Not only in the Dark Ages. But way more expensive than it need be. Can you imagine what a car would cost if regulated this way?
Much of the problem stems from Medicare. That massive program runs by billing codes. Billing codes control the way various services are packaged and priced; currently, Medicare has a list of about 7,500 physician-related tasks they can get paid for doing. As John C. Goodman of the National Center for Policy Analysis points out, private insurance tends to pay the way Medicare pays. So do most employers.
But think of the two most common—and most critical—tools in our technology-driven world: communicating by telephone or email. One of these is a very old technology and the other one not new. Yet Medicare won’t pay for physicians to consult with patients using either of these devices—at least, not in any meaningful way. State laws and regulations also make it difficult to for physicians to offer medical advice by email—especially if the patient lives across state lines. Doctors are typically licensed to practice in only one state, and so might not be able to offer medical advice in another.
Imagine for a moment that producers of all manufactured products were barred by federal regulation from using telephone or email. How much do you think products would cost if their production were subject to such rules? How much would any product cost if its production and delivery had to stay in the dark ages?
There are many other examples. Let’s say you need to refill your prescription. Medicare will only pay the doctor if you come to his office and make it an “office visit.” It doesn’t matter that you probably don’t need an office visit and this is just wasting everyone’s time.
While these may be mere inconveniences for most of us, for others they represent dangerous gaps in their quality of healthcare. Disabled patients might not be mobile, and are often in need of even more frequent contact with doctors—though they don’t necessarily need an office visit. What if they could have actual conversations by phone, or get quick answers by email, or even have face-to-face consultations via Skype? These tools would benefit patients living in rural areas with limited access to medical care the same way.
It’s not just phone and email and prescriptions. Medicare won’t pay for your doctor’s assistance in getting a low price for a CT scan or for negotiating on your behalf for specialist services or for any other cost-saving he or she devises. It won’t pay a doctor to teach a diabetic how to monitor his own glucose level and in other ways manage his own diabetes. The same goes for all chronic illnesses—even though that’s where most of the money goes and even though studies show that well-trained patients can manage much of their own care, with lower costs and higher quality outcomes.
Once a medical office has a system is in place, it is very difficult to change it—even if it reduces medical costs. At a time when doctors feel that they are being squeezed on their fees by insurance companies, most become very focused on which activities are billable and which are not—and most are going to try to minimize their non-billable time. They are certainly not going to do anything that takes money out of their own pockets.
Speaking of out-of-pocket expenses, you may be interested to know that Medicare (and therefore most insurance) doesn’t cover blood and urine tests unless prompted by an illness, so even if you can get your doctor to order them, you have to pay for them yourselves, and that may subject your doctor to all sorts of risks, even the risk of jail, which we will discuss in a future article. Yet these types of screening tests are vital; they are where the future of medicine lies.
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The best thing our government could do for the health of the citizenry would be to ban and outlaw the American Medical Association and the FDA .
Wow what a great start toward honest “medicine”
I think it is important to understand the BASE problem with our “Medical System”. Around 1900 or so the Rockefeller clan captured much of Medical teaching by funding the teaching of medicine. In the 1950s they completed the capture of most of medicine by capturing HHS.
In 1950 we spent about 4% of GNP on “health care” today it is approaching 20% and we have WORSE health.
This is NO ACCIDENT! The destruction of the USA is proceeding in part by the construction of a BOGUS Medical System intended to promote disease and bankrupt the country we love.
so what do we do about it?
It is a corrupted world. Every day I learn how the powers that be are sabotaging our health and well being for profit. I am 66 years old and I have not seen a doctor in maybe six years. Every one of them in my area are corrupted by big pharma and I will have none of it.
So in other words, the focus is on how to get paid rather than how to improve and maintain health. It seems like we need to give doctors the freedom they need and an incentive system in place to help people maintain their health.
i am shocked that blood tests would not be covered as they are so important in diagnosing a condition that is servious. our health care system is broken. why can congress recognize how broken it is. i don’t see anyone but obama coming up w/an alternative plan. maybe the congress should stop being so stubborn all the time.
