As we close out another year in our professional lives, and the last month of this millennium, we reflect on where we’ve been and envision where we’re heading. Many disgruntled physicians ask, “Are we moving forward in the cause of helping our patients, or are they worse off?” One doctor wrote me a five page letter on how to revamp health care—if I didn’t think his suggestions would work, he had a dozen more. I also hear from unhappy patients. Few of them understand the complexities involved. It may be helpful to go outside our organization to take a look within. And this is what happened at a recent conference.
A quite resort on a lake in Coeur d’Alene, Idaho, with forested mountains all around, with chefs designing an entire dinner around the Idaho potato, was the background for the recent seminar, “Physician, Heal Thyself—Reclaiming the Medical Profession.” Sponsored by the Association of American Physician and Surgeons, it highlighted the experiences of physicians in this country during the final year of the twentieth century. Their experiences are very unsettling.
Each year at this conference a number of physicians recount their interface with Medicare. Opting out of Medicare continues to be a major story—one which chronicles the progress of physicians in restoring private medical practice. Dermatologists, internists, family physicians, and others are now seeing patients and, during the visit, are receiving a fee for services rendered. These physicians related how, when the day is over, the professional services are all paid for and there are no books, billing records, or accounts receivable to worry about. These physicians return home to their families at a decent hour satisfied that the services for which they were paid were also appreciated. Although their gross income may have dropped 50%, their net income has dropped very little. Billing costs, collection costs, patient mailings, E & M guideline costs, coding costs, record costs, and the personnel required to do such things, have nearly been eliminated with the medical record reduced to only what is essential for patient care. And many felt that the costs of compliance with the AMA guidelines have now exceeded the medical costs of caring for patients.
Living simply is a complex problem. How are physicians simplifying their lives? “SimpleCare” is the answer for some. Their Web site (www.simplecare.com) lists physicians who are part of this simplified system. Any physician can join for $35 a year (about 10¢ per day) and then signs a simple pledge, “SimpleCare patients who pay in full at the time of service will get my best price.” In these practices, charts are flagged with an orange sticker, the patient states whether he wants 10, 20, or 30 minutes with the doctor, and after that amount of time, pays his bill and no further billing records need be processed. State authorities reviewed this plan and found that it did not conflict with any laws. Although these doctors still see Medicare and Medicaid patients, the cash portion of their practice is growing faster than the insured portion is declining.
A former FBI agent, who now is an HCFA cop, stated that his job was to make sure that all physicians in the United States taking care of Medicare patients would be prosecuted, hopefully jailed, and if that failed, to be fined at least $200,000. When pushed, he stated that all physicians are crooks, guilty of overcharging Medicare, and deserved to be imprisoned.
Physicians are being treated like gangsters, drug runners, and violent criminals.The speaker stated that never has a profession or a business been as ill treated. No other profession, whether law, clergy, or teaching, has been treated like the medical profession because doctors don’t have the leadership to do anything about it. In fact one AMA delegate stated that our leaders are in bed with the government and thus are party to the assault on us.
What the public doesn’t understand is that doctors are spending as much time on office calls and consults as they ever have. Many doctors, I know, have not increased their charges in nearly a decade, except for minor adjustments. For example, a doctor may have charged $50 for an office or convalescent hospital call for many years. With the old RVS, a code was assigned for this service. Now we have to get used to the new RBRVS system, which many physicians still do not understand. Why should they? They may still be charging the same $50 for the same amount of work in an inflationary economy. Charging but by not coding the services according to the RERVS, many physicians are now criminals without any medical practice component to the crime. We found that Sacramento is not the only place with physicians spending time in jail. And in the process, they have lost their most valuable piece of property known as a “medical license.”
Can we, physicians, still heal ourselves? Remember in colonial America, less than 10% of the population believed that they could regain freedom. But after they won the war, the other 90%, as well as succeeding generations, were grateful. My email and faxes, as well as my interface with colleagues in the staff rooms, at meetings, and on the avenues, suggest that the majority of us still feel we can regain the freedom to practice patient-based relational medicine. We have to network to get our strategy in focus. It is the electronic age; we cannot process any more paper. Send an email if you want to join the network and explore the possibilities. Our patients and their children will be grateful for your efforts. Otherwise, after we have spent our life surmounting our professional challenges, we may find that we have climbed the wrong mountain.