Sunday, November 19, 2006

Medical care fast becoming a privilege of the wealthy alone.

Entry for January 30, 2006

First, the story and then the commentary:


WASHINGTON (Reuters) - Primary care -- the basic medical care that people get when they visit their doctors for routine physicals and minor problems -- could fall apart in the United States without immediate reforms, the American College of Physicians said on Monday.

"Primary care is on the verge of collapse," said the organization, a professional group which certifies internists, in a statement. "Very few young physicians are going into primary care and those already in practice are under such stress that they are looking for an exit strategy."

Dropping incomes coupled with difficulties in juggling patients, soaring bills and policies from insurers that encourage rushed office visits all mean that more primary care doctors are retiring than are graduating from medical school, the ACP said in its report.

The group has proposed a solution -- calling on federal policymakers to approve new ways of paying doctors that would put primary care doctors in charge of organizing a patient's care and giving patients more responsibility for monitoring their own health and scheduling regular visits.

U.S. doctors have long complained that reimbursement policies of both Medicare and private insurers reward a "just-in-time" approach, instead of preventive care that would save money and keep patients healthier.

"Medicare will pay tens of thousands of dollars ... for a limb amputation on a diabetic patient, but virtually nothing to the primary care physician for keeping the patient's diabetes under control," said Bob Doherty, senior vice president for the


The ACP plan called for innovations such as using e-mail to consult on minor and routine matters, freeing up expensive office visit time for when it is needed. Doctors would be compensated for an e-mail consultation.

The proposals include incentives for doctors to work more efficiently and to provide better care, ACP President Dr. C. Anderson Hedberg told a news conference. "ACP proposals would provide patients with access to care that is coordinated by their own personal physician," Hedberg said.


The ACP cited an American Medical Association survey that found 35 percent of all physicians nationwide are over the age of 55 and will soon retire.

In 2003, only 27 percent of third year internal medicine residents actually planned to practice internal medicine, the group said, with others planning to go into more lucrative specialty jobs.

"Primary care physicians -- the bedrock of medical care for today and the future -- are at the bottom of the list of all medical specialties in median income compensation," the ACP said.

The group, which represents 119,000 doctors and medical students in general internal medicine and subspecialties, joins others that warn the U.S. health care system is untenable.

"If these reforms do not take place, within a few years there will not be enough primary care physicians to take care of an aging population with increasing incidences of chronic diseases," said Dr. Vineet Arora, chair of the College's Council of Associates.

Dr. Sara Walker, a Missouri physician, said she believed doctors were leaving general practice because of drops in Medicare reimbursement to doctors.

"A drop in Medicare payments will not only force me to stop taking Medicare patients but could force me out of business," agreed Dr. Kevin Lutz, a solo practitioner in Denver.


This country should be terribly embarrassed about the pathetic medical situation here. The United States is the only major nation that doesn't guarantee basic primary care to its citizens. There is no reason that primary care physicians should be controlled by insurance companies instead of their patient's best interests.

Primary care physicians should not be involved in fee-for-service billing. Primary care physicians (and pediatricians, too) should be paid a salary, period, for working a certain number of hours per weekday and bonuses for weekend hours. Fee-for-service is a scam made up by insurance companies to screw both the physicians and the patients. I should know, because I used to work in computerized medical office management. My job was to train nurses and other workers in physician's offices to use the computerized procedure tracking and billing programs. The insurance companies have made it so that CPT (procedure) code for basic services pay almost nothing.

The doctors fight back, however. Instead of coding in the correct CPT and ICD (diagnosis) codes into the system, they pick the ones that will pay the most. Think of grade inflation, and then translate to the key of insurance billing. For example, I once received a copy of a statement from an emergency room visit where one of my children needed just a couple of stitches from falling on a paved sidewalk and landing on a rock with a sharp edge. The child was perfectly calm, in no real pain, and certainly not in any danger. However, when I looked at the bill, I noticed that the hospital had coded the visit for the highest possible level of emergency care - in other words, they used the code for a situation where the patient comes in with a life-threatening trauma that requires immediate intensive treatment and the patient is in danger of dying on the spot.

Our health insurance is from my husband's place of employment, which is self insured. Humana handles the paperwork, but it is an independent corporate insurance pool. So, of course, I called the Human Resources office and told them about the bill, and even brought them a copy of the CPT code listings for emergency room visits (there are 5 levels, of which my child's should have been coded at the second lowest [due to blood, it was technically a biohazard case].) But the vast majority of people who received these "summary" bills from their doctors and hospitals don't have the foggiest idea what all those numbers mean.

The system, in other words, is rife with corruption and scamming on both sides, because insurance companies know those ICD and CPT codes too, you know, and frequently challenge even legitimate diagnoses and procedures to try and get the doctor to agree to downgrade them. Since it is often way too much hassle for the doctor to try and defend his legitimate billings, they often will just let it pass in order to at least be paid something. If they disagree with the insurance company, their payments will be held up for months while the insurance company "investigates."

So the whole system is a trap, where doctors and patients are at a gross disadvantage, and those doctors that do succeed in inflating their codes end up costing the rest of us even more money. The entire thing needs to be tossed in the trash when it comes to primary and pediatric care, and universal guaranteed primary care (only for citizens, I should say) should be implemented.

Is this socialism? No, it isn't. It is government doing its job - guaranteeing basic rights to its citizens. Health care is not a luxury, it is a basic human right. Every time a doctor or hospital turns a patient out on the street without adequate care, it is another crime against humanity, class.

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