How often do you go to the doctor? If you are like me you don’t go often because it is inconvenient and expensive. Health issues tend to pile up. When something comes along for which I really need immediate treatment, I make an appointment and I go. Now, the national average cost for a visit to the doctor’s office is about $65. That, however, does not tell the whole story. If I go in for a sore throat and I am seeking an antibiotic, I also do a “health care dump”. “Doc I have a sore throat, but there is more. My elbow hurts, I have a mole on my arm I would like you to look at, allergy season is coming and I need a new antihistamine, and I am about out of my asthma medication.” My doctor listens intently and taps away on this little electronic note pad. He then diagnoses and prescribes something for each of my illnesses. Each malady is an International Classification of Disease (ICD). Each prescription is a Common Procedural Terminology (CPT). For every CPT, the doctor is reimbursed. So, when I go in for my sore throat which should cost me $65, I walk out of there with a bill for $300! This leads me to my second observation. Insurance co-pays are going away in all but the most “cadillac” of insurance plans. The co-pay will be replaced by higher deductibles. For most people the significance of this is lost, but when you combine the “health care dump” to the end of co-pays, you get a very significant monetary event. Before, I paid $15 to $25 for my co-pay and I could tell the doctor everything that was bothering me. I would do so because it was convenient and because I was making the best use of my co-pay. The insurance company paid the remaining $285 for the CPTs. Now, if I have failed to exceed my deductible, I have to pay the entire $300. It shifts the cost burden away from the insurance company and on to the consumer. In some ways, this is a good thing. It forces the consumer of medical services to shop for a better deal in health care. However, it could mean that I opt not to have the doctor help me with my elbow or take a look at the mole. Maybe I do without the asthma treatment, which, during an asthma attack, can put tremendous strain on my heart. No, the best solution is not to eliminate care, but to find a more cost effective delivery system. Many telemedicine offerings will do the entire “health care dump” for a flat fee. Viva la consumer!!!!
Posts Tagged ‘CPT Codes’
How Many Things are Wrong with You??
Wednesday, February 24th, 2010What are CPT codes?
Sunday, February 14th, 2010CPT or Common Procedural Terminology codes are the basis for reimbursement in our medical system and must be understood in order to comprehend the health care debate. Here is a link to a good informational site.
Past Wall St Journal editorial
Saturday, February 13th, 2010About a month or so back I read an editorial in the Wall St Journal that really shed some light on the health care debate. It was written by a freelance writer in New York and it discussed the impact the bill would have on his personal health decisions. He pointed out that the bill had a mandate to purchase full coverage. For him as a single person in New York the purchase price of a full policy with all of the required coverage would run about $13k per year. Currently, he carried only a catastrophic coverage policy that cost about $2k per year. He figured that left him with $11k per year to cover all of his incidental medical expenses and if he stayed under that limit, he was ahead of the game. He rightly pointed out that this was his health plan, he liked it and that President Obama had repeatedly assured him that if he liked it, he would get to keep it. Unfortunately, that is not the case. The bill would force him to join the insurance pool precisely to utilize his $11k to subsidize others who had no insurance. While I was reading this editorial, it occured to me the efficacy of his plan. The AMA created something called Common Procedural Terminology or CPT codes. It has created a procedural based system. Every procedure has a CPT code and reinbursement is based on the code. The codes effectively dictate what is repaid to the physician. The practice of medicine becomes one long list of procedures. The more procedures, the more repayment. Doctor compensation is not results based, it is procedures based.