Skip to main content

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!

Comments

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!"
Anonymous 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.

Popular posts from this blog

scintillating scotoma

Nothing like experiencing a medical condition first-hand to really help a doctor understand it from the patient's point of view.  After all these years, I had my first (and hopefully last) scintillating scotoma while sitting on the couch playing "words with friends" on my ipad and watching TV.  A scotoma is a partial loss of vision in a normal visual field.  Scintillate is flashing, sparkles.  Put them together and you have moving, flashing sparkles with a blind spot in your eyes.

This visual aura was first described in the 19th century  by a Dr. Hubert Airy who had migraine headaches.  The visual sparks and flashes are in a zig-zag pattern and they can precede a migraine headache or occur without any pain.   The scotoma affects both eyes and closing one or the other does not make it go away.  Sometimes the term "ocular migraine" or "retinal migraine"  are used to describe this phenomenon but these involve only one eye, not both.  The terms are often …

Do Doctors Make Too Much Money?

An article in theNew York Times says the reason health care costs are so high in the United States is because doctors are paid too much. I saw that and my eyes bugged out. I just came home from a meeting with physicians and hospital administrators and the entire meeting was spent discussing the financial challenges physicians face in keeping their doors open to see patients. The goal of this meeting was to keep health services in that community so patients will have someone to care for them. Not a person in the room would agree that the doctors earn too much.

Physicians paid too much? Lets break that down. A doctor spends a minimum of 11 years in education and training after the age of 18. Many are in training for 15 or more years. They are living on student loans and contributing zero to their family's income until the residency years. At that time they earn less than minimum wage if you factor in the 80-100 hour workweek. When a doctor emerges from training (and believe me…