Posts Tagged ‘physician’

Concierge care and retail clinics: two-tiered health care?

August 8th, 2012

Do you feel like a doctor’s visit these days is sometimes akin to being herded like cattle? My mother related to me that her recent visit with her doctor lasted “five minutes.” She may not have been exaggerating. A few minutes is hardly enough time for a physician to thoroughly examine anyone. So some patients are turning to what’s called “concierge care” – paying a doctor an extra annual fee for the privilege of more time and attention. Critics of concierge care worry that if it becomes widespread, it could make access to care more difficult for those who can’t pay extra. But the doctors who provide the service say it’s a way to relieve the burden of seeing so many patients during the day, gives them the opportunity to do a more thorough job for their patients, and helps keep them from losing money in an environment of high costs and low reimbursement rates.

Meanwhile, a shortage of primary care physicians, combined with the expected influx of 30 million people soon to be added to the insurance rolls via the Affordable Care Act, is contributing to the rise of retail medical clinics. Retailers such as CVS Pharmacy and Target are building in-store clinics which employ nurse practitioners or physician assistants to provide simple check-ups and treatments for minor conditions. Critics contend that these retail clinics are inadequate for managing more complex conditions. But the harder it is for people to get a doctor’s appointment, the more people turn to these clinics.

Both “concierge” care and retail health clinics are symptoms of a dysfunctional American health care system where the quality of care is still determined by how much someone can pay. So we are hurtling toward a two-tiered healthcare system, one where the well-to-do can pay extra for more attention and another where people who can’t get a doctor’s appointment at all must turn to the limited offerings of a retail clinic.

These trends show how the United States hasn’t kept up with the rest of the industrialized world with universal healthcare systems in producing enough primary care physicians for its population. According to the Organization for Economic Co-operation and Development, the U.S. has 2.4 physicians per 1,000 people compared with an average of 3.1 per 1,000 for all OECD nations. No wonder those doctors turning to concierge care feel rushed. And no wonder corporations see an opportunity to fill a void.

Medical school tuition in America is way too expensive, forcing many young physicians to eschew primary medicine (or practice in rural and low-income urban areas) in favor of entering the more lucrative specialties. By 2015, the U.S. will be nearly 63,000 doctors short of what’s needed for the population.

“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”

The American Medical Association in the past worked to keep a lid on the number of new doctors because the organization feared a physician glut. So the construction of new medical schools slowed. The AMA’s error in judgment has proven costly for our healthcare system. Another contributor to the physician shortage has been federal spending cuts to training programs for medical graduates. Add to all this an aging baby boom population, an exodus of retiring physicians and a lot of unhappiness within the medical profession itself.

We now have another mess, on top of out-of-control costs and unequal access. Even with the Affordable Care Act in place, many may still not get the care they need, unless they can pay extra. Under the ACA, the Obama administration has pledged to provide funding to train more primary physicians to practice in underserved areas. Yet, more must be done. The cost of medical school – like the cost of college – must come down dramatically. Without the burden of crushing loans, more newly minted doctors can go into primary care. Taking the profit out of health care by establishing a truly universal, publicly-supported system would also help bring bloated specialist salaries back down to earth. If the U.S. had in an earlier time treated health care as an equally shared public good, rather than a commodity, the very idea of having concierge care and corporate health clinics would sound like a bad joke.

Sylvia@californiaonecare.org

 

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OMG! Commonwealth study: U.S. MDs spend $83,000 (yearly) on insurance administration costs

August 5th, 2011

by nyceve

The other day, my brother asked me to explain why a simple yearly doctor visit costs $1500?  I started to explain, and he didn’t believe me.  I told him, doctors have to employ armies of people to deal with hundreds of insurance companies, this adds huge and unsustainable costs to our system.   I knew it was bad, but I didn’t know it was this bad.

Fasten your seat belts.  And as you read, keep in mind that the Affordable Care Act, has cemented into place this broken and dysfunctional system.  The for profit insurance industry has also taken our country hostage.

It’s all here, in this chart. And tragically the Affordable Care Act cements the for-profit health insurance industry at the heart of our completely broken profit centered health care system.

The way we bring health care costs under control is to remove profit from our health care system, but that won’t happen as long as the political class is bought and sold by the insurance industry.

