best place for medical care. It's under their health section, may be an interesting read.

I couldn't agree with you more. I think we need to shut down some law schools and stop producing so many lawyers (someone was complaining how easy it was to get into a law school since there are a HUGE abundance of them--cheaper and more profitable to run than a hospital!!). They've gotta eat somehow too, and they leech onto anything they can at times.

-Liz

 

[ophtho1122]

I wish I could get away with the same business practices the insurance companies get away with. The next time I take my car in to get fixed and the mechanic gives me a bill for $1,200, I'll just give him $700 and say that is all I think this particular fix up is worth. He'll have to accept it with a smile, and I'll go on my way.
If your insurance company refuses to pay for what is billed and you knew what the bill was going to be before services were rendered, then I believe you should be responsible for the part of the bill that the insurance company doesn't pick up. Should the doctor be the one to eat the cost? And, when the doctor does eat the cost, is it tax deductible? If it is, it seems physicians overall wouldn't have much taxes to pay at the end of the year.
I'm all for affordable healthcare but not at the expense of hardworking physicians that sacrifice half their lives just to get through medical school and residency. If greedy malpractice lawyers can pocket 40% of a million dollar + lawsuit settlement from people with birthdefects, etc. that really need that money, I think a hard working, honest physician deserves to at least get paid what he/she bills.

 

[beriberi]

You can't charge whatever you want as a doctor if you see anyone on Medicaid/Medicare (you can't charge any patient more, not just the federally subsidized ones). Reimbursement is incredibly tricky. That is one area a lot of money goes to--paying people to bill, collect money, negotiate with insurance.

Usually, physician salaries are quoted after costs (i.e. nursing support, OR fees, malpractice insurance). So, even though insurance costs effect how much people are paid, if you know a doctor that makes 200k, they make 200k.

Also, you don't need 300K a year to live a decent life. Student loan payments on 210K can be as low as 500/month for the first 10 years, 1000 a month for the next 20. (At current rates).

These things (billing rules) do not occur spontaneously. They are the (somewhat) predictable result of years of overbilling. The system changed to keep that from happening anymore. It may have gone too far the other way, but you should understand some of the history behind all of this.

 

[freelancewriter]

Interesting article - Malpractice: Docs sue Docs
http://chicagobusiness.com/cgi-bin/news.pl?id=12256

The article above doesn't talk about this, but what I find fascinating about malpractice suits is that they often rely on "expert testimony" from doctors who are "expert witnesses." Without these doctors, would the lawyers be so successful?

 

[dr.smurf]

when you as a group or solo practioner are deciding on which insurance carriers to accept cant you limit your coverage acceptance to those companies known to pay the most pay out? Or are they pretty much standarized? I know its all a percentage of what medicare deems as sufficient (which is a load of crap).

Also I was wondering if you could theoretically make your pts pay a higher copay for your services?

I know how bad this sounds, but Im just wondering. Im not out to screw my pts for $$$, but s*** something has to give!!

 

[edmadison]

If your insurance company refuses to pay for what is billed and you knew what the bill was going to be before services were rendered, then I believe you should be responsible for the part of the bill that the insurance company doesn't pick up. Should the doctor be the one to eat the cost? And, when the doctor does eat the cost, is it tax deductible? If it is, it seems physicians overall wouldn't have much taxes to pay at the end of the year.

Actually the patient is liable for the difference. That is unless you decide to take and insurance plan that is take it or leave it (Medicare/Medicaid) or have chosen to be in a provider network (PPO HMO) where you agree to the insurance companies fee schedule.

Ed

 

[beriberi]

You can't charge different prices to different patients. ($50 for medicare office visit, $150 for other people). You have to have one set rate. If any of your patients (just one!) is on medicare/medicaid, then that price has to not exceed 120% (I think, this number may be off a bit) of the medicare price--for any patient. Anything else is medicare fraud.

You can expect patients who are insured to pick up the price difference, however, most insurers reimburse better than medicare (so there is not so much difference to pick up).

This all assumes you have no contract with any HMO/PPO (as ed pointed out above, these negotiated contracts will further hamper your ability to set your fees).

 

[banner]

You better be scared.

There are three solutions for all of us:

1. Devise a way to use the system to your advantage.

2. Learn to love being a whiny martyr.

3. Quit.

You must realize that lawyers aren't 100% to blame. Physicians, who refuse to lobby collectively on anything (they all think they're still fighting for AOA or something) are also to blame for this crisis in medical care. Medical schools poorly pick candidates who are likely to become useful leaders in medicine using outdated criteria. Who cares about the guy who set up a clinic for the indigent, give me the guy who wants to do this for the money. He's the guy who will surely more likely defend the professions' monitary interests. Also medical schools fail to teach medicial students to swim (or even that they will be swimming) with the sharks. The Deans would rather push primary care so that the school gets more government funding.

Face it, you're sitting at the "dork table" of society's lunchroom and the jocks are going to pound on you every day. Forget about your loser "friends" sticking up for you.