"it's so hard for primary care docs to get reimbursed" -- what does this REALLY mean?

I am doing a several month Rural medicine elective which has a lot of time in the office, so I am learning a lot about billing and coding and all those minor things that they never teach us in medical school (and aparently teach us very little about in residency, because it is not like we need to know it).

From the experience I have had and from hearing doctors complain this is what I have found. Paps are almost always paid for because the appropriate aged woman needs them (some insurance companies are not paying for older women and rightfully so), the problem is in the well adult exam, you know the Q2 year physical for the average adult without medical problems, or the guy with only hypertension who wants a full physical because for some reason people think physicals help (they do not by the way, there are lots of evidence to argue against routine physical exams) anyway, most insurance companies will not pay for them and most people cannot afford a 120 dollar bill for a physical so this is the problem - the doctor eats the bill.

Also labs, PSA one hour shy of one year, no payment. Not a diabetic, no fasting glucose (even though it is hard to diagnose DM without it). The other problem is to give appropriate care to the chronically ill, you cannot see more than 20 patients a day and truly do a complete job and no practice can survive on this. That is why PA and NP are essential to primary care because they can see like 30 a day of the acute.

Again, not a doc, not practicing, but spending the last 8 months in a primary care office, this is what I see and hear all the time. You really just need to know what each insurance company wants, but since there are so many, the secret is know what medicare wants because most insurance companies follow medicare, except the really good ones like Mutual of Omaha, the pay for everything and very well too. 140% of medicare, that is unheard of.

 

3rd party payors reimburse disproportionately more for procedures than for cognitive activity. I have to spend 30 min of a 20 min trying to figure out vague symptoms, then send on to someone else who will get paid more to deal with a diagnosis I've already made. A radiologist down the hall makes 200k more than me, has almost no call, 4 weeks more vacation, almost no patient contact, & has no further responsibility once the Pt's gone.

Not to say I don't get paid plenty, but there's a definite feeling the system is unfair.