Primary Doctor Talks About What He Makes and How Devastating Medicare Cuts Would Be

This tells the story pretty well and there’s stories just like it all over the US. Fixed costs have gone up over the years an d basically family practice doctors have not had any increase since 2001.

In my travels, I have run into physicians who see HMO patients with many IPAs (independent physician associations) and Medicare that are not even making 100k a year. When you stop and think of the school time and expense, that is not a lot. I have even seen some in some area of southern California that make half that amount. What it comes down to is what is left after the bills are paid, that is what they make. This week we had a good taste on seeing one of the “Me, Myself and I” members of Congress show the absolute cold shoulder of not only being less than human, but just plain out stupid when it comes to compassion and caring for your fellow man/woman, but let him need care and he would scream bloody murder and continue to exhibit more childlike antics which we all are so tired of, most of them coming from “tech denial” and being at a loss of understanding the world we live in today and how technology is making changes rapidly.

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Malpractice doesn’t usually go down either. On top of everything else, add on the complicated medical billing and claims situation. As a patient you probably have never seen this nightmare. I have a simple comparison here, think of it as doing your taxes, but with taxes you do them once a year. Think of every medical claim as a 1040 short form, and then there are those who cannot use the short form and itemization is needed. Ok so the doctor sees 30 patients a day, you have 30 tax forms (the equivalent of forms and time) to do for the day, and then like the IRS in the form of audits and itemization, the practice has to dig out additional chart information and submit as well as spending time on the phone for those claims in question, you know, like the IRS wanting additional information. The idea of the comparison here is the “red tape” and time to get paid.

Now for the insurance side of this, they have algorithms that generate the additional documentation for the practice. It’s all in the algorithms on automated claim processing.

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When it comes to claims it all the doctor’s time, staff time and sometimes yours. These folks all use data and algorithms to calculate and score you for payment purposes, something that obviously can’t be done with caring for a patient as that involves us, humans who are sick and need care.

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But they seem to want to think at the “bean counter” end that visits to the doctor can be handled like algorithm and it’s not. They see numbers and I’ll say this there’s a lot of room to save money and doctors can be more efficient, but not by cutting Medicare. It’s always easier to be the Monday morning quarterback and judge; however the insurance company algorithms were not present at the point of care, the problem with how we do some of healthcare today in forgetting the human element of giving care at the reimbursement end of the line. BD

NEW YORK (CNNMoney.com) -- When you think of low-paying jobs, doctor doesn't usually come to mind.

But with a 21% cut in Medicare payments slated to take effect later this month, physicians who say they are making an OK living may be reduced to income levels that no longer make their profession viable. That's especially true for those still paying medical school costs and other training.

Schreiber sees 120 patients a week. About 30% of them are enrolled directly in Medicare, while another 65% have private insurance plans that peg their payments on Medicare's rates. Only 5% pay on their own.

As a result, Schreiber expects the cuts to take away $3 out of every $5 he currently earns. And, as a primary care physician, he already wasn't earning anything near the salary of a specialist.

He spends about $60,000 a month on "fixed costs" to run his practice. "That's more or less my breakeven point," he said. "If I spend more, I'm in the red for the month."

The first code represents a simple visit, which might include blood pressure and cholesterol checks. Schreiber gets about $44 from Medicare for the $70 fee he charges.

The second and third codes correspond to a sick visit, when he spends 15 to 20 minutes evaluating a patient for symptoms such as coughing or shortness of breath. Schreiber charges $92 for a sick visit, of which Medicare pays about $58.

The last billing code is a complex visit. "This is where a patient comes in with many problems like heart disease, hypertension, diabetes," he said. Such a visit requires about 30 minutes of his time.

Schreiber charges $120 for these visits, and Medicare pays $88 of that.

Medicare backlash: A primary care doctor lays out his costs - Mar. 4, 2010