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.

Does “MD” = “Credible”?

Finding reputable information online can be hard.  It’s even more difficult when someone with “MD” after his name publishes inaccurate information.

As far as I’m concerned, doctors can write pretty much whatever they want on blogs.  I might not agree with opinions expressed, I might disapprove of the unprofessional tone a few blogs take, but they’re blogs and not usually purporting to provide medical advice.  It’s different when someone has a website for a medical practice and is supposedly providing patient information.

Medical explanations on practice websites ought to be accurate.  The above-pictured sample is inaccurate and harmful.  Patients struggling with a decision on what type of medicine to take wonder why their doctor wants such strong meds, yet this doctor on the internet says conservative treatment is fine.  Patients who take the plunge and fill a DMARD prescription have spouses/siblings/parents try to dissuade them because they found a website saying they don’t need anything more than simple ibuprofen.  Patients struggling with the fact that most of the world has no clue about RA also have to deal with doctors who can’t tell the difference between RA and OA.

Rheumatoid arthritis needs early, aggressive treatment.  You will piss off the RA community if you publish bad advice on this subject.  We had a very difficult time finding good information when we were diagnosed, and are trying to make life a little easier for those who are unfortunate enough to come behind us.  NSAIDs do not lead to a good outcome.  DMARDs are needed.  If milder DMARDs fail to work (it’s the med that fails, not the patient, btw), then biologics are needed.  It is scary enough to read the side effects of these medicines and contemplate taking them, without having a medical doctor telling people that they only need conservative treatment.

I’m truly astonished at how bad just a few paragraphs can be and still get published.  If this were handed in as a school assignment, it would be returned with red ink all over it and have to be re-written.

Web pages like this scare me.  I don’t think I will ever again believe that “MD” after someone’s name automatically equates to credibility when discussing medical information.  The fact that a surgeon (substitute specialty of your choice here) gets referrals for RA patients does not necessarily mean that the surgeon (__) has kept current on rheumatology.

Consider the source.  Don’t ask a neurologist for advice about cardiology.  Don’t ask a surgeon about RA treatments.

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Edit to add:

Just to clarify, I have intentionally not named the doctor who wrote the article in question so that googling his name won’t bring up this post.  I believe that:

  1. the author does not understand RA enough to be publishing online definitions.
  2. people should look at the article in context.  The author is a surgeon.  A surgeon’s website about how to deal with back pain is going to have the option of surgery as a presupposition, whether or not that is explicitly stated.  Surgeons tend to define “conservative” as “not surgery,”  so it is reasonable to believe that the author did not intend to say “stick with NSAIDs; avoid DMARDs and biologics” but might have meant “try medicine/PT to treat this, instead of jumping straight to surgery.”  That is not what he says, but it’s entirely reasonable to think that’s what he intended to say.
  3. the author needs to update his website to reflect current medical knowledge of RA.