I don’t understand, are you saying there will be changes? I am on Medicare and have supplemental insurance. In May I had a blood test, I was not ill, and I did not have to pay anything. I recently, called the pharmacy for a prescription refill, I paid a portion of the cost. I did not have to visit the doctor for either.
What a big bunch of B.S.!!! How dare anyone try to take away from those in need, “these” types of treatment/preventitive Health Care!??? Stupidily outrageous, bogus, & totally & “greedily” idiotic & cruel!
As a nurse I have some issues with parts of this article.
ICD9 codes can usually apply in such a way as to cover most tests. Although e-mail and telephone calls are convenient they are not practical because of HIPPA laws of confidentiality, security, and reliability. often It has taken numerous calls to some doctors to actually get a response when there have been patient concerns. Doctors offices actually screen out patient calls, preferring to hear from other professionals who can provide an assessment. Yet some doctors do call patients on rare occasions.
Disease management training is usually provided by the hospital, office, and home health nurses. A more meaningful way to reduce costs would be to reduce many of the unnecessary tests and medications.
With computers helping the advancement of technology there are many new ways that the medical profession has come a long way from the past. We must allow the new techniques to take over and take us out of the dark ages of the Medical profession. Going forward is our only salvation for our nation.
This is just another prime example of the pathetic manner in which Medicare was/is framed. I have been on Medicare for several years and am embarrassed at the way Doctors are paid and the restrictions on care. It is time for a DRASTIC overhaul to Medicare and your suggestions are sound,valid and reasonable for improving delivery of healthcare and giving the patient a better opportunity to hold down costs and improve service. Another sterling idea,which will cause the FDA and their cohorts the AMA fits, would be to cover Natural Healing practices and that of Chiropractic Doctors by Medicare!
Modernize our medicine, it definately needs it.
It is a shame that the above approaches should be considered wrong and that ins/medicare will not allow these services. How much money would medicare and ins. save if a phone consultation with your Dr. could easily solve the problem. When I was young this was a commonly accepted form of advice, The Dr might then call the pharmacist for a prescription for you to pick up.An office call was averted, time was saved for all concerned. WE find so many ways to charge where a charge is unnesssary. I had a large wart on the back of my ear, saw my GP and he sent me to a specialist! The specialist sprayed something on it, said to come back in three weeks if it were not gone, it wasn’t and I was back to be sprayed again! Three visits for a wart and it took a specialist to use a spray! Can we find more ways to complicate a matter that was so simple on the old days?
It is a shame that the above approaches should be considered wrong and that ins/medicare will not allow these services. How much money would medicare and ins. save if a phone consultation with your Dr. could easily solve the problem. When I was young this was a commonly accepted form of advice, The Dr might then call the pharmacist for a prescription for you to pick up.An office call was averted, time was saved for all concerned. WE find so many ways to charge where a charge is unnesssary. I had a large wart on the back of my ear, saw my GP and he sent me to a specialist! The specialist sprayed something on it, said to come back in three weeks if it were not gone, it wasn’t and I was back to be sprayed again! Three visits for a wart and it took a specialist to use a spray! Can we find more ways to complicate a matter that was so simple on the old days?
It is a shame that the above approaches should be considered wrong and that ins/medicare will not allow these services. How much money would medicare and ins. save if a phone consultation with your Dr. could easily solve the problem. When I was young this was a commonly accepted form of advice, The Dr might then call the pharmacist for a prescription for you to pick up.An office call was averted, time was saved for all concerned. WE find so many ways to charge where a charge is unnesssary. I had a large wart on the back of my ear, saw my GP and he sent me to a specialist! The specialist sprayed something on it, said to come back in three weeks if it were not gone, it wasn’t and I was back to be sprayed again! Three visits for a wart and it took a specialist to use a spray! Can we find more ways to complicate a matter that was so simple on the old days?
