Some decades ago, there was a series titled “Eutychus and His Kin” which used anecdotal information and opinions to bring issues into sharper focus or give them a different perspective. With Hippocrates & his kin,” Sacramento Medicine initiates a monthly column that could, with your help, achieve a similar goal. There is intense competition for our attention and energy, which often distracts us from our primary responsibilities of patient care and search for excellence. Even now we have diversions into nonscientific care such as acupuncture. We trust, however, these short “notes from the trenches” will be helpful and of interest. The column is open to any appropriate vignettes, anecdotes and items.
Heard from a patient . . . who informs us that the cost of her yearly pelvic exam and pap smear has tripled in three years. She thinks it was about $65 when her gynecologist was a member of a partnership. The next year she thinks it was somewhere over $100 when it came from SSMG. This year it was $269 and came from a Hospital Medical Foundation. This is the statement she brought in.
| 99215 Office visit, DX V70.0 | $ 128 | ||
| 57452 Examination of Vagina, DX 795.0 | 105 | ||
| 82270 Blood, Occult, Feces, DX 626.8 | 13 | ||
| 85014 Hematocrit, DX V70.0 | 13 | ||
| 99070 Sterile Tray, DX 795.0 | 10 |
. . . Is this hospital technique, which I understand is called “unbundling,” the answer to our problems? [See box example below for some possibilities of this process]
Heard from a surgeon . . . who informs us that the laparoscopic cholecystectomy that was expected to save considerable health care costs by reducing the hospital stay from 5 days to overnight may not do so. A patient brought in a statement for her overnight stay that had the same DRG at $8700 for the 23-hour stay. . . A 250-bed hospital, if full, could have $2 million in daily revenue. A 350-bed hospital, if full, could have $3 million in daily revenue. (One billion dollars per year!)
SF Chronicle (6/4/93) reports that Bay Area hospitals reporting operating losses of >$150 million a year, with red ink projected to reach $705 million a year by the year 2000, may be a distortion. According to Local 250 of SEI Union, state regulators reported a $144 million net income and construction bankrolling of $134 million?
. . . Are hospitals the health care cost problem?
A patient asked us why Medicare pays more to the hospital nurse making a home visit than we charge. She stated that the nurse visit was $112. My billing service informs me that Medicare discounts my $80 home visit to a ventilator patient.
. . . Is the physician the best bargain in health care?
We had our annual dinner guests from London the night before the Jazz Festival which they attend every year. On asking about a missing trumpet player, we were informed that “he was in a bad way. He had a stroke and after several days of coma, was transferred to a larger hospital in London where they had a CAT Scanner.” The waiting list is shorter for in-patients than for out-patients. . . . A member of our committee was hospitalized while visiting Florence. He states that he was better able to monitor his blood glucose with his American technology than the hospital could.
. . . Why do we allow our health care system to be compared with others? Aren’t we the ultimate standard and goal for the world?
After noting the number of physicians making less than $100K per year, Medical Economics (4/12/93) now points out that over 40% of us are unable to put aside even $3,000/yr in our retirement plan. Physicians with less than $100K in total assets are increasing! . . . When I had my annual eye exam, I asked my ophthalmologist if he was about to retire. He said that he would not have enough money in his plan until he reached 70. . . I asked a couple who were both teachers for the San Juan School District why they took early retirement. The response was that it was cheaper for the district to hire new teachers at the entry wage than to pay them another five years at the top wage.
. . . Aren’t the wrong professionals being painted as greedy?
INTERNAL MEDICINE CONSULTATION
(a nonserious extrapolation)
| Complete medical interview, 35 minute face to face | $ 85 | ||
| Consultation room charge | 15 | ||
| Blood pressure and pulse evaluation | 13 | ||
| Blood pressure and gauge charge | 11 | ||
| Ophthalmologic exam including fundoscopy | 40 | ||
| Ophthalmoscope charge | 12 | ||
| Otorhinologic exam including pharyngeal inspection | 35 | ||
| Otoscope charge | 10 | ||
| Examination of the Chest, including stethoscopic | 55 | ||
| Cardiovascular exam, including stethoscopic heart sounds | 55 | ||
| Abdominal examinaiton, including stethoscopic bowel sounds | 50 | ||
| Litmann duo head stethoscope charge | 10 | ||
| Examination of the genitalia or pelvis (See SSMG above) | 128 | ||
| Examination of the vagina or the penis (See SSMG above) | 105 | ||
| Digital rectal examination, including prostate or cervix | 35 | ||
| Latex glove charge | 4 | ||
| Orthopedic exam of axial skeleton, proximal and distal joints | 70 | ||
| Neurologic exam, incl cranial nn, motor, sens, DTR, Coord | 65 | ||
| Acuity chart charge | 3 | ||
| Percussion hammer charge | 2 | ||
| Tuning fork charge | 3 | ||
| Tailor’s pin wheel charge | 4 | ||
| Mental status examination | 55 | ||
| Examination room and table charge | 15 | ||
| UA | 13 | ||
| HCT | 13 | ||
| Preparation of report, discussion of findings with primary care physician, and dictation |
20 | ||
| Transcription of 4-page report (one hour at $20 per hour) | 20 | ||
| Word Processor Charge | 5 | ||
| _____ | |||
| Unbundled Internal Medicine Consultation | 966 |
. . .The extra $800 per consultation should allow each of us to hire a $75,000 CPA or MBA to find other hidden charges.