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What’s A Little Pain

Friday, July 31, 2009  |  posted by Hugh Hewitt
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An interesting e-mail:

Dear Hugh Hewitt and Co.,

I own a medical billing company specializing in anesthesia billing. I would like to point out something of grave concern in the new
healthcare bills that nobody seems to be talking about. Medicare pays anesthesiologists about 20 cents on the dollar compared to private insurance companies. The healthcare bills set reimbursement rates at Medicare rates plus 5%. That might be fine for most specialities, where Medicare rates and private insurance rates are fairly close, but it will destroy anesthesia. What doctor is going to take an almost 80% pay cut? My doctors are talking about staying home with their kids or going into real estate as a profession. There is already a shortage of anesthesiologists in America. Yes, yes, CRNAs are wonderful, and can do a lot of what an anesthesiologist can do – but there aren’t enough CRNAs either. And, frankly, when you have a preemie having heart surgery, or an 88-year-old with three different conditions who is on a host of medications, you want a doctor handling that case.

So good luck finding someone to put in an epidural when your wife or daughter is having a baby, or give you propofol for your next
colonoscopy. You’ll have to just tough it out.

Sincerely,

KW

UPDATE: Another e-mail:

Hugh,

As a practicing anesthesiologist, I can verify the e mail about our Medicare reimbursment. We provide care at below cost for Medicare patients. The proposals under consideration would be a complete disaster for the medical specialty of anesthesiology, and would put all surgical patients at great risk. Perhaps this is an example of how liberals plan to disincentivize the provision of medical care they deem too expensive.

Dr. K
Phoenix, Az

and another:

Hugh,

I’m a pathologist and our experience is similar to the
anesthesiologists. For those who don’t know, pathology is divided
into Anatomic and Clinical Pathology. Anatomic Pathology is basically diagnosing disease. Looking at colon biopsies, Pap smears, hysterectomies, large tumor resections, biopsies from radiology procedures, diagnosing and staging cancer…Clinical Pathology is running the hospital laboratory.

Medicare reimburses at ~20% of billed charges or $.20 on the dollar. The Medicare reimbursement rates have decreased consistently since 1999 with a threat of another 20% cut. We are required by the hospital where we work to accept Medicare and Medicaid, so we do.

The contracts that we have signed with private insurance plans
reimburse anywhere from 75-95% of billed charges. There are major insurance companies out there who cover 80% of billed charges if we are a non-participating provider (don’t have a contract with the company). The consumer is responsible for the other 20%. They offer to pay us 30% of billed charges if we sign a contract with them. Go figure. I’ll pass. This leads to a write off rate or as it is called “adjustments” of 50%.

So, what would a government plan of health care do to pathology? I
think that a lot of people will retire or leave the field. Younger
pathologists will work until they are able to retire. All of this is
going to lead to a major shortage of pathologists, as others have
stated. Delay in diagnosis. Why would anyone enter into this field in the future?

Dr. S
Nebraska

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