Wednesday, April 26, 2006

Oh Those Bad, Rich Physicians? Think Again.


The Robert Wood Foundation is at it again, folks. This time a massive study of 6,600 physicians which discovered the following (though I do not know what it was intended to study):

68% of physicians now provide charity medical care to the indigent
That's down from 76% from 10 years ago.
Now, let's don't gloss over that ten years ago, over 75% of doctors treated people for free or reduced costs. It's more common than you would think.

Today? Over half still do, and that's probably more than the number of people who contribute to charity. If he simply gives away his time, well physicians serving as expert witnesses these days command up to $600 an hour.

But not all doctors are "rich". There are many who are struggling, saddled with huge med school debts, and loving their practice but finding if it doesn't include "procedures," they're trying to run a "business" on very shaky grounds.

"To make any money," Dr. A. told me, "I'd have to see one patient every 8 minutes, and I'm not willing to practice medicine that way." The good doctor continued to treat patients, some of whom had been with him 40 years, the way he always has, about 4 an hour, less if someone needs more attention, and recently he had to close down his private practice and go work at a clinic.

Medical malpractice takes one of the bigger bites in "overhead" and that's another story.

Now wWHY HAS DOCTOR-CHARITY DECLINED? Donald Devine had wondered about this himself, and sort of felt like he ought to know, since he's a professor of political science at Bellevue University and was formerly director of the Federal Employees Health Benefits and Civil Service Retirement programs during President Ronald Reagan’s first term.

I guess the teacher was ready because the pupil came. There happened in his class one day a woman who said SHE KNEW WHY. Her job, she said, was working for a medical practice and she had been hired to keep the firm's health professionals from defrauding the government.

Fine, you say. What does that have to do with "charity"?

You're not going to like the answer.

"It seems that Medicare and Medicaid consider it fraud if a physician charges any patient less than the government must pay for a medical service," says Devine. "If a doctor feels compassion for some poor soul and offers a discount, he must grant that 'discount' for every billing for every patient in the government programs. If he forgives one indigent from paying at all, the government never has to pay for any such procedure. The only reason the study shows so much charitable activity is that the physicians counted extra time spent at hospitals treating indigents as charity, which it really is not since treatment is requited by law." ("requited" could be a typo for "required" - I'm not up on that language.)

Devine continues: The woman wrote “I am employed as a Coding and Compliance Manager. Along with supervising nine people, I perform audits on the physicians' billing, credentialing, coding, collections, and directly supervise charge entry, posting payments, pre-certifications and referrals." [Then she talks about the horrendous job physicians have complying, and all the paperwork.]

She adds, “God help us if we inadvertently write off charges or perform services that Medicare doesn’t see medically necessary and bill the patient without an advance beneficiary notice (ABN) signed. The average citizen does not understand basic health insurance let alone all the rules and regulations surrounding it. So for them it is hard to understand why we cannot just write off their balance. They think physicians are money hungry."

Adds Devine, "When one reads about doctors being hauled off to jail for fraud, odds are this is the cause, guilty not of fraud but of charity. If a health provider bills for either government program, it is subject to a Federal audit. Every patient’s record, whether Medicaid or Medicare or not, is scrutinized to assure that no non-government patient pays less than the government is charged. If the health provider gives anyone an undocumented break this is considered 'fraud' and it is off to jail for the foolish Mother Theresa."

Think YOU'VE got a nit-picking, micro-managing, uptight boss? It looks like physicians in "private" practice do as well.

++Medicare has an unfunded liability of $30 trillion
++This dwarfs Social Security’s liability and will bankrupt the national government all by itself
++The joint Federal-local Medicaid will bring down the state governments as well
++So they went after the doctors
++There's an arbitrary payment scale to reimburse physicians regardless of the market or even local costs
++"No one pays less than the government" is the slogan
++This means no one gets a break on their bill or balance
++As doctors in smaller practices become aware of the government practices -- and audits -- (it's impossible to keep up), expect charitable acts to decline further
++As will doctors' salaries
++So we will get less competent physicians
++Yes. It isn't all "follow the money," but the doctor who lives across the street from me clears about $30k a year. She thinks she might have less stress being a secretary for that same $30k a year, but ...

Now a word here from a fundraiser. I have raised funds for various entities, including a homeless shelter. I think charitable giving is one of the best things around, not because it helps those in need, which is occasionally does, but because it helps those in need of giving. "My job," said my minister-mentor friend, "is to comfort the afflicted and afflict the comfortable." Yes, we helped those in need -- both those in need of shelter, food, and clothing AND those in need of connection, of giving, of gratitude, those who needed to make a difference, and those who needed to give back.

Our American heritage of private and local charity is unique, and of inestimable value. "[It] has amazed the world since the French observer Alexis de Tocqueville described it so vividly in the early 19th Centurey," says Devine.

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