It is a shame that the above approaches should be considered wrong and that ins/medicare will not allow these services. How much money would medicare and ins. save if a phone consultation with your Dr. could easily solve the problem. When I was young this was a commonly accepted form of advice, The Dr might then call the pharmacist for a prescription for you to pick up.An office call was averted, time was saved for all concerned. WE find so many ways to charge where a charge is unnesssary. I had a large wart on the back of my ear, saw my GP and he sent me to a specialist! The specialist sprayed something on it, said to come back in three weeks if it were not gone, it wasn’t and I was back to be sprayed again! Three visits for a wart and it took a specialist to use a spray! Can we find more ways to complicate a matter that was so simple on the old days?
It is a shame that the above approaches should be considered wrong and that ins/medicare will not allow these services. How much money would medicare and ins. save if a phone consultation with your Dr. could easily solve the problem. When I was young this was a commonly accepted form of advice, The Dr might then call the pharmacist for a prescription for you to pick up.An office call was averted, time was saved for all concerned. WE find so many ways to charge where a charge is unnesssary. I had a large wart on the back of my ear, saw my GP and he sent me to a specialist! The specialist sprayed something on it, said to come back in three weeks if it were not gone, it wasn’t and I was back to be sprayed again! Three visits for a wart and it took a specialist to use a spray! Can we find more ways to complicate a matter that was so simple on the old days?
It is a shame that the above approaches should be considered wrong and that ins/medicare will not allow these services. How much money would medicare and ins. save if a phone consultation with your Dr. could easily solve the problem. When I was young this was a commonly accepted form of advice, The Dr might then call the pharmacist for a prescription for you to pick up.An office call was averted, time was saved for all concerned. WE find so many ways to charge where a charge is unnesssary. I had a large wart on the back of my ear, saw my GP and he sent me to a specialist! The specialist sprayed something on it, said to come back in three weeks if it were not gone, it wasn’t and I was back to be sprayed again! Three visits for a wart and it took a specialist to use a spray! Can we find more ways to complicate a matter that was so simple on the old days?
I do not have to go to my doctor every time I need to refill a prescription. I can certainly see that the first time one needs a prescription a doctor’s visit is necessary. But for a renewal, never happens to me. Just a ‘phone call and it’s mailed to me. Sounds like some of your victimes are using unscrupulous doctors.
This is typical and exactly what I would expect from congress people who don’t have the nerve to let the legislature stand on its own.
In the interest of efficiency, technology, consideration of the best interests of the patient, and the capabilities of the medical community a rational approach to patient care needs to allow for the ability to care for patients in efficient, low cost, convenient ways such as by telephone or email including across state lines especially for patients already under a doctor’s care. Please consider removing some of the barriers to patient care.
Sincerely,
Velma Conte
The medicare should be covering blood tests and urine tests. These are tests that help to diagnose
conditions and if people do not have the money to pay for these tests and neglect having them done they may need more expensive treatment because of the delay.
This thinking is pennywise and pound foolish.
The article does make a great point but the victims are the patients, citizens who pay into medicare and taxpayers. The AMA lobbies heavily for certain regulations and for others to remain intact to increase their bill-ability. The AMA gets in the way of efficiency. By having the patients come to the office, it increases the likely chance that the patient will use their equipment, labs, etc. Some hospitals will not accept other hospital tests since they were not done in their hospitals labs or departments…Guess who are the major stockholders in the hospitals…Medicine is run like a business that the first rule is to benefit the physicians first then the patients. MD are told at their monthly meetings what test quotas have to be reached in order for new hospital equipment/machines IE; MRI scan need to be paid off before a profit can be made. Do you think all hospital tests are necessary on every patient? No, but if they can make the argument for that MRI scan it will be done to meet that monthly quota. Patients live on the conveyor belt of care…As the article states “They are certainly not going to do anything that takes money out of their own pockets”. Voila!
