Thoughts and Ruminations

Hypocritical Society

Compliments of Dr. Falkoff: 

Hypocritical Society Doctors can’t accept pens, pads, lunches, gifts, concert or sports tickets, trips, medication samples etc, etc from Pharmaceutical and other Medical Related companies. Of course because Physicians despite their usually extensive education are just human too and will succumb to greed, catering to their vanity and sense of self importance. 

They can’t be independent businesses, independent contractors and set their own value for the service they provide and responsibilities they take on. Let’s also remember they can’t ever make a mistake, for this could lead to their becoming not only defensive but actually lose their expensive, heavily time and money invested career in the blink of an eye through a lawsuit for potentially something they had no control over or heaven forbid was human enough to make a mistake. Can you blame physicians for being accused of practicing defensive medicine. 

Yet, the Government at Local, State, National levels who will shape how Billions upon Billions to Trillions of Dollars are spent, which are typically raised through taxes on its citizens, the government gets Lobbied by Interest Groups that give them Millions to Billions of Dollars to Hear their Opinions and Influence the thinking of these same individuals who then come up with these ideas that physicians can’t receive things – gifts, money, food etc…. because we as highly educated individuals can’t decide to do the right things regardless of some material gain. Despite the fact that in just about every other industry in this country and the world does this go on where a company that provides a product or a service, market itself, wine and dine present and potential clients etc. 

The Insurance Industry is a huge lobby, the Pharmaceutical Industry is a huge lobby and even Hospital Systems and Physician Owned Hospital and Health Systems are all huge lobbies. Just look at all the ads flying about the Healthcare Reform situation. All varied, self interested groups. All at the same time supporting the idea that physicians should get nothing that potentially influence their decisions in treatment. 

Does the AMA, ACOP, AAFP and all our other professional organizations get all this? For they too don’t think their memberships can utilize independent thinking and thought processes and can be so easily influenced. And if so, then so what if this is the way those making the rules function. Just seems that all this is the height of hypocrisy.

Sincerely, 

Alan T. Falkoff, M.D., D.A.B.F.M., F.A.A.F.P. High Ridge Family Practice

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How Doctors Get Paid

Posted with permission from author:

Imagine going to your favorite restaurant. You are greeted at the door by the hostess, who seats you and takes your drink order. You order through your favorite waiter, Andrew, who recommends the special of the day: prime rib with a dinner salad and a chocolate tort for dessert. Soon after, the food is brought out and it is delicious. You have time to enjoy your food. You then receive the bill and pay for your meal, returning to your home satisfied, all your dining needs met. Let’s say you paid $75 for this meal:$50 for the steak, $10 for the salad and $15 for the dessert.

A change then occurs in the restaurant industry. A new form of eating out has been adopted. Your favorite restaurant has now contracted with over 30 different ”restaurant insurance companies.”

Anticipating another pleasant dining experience, your return to the restaurant with your new “subscribers card.” You pay your $5 “copay” and sit down in the foyer of the restaurant. After waiting an hour, even though you made reservations, a harried Andrew greets you and quickly takes your order after you briefly glance at the menu. The food arrives at your table, but before you have time to truly enjoy it, Andrew informs you that “your time is up” and the table is reserved for another party. You are escorted outside with your hastily boxed left-overs.

What has happened to the restaurant? Behind the scenes, the restaurant owner has learned some tough realities of the “new system.” During the first month of taking insurance, the owner submits the charges for the $75 steak dinner. The contract with this particular insurance company already states that they will only pay $45 for the $50 steak, but the owner decides that the extra customers brought to the restaurant by contracting with this insurance company will more than off-set this small loss.

The first attempt at collecting the $75 dollars for the full meal is returned unpaid due to a clerical error. The owner mistakenly used the number assigned by another insurance company. The owner mails the corrected form.

In response to the second request for payment, the insurance company does not send a check, but a detailed questionnaire: Was basil used in seasoning the steak? Was it necessary to use basil for this particular recipe? Did the restaurant ask for permission to use basil from the insurance company before serving the steak? The owner submits the answers, emphasizing that the basil is part of a family recipe that made the restaurant famous.

The owner waits another week (it has now been 3 weeks since the dinner was served). The check arrives three and a half weeks after the meal was served. The check is for $20 and states that it is specifically for the steak. The check also comes with a letter stating that no billing of the patron may occur for the salad, but no other explanation is enclosed. No mention is made of the $15 dessert.

The now frustrated restaurant owner calls the provider service number listed in the contract. After five separate phone calls to five different numbers (The harried voice behind phone call number four explains that the insurance company has merged with another insurance company and the phone numbers had all changed last week, sorry for the inconvenience…), the owner gets to ask why, when the contract says the steak will be paid at $45, has the check only been written for $20? And what happened to the payment for the salad and the dessert?

As it turns out, this particular patron’s insurance contract only pays $45 when the patron has reached their deductible, which this patron has not at this time. The remaining portion of the steak must now be billed by the restaurant to the patron directly.

The $10 for the salad would have been paid if the patron had ordered it on a different day, but, per page 35 in the contract, because it was billed on the same day as the steak, it is considered to be part of the payment for the steak and no extra money can be collected from the patron or the insurance company.

The dessert should have had a “modifier” number put with its particular billing code in order to receive payment when billed with the steak and the salad.

Realizing that the billing is quite a bit harder than anticipated, the restaurant owner hires a person to specifically make sure these errors do not occur again. The owner must lay off the hostess and the bus boy to hire the biller, but feels these duties can be added to the waiter’s other responsibilities.

In the meantime, the restaurant owner has now had to have the waiter take on the job of answering the phones due to the now high volume of phone calls from patrons questioning why they are receiving bills for meals they ate over 2 months ago and why did their insurance company not pay for this portion of the meal. This extra work is now resulting in longer times patrons must wait to be seated and served, and grumblings from the waiters who “were not hired or trained to do this kind of work.”

The owner now realizes that, although the dinner originally cost $75 to make, only $22 has been paid. The remaining $30 billed to the patron has now cost $10 in overtime for the biller and mailing a second bill to the patron after the first bill went unpaid. By the third billing cycle, the owner realizes a collection agency must be employed in order to have any hope of receiving any portion of payment from the patron.

In order to meet costs, the restaurant owner now must seat twice as many patrons in the same amount of time. The owner has now over-extended the waiter, who was an excellent waiter, but is now taking on the roles of host, phone answering and table bussing, as the pay for these employees has been shifted to the biller and the collection agency.

What was once an outstanding business that focused on fine dining and customer service has now been turned into a business in the business of trying to get paid.

Alas, I wish this were a fictional tale, but it is not. The only fictional portion is that this is not your favorite restaurant, but your favorite doctor’s office, who is responsible not for meeting your dining needs, but those of your health.

Megan Lewis, M.D.
A family doctor in rural Colorado.