Endurance

Perturbed, frustrated, aggravated, irritated, upset, disturbed, annoyed, bothered, discouraged, disheartened, dispirited, downcast, dejected…  I need a bigger thesaurus.

When I left rheumy #1 for rheumy #2, I was clear about what I wanted:

  • a doctor with whom I had good rapport
  • a doctor in private practice, not owned by a hospital
  • a doctor who saw patients without shuffling them aside to a PA

For a few years things were going well.  Unfortunately, about a year ago my doctor’s practice sold out.

Once they were owned by a hospital, things changed.  First thing to go was the excellent front office staff.  They were moved elsewhere within the system and replaced by lemon-suckers who just seem to be going through the motions.  Next my doctor’s MA (who always managed to process prescription refills within one day) disappeared; it now takes five days to approve refills and there’s a different MA every time I’m there.

To add insult to injury, the hospital brought in PAs.  Instead of seeing my private MD, I now see a hospital-employed PA.  The PA might be a nice person, might be competent after learning to do joint exams without causing pain, might be a lot of things. What the PA is not is the doctor with whom I established a relationship.  I feel betrayed.

Now the office is calling to move my appointment.  It seems that the hospital system has decided to open another clinic at another one of their hospitals.  My choice is to drive an extra 30 minutes or move my appointment to a different day.

I want out, but there doesn’t seem to be any point in finding a new doctor right now, since whoever I find could eventually sell out, leaving me right back in the same position.  Instead, I will show up for appointments as rarely as possible so that my prescription refills will be approved.  My youngest child is twelve; in six years he’ll head to college, and four years after that he should graduate.  That means I just have to deal with this ten more years before we can retire and move away.  If I can get away with follow-up visits every six months, that means I only have to go in twenty more times.  By then, I expect the medical profession to have undergone significant changes, and finding a new rheumy will likely be a completely different situation than it is now.

Twenty might sound like a lot, but I remember how many appointments I had the first few years after I was diagnosed. Twenty is nothing.  Although I was unhappy about things when I started this post, I actually feel better now.  I can endure twenty visits.

I want to earn $910 per hour

It boggles the mind that some people think the cost of healthcare will go down if all doctors become hospital employees.  When a private practice doctor can make a profit by seeing patients for $200, but the fee for the exact same 25 minute appointment becomes $455 when the doctor is employed by a hospital, something is dreadfully wrong.

How can charging more than double be construed as reducing costs?

To me, it seems that patients could put an end to such nonsense by refusing to see a doctor employed by any hospital using such tactics.  Unfortunately, it doesn’t work that way.  Since the insurance reform law passed, it’s getting harder and harder to find doctors in private practice.

For my daughter, it’s impossible.  According to the ACR, there are only five practicing pediatric rheumatologists in my state.  All of them are at Children’s.  If it were me, I’d look for a different doctor – one not affiliated with a hospital extorting facilities fees.  I can’t take my daughter elsewhere, though; there is nowhere else.  We’re stuck.

We recently discovered something that sheds a little light on the situation.  The hospital is requiring doctors to do lots more computer work.  An oddly reasonable administrative ruling has lightened doctors’ patient load to give them time to do that paper computer work.  The problem that the hospital ran into is that if doctors see fewer patients, they’ll earn less money and that puts a huge crimp in the cash flow.  Now I understand the reasoning behind the facilities fee.  Instead of seeing two patients to earn $400, they’ll just see one patient and charge $455.  Half the work, but even more income.

There’s a flaw in that solution.  Tacking on a facilities fee does not mean that the hospital will get more money.  It means that people like me, who would never have dreamed of asking for financial assistance in the past, are now doing it.

Welcome to unintended consequences.

Highway Robbery

Charging a “facility fee” in addition to physician fees for a doctor’s appointment is immoral.  It is a barbaric method of gouging extra money out of people who are sick and desperately in need of a physician.

Imagine if the only physicians available to treat your condition worked 65 miles away at the outpatient clinic associated with a specialty hospital, and you received a hold-up letter:

Starting Oct. 1, we will bill a facility charge for hospital-based clinic visits…

A facility charge includes hospital expenses for a clinic visit that are separate from the cost of the medical provider.  You will continue to receive a separate charge from your medical provider for their (sic) services.  The facility charge includes costs for running the “facility” like supplies, equipment, exam rooms and other hospital staff…

Supplies, equipment, exam rooms, and support staff are simply part of the cost of providing medical care.  The high cost of doctor’s appointments is often justified because that money pays more than the doctor’s salary; it pays the support staff, the rent or mortgage, and the other costs associated with running a business.  Those costs are similar everywhere.  All businesses have overhead costs.  Those expenses don’t justify extra fees, and it is ludicrous for hospitals to think they’re special in this regard.

In an attempt to justify this travesty, the letter goes on:

All our other departments charge a facilities fee, so now the outpatient clinic will be billed the same way.

This is a standard practice for most other hospital-based clinics.

Due to recent funding cuts, we have to find somewhere else to get the money.

The fact that hospital facility fees are charged for hospital services, in no way implies that hospital facility fees are appropriate for outpatient services.

“Everyone else is doing it” isn’t an acceptable excuse when kids say it, and it’s not acceptable here.  First, because everyone else isn’t doing it.  Second, because it doesn’t matter what everyone else is doing (if everyone else was jumping off a bridge, would you do it?).

I am outraged to think that this hospital thinks they can charge every patient seen in an outpatient clinic an extra $255 per appointment.