A new study comparing health care costs in Ontario Canada which has a single payer system to our for-profit system reveals the terrible and unsustainable costs our for-profit healthcare system extract from the U.S. economy.

If there was any serious intent in Washington to bring our deficit under control, the first place one would look would be the for-profit health care system.  This is why what we just witnessed with the debt ceiling fiasco is so troubling, it was depraved Kabuki theater at its most grotesque.

If you want to know why we pay four, five, six times as much for a routine doctor appointment in the United States, look again at the chart.  It’s nauseating. And it’s because our broken and fragmented health care system is being held hostage by the for-profit insurance industry which .

Don’t believe a word I say, but please believe Dean Baker.

The reason that Medicare, Medicaid, and Social Security are projected to “usurp much of the revenue from federal taxes,” is that health care costs in the United States are out of control. If the U.S. paid the same amount per person for health care as any of these other countries it would be looking at huge budget surpluses in the long-term, not deficits.

The survey research reveals that physician practices in the United States incur nearly $83,000 in administrative costs per physician each year, nearly four times the amount spent by their Canadian counterparts. The U.S. could save almost $27.6 billion in annual health spending if administrative costs were similar to those in Canada.

Administrative costs are a major factor in the high cost of health care in America. One significant component is the expense physicians incur when they have to deal with multiple health insurers. In a new Health Affairs study comparing these costs in the U.S. and Canada, Commonwealth Fund–supported researchers show just how much more U.S. practices spend than their counterparts across the border.

Based on survey research, the authors, led by the University of Toronto’s Dante Morra, report that the time and labor spent by U.S. physician practices on filing claims, billing, obtaining prior authorization for patient services, and dealing with pharmaceutical formularies amounts to at least $82,975 per physician annually. That figure dwarfs the $22,205 spent by practices in Ontario, which operates within Canada’s predominantly single-payer health system.

Commenting on the new study, Commonwealth Fund president Karen Davis cited an inefficient and fragmented insurance system as a contributor to high costs in the U.S. “Greater continuity of insurance coverage and administrative simplification reforms in the Affordable Care Act can begin to streamline health care administration and reduce the time medical staff must spend on billing and authorization issues,” she said.

The authors of the study estimate total savings of about $27.6 billion per year if U.S. physician practices had administrative costs similar to those in Ontario.

Our country is in free fall, we have 55 million without access to health care and those of us still hanging on to our junk insurance are hostage to a government bought and paid for by the health insurance industry.

Nyceve is a board member for California OneCare. Originally posted at the Daily Kos.

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Don McCanne, MD: Impact of single payer on physician income in Canada

August 1st, 2011

The Impact of Single-Payer Health Care on Physician Income in Canada, 1850–2005

By Jacalyn Duffin, MD, PhD
American Journal of Public Health, July 2011

Over nearly 60 years, into the 21st century, physician income grew at a rate of increase that outpaced that of other Canadians. Since 1958 through the advent of medicare, until at least 1992 and probably into the present, physicians, as a professional category, were the top earners in the country.

In 2005, US doctors earned about five-and-a-half times the US GDP per capita; Canadian doctors earned about four times their country’s GDP per capita.

The observation that Canadian physicians are paid less than their American counterparts invites us to ask, what do Canadians “get” in exchange for paying their physicians less than their American counterparts? A 1990 study showed that, although per capita expenditures on health in the United States were higher than those in Canada, the actual number of services was fewer. In other words, Canadian citizens were getting more and spending less.

From this research, we observe that even when the readjustments resulting from various policy and payment alterations are taken into account, Canadian medicare did not lead to a loss in physician income. Rather, physician incomes grew more quickly than those of other Canadians and are considerably greater. In short, the medical-income argument against moving toward a Canadian-style system is feeble.

The universal, single-payer system has been good not only for Canadians but also for their doctors.

http://ajph.aphapublications.org/cgi/content/abstract/101/7/1198

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By Don McCanne, MD

The experience with single payer in Canada has revealed that not only were physicians’ incomes not harmed, physicians remain the top earners in the country. This article should allay the fears of U.S. physicians who would like to see us achieve a health care system that ensures quality health care for all but who remain apprehensive that their incomes might be adversely affected. As this report states, “The universal, single-payer system has been good not only for Canadians but also for their doctors.”

Re-posted with permission from pnhp.org.

