Friday, January 5, 2007

Reimbursement for services

No matter where you live and practice in this wonderful country of ours, what you are able to charge for services rendered and ultimately what you make practicing health care is largely regulated by our federal government. Most, if not all, payor contracts are tied to Medicare reimbursement which means that when Medicare payments are reduced, the entire practices revenue stream (bottom line) is impacted.

The main underlying issue is that the way physicians are reimbursed is largely procedure based. A fundamental problem is that health care is a service based industry and not a business which sells widgets. It will be essentially impossible for health care to move towards a preventative based service until Medicare and other payors are willing to reimburse health care providers for their time and expertise. Doctors must be compensated for spending time getting to know their patient, taking a thorough H & P, listening to what makes that individual tick. I underscore "individual" because each patient is just that, an individual with unique needs, questions and concerns. Each patient does not fit into a nice neat pigeon hole as the payor matrix tries to suggest.

It is interesting that the few CPT codes dedicated to this process of "getting to know" the patient, and ultimately allowing the provider to make the best judgement for that individual, are all but disregarded or at least discounted. These E & M codes are the vary codes that will help to enable western medicine to move form a more "curative" focus to one of prevention. Providers must be reimbursed for their expertise in listening to a patient, gathering specific information and treating the individual as just that. Almost universally, professionals are paid for their time. As an example, Lawyers charge by the hour not by the end document or opinion produced.

Currently Medicare uses flawed formulas to determine reimbursement rates: the Sustainable Growth Rate (SGR), and Geographic Practice Cost Index (GPCI). There is currently a bill introduced in Congress by the incoming Energy and Commerce Chairman John Dingell, which would repeal the SGR and replace it with positive increases of the Medicare Economic Index (MEI) for the next two years while Congress works out a permanent solution. It is imperative that health care providers individually as well as collectively voice their concerns and opinions and not take a passive back seat hoping that these issues will be resolved. One forum for this is to post to this BLOG so that we maintain a collaborative, cohesive and coordinated voice; a working petition so to speak.

Please take a moment to contribute to this process. Respond with your thoughts, questions and ideas. I will be certain that those in power are aware of this site and listen to what is being exchanged here.

Wednesday, January 3, 2007

Welcome to my Doctors Dining Room

Welcome to Doctors Dining Room.
The Genesis of this site came from years of being in health care. I have been a provider, an educator, a hospital administrator, an out patient clinic owner, a county health commissioner and a practice/business management consultant. In over 25 years of experience, I have found a common thread to be the need or desire for a forum where physicians and dentists are able to share successes, failures, challenges and frustrations with everything health care.

Physicians have the luxury of a place they can go with in the walls of the hospital and communicate with their peers about the business of health care, the frustrations of escalating costs and diminishing revenues. They can share cases and exchange ways of practicing medicine. This place is called the "doctors dining room". The problem is that typically providers only have enough time to grab a bite to eat, say hi and run off to the OR or to round on their patients or get back to the office so that they can pay the overhead. Dentists on the other hand do not even have an area where they can share with their peers. Typically dentists are in solo practice and have very little opportunity for peer review or interaction.

The purpose of this site is to allow health care providers the time and forum to discuss anything they might want to when it comes to the business or practice of their discipline. The main focus of the site will be to discuss the "business" of health care. It is imperative that practices be run as businesses and this site hopes to accelerate the learning curve of providers so that they might avoid some of the more common business mistakes as well as share stories of success and failure.

While the business of health care is essentially the same regardless of what type of health care service you practice, it is my intention to start to develop sites specific to the various disciplines, IE. medicine, dentistry, podiatry, hospital administration, etc. I welcome your comments, topics for discussion, insights, thoughts, frustrations as well as ideas for meaningful change.

This site does not profess to be the last word or legal authority on those issues we discuss. As always, the proper professionals should be consulted prior to adopting any strategies discussed on this site. We will be honest, open and frank in our discussions with a goal of making health care better for the providers, staff, families and patients. Again, welcome to the Doctors Dining Room.