Monday, April 29, 2019

Twitter asks ... I Answer

I am not sure why, but Twitter seems to be filled lately with complaints or comments about service at their Doctor’s. To an outsider, I suppose some of the things that are done in a Doctor’s office seem inappropriate, but there really are reasons for everything that is done. I will try to answer some of the more basic questions.

Twitter Post: “Does anyone else feel like they give a full history every time you go to the doctor? I asked the girl today “maybe try writing some of this shit down.”

Reason: The Government (this will become a recurring theme) has mandated many, many questions that have to be asked once a year to ensure that you as a person are following the rules of society:

Questions such as, “Do you have a gun in the house?” My favorite answer to this one was “What does a gun have to do with a vagina?” Or, “Do you feel safe in your house?” or “Do you have fall risks?”

Sometimes the questions change based on societal changes, such as “Have you traveled to an area that had the zika virus?”

All these answers are entered into the EMR, which is uploaded to Insurances and the Government for tracking purposes.

"Why?" you may ask.

Well, falls account for the majority of Hospital Visits for elderly, costing Medicare money. If a fall can be prevented, then that is money that Medicare does not have to spend. If you do not feel safe in your house, is there a domestic violence issue, which could result in a visit to the ER which costs money? The Government (there it is again) mandates that these questions are asked once a year and then reviewed at appointments as needed.

Twitter Post: Regarding a post in an exam room explaining the difference between a problem visit and preventive visit: “From the “is it bait and switch or just dumbassery” files, this. Posted in exam room. Guarantee billing for two visits, or just some bureaucratic bullshit?”

Reason: The Government (told you this would get old) has mandated through the Center for Medicare and Medicaid Services appropriate billing. Billing is done through a series of codes defined as the Current Procedural Terminology. There are two sets of codes for Office Visits, Preventive Visits and Problem Visits. The Preventive visits are your yearly checkups to ensure you are healthy, i.e. preventive care. These visits cannot be combined with any Problems you may have, such as that rash on your foot that has been there for 6 months but you waited for your preventive visit to talk about it.

The ACA ruled that Preventive visits are paid for at 100% by Insurance companies. Since Insurance companies are paying in full for these visits, they do not want to pay for any Problems that by coding rules are financially the patient’s responsibility.

Thus, these visits are separate and identifiable from one another and must either be done at separate times or if done at the same visit, both codes are billed and you the patient will pay your portion. 

Twitter Post: There is so much turnover at my doctor’s office, new staff every 6 months.

Reason: Good employees are hard to find for any business, but healthcare is even more difficult. The reason is very simple, healthcare is hard work and pay is low. Many staff find that they can make more money in other career fields and get tired of the abuse from patients and doctors, the long hours, and the Government (yep) regulations that they must follow.

Well, that one seems easy to fix, pay the staff more.

There is one problem: Doctor’s make the money in a Medical Office and payments from Insurance Companies have not kept up with the cost of overhead. The fee schedule is based on the Government Medicare Fee Schedule, which has been kept flat since 1996. What this means is that for 20 years, the reimbursement for medical services has not significantly increased to allow for Doctor’s to stay in business. The result of this is Doctor’s selling their practice to large groups or Hospitals and salaries staying flat.

Due to Government Regulations (yep, it is here, too), the average staff to Doctor ratio is 3 staff to every Doctor. So, the Doctor must make enough money to pay his or her staff and the overhead of the medical office, we all like electricity and running water. I know of many, many offices where staff do not get raises or must take on more of the benefits costs themselves, that is if the office can afford to offer benefits.

If you have any burning questions about why your doctor’s office does something feel free to ask.
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