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First, you are wrong that "no eye doctor works on the weekends"..did you even try to call the office?
Second, ER care is expensive, which is why you only go there when needed. Did you look at other options in your area. The urgent care center near our house has 24 hour care and would be equipped to deal with something like this quite easily.
Third, it's not just the doctor that needs to be paid out of that bill.....
Fourth, $1000 for an ER visit is pretty cheap actually....
First, you are wrong that "no eye doctor works on the weekends"..did you even try to call the office?
Second, ER care is expensive, which is why you only go there when needed. Did you look at other options in your area. The urgent care center near our house has 24 hour care and would be equipped to deal with something like this quite easily.
Third, it's not just the doctor that needs to be paid out of that bill.....
Fourth, $1000 for an ER visit is pretty cheap actually....
Doctors fees are less than 10% of healthcare spending. Yet they are always pigeon holed as the "greedy doctors". The hospital and insurance company CEOs are laughing on the way to the bank.
Doctors fees are less than 10% of healthcare spending. Yet they are always pigeon holed as the "greedy doctors". The hospital and insurance company CEOs are laughing on the way to the bank.
The numbers that I see suggest that the percentage of health care expenditures made up of physician fees is 20%.
Obviously, there is much more to high health care costs than doctor's salaries. However, twenty percent is a significant part of the overall cost and reform of health care costs is going to require that some attention be given to these fees.
An average family doctor in my state earns between $140,000 and $150,000 per year. These figures are a bit skewed though because apparently they count the income of resident physicians who are earning way less than practicing physicians are. I compare this salary with what a district court judge in my state earns. Our state pays district court judges about $130,000 a year currently. There are perhaps 100 district court judges in my entire state. On the other hand, we may have as many as a thousand family doctors. Should each one of those family doctors really earn more than a district court judge does? Let's take this a bit further. Family doctors are among the lowest paid of all physicians. I believe pediatricians earn a bit less, but that is about it. Specialist physicians, depending on their specialty earn between $175,000 and $300,000 per year in my state. Doctors of internal medicine would earn closer to $175,000 and neurosurgeons would earn close to $300,000.
This is more than doctors earn in virtually any other country in this world.
My basic problem with all salaries and expenditures in the healthcare field is that I don't see them as market driven. In fact, they may be impermeable to market forces. The need for medical care is overwhelming and when people get sick they are going to want to pay any price to get better. Its not the same thing as negotiating over the price of a car at the local Ford dealership. In that context, there is plenty of time to make a choice and the participants in the transaction have clear alternatives available to them. I can put off buying a new car. I can go to Toyota and find a comparable vehicle. I can even go to other Ford dealerships.
I think this country has to look at physician salaries and what can be done to reduce the cost of delivering care. I think much primary care could be delivered by physician assistants and nurse practitioners. Another possibility is allowing a few more foreign doctors to immigrate to the USA and practice here. Perhaps, the entrance requirements for these doctors should be loosened a bit.
We need to look at a whole lot of things. However, physician salaries are one of them
This article from Atlantic Magazine may give you an idea just how high physician salaries are. It was eye-opening to me.
No matter what the billed amount is Medicare will only pay the amount it allows. There is no "system to pay bills automatically". Fraud happens when bills are sent for services that were never provided.
I'm afraid you're wrong. Doctors and hospitals that accept assignment are paid automatically. I think the time frame is 48 hours. Only later are a certain percentage of cases audited. To be sure, Medicare will often only pay a certain amount, regardless of what is billed. As for "fraud"? Sure. The automatic payment system is part of the problem.
Let's say a provider opens a clinic of some sort and passes the initial Medicare screening procedures. Let's further assume that provider isn't honest. He may well see real patients, but there's not much to stop him from submitting false claims for services that were either unnecessary or never provided. Sooner or later he will likely be caught, but it will likely be later and by that time he's probably skiing in the Swiss Alps on taxpayer money.
I'm afraid you're wrong. Doctors and hospitals that accept assignment are paid automatically. I think the time frame is 48 hours. Only later are a certain percentage of cases audited. To be sure, Medicare will often only pay a certain amount, regardless of what is billed. As for "fraud"? Sure. The automatic payment system is part of the problem.
Let's say a provider opens a clinic of some sort and passes the initial Medicare screening procedures. Let's further assume that provider isn't honest. He may well see real patients, but there's not much to stop him from submitting false claims for services that were either unnecessary or never provided. Sooner or later he will likely be caught, but it will likely be later and by that time he's probably skiing in the Swiss Alps on taxpayer money.
Nothing is automatic. A claim has to be submitted to Medicare just like the commercial payers, and they are often denied the first time around for no good reason.
a few weeks ago My dad had a retinal tear on a weekend, when no ophthalmologists were available.
It's urgent, but not a true emergency, although it could worsen to a retinal detachment.
In such weekend cases, you go to the ER, and they page the eyedoc on call.
<snip>
I didn't want them to do unnecessary tests and labs.
With no signs of stroke, they wanted to do a CT scan on my dad. I refused that too.
Finally, after the ER doc went through the motions of doing a half-assed eye exam (didn't even dilate the pupils), she called the eye doc for the consult.
<snip>
basically, my dad just sat on the edge of the bed for 15 minutes, and Medicare approved $1000 for it.
I think I know why our healthcare system is bankrupt.
If your father had a history of retinal tears or is at high risk for retinal tears, he needed to be seen immediately. Retinal tears need to be repaired ASAP.
If your father had a reduction in his field of vision, included in the differential diagnosis is a CVA, i.e. stroke. Even without a reduction in his field of vision, the symptoms of a vitreous tear and/or retinal tear can suggest a TIA or ophthalmic migraine. Because you took him to an emergency room, I'm not surprised the docs wanted to get a CT scan. Let's be honest here, if he WAS having a stroke and the doc missed it - you would have sued him and the hospital.
