I think it is the right thing for doctors to post their prices for all to see. I am posting my prices for the most common procedures that I do. You can call my office if you need additional prices for things like x-rays, lab tests, mole removals, etc.. I challenge other area doctors and the hospital to do likewise. Medicare and Medicaid are unique in that the government largely mandates those prices for everyone, with little to no difference among doctors, and so I won't be listing those prices here.
To make sure you are comparing apples to apples and oranges to oranges you need to know that all doctors use Current Procedural Terminology (CPT) codes to bill insurance and patients. Every billable thing a doctor does has a procedure code, even office visits. You can compare prices if you know the codes. I'm listing some of the most common codes I use. The most used ones are the office visit codes which get charged for virtually every visit.
The CPT code is followed by the procedure description and then my charge for 2007.
99212 office visit brief $42
99213 office visit expanded $54
99214 office visit detailed $85
90718 tetanus shot $38
73140 finger x-ray $46
80061 lipid profile $16
84703 blood pregnancy test $17
11300 small mole removal from the trunk $133
11730 toenail removal, non-permanent $104
Note also that most doctors use slightly different codes for the office visit charge to new patients. This allows a higher charge to make up for the additional expense of chart creation and computer data entry. I choose not to do this. But for comparison's sake a 99202 is the same level of service as a 99212 visit, just with a new patient instead of a returning one. Likewise 99203 is used like 99213 and 99204 like 99214.
Feel free to call your doctor and ask how much they charge for the same code so you know you are comparing the same procedure. While price alone should not be the only determining factor in choosing your doctor, you have a right to try and get the most value for your money.
1/29/07
1/28/07
I CAN SEE CLEARLY NOW
I think transparency is an idea for health care whose time is long overdue. It refers to publishing charges for specific procedures (including office visits) so that consumers can price compare as they do for virtually everything else. In the "good old days" this was not necessary as insurance companies paid whatever charges doctors submitted and those without insurance had their bills written off or reduced. As insurance companies became more sophisticated (read: greedy), they decided how much a doctor was allowed to charge.
Nowadays as more and more people are uninsured or have a health savings account, the doctor's charges become much more relevant. This matters little to those with an HMO, PPO, Medicare, Medicaid, or many traditional insurances as the price is preset and bears very little resemblance to what is charged. As all insurance companies pay the lesser amount of the doctor's charge or what the insurance company decides the "usual and customary" charge should be, the doctor wants to make sure his charge is not less than that lest he lose out on some money. Some insurance companies automatically deduct a certain percentage (say 20%) from whatever the doctor's charge is thereby encouraging a falsely inflated charge.
The dirty little secret is that the people who can afford the least get charged the most. Most doctor's offices and hospitals do this. Is it ethical? I don't think so, but I'm in the minority.
One of the reasons for this practice is that Medicare and most insurance companies put wording in the contracts with physicians that state the doctor has to give their subscribers the lowest rate for a given procedure. And since the insurance companies, unlike Medicare (score one for them), go to great lengths to keep a secret of the most they are willing to pay for a procedure, the doctor will overcharge knowing that the insurance company will not pay the full amount, nor will they allow the doctor to charge the patient this inflated amount. Guess who's left holding the bag? The poor schmuck who doesn't have insurance.
For example, say a doctor charges $70 for an office visit, Medicare will only allow $39 for that procedure (and yes, the differences are often this large or larger). Another insurance company that has a contract with the doctor may declare that the "usual and customary" charge for that procedure is $42. This means the doctor cannot collect more than $42 from the patient even if the deductible has not been met and the patient has to pay all of the charge himself. The patient with an insurance which is contracted with the doctor has a built in discount. The sap without insurance is expected to pay the full $70.
Say the doctor charged $45 dollars for the procedure. He's still maxing out on most insurance charge limits, but the problem is with those companies that automatically discount his charges. The $45 charge is discounted 20% to $36 while the doctor who charges $70 might get $56 for the same procedure from the same insurance company. One plan may be willing to pay $49 or $50 for that procedure, but the doctor has no way of knowing this ahead of time and so artificially charges an amount that he knows that no insurance company is going to pay in full. If he charges everyone $70, he is guaranteed to get the maximum amount from each insurance company. The naive doctor who charges a reasonable fee is still forced to provide an additional discount from many insurance companies. Instead of making a reasonable amount from an inflated charge, he is making an unfairly low amount from a reasonable charge. The only person who gets hurt by the doctor doing this artificial charge inflation is.... you guessed it, the patient without insurance.
The solution for primary care doctors, is easy. Charge everyone a fair and reasonable price and don't contract with insurance companies that demand a percentage discount. They often demand a discount in return for sending the doctor those patients in their insurance plan. This discount is not necessary if the charge is reasonable already and not artificially raised in anticipation of having to give a discount to insurance companies.
Nowadays as more and more people are uninsured or have a health savings account, the doctor's charges become much more relevant. This matters little to those with an HMO, PPO, Medicare, Medicaid, or many traditional insurances as the price is preset and bears very little resemblance to what is charged. As all insurance companies pay the lesser amount of the doctor's charge or what the insurance company decides the "usual and customary" charge should be, the doctor wants to make sure his charge is not less than that lest he lose out on some money. Some insurance companies automatically deduct a certain percentage (say 20%) from whatever the doctor's charge is thereby encouraging a falsely inflated charge.
The dirty little secret is that the people who can afford the least get charged the most. Most doctor's offices and hospitals do this. Is it ethical? I don't think so, but I'm in the minority.
One of the reasons for this practice is that Medicare and most insurance companies put wording in the contracts with physicians that state the doctor has to give their subscribers the lowest rate for a given procedure. And since the insurance companies, unlike Medicare (score one for them), go to great lengths to keep a secret of the most they are willing to pay for a procedure, the doctor will overcharge knowing that the insurance company will not pay the full amount, nor will they allow the doctor to charge the patient this inflated amount. Guess who's left holding the bag? The poor schmuck who doesn't have insurance.
For example, say a doctor charges $70 for an office visit, Medicare will only allow $39 for that procedure (and yes, the differences are often this large or larger). Another insurance company that has a contract with the doctor may declare that the "usual and customary" charge for that procedure is $42. This means the doctor cannot collect more than $42 from the patient even if the deductible has not been met and the patient has to pay all of the charge himself. The patient with an insurance which is contracted with the doctor has a built in discount. The sap without insurance is expected to pay the full $70.
Say the doctor charged $45 dollars for the procedure. He's still maxing out on most insurance charge limits, but the problem is with those companies that automatically discount his charges. The $45 charge is discounted 20% to $36 while the doctor who charges $70 might get $56 for the same procedure from the same insurance company. One plan may be willing to pay $49 or $50 for that procedure, but the doctor has no way of knowing this ahead of time and so artificially charges an amount that he knows that no insurance company is going to pay in full. If he charges everyone $70, he is guaranteed to get the maximum amount from each insurance company. The naive doctor who charges a reasonable fee is still forced to provide an additional discount from many insurance companies. Instead of making a reasonable amount from an inflated charge, he is making an unfairly low amount from a reasonable charge. The only person who gets hurt by the doctor doing this artificial charge inflation is.... you guessed it, the patient without insurance.
The solution for primary care doctors, is easy. Charge everyone a fair and reasonable price and don't contract with insurance companies that demand a percentage discount. They often demand a discount in return for sending the doctor those patients in their insurance plan. This discount is not necessary if the charge is reasonable already and not artificially raised in anticipation of having to give a discount to insurance companies.
1/16/07
EVERYONE WANTS TO BE A DOCTOR BUT NO ONE WANTS TO GO TO MEDICAL SCHOOL.
I think physician assistants and nurse practitioners (known collectively as physician extenders) should have a limited role in our health care system. As a general rule they do not have the quality or quantity of training necessary to function as a doctor though they often do.
Nurse practitioners are registered nurses whose post high school education can be as little as two years for an associate degree in nursing (or up to 5 years for a bachelor of science degree in nursing), and who then undergo as little as under 18 months training, which can be completed online. In Indiana they are required to practice medicine with the "collaboration" of a physician. This does not require the physician to directly supervise or even to be in the same building or city as the nurse practitioner. They are permitted to prescribe all medications that a physician can with the exception of prescriptions for weight management.
Physician assistants are non-physicians who depending on the particular educational program, are high school graduates who may or may not have previous health care experience and/or some college education. The two training programs in Indiana require up to 2 years of prerequisite college work followed by 2-3 years of specific classroom and clinical training.An internship or residency is not required. They are required to be supervised by a physician but the supervision is not necessarily in person. A chart review within 24 hours of the visit is required. They are not allowed to prescribe medicine in Indiana.
A physician's training requires a minimum of successful college undergraduate college degree followed by medical school, usually of 4 years duration. A one year internship in an accredited training program is usually followed by between 2 and 9 more years of education depending on the particular specialty.
The reason for physician extenders depends upon whom you ask. Those that are physician extenders like the work that they do and the money they make for the amount of time and training they put in. The doctors who hire them, like charging patients and making money without having to see any extra people. Patients may like them so that they can get seen sooner than they otherwise could as the doctor's office now has more appointment times available.
I think there are several problems with the whole concept as it currently exists.
First of all, they are not needed. If there were not enough commercial airline pilots, would the solution be to allow a less rigorous and shorter training period and allow those people to have their flight logs inspected within 24 hours of a flight. (That's a rhetorical question by the way.) If we don't have enough doctors we need to have more medical schools. If we don't have enough applicants, we need to make the job more appealing (lawyers, the government , and insurance companies will be addressed in other articles on ways they make the job often unappealing).
Secondly, they do not have the depth of training that a physician has. They may be able to see and treat many conditions, but they may not pick up a serious and/or unusual condition, as many present similar to innocuous ones. If you haven't at least heard about and studied a disease you are not going to be able to diagnose it. They may be good-hearted, hard-working people, but they are not doctors. More often than not, they independently evaluate and treat patients with the physician only briefly reviewing the chart or discussing the case without ever personally examining or talking with the patient.
Thirdly, as a patient, I wouldn't like being charged the same amount for seeing the physician extender as I am when I see the doctor. When you go to law firm, accounting firm, or most other businesses, you get charged more by the people in the organization who are the most knowledgeable and have the most experience. This is widely accepted and makes sense. If I don't need a higher level of expertise I don't want to pay for it. In the doctor's office however, you pay just as much whether you are seeing the doctor or the lesser trained physician extender.
I think the appropriate role of the physician extender is to assist a doctor with various patient tasks or procedures. They should not independently be the first to evaluate and treat a patient. They could also follow along a patient with a chronic condition with a physician to oversee the plan once the physician has initiated a treatment plan.
At an office visit you are paying for an evaluation and treatment by a physician. I guarantee you that if your doctor needed to have a medical problem evaluated; he would not accept being evaluated by a physician extender. I know I wouldn't. You shouldn't either.
Nurse practitioners are registered nurses whose post high school education can be as little as two years for an associate degree in nursing (or up to 5 years for a bachelor of science degree in nursing), and who then undergo as little as under 18 months training, which can be completed online. In Indiana they are required to practice medicine with the "collaboration" of a physician. This does not require the physician to directly supervise or even to be in the same building or city as the nurse practitioner. They are permitted to prescribe all medications that a physician can with the exception of prescriptions for weight management.
Physician assistants are non-physicians who depending on the particular educational program, are high school graduates who may or may not have previous health care experience and/or some college education. The two training programs in Indiana require up to 2 years of prerequisite college work followed by 2-3 years of specific classroom and clinical training.An internship or residency is not required. They are required to be supervised by a physician but the supervision is not necessarily in person. A chart review within 24 hours of the visit is required. They are not allowed to prescribe medicine in Indiana.
A physician's training requires a minimum of successful college undergraduate college degree followed by medical school, usually of 4 years duration. A one year internship in an accredited training program is usually followed by between 2 and 9 more years of education depending on the particular specialty.
The reason for physician extenders depends upon whom you ask. Those that are physician extenders like the work that they do and the money they make for the amount of time and training they put in. The doctors who hire them, like charging patients and making money without having to see any extra people. Patients may like them so that they can get seen sooner than they otherwise could as the doctor's office now has more appointment times available.
I think there are several problems with the whole concept as it currently exists.
First of all, they are not needed. If there were not enough commercial airline pilots, would the solution be to allow a less rigorous and shorter training period and allow those people to have their flight logs inspected within 24 hours of a flight. (That's a rhetorical question by the way.) If we don't have enough doctors we need to have more medical schools. If we don't have enough applicants, we need to make the job more appealing (lawyers, the government , and insurance companies will be addressed in other articles on ways they make the job often unappealing).
Secondly, they do not have the depth of training that a physician has. They may be able to see and treat many conditions, but they may not pick up a serious and/or unusual condition, as many present similar to innocuous ones. If you haven't at least heard about and studied a disease you are not going to be able to diagnose it. They may be good-hearted, hard-working people, but they are not doctors. More often than not, they independently evaluate and treat patients with the physician only briefly reviewing the chart or discussing the case without ever personally examining or talking with the patient.
Thirdly, as a patient, I wouldn't like being charged the same amount for seeing the physician extender as I am when I see the doctor. When you go to law firm, accounting firm, or most other businesses, you get charged more by the people in the organization who are the most knowledgeable and have the most experience. This is widely accepted and makes sense. If I don't need a higher level of expertise I don't want to pay for it. In the doctor's office however, you pay just as much whether you are seeing the doctor or the lesser trained physician extender.
I think the appropriate role of the physician extender is to assist a doctor with various patient tasks or procedures. They should not independently be the first to evaluate and treat a patient. They could also follow along a patient with a chronic condition with a physician to oversee the plan once the physician has initiated a treatment plan.
At an office visit you are paying for an evaluation and treatment by a physician. I guarantee you that if your doctor needed to have a medical problem evaluated; he would not accept being evaluated by a physician extender. I know I wouldn't. You shouldn't either.
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