A Blogging Doc

I"ve screamed enough at the television, the newspaper, and anyone nearby about the evolution and drastic changes and overall craziness affecting healthcare. I have practiced long enough to experience this evolution in significant ways, and I still have enough of a career left to care deeply about what happens to healthcare in this country. Now I have a place to write it down. May not be read by anyone, but at least it will be carthartic. This topic is huge, so I'll try to pick out small pieces at a time. I will discuss specific diseases and ailments as well, especially if asked.

Most of the changes occurring deal with paying for healthcare. This of course directly affects getting paid for healthcare- me. I used to say that we were paying for the excesses of the 70's. That is when the stereotypical "rich doctor" evolved. The system in place at the time basically paid the docs whatever they charged, and as often as they charged it. This led to increasing efforts by the government to control costs because of the skyrocketing costs to Medicare. Direct control of what docs made became serious in the eighties, and has exponentially increased since then. When I began my surgery residency training in 1987, Medicare was the "bad insurance", much like medicaide is thought of today. Private payors were much slower to directly curb payment of healthcare dollars. Now, Medicare is thought to be pretty good coverage to practicing docs. For me, this is because I generally know what I am going to get paid for a procdure, and actually recieve the payment in a reasonable amount of time. Private companies not only have learned to copycat medicare's restrictions and reductions, but have become very skilled at delaying and decreasing reimbursements. I often feel like I have to work harder to get paid for fixing your carotid artery than I did to actually fix it.

If a plumber comes to your house and repairs a sink drain in the guest bathroom, and during the same visit repaired the toilet in the master bath, how do you think he would respond if you told him that since he was already at your house, for the sink, you would only to pay half fthe charged amount on the toilet repair? He would say you were insane, and probably un-repair something real fast. Medicare does this every day. If I have you on the table and sedated with a large needle in your leg doing an angiogram (injecting dye in your arteries to find blockages), I get paid much less to go ahead and fix the problem I found in your arteries, and even less per procedure to fix more than one problem at that time. Last years' cuts in reimbursent and this years increases in malpractice insurance, employee costs, regulatory costs, etc., strongly encourage me to stop the angiogram after injecting dye, and bring you back another day to do it all over again,,,stick another hole in your artery, double your risks, double your time off work, pain and discomfort, so that I can get paid regular prices for each repair. If I fix two things at once, I get half price for the second one. I do not practice this way (I do it all at once), but many docs do, and it is considered routine and standard of care.

Did you know I have great difficulty getting insurance to pay for diabetic shoe orthotics and many supplies diabetics need, but I have no problem getting paid to amputate the foot? I have no problem getting paid to see you regularly for refills of your narcotic perscription medicine for your chronic pain, but it is very difficult to get insurance to pay to treat your resulting addiction?

I'll stop for today. I promise i will be more clinical and generally useful in the future. This first blog was for me.

Want to hear about blocked arteries? Diabetes? Cancer? Preventive medicine? Diet pills or colonic cleansing (sic) let me know!