I am more concerned that you do not view a retinal tear as an emergency because "it could worsen to a retinal detachment" which can result in permanent blindness. As others have noted, ophthalmologists and retinal specialists provide 24 hr coverage, including weekends.
Since he had a retinal tear, I am assuming an ER doc referred him to a retinal specialist. Next time this happens, call his retinal specialist.
Obviously, there is much more to high health care costs than doctor's salaries. However, twenty percent is a significant part of the overall cost and reform of health care costs is going to require that some attention be given to these fees.
An average family doctor in my state earns between $140,000 and $150,000 per year. These figures are a bit skewed though because apparently they count the income of resident physicians who are earning way less than practicing physicians are. I compare this salary with what a district court judge in my state earns. Our state pays district court judges about $130,000 a year currently. There are perhaps 100 district court judges in my entire state. On the other hand, we may have as many as a thousand family doctors. Should each one of those family doctors really earn more than a district court judge does? Let's take this a bit further. Family doctors are among the lowest paid of all physicians. I believe pediatricians earn a bit less, but that is about it. Specialist physicians, depending on their specialty earn between $175,000 and $300,000 per year in my state. Doctors of internal medicine would earn closer to $175,000 and neurosurgeons would earn close to $300,000.
This is higher than doctors earn in virtually any other country in this world.
My basic problem with all salaries and expenditures in the healthcare field is that I don't see them as market driven. In fact, they may be impermeable to market forces. The need for medical care is overwhelming and when people get sick they are going to want to pay any price to get better. Its not the same thing as negotiating over the price of a car at the local Ford dealership. In that context, there is plenty of time to make a choice and the participants in the transaction have clear alternatives available to them. I can put off buying a new car. I can go to Toyota and find a comparable vehicle. I can even go to other Ford dealerships.
I think this country has to look at physician salaries and what can be done to reduce the cost of delivering care. I think much primary care could be delivered by physician assistants and nurse practitioners. Another possibility is allowing a few more foreign doctors to immigrate to the USA and practice here. Perhaps, the entrance requirements for these doctors should be loosened a bit.
We need to look at a whole lot of things. However, physician salaries are one of them
This article from Atlantic Magazine may give you an idea just how high physician salaries are. It was eye-opening to me.
Most people use the 10% figure because (as noted in your article) roughly half of physician fees go to paying overhead such as their employees. But even if it's 20%, if you cut physican fees in half, you have only reduced total healthcare spending by 10%. What about the other 90%?
Short-sighted appraisals like this love to over simplify things. How much does it cost for a judge to pay for his education? How much do doctors in other countries you reference pay for their education? It's easy for people with an agenda to look at what is going IN to physicans' pockets, but they conveniently ignore what is going OUT of their pockets. The price of entry in both time and money for US doctors is not addressed in your summary. Feel free to get back to us when you got all your stuff together.
Nothing is automatic. A claim has to be submitted to Medicare just like the commercial payers, and they are often denied the first time around for no good reason.
As I understand it (and things may have changed over the past 10 years or so), providers that accept assignment and participate in the electronic billing and payment system are paid automatically if the claims are properly coded. There's a code for everything. For example, a doctor sets a broken arm. There's a code for that.
I used to see the fraud cases at the federal court level, so I have some idea of how the system works.
Maybe someone with knowledge of the current procedures can chime in.
As I understand it (and things may have changed over the past 10 years or so), providers that accept assignment and participate in the electronic billing and payment system are paid automatically if the claims are properly coded. There's a code for everything. For example, a doctor sets a broken arm. There's a code for that.
I used to see the fraud cases at the federal court level, so I have some idea of how the system works.
Maybe someone with knowledge of the current procedures can chime in.
I have knowledge of the current procedures as a Medicare provider. Although I am kicking Medicare to the curb in my practice on January 1st, 2016.
I wish it was as simple as just submitting a code. We have to submit the code with "correct" modifiers, and with a diagnosis that will link to the code. But they WILL NOT tell us the "correct" way to do it. For example, I had a claim denied yesterday for a 38724 (modified radical neck dissection) that I submitted with a -59 modifier indicating a separate procedure from the 41130 (hemi-glossectomy) I also did. I have learned that without the -59 modifier Medicare will deny it and tell me that I should have used 41135 (glossectomy with radical neck dissection) because it includes the neck dissection. But they are incorrect about that because 41135 includes a radical neck dissection (38720), but not a modified radical neck dissection. For the first time in years, they found a new way to deny it. They sent back a denial letter stating the 38724 code requires an "anatomical modifier" even though they have never required it before. And there is no database that lists which of the 60+ modifiers are required in any situation. So now I have to pay my staff again to re-submit the claim again with a 38724-59,LT series of modifiers to see if that will work. We called them to ask and, as expected, they said "we cannot tell you how to code." I hope the one I submitted is the one they are looking for. It took me 2 months to find out the first time and now it will take another 2 months to see if I got it right. Who else here likes to work and not get paid for 4 months?
I have learned that the general public really thinks we just submit a bill to the insurance company that says "broken arm, fixed it" and we get paid. Every dollar is a fight. Remember...insurance companies are not in the business of paying claims, they are in the business of NOT paying claims.
Last edited by toofache32; 11-20-2015 at 10:09 AM..
Let's not forget that your medical education was subsidized by government grants to universities. You didn't pay the full cost of your education. Tax dollars helped to subsidize it, including tax dollars that those people who are now on Medicare that you are "kicking ... to the curb in ... January 2016".
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