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Sunday, September 15, 2013

You can't afford your doctor - transparent accounting

The math is unambiguous. You cannot afford your doctor. However, the injection of third party payment into health care delivery has obscured this reality. Let's take a simple drill down into basic health care finance in terms of ambulatory care. Let us assume that your very average primary care physician makes roughly $200,000/yr. That works our approximately to about $4000/wk, assuming working around 50 weeks a year (which is a generous assumption). Assuming that the average physician works 8 clinical sessions per week which allows for time to do other essential functions (calls, note completion, test follow up), this means that