Why your doctor is struggling to stay afloat

[disneysteve]

Hmm, I don't know if I would consider that as Dr.s eating the cost.

She saw 200 more patients and earned $30,000 less in the process. She ate a lot of the costs due to lower reimbursement. Making 1.5x when you used to make 2x for the same service is not a good thing.

[Singuy]

She saw 200 more patients and earned $30,000 less in the process. She ate a lot of the costs due to lower reimbursement. Making 1.5x when you used to make 2x for the same service is not a good thing.

That's because it sounds like she doesn't have enough patient to be saturated on her schedule so she can definitely afford to have the pt come back taking another time slot for the full 1x pay vs the 0.5x for the same time.

When you have a practice in which you have a saturated schedule, it no longer make sense to have the person come back again when you can make the 1.5x here and now.

There's an ophthalmologist who paid my wife 500 dollars just to do a really quick lasik follow up visit just so this pt doesn't take up a slot at his practice since his time slots are worth way more than the 500. My wife's slots are worth like 65 so we absolutely loved it.

[TexasHusker]

Oh you can certainly pay out of pocket for anything you'd like. That just isn't a viable option for the average person. Just paying copays is often a struggle. Heck, when I hurt my shoulder and had to do PT 3 times a week, the $30 copay added up really quick. I quit that and switched to a home program as soon as I could.

People think nothing of buying $50 worth of lotto tickets, vapes, or booze, but when they need medical care, the copay is unaffordable.

[TexasHusker]

She saw 200 more patients and earned $30,000 less in the process. She ate a lot of the costs due to lower reimbursement. Making 1.5x when you used to make 2x for the same service is not a good thing.

OB GYNs, PCPs, Internists, and Pediatricians bill “evaluation and management” CPT codes most of the time. These are generally 992XX codes. Reimbursements for these codes have moved very little in the last 20 years.

This is a function of free- markets. There is no market pressure for these fees to rise. That is because nurse practitioners and physician assistants have taken the easy work of the aforementioned doctors. In fact, in many states, NPs and PAs can now have their own practices!

So there is a tremendous glut in the supply of these physicians, although not true in many rural markets.

[disneysteve]

That's because it sounds like she doesn't have enough patient to be saturated on her schedule so she can definitely afford to have the pt come back taking another time slot for the full 1x pay vs the 0.5x for the same time.

It's not about having the time. It's about doing what's best for the patient even if it costs us income. We don't want to tell the patient we can't address their concerns while they are sitting in front of us and force them to come back again. Unfortunately, the insurance company doesn't care what's best for the patient. They only care about spending as little as they possible can.

[disneysteve]

People think nothing of buying $50 worth of lotto tickets, vapes, or booze, but when they need medical care, the copay is unaffordable.

I saw that a lot among the lower income folks. I worked in a very poor area and that mindset was very common.

I was thinking more of middle class folks. Look at my PT example. $30 copay. If you have to go 3 times a week for 4 weeks that's $360. How many average families can easily come up with that.

My last insurance had a $50 copay so a visit with Ortho, then an MRI, then 4 weeks of PT would come to $700. Plus the initial PCP visit to get referred to Ortho for another $30. A family living paycheck to paycheck, as most are, can't do that.

[disneysteve]

OB GYNs, PCPs, Internists, and Pediatricians bill “evaluation and management” CPT codes most of the time. These are generally 992XX codes. Reimbursements for these codes have moved very little in the last 20 years.

BINGO! That's the problem. Reimbursements have been flat or even declining for many years. But expenses keep rising. So income keeps falling year after year after year.

And they wonder why there is a physician shortage.

[TexasHusker]

BINGO! That's the problem. Reimbursements have been flat or even declining for many years. But expenses keep rising. So income keeps falling year after year after year.

And they wonder why there is a physician shortage.

There may be a physician shortage, but there's certainly not a NP or PA shortage. Those two are putting the squeeze on Primary Care physicians.

There will come a day when an RN can take a six-week course and be qualified to autonomously perform primary care and write prescriptions.

I'm not saying that is right, but it is reality.

[TexasHusker]

I saw that a lot among the lower income folks. I worked in a very poor area and that mindset was very common.

I was thinking more of middle class folks. Look at my PT example. $30 copay. If you have to go 3 times a week for 4 weeks that's $360. How many average families can easily come up with that.

My last insurance had a $50 copay so a visit with Ortho, then an MRI, then 4 weeks of PT would come to $700. Plus the initial PCP visit to get referred to Ortho for another $30. A family living paycheck to paycheck, as most are, can't do that.

I hear you, but if you've got a condition requiring three visits a week to the PT for a while, you obviously had some sort of mishap and hopefully you have some savings to use until you meet your deductible. That's how insurance is supposed to work.

Part of the issue is "health care" versus "medical care". When our society began demanding that their "health" be cared for continuously by a third party (doctors), things got a LOT more expensive in a hurry. Insurance had to rise because utilization of services spiraled out of control. Someone else was paying for the coughs, sniffles, and flu shots.

My homeowners insurance is $200 per month with a $5,000 deductible. I wonder what it would cost if it became "home care" insurance that paid for every broken window, faucet leak, and A/C filter? Any time something broke, I just paid a copay and Mr. Fixit showed up? Maybe $1000 a month or more?

We need to get back to "medical care". I pay for all of my own medical care until such time as a meet a deductible, then it's someone else's problem.