What's Your Doctor Worth?

American Thinker ^ | January 25, 2007 | Linda Halderman, MD

[neverdem]

How much money does your doctor earn?  If your doctor is a Surgeon practicing in rural central California, you're about to find out.

First, some background:  Perhaps your 51-year-old neighbor's screening mammogram this year showed a suspicious area.  She is called back by the Radiologist for more testing, including additional mammograms and an ultrasound.  She then receives a call from her Gynecologist explaining that the x-rays are "non-reassuring," and she'll be sent to a specialist in breast surgery.

That's where my office gets involved.  Five or ten faxed pages arrive on my assistant's desk.  She calls the Gynecologist's office to request additional material, including copies of the mammogram report, the patient's contact information and insurance data-if the patient is insured.

As it happens, like more than 60% of the women I care for, this patient is either uninsured or underinsured by Medi-Cal or BCEDP, the State of California's breast cancer detection program for low-income women.

The paperwork piles up.  Now my assistant must confirm eligibility in addition to scheduling the consultation, creating a chart and retrieving x-rays for me to evaluate.  Prior to the visit, I review the chart and create an electronic medical record.

Next, the visit.  Your neighbor arrives at my office.  I speak with her for about 15 minutes, learning her medical and surgical history, asking about symptoms and risk factors, and answering questions.

I examine her carefully, assessing not only for breast abnormalities, but also for swollen glands in eight regions of the body.  A heart and lung exam is done to identify problems that would make her a higher surgical risk, and the neurological, abdominal and musculoskeletal evaluations provide evidence for or against tumor spread.

After my patient is dressed, she asks me to bring her sister and husband in for the discussion of my recommendations.  This is often the most time-consuming part of the visit, requiring patience, repetition and reassurance for a frightened patient and her concerned family.

Although our first visit has ended, the work has not.  I fill out a form ordering testing to further characterize the abnormality seen on my patient's mammogram.  I'll pore over a list of codes required by Medi-Cal to identify the visit, choosing the most appropriate ones and hoping they don't merit automatic rejection of the bill (a frequent occurrence, prompting up to nine months of back-and-forth debate with Medi-Cal).  Because the necessary biopsy requires a Radiologist's assistance, I'll communicate with him as well as the Pathologist who examines the specimen provided.

The diagnosis is Breast Cancer, and it's my job to break the news.

Our second visit is very different.  Not only do we talk about her diagnosis, we review all of the options for treatment, alternatives and their possible outcomes.  There may be tears and anger, self-blame and fear, and the inevitable, impossible question: "Why?"

This visit is the most difficult one for my patient and her family.  I, too, find it the hardest part of being a Breast Cancer Surgeon.  Some wounds cannot be healed with sutures and sterile bandages.

Back to the question at hand: How much is your doctor paid?

What payment will be made for the initial consultation and exam?  What dollar amount is assigned to the time spent with my patient and her family, explaining and encouraging, counseling and comforting? 

Every doctor who practices independently must be not only a medical expert but also a good enough business owner to keep the doors open.  No amount of compassion, however critical to successful treatment, will pay the bills. 

Payment for a visit must cover the rent and utilities to keep the office open.  Office staff needs to be paid, their health and dental insurance premiums covered.  There are additional payments to be made for Worker's Compensation, malpractice and liability insurance.  Office supplies, medical supplies, biopsy equipment and disposable instruments are essential and expensive.  There are also laundry and cleaning expenses, postage and biohazardous waste service.  Your doctor must also pay the 24-hour answering service, the billing company, as well as the bookkeeper, accountant and attorneys.   And, like everyone else, your physician must pay Federal taxes, State and local taxes, payroll, income and unemployment/disability taxes.

Here are the actual Medi-Cal billing codes and payment schedule for central California breast cancer Surgeons in 2006:

For the initial consultation and exam of the lady with the abnormal mammogram:

CPT#99243 $59.50.

For the visit in which she is told she has Breast Cancer and is prepared for surgery:

CPT#99213-57 $24.00.

This is what your doctor is paid.  Now ask yourself what she is worth.

Dr. Halderman is a Board-Certified General Surgeon practicing in rural south Fresno County, California.

[DB]

My sister's daughter recently spent about two weeks in ICU with severe pneumonia. Happily she recovered. The bill (which are still coming in) is pushing half a million dollars... While I'm sympathetic to the writer of this article, someone is making money. A lot of money.

[palmer]

someone is making money. A lot of money.

Not necessarily, the money squeezed out of insured patients like your niece is used to fund uninsured care. Also like the author shows, the money sent to the neediest doctors is a joke so naturally they will affiliate with a big bucks hospital just so they can keep providing care out in the country.

