Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Thursday, June 05, 2008

Candidate for the "Full of Shit" Award

From the comments on my previous post:
Specialist’s [sic] are earning 2:1 over the primary care physician. On average, specialists are earning near $300K while the PCP earns roughly $150K, sometimes LESS! Do you know why?
Yep: it's because they've hijacked the group charged with setting payment, via RVUs; packing it with specialists and scratching each others' backs.
It doesn't make any sense considering there are more ICD-9 and CPT codes available in the primary care setting.
Say what? Aside from the Evaluation and Management codes, pretty much the only ones available to me are the immunization and minor surgery codes. The rest of that two-inch-thick code book is filled with surgical, radiological and interventional cardiology codes.
It's because the U.S. Healthcare System has changed… it has “moved” money away from office visits and therapy, and shifted it towards patient outcomes.
That's what they want you to think, because that's what they say they are trying to do. Hell, no one even knows precisely how to measure outcomes. (See Einstein on DB's sidebar: "Not everything that can be counted counts, and not everything that counts can be counted.")
Reimbursements are down, costs are rising! As a result, physicians who continue to operate as they have in the past are feeling “financially” squeezed!
Um, yeah; that's because we are. And please banish the word "reimbursement" from your vocabulary on the topic of physician "payment."
In attempts to offset their losses many are working longer hours seeing more patients, while earning less. They are also trying to reduce nonessential services and overhead by working with fewer people, in less space. Then there are some who are choosing to decline services due to capitation issues.
Right; these are appropriate business responses.
None of this helps! Do you know why?
Why do I get the sense that the answer ultimately involves paying you money?
Because the Healthcare System knows most PCP are “flying under the radar” by operating in “waived” settings and avoiding the responsibilities that accompany providing quality care.
The money has been moved to three main practice areas- diagnostics, imaging/radiology, and clinical lab.
Yep: those are definitely the areas where there is still big-time money to be made, thanks to maintenance of artificially high payments in the face of drastically reduced costs, yielding continued profitability instead of passing on the savings.
The idea behind the shift is to improve patient outcomes by placing money as an incentive for PCP to uncover asymptomatic illnesses before they become chronic and cause catastrophic costs to the overall system.
In other words, "preventive care saves money." Too bad it doesn't.
The trick is to align your practice within the changes that have taken place in the healthcare system.
By align your practice, I mean according to your specific patient base and data requirements to ensure the additional revenues generated will greatly exceed the cost of change.
Are you talking about adding ancillary services like lab and imaging to my primary care office?
(e.g. If you are seeing 3 elderly patients per week with dizziness symptoms, I can give you the Medicare issued healthcareICD-9 code & CPT code that reimburses $450 per procedure. Buying the proper box costs $700 per mo. So figure an increase of $5200!)
By gum, I think you are. So leaving aside that I'm *not* seeing that many dizzy grannies weekly -- week in and week out -- you can, for a small one-time fee (and continuing to sell me the reagents, I'm sure) teach me how to game the system by ordering a battery of tests that may or may not be needed. Wow. Remind me again, though, how this either "improves patient outcomes" or "uncovers asymptomatic illnesses before they become chronic and cause catastrophic costs to the overall system"?
This is just one example of what I'm talking about. The problem is- every situation has specific needs! I can't say this is best for you, but I can tell you there are 100s of these. It's just a matter of knowing what to do for your specific patient base and volume requirements.
I see. You're a representative of yet another one of those parasitic entities sucking gullible physicians into shelling out beaucoup bucks for lab, imaging and diagnostic equipment using ridiculously optimistic financial projections. It's a business model whose effectiveness is inversely proportional to physicians' business savvy; that is to say, it ain't gonna work on me, and on increasing numbers of us in the months and years to come.
Trust me when I say this, almost every PCP practice seeing 25+ patients per day, including the solo practitioner can increase their income by $125,000.00. It's just a matter of OPTIMIZING their practice!
Dude, I trust you about as far as I can throw you. OPTIMIZING my practice involves keeping my checkbook far away from you and your ilk. (Oh, and "check out" this blog as well.)


At Fri Jun 06, 08:12:00 AM, Blogger CrankyProf said...

Dude, if you start making me undergo questionable tests -- esp. ones that involve NEEDLES or orifice-invasions -- I'm gonna come over there and take a dump in your filing cabinet. All three drawers.


At Fri Jun 06, 10:54:00 AM, Blogger Ian Furst said...

please tell me you followed the original link to the commentors web site -- hilarious.

Dino -- you can make an extra $15 per patient by aligning your practice with your car wash.

At Fri Jun 06, 11:23:00 AM, Blogger Resident Anesthesiologist Guy (RAG) said...

This actually sounds like an office I rotated through early in third year - had rad equipment, was doing stress tests, PFTs, nuclear imaging, was having a new wing of Xrays and CTs placed (seriously) and had patients who would be given these tests for any number of buzz word complaints. Cough? PFT! Some burning after eating with h/o GERD? Stress test!

I learned what not to do in medicine from that guy. Nothing more.

At Fri Jun 06, 06:15:00 PM, Blogger Lynn Price said...

Dearie me! Dino, you sound stressed. How's about a nice Reiki treatment?

At Sat Jun 07, 11:11:00 AM, Blogger Alexis said...

You know, if you would just install a CT scanner at the entrance to your clinic, you could find everything that's wrong, or not, with everyone, each and every time they walked in! It would pay for itself in no time! And the masses (with their unknown masses?) would be grateful and sing in the streets, right? right?

And, man, if you meshed with that carwash idea, AND had a coffee bar, just think of the income you could rake in!

Maybe if you align your practice with Paris Hilton......

At Sat Jun 07, 01:05:00 PM, Blogger CrankyProf said...

Maybe if you align your practice with Paris Hilton......'d write scripts for a LOT more Valtrex.

At Sat Jun 07, 02:21:00 PM, Blogger Diane J Standiford said...

Thank goodness I found your blog. I am sick of what is happening with PCP's and the tests...but I couldn't quite figure out what was happening. I get it.

At Mon Jul 14, 09:41:00 PM, Blogger Christina RN LMT said...

The office I used to work at got scammed like this, with nerve conduction study equipment. We paid for the equipment, had to pay OUTRAGEOUSLY every time we ordered new leads, paid for every report they sent us, etc, etc.

Sad, so sad. And of course the payments we received from the insurance companies were oddly enough much, much smaller than quoted to us by the nerve conduction folks. *sigh*


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