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Doctors should share in the sacrifice

June 14th, 2011

by brooklynbadboy

Whenever there is a debate about making cuts to education, both parties zero right in on teachers. But when the debate is about making cuts to health care, nobody zeroes in on doctors. A curious thing, wouldn’t you say? In both professions, the primary practitioners of the profession are seen as being ultimately responsible for the product. Educators are constantly put under pressure. They must accept cuts in pay, cuts in benefits, cuts in job security, cuts in funding for their ability to do their job. They must do more with less, always. But in the case of health care, doctors seem to escape any scrutiny whatsoever. In fact, any cut to their income no matter how insignificant, is always portrayed as doing irreparable harm to the health care system.
I’m going on the record: Doctors make too much money and they need to start taking it in the chin if we are going to get control of health care costs.

In 2007, Alex Berenson writing in the New York Times hit the nail on the head of this subject in his seminal article “Sending Back the Doctor Bill.”

Easy, liberals say. If Washington would just force cuts in prescription drug prices and insurance company profits, plenty of money would be left over to cover the uninsured. Conservatives prefer to argue that the answer lies in forcing people to pay more of their own medical costs. But many health care economists say both sides are wrong. These economists, some of whom are also doctors, say the partisan fight over insurers and drug makers is a distraction from a bigger problem: the relatively high salaries paid to American doctors, and even more importantly, the way they are compensated.

Berenson goes on to make the point that doctors in the U.S. make two to three times what doctors in Europe make. While primary care general practitioners in the U.S. have earnings comparable with Europe, the specialists are making a killing. A 2006 study by the Congressional Research Service compared the pay of doctors by adjusting for purchasing power of the local currency and found that American medical specialists are paid an adjusted average of $230,000 a year. General practitioners? $161,000. Nurses, who actually do the lion’s share of the real work? $56,000. In Germany, specialists make an average of $77,000. In The UK, $151,000. In Canada, $161,000.

I think we all agree doctors should be well paid. After all, it is an important profession that requires quite a bit of training. But do they really need to make $230k and up? No. Especially considering that specialists in other industrial nations that have lower health care costs and better health care outcomes seem to get by all right by paying their doctors a lot less.

To be sure, the insurance companies have always blamed the doctors for rising health care costs. The doctors, of course, blame the medical device companies and the pharmaceutical companies. All of them both blame government, of course. The truth is there is plenty of blame to go around. But the one group that seems to keep escaping accountability is doctors.

In 2009, during the heat of the health care debate, The New York Times published an article about this subject:

Many studies have shown that patient care and spending vary enormously from community to community, depending on local practices, which are largely determined by doctors.
The health care system has long been accused of emphasizing the quantity — rather than the quality — of care, giving doctors and other health providers incentive to order extra tests and procedures when they don’t improve the outcome. “It is a model that has taken the pursuit of medicine from a profession — a calling — to a business,” President Obama said of the system.

A lucrative business. Especially if you are a specialist. While doctors always have to second guess a procedure when payment comes from an insurance company, they never have to do that with Medicare. Medicare will always pay because Medicare doesn’t review the costs of procedure. What Medicare does do, very well in fact, is just fix the price lower than what can be expected from private insurance. On the one side, Medicare pays, but pays low. On the other side, private insurers pay high, but doctors may or may not get paid in a timely manner. (It’s another reason why a single payer system like Medicare works better, but that’s another debate for another time.) Under this system, doctors have every incentive to milk the system for all it’s worth, ordering as many procedures as possible and shifting Medicare’s lower payments to private insurance. Since private insurance may or may not pay depending on their profit schedule, doctors have every incentive do either deny care or throw as much car as possible out there to see what sticks. And it is especially milky for those with specialties. As Berenson notes in the article, the way doctors are paid is as much a problem as how they are paid.

Let’s get the doctors in on this “shared sacrifice” business. Reforms in the health care law to encourage more doctors to simply get a job rather than trying to run a business should help. Let’s put doctors on a good salary, with good health benefits and a good pension. If we are going to get health care costs down, it seems to me a quarter-million dollar specialist should be the person who should take the hit first. They’ll be just fine suffering though the indignity of 20% more than general practitioner’s six figure pay rather than 50%.

Originally appeared in the Daily Kos, May 29, 2011. Re-posted with permission.

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