Can’t wait to read other info. Please expedite!
I refuse to eat American beef, chicken or pork. They are poisoned with antibiotics, growth hormones and other dangerous chemicals.
You’re not trying hard enough. I buy chicken, pork and sometimes beef from Polyface Farm, that is not poisoned with anything. Ever. I also have sources for grass fed bison, lamb and dairy products from 100% grass fed cows. No hormones, antibiotics or other things that God did not create these animals to eat.
I work for a home care agency and our nurses go to patients’ homes and give them diabetic teaching among other things. Some of these patients aren’t receiving diabetic teaching even while inhospital and it’s being left to home care agencies to do this. It’s not just about the doctors. Furthermore, Medicare does not pay for prescriptions. Only Medicare Part D does that, if people buy that option. Plus, many patients are elderly and not able to access emails and SKYPe, some of them because they can’t afford it and others because they are not mentally able to. I feel that your information is somewhat faulty in this regard. I think you need to do more research on your information before publishing it on the web. Up until now I had thought that you were giving truthful information. Now I’m not so sure.
I don’t see where you’re finding fault with their information. _Physicians_ aren’t reimbursed for teaching to any reasonable degree. When I spend an hour with a patient, I earn a quarter of what I would if I saw 4 patients in that hour. There’s no incentive to help patients – only to pump ’em through as fast as possible.
I don’t see anything in the article about medicare covering medications.
God has provided herbs and such, not chemical witch craft to heal his creation.
Look at the general physical condition of most Americans and you can ask yourself, did God intend for man to gluten himself to the point of pathetic weight gain? If the overwheight and coach loving people didn’t burden the medical insurance industry and were rated as higher risk for payment on group plans, then the insurance industry might lower the costs for everyone. Of course the CEO of the insurance co. might weigh 300 pds also. He can afford it.
First of all, consider the fact that all illnesses are bogus, that they require too things to be believed, an ignorant public, and M.D.’s that are unwilling to educate the public. Well, I’m not an M.D. so I’m happy to educate anyone who will listen: Its all about vitamin C! Read “Primal Panacea” and/or ‘The healing factor, Vitamin C against Disease”. Learn about vitamin C. Take an optimal amount, (at least 1 gram per 25 pounds of body weight, as a MINIMUM. Stay healthy.
I think that we all agree the the cost of healthcare must be lowered. Our reasons for thinking the way we do may be very different, but we all know that costs must be lowered for all involved. One very big possible tool is technology, which should be utilized on the administrative side much more than it is. We hope your reason for limiting the use of technology in this way is not self serving. We are already behind other developed countries in terms of life expectancy and the overall quality of healthcare, particularly for seniors and for the handicapped. Cost here is much higher also. This is
not the way those comparisons should work out for the America where I have lived all my life.
My mom, sister, and I all get Rx refills without going to Dr office so I question the info you presented. We all get Medicare.
The info is correct: we are not reimbursed for this. So, if a doctor chooses to do this unreimbursed work (yes, it does take time to look up the patient’s chart and make sure things are done appropriately), it is because your doctor is putting service above the bottom line. However as doctors get squeezed, they are doing less. Also, as patients get rude and demanding doctors wonder why they’re putting themselves out to be treated like that.
So, count yourself lucky that you have a caring doctor and be sure to let them know you appreciate them and treat them right.
Keep it simple and make it less expensive.
Do not keep medicine in the dark ages or more expensive than it need be
In France my doctor urges me to contact him by phone, as opposed to taking up his office time to simply get a prescription renewal. I can call and he will answer whenever he is in his office, even when with another patient. I found this unsettling the first time my office call was interrupted in this way, but once I understood the system, it made perfect sense. I call the doctor and let him know it is time for another blood work up or prescription and later that day I drop by the office and pick up the necessary paperwork from the receptionist. I guess this is just too logical for America.
The government is not capable of doing anything efficently. This kind of clumsy manangement is characteristic of each and every area it attempts to manage. The solution is easy. Hand it over to the private sector. It works every time. Hello!
