#21 ·
No, Michael Cox40, I think the people with the most impact are the voters—the ones who elect the government that appoints the Secretary of Health and shapes social policy.
Here’s an example: I’m a specialist running a surgical outpatient clinic. We handle pretty much everything, from initial exams and diagnostics to full surgical procedures. Our billing is standardized; essentially, every exam or procedure is assigned a specific number of points. There’s a monthly cap, say 5,000 points per team, just as an example. If we exceed that, Medicare DOES NOT PAY us for the extra work; they only pay for those 5,000 points and not a cent more (a point is worth roughly $2.00). Of course, if we do less than the cap, we get paid for what we actually did. That revenue has to cover our overhead, supplies, medication, and the team's gross salaries.
However, if a patient comes in at the end of the month after we’ve already hit our quota—say, someone with an urgent hand tendon injury—I am required to see them. That’s fine, but I also have to use a significant amount of expensive medical supplies on them. When that happens, Medicare DOES NOT REIMBURSE me for those supplies, which means I’m directly in the red. In short, I’m losing money for my practice.
To put it bluntly, Medicare forces us to limit our patient volume; we can't just see as many people as we are physically capable of treating, but rather only as many as we can afford to supply with medicine and materials.
It’s the same story with primary care. If a patient doesn't visit their doctor often, they don't cost much beyond the standard per-patient fee, but if a doctor has several high-needs patients, everyone loses.
A friend of mine, who is a family practitioner, had a patient with pancreatic cancer who was suffering for a long time. She was providing analgesics, dressing his wounds from being bedridden... basically, the material costs (medication, bandages, gas for the car to make home visits) exceeded $5.00 per month. When she sent a formal request to Medicare asking for reimbursement (she receives about $10 per patient monthly, out of which she has to pay utilities, rent, meds, supplies, and her nurse's salary), she was told she couldn't receive anything beyond the standard per-patient rate. They basically implied it wasn't their problem if she was unlucky enough to have a patient with such intensive needs. Naturally, the patient is entitled to care, and you cannot and should not bill them for it. Luckily, she has a husband who owns a retail business, so she didn't go hungry...
The typical patient looking to claim their rights usually doesn't realize this... though I think people really ought to know. Every coin has two sides....
Here’s an example: I’m a specialist running a surgical outpatient clinic. We handle pretty much everything, from initial exams and diagnostics to full surgical procedures. Our billing is standardized; essentially, every exam or procedure is assigned a specific number of points. There’s a monthly cap, say 5,000 points per team, just as an example. If we exceed that, Medicare DOES NOT PAY us for the extra work; they only pay for those 5,000 points and not a cent more (a point is worth roughly $2.00). Of course, if we do less than the cap, we get paid for what we actually did. That revenue has to cover our overhead, supplies, medication, and the team's gross salaries.
However, if a patient comes in at the end of the month after we’ve already hit our quota—say, someone with an urgent hand tendon injury—I am required to see them. That’s fine, but I also have to use a significant amount of expensive medical supplies on them. When that happens, Medicare DOES NOT REIMBURSE me for those supplies, which means I’m directly in the red. In short, I’m losing money for my practice.
To put it bluntly, Medicare forces us to limit our patient volume; we can't just see as many people as we are physically capable of treating, but rather only as many as we can afford to supply with medicine and materials.
It’s the same story with primary care. If a patient doesn't visit their doctor often, they don't cost much beyond the standard per-patient fee, but if a doctor has several high-needs patients, everyone loses.
A friend of mine, who is a family practitioner, had a patient with pancreatic cancer who was suffering for a long time. She was providing analgesics, dressing his wounds from being bedridden... basically, the material costs (medication, bandages, gas for the car to make home visits) exceeded $5.00 per month. When she sent a formal request to Medicare asking for reimbursement (she receives about $10 per patient monthly, out of which she has to pay utilities, rent, meds, supplies, and her nurse's salary), she was told she couldn't receive anything beyond the standard per-patient rate. They basically implied it wasn't their problem if she was unlucky enough to have a patient with such intensive needs. Naturally, the patient is entitled to care, and you cannot and should not bill them for it. Luckily, she has a husband who owns a retail business, so she didn't go hungry...
The typical patient looking to claim their rights usually doesn't realize this... though I think people really ought to know. Every coin has two sides....