Originally published December 30 2014
Top-earning doctors milk their patients for every dollar possible, research shows
by Jennifer Lilley
(NaturalNews) After examining what Medicare was billed versus what it paid to clinicians, researchers from the UCLA Department of Urology and the Veterans' Health Administration discovered what has been described as "very surprising." Based on their findings, it would appear that they've stumbled upon the reason why some high-earning physicians are making top dollar: Quite simply, it is because they're pushing more services per patient than they are actually treating them or seeing new patients.(1)
Could this explain the frustrations that many patients feel when some medical professionals hastily offer them a new service, rather than taking the time to fully assess their condition?
"With clinicians making more not by seeing more unique patients, but by providing more services per person, additional research needs to be done to determine if these additional services are contributing to improved quality of care," said Dr. Jonathan Bergman, first author of the letter that details the discovery. "These findings suggest that the current health care reimbursement model -- fee-for-service -- may not be creating the correct incentives for clinicians to keep their patients healthy. Fee-for-service may not be the most reasonable way to reimburse physicians."(1)
Dr. Bergman is also a urologist and bioethicist at the Veterans' Health Administration-Greater Los Angeles as well an assistant professor of urology and family medicine at the David Geffen School of Medicine at UCLA.
Compromising quality healthcareThe letter, titled "Service Intensity and Physician Income: Conclusions From Medicare's Physician Data Release," was published in the journal JAMA Internal Medicine. The letter states the following:
These data indicate that higher-earning physicians earn more not by treating more patients but by offering more services per beneficiary. The relationship between these additional services and any meaningful improvement in outcomes is undefined. ... In Medicare's fee-for-service system, some physicians are collecting large fees by ordering services munificently.(2)
It also suggests that the fee-for-service model may not be ideal, raising the question of whether or not it could jeopardize the level of care that a patient receives:
For instance, advising a patient that she does not need a computed tomographic scan often takes more skill and time, and may represent higher quality of care, than ordering a scan or performing a service.(2)
According to Medicare.gov, Original Medicare coverage consists of Part A and Part B. The website explains that Part A pertains to things like hospital care, hospice and home health services. Part B, according to the site, primarily covers that which is deemed medically necessary, such as "Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice."(3,4) It is data from Part B which was studied by the UCLA researchers and what led them to express their concerns in the published letter.
"Our findings suggest a weakness in fee-for-service medicine," said Dr. Bergman. "Perhaps it would make more sense to reimburse clinicians for providing high quality care, or for treating more patients. There probably shouldn't be such wide variation in services for patients being treated for the same conditions."(1)
Is the fee-for-service model synonymous with excessive expenditures and fraud?The fee-for-service model also raises questions about potential fraud and less-than-ethical billing habits.
For example, Charles Hugh Smith wrote in a DailyFinance article that the model oozes with eyebrow-raising techniques. He explains an instance in which his mother had a one-hour foot procedure that required local anesthetic and that the $2,000 recovery room fee seemed awfully steep for what was comprised of her sitting in a chair while waiting to be taken home. Recovery rooms, he says, are meant for those who were given general anesthesia, not for people who had a local anesthetic.(5)
So, what's Smith getting at?
"The point here isn't whether this particular fee met Medicare guidelines; the point is that the fee-for-service model provides powerful incentives to pad bills or even commit fraud," he wrote. "Indeed, poor medical practices net providers more money. According to a recent report, only 3% of the millions of charges submitted to Medicare are reviewed, and over 10% of Medicare's $453 billion in annual expenditures are outright fraud."(5)
He also explains that these "perverse incentives" don't help patients make wise decisions, such as whether or not they should opt out of unnecessary procedures or pursue more affordable services. "It's like going to an auto mechanic and agreeing to pay for whatever services he deems necessary, at whatever price he chooses, with no penalties to the provider if the service is poor."(5)
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