Actually, despite it’s problems, medicare is _much_ more efficiently run than _any_ private insurer, with nearly all of it’s money going for care and very little for overhead. Private insurers skim off piles of money for themselves.
While much hay is being made claiming that the private sector does things more efficiently, there are innumerable examples of the opposite being true: once things get privatized, quality goes way down. Most charter schools can’t keep up the quality that the public schools did and make massive amounts of money by hiring barely skilled teachers with few benefits while barring access to high-maintenance kids. Privatized prisons are haves of abuse and even subsidize politicians who push for more punitive laws to keep the incarcerated population high.
If you’re getting these ideas from certain media channels, you must realize who is subsidizing that propaganda: the people who are raking in the big bucks.
Dr. S You cannot be serious if you are being paid by Medicare for anything!!! You surley have never had your medical records reviewed or had a Medicare Audit. I run my Husbands chiropractic office and we had a nightmare 2 years ago when all of the Chiro’s in Nevada Calif and Hawaii were being audited regularly. They actually asked us to have the doctors change their signatures so they were “Legible”. Every note must state that the patient was adjusted using his hands (isn’t that what a Chiropractor does?). That is efficent? The insane rules Medicare uses sometimes makes it impossible to get paid let alone practice their specialty. What this article forgot to tell you is that on Jan. 1 2013 (less than 3 weeks from now) ALL doctors get cut and additional 30% by Medicare thanks to Obamacare!! Oh Boy can’t wait. Patients will not be able to find physicians to treat them. Don’t beleieve me the 2013 fee schedule is available at Medicare.gov!!
Last I checked, the US ranked in at #49 in world health care. Our confidence at being a world leader is certainly challenged when solutions to medical problems are suppressed and/or made unaffordable. Can the healthcare system rise to the challenge? More importantly, how willing are they to rise to the challenge? Seems “big pharma” , insurance companies, and the medical establishment at large are more protective of their bottom line than preventing the flat lining of their patients.
People complain about how long it takes them to get in to see their doctor and now I know why. This is wasteful, expensive, and inconvenient for both doctor and patient. I think the best bet would be for more people to have a legitimate option to opt OUT of Medicare.
I’m on Medicare, have coverage thru Kaiser – and they encourage the use of emails to communicate with the doctors –
My partner is not yet on Medicare, but the office he is going to (not Kaiser) is moving towards having records accessible on line for patients and to offering better email communication –
maybe it isn’t improving as fast as it should be, but it is improving –
It’s not just medicare, it is all insurance. My daughter requires blood work every 3 months and a prescription each month and even though I am more qualified than her Dr to read her labs and notify him of any adjustments needed in her medication, and he completely trusts me to do that, I have to haul 3 kids to his office for an official visit so he can get paid. I understand he needs to be paid for his service of ordering the labs and the medicine, but it is rediculous that he can’t get paid for doing this over the phone. Excellent article!
Yeah Buck! I have to agree that would be a good start.
For true Health & Wellness; take control of your health, stay informed and see a Chiropractor!
I read one of the messages from a person who said she and her family members who are all on medicare, just call their physicians to get a refill and they do it. I do too. Many time my pharmacy makes the call for me when I run out of refills. No problem for me either. I generally don’t question many of your fine articles, but in this case, I don’t think there is any merit to this claim.
Where health care providers are working in organizations providing charity care on private fundraising or state and/or local government funding, they often have enough sense to try to figure out what is cheapest rather than tie themselves up in knots with bureaucracy.
I do believe what the article is refering to is the need to reexamine patients yearly whether they need it or not just to refill prescriptions. Those regulations are established by Medicare and insurance companies not doctors.
It’s not that the government is not efficient but that they have bought into the idea that big business and insurance can do it better when in reality insurance in the US raises the cost of medical care and medicine. Meanwhile, physicians are paid less then they were 20 years ago.