Dr. Andy

Reflections on medicine and biology among other things

Monday, April 04, 2005

Medical Economics

for beginners in this Atul Gawande New Yorker piece. It does a good job of showing how medical care is payed for and some of the problems. He doesn't have the solution, but eithe does anyone else.

I would say the pay set-up for attendings at the Brigham is pretty free enterprise (they get paid for surgery and are charged for expenses, at least after a few years of straight salary support). I (and I think many academic physicians) am paid a salary with a small (10-15% of salary) incentive payment depending on productivity and academic achievement. I don't know which is best, but the piecework system clearly creates incentive to increase the amount of medical care provided.

The hassles with insurance are unbelievable. One advantage of practicing at an academic institution is that there is a huge bureacracy to deal with these issues.

The downside is it is done less well than I'd do it if my pay depended on it (our incentive is based on RVUs billed not collection) and all those people are expensive so I make less than I would in private practice. I recently found out that I was not accepting patients with several different insurance plans because my credentialling hadn't gone through. I found out by accident (I had spoken with a pediatrician about a patient and asked the schedulers to add him on, but they told me they couldn't because of his insurance) and started asking around. I found out I was indeed accepted by those plans but for some reason the scheduling program wouldn't accept me as a provdier, so the schedulers were just booking those patients with other physicians. Apparently, no one thought to look into fixing thisAaargh. Of course if I was running my own practice I'd have been more on top of this (or fired the people who didn't do anyting about it).


At 9:34 PM, Anonymous jb said...

I am at the other extreme end of the spectrum of surgeons- a solo practice with 2 employees. I am intimately involved with the business end of my practice, and it does take a lot of time, but I know literally where every dollar comes from and where it goes. As a result, I suspect that I am a lot more efficient than you are in determining whether to concentrate on this procedure, offer another new service, contract with or drop a medical plan, etc. BUT, I'm not making a million a year, because, unlike you, Blue Cross and its ilk can push me around to its heart's content. Blue Cross needs your group, It doesn't need me, I need it. I have to take whatever they decide to pay me for a particular procedure, and it ain't pretty. I suppose that at the end of the year,I do about the same as you would for the same amount of work. I know how bad they screw me, you can only guess, but it's all the same.


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