Whenever the media decides to hype Medicare fraud without really investigating what checklist mentalities construe as fraud, readers should at the same time think about why any physician would put up with these blatant attempts to deny them payment for the care they provide.
Physicians spend many years in training, more than most professionals. Veterinarians do not have to file claims with Medicare or insurance companies that reimburse half of their charges. Airline pilots don’t have to submit a bill to a third-party payer for their salaries and get only half of the charge reimbursed. CEOs of large corporations don’t submit claims to their company boards and expect to get less than half of their submitted charges.
For that matter, when consumers go into a grocery store, they don’t expect to take the loaf of bread to the checkout counter and pay half the cost on the price sticker. At least, not unless they want to be hauled off for shoplifting.
Health care is the only business in which physicians who have spent between 15 and 20 years learning medicine are expected to accept half or less in payment for the services they provide. The public tends to think this is O.K. because physicians make so much money, or because physicians are arrogant. There’s a name for this kind of logical error: non sequitur. The conclusion (it’s O.K. to pay physicians less than they charge) has no logical connection to the problem. Other professionals are not expected to discount their bill by 50 percent or more.
Consumers need to keep in mind that as the myriad of problems with this country’s dysfunctional health care continue to escalate, and especially as physicians are targeted by all manner of mean-spirited attempts to pay less and less for the care they provide, physicians are opting out of the current dysfunctional health care delivery system at an increasing rate.
Dr. Robb Lambert is one of the physicians who has decided to no longer put up with the status quo. On his September 8, 2012 post on “Dropping Out,” Dr. Lambert describes the problems of working within our dysfunctional health care system:
- I am far too busy during the day to slow down and give people the time they deserve….I’d rather work with them to prevent the problems in the first place.
- There’s a disconnect between my business and my mission….the only way to make enough money is to see more patients in my office, making it hard to spend time with people in the office, or to handle problems on the phone…Why am I penalized for caring?
- The increased burden of non-patient issues added to the already difficult situation….E/M coding for all of my notes….comply with “Meaningful Use” criteria for my EMR….defensive medicine to avoid lawsuits….more and more paperwork, more drug formulary problems, more patients frustrated with consultants, and less time to do it all.
On November 16, 2012, he talks about the things that made this decision difficult in “Tough Decision: What to do About Medicare.” Dr. Lambert has provided an excellent list of all the problems physicians have in dealing with Medicare:
So why not stay in Medicare? Let me count the ways:
- I have to bill for care. Simplicity is one of the cornerstones of a direct-care practice, while complexity is synonymous with medical billing. I don’t want to have people owing me money, I want them to pay at the start of the month for everything.
- Billing for Medicare would also mean I’d have to bill all other patients for the same services, as I am not allowed to charge others less than I do for Medicare beneficiaries.
- I’d have to get (and pay for) a billing system.
- I’d have to hire staff to do the billing and collect on it.
- I’d have to write my notes to meet the requirements for payment (as opposed to writing them for better patient care).
- I’d have to submit my bills using the proper procedure codes, paired with the proper diagnosis codes, submitted in the proper format, sent to the proper vendor.
- I’d have to deal with denied claims and the appeals process.
- Failure to do any of this (either by intent or mistake) would leave me open to fraud charges (even if my doing so was to my own financial detriment).
More and more independent physicians are deciding to opt out of Medicare and the insurance game. Many are finding a reasonable, alternative way to treat their patients, get paid for their services, and avoid being treated like criminals.
It’s time those involved in health care reform started looking around and asking where all the physicians have gone.
