Monday, October 27, 2008

Why Doctors Want To do Procedures Rather than Diagnose


The Happy Hospitalist wrote a blog that addresses many issues in health care. It answers why doctors are fleeing from primary care specialties into the procedure specialties (Derm, GI, Cardiology, Interventional Radiology, Urology, Anesthesiology, Surgery). It also gives a peak into the Byzantine coding requirements that are required of Physicians by Medicare and continued by every health insurer. It also explains how crazy and inequitable the reimbursement schemes are in Medicine and why we have runaway costs. Here is a sneak peak...but read his entire post.

"How does the AMA define a 99232?
Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit.

25 minutes? Really. In my state a 99232 pays $6o. That works out to $144 an hour if in fact a 99232 really took 25 minutes. A colonoscopy without specimen collection (45378), pays about $180 if it's done at the hospital, $330, if it's done at the docs office. If you do a single biopsy (45380), it pays $220, if done at the hospital, $400 if it's done at the docs office. I'm pretty certain after several thousand of 'em, I could do at least two an hour, maybe three. This also explains why every colonoscopy has a random biopsy. You would be throwing away $80 an hour not to do it. You do the math. $144 an hour for cognitive care, or $800 an hour or more for screening colonoscopies at the office. "

Thanks, Happy for shining a light on this insanity!

3 comments:

The Happy Hospitalist said...

Insane it is. A game we are all forced to play that does nothing for patient care

ERP said...

We call it "Scoping for Dollars!"

PookieMD said...

Until primary care is more than a conveyor belt of patients with physicians running room to room, putting a camera in someone's behind will be much more attractive to young physicians. Primary care physicians need to be paid to do what they do best--think.