When It Pays More to Do A Test Than an Exam
One of the problems with our medical system is the bias to pay doctors more for performing a test or procedure than for using our heads to make a diagnosis or manage a disease.
Obtaining a thorough history and physical exam and reviewing tests to make a challenging diagnosis pay much less than conducting a battery of tests or performing a diagnostic procedure.
If I spend 30 minutes in an extended office call for a patient with diabetes, high blood pressure and heart disease, I get paid an average of $69. If I remove a skin cyst off the patient’s back in that same time, the minor surgery would bring $110.
If I do a screening colonoscopy at the hospital to check for colon cancer for the same patient in the same time, my average reimbursement is $478 with essentially no office overhead. It’s no wonder that medical students want to go into procedural specialties like gastroenterology and fewer want to pursue cognitive specialties such as general medicine.
This is old news for readers of this blog. I am encouraged that this article appeared in the Wall Street Journal, however, I remain skeptical of how our writing will impact the total lack of sense in our current reimbursement mishmash. The answers seem so clear down here in the field. All medical students, interns and residents understand the system. I suspect the insurers understand, but really do not care.
We live in a society that has a love hate relationship with thinking. Geeks are chic, but usually at a distance. We rarely show intellectuals the respect they deserve.
We all want the benefits if great thinking, but I fear that most in our society do not really respect the thinkers. We clearly respect the doers.
Perhaps that is why fees for surgery and procedures exceed fees for thinking. Cognition makes one a nerd.
Perhaps I am too jaded this morning. Perhaps my analysis is flawed. I have been thinking, and it is hard work. I am trying to reconcile the illogic of reimbursement. Could the imbalances come from an underlying prejudice against intellectuals?
Just some speculations to cheer the readership, and perhaps stimulate your thoughts (although that just might be dangerous and clearly not financially rewarded).
