I'm a physician in California currently working in a rural clinic because I make more money serving Medicaid patients than I did serving private insurance patients. Yep, you heard right. Since Medicaid is subsidized for rural areas, we get paid heaps of money for treating the toothless meth freaks who live in the hills of Central California.
But that's not what my diary is about.
I recently had a surgery for some "female problems" typical to ladies in early menopause. I've actually had 4 different surgeries for this over the last 6 years, and finally had a hysterectomy. Nuff said about that part.
But here's what's making me crazy:
First surgery: Emergency D&C, same day surgery. I was not on insurance at that time because I had just started a new job and couldn't afford COBRA at $1,200/month(yes, that's right, a physician couldn't afford COBRA. How is a motel housekeeper supposed to afford COBRA?). Well, the charges were about $8,000. I had to pay the whole thing.
Second surgery: Planned D&C, same day surgery. On Blue Cross HMO insurance by then. Charges were $12,000, the insurance paid $1,250, the hospital wrote off the rest. I paid nothing.
Third surgery: Planned D&C, same day surgery. Blue Cross PPO insurance, charges $9,500, insurance paid $250, I had to pay $1,240. Hospital wrote off the rest.
Fourth surgery (the most recent one): planned hysterectomy, two day stay at a surgical hospital (by the way, I had to go to the surgical hospital because the local hospital doesn't accept Blue Cross anymore). Blue Cross PPO with high deductible/health savings account. Charges $68,316 for "room and board". My insurance allowed $2,926, the hospital wrote off $65,390, and I paid nothing (because we've already met our $5,800 deductible this year).
Hey, hospitals: You say you'll go broke if insurance rates are tied to Medicare reimbursement. How the hell are you able to provide services you value at $68k, accept $3k, and write off the rest, just because you made a contract with Blue Cross? If I were a cash patient, you can bet I would have paid tens of thousands for that surgery, much more than $3k, the "negotiated" price for Blue Cross.
Another example: My husband had a x-ray. It was billed to the insurance for $500. The insurance paid $85. The hospital wrote off the rest. How much does the x-ray really cost? If it costs $85, why do they bill $500 (and expect that much from cash patients)? If it costs $500, how can they stay in business by accepting shit money from the Big Blues, just to be on their "preferred list"?
In my experience when I was in a fee-for-service practice, Blue Cross paid less than anyone except Medicaid. MediCare paid more than Blue Cross. How can AHIP be throwing a fit about tying reform to MediCare rates, while they keep cutting deals with the crooks at Blue Cross and United?
This whole system is a giant, money-making house of cards, and I want to see Congress knock it down. Make charges and payments transparent and uniform. If it costs $500 to do an x-ray, then providers need to be paid that much. Maybe we'd do fewer x-rays. That would likely be a good thing. But as long as there is such a discrepancy in what is charged and what is accepted, as long as administrative costs account for so much of our premiums, we are not having a real discussion about Health Care Reform.
The big insurance and hospital groups would scream bloody murder if we tried to set realistic payment levels for each region of the United States. However, if we set fee schedules to match what hospitals and providers are actually accepting from the insurance companies right now, to cost of medical care would look dramatically different and reform would look a heck of a lot easier to do.