[There's millions of'em]

"How much money does your doctor earn?"

It would help if the goos DR had answered her own question.

[DB]

It is certainly a mess.

Another example of government intervention.

What's worse is people will demand more government intervention to "fix it" only to make it worse.

[DB]

She did.

[iowamark]

Clicking on the link shows that the good doctor is a California plastic surgeon: "offering Medical Spa Services, we provide a place to improve and maintain your appearance in a safe, professional environment."

I doubt that we need to take up a collection.

[Sapirit]

someone is making money. A lot of money.

Insurance companies!!! They gotta be dismantled. Health insurance must be outlawed, seriously. A doc who operated on my knee, got something like $150 for the surgery. Even anesthesiologist got more. What a joke!

[thegreatbeast]

It would help if the goof DR had answered her own question.

Good point.

[neverdem]

It would help if the goos DR had answered her own question.

She stated the rates with the code numbers as well.

[Fairview]

the good doctor is a California plastic surgeon: "offering Medical Spa Services, we provide a place to improve and maintain your appearance in a safe, professional environment." I doubt that we need to take up a collection.

It's because she makes money as a plastic surgeon that she can even afford to take on the Medi-Cal patients who chew up days of her time for a total of $83.50. Of course the $83.50 does not include the equally pathetic amount she will be paid for performing the surgery and doing follow-up visits, but the principle is the same: there is no way she can consider caring for Medicare and Medi-Cal patients anything other than charity. The costs of maintaining her office, paying her staff, and paying the staggering amount in malpractice insurance she has to carry also aren't even touched by the money she makes from this charity care.

And what she says in her article about the problems of medical coding is true. She is billing a 99213, an extended visit, for the time she spends telling the patient about breast cancer options. That number implies that she's spending 20-30 minutes with the patient. The truth is she is spending far more time, perhaps an hour or so, and then may have to devote additional time to fielding phone calls from the patient. She should have billed 99215, a CPT-4 code involving much more time, but Medi-Cal would have rejected the claim altogether if she had.

[darkangel82]

Health insurance must be outlawed, seriously.

Fine, you want government healthcare, go right ahead.

[Jim Noble]

My sister's daughter recently spent about two weeks in ICU with severe pneumonia. Happily she recovered. The bill (which are still coming in) is pushing half a million dollars... While I'm sympathetic to the writer of this article, someone is making money. A lot of money.

Her care probably cost close to that, if not more.

What do you think it costs to have that ICU available so your niece could be admitted to it at any time, 24/7/365?

And who do you think should pay for that cost?

[seemoAR]

Do doctors or lawyers ever get proficient at their chosen profession? I do not understand the practice thing. Can mechanics charge more if they call it a practice?

[Harrius Magnus]

You are either a provider or affiliated. You speak the truth. The "trusted" group of GYNs we use for our patient's just totally redid their services menu, from meet and potatoes to Botox, massage therapy, and pregnancy body molding (WTF?), among other things. Folks will pay cash on the head for these services, but boy, so much as misplace one digit on a ICD9 code and you will generate hours of misery for a patient and practice alike. This is everybody's problem, in the big picture.

[DB]

First, I don't believe it cost that much to care for her. Not even close.

Second, I didn't say I thought someone else should be stuck with the bill.

Third, it is just as available to the other 50,000 people in the area as it was to her. Her bill came to about $35,000 a day.

Forth, we don't charge the entire cost of the fire department since the last fire to the next fire victim just because they had a fire.

[Jim Noble]

Forth, we don't charge the entire cost of the fire department since the last fire to the next fire victim just because they had a fire.

That's actually a good analogy.

Fire Department infrastructure and salaries -all of it-is paid by taxpayers.

What's the line item in your town budget to maintain and equip your local hospital?

Huh?

[Netizen]

A doc who operated on my knee, got something like $150 for the surgery. Even anesthesiologist got more. What a joke!

Think that's bad. I've had two surgeries in 3 years for the same dang problem. Each time the surgeon operates, the problem just gets worse, the last surgery being done this past Oct. and I had to be see early Jan. because new problems have devoloped at the incision area and the main problems are STILL there. I thought they were wupposed to make things better, not worse.

[Cate]

I agree with you. I think insurance companies should be abolished. Medical savings accounts can be set up that earn interest, patients can pay whomever they want for their medical care at the fees the physicans set. It is absurd for an insurance company to dictate to a physican the course of care they must follow. Get the system back to physician - patient relationship.

[GBA]

That's about the same as an oil change and a tire rotation at the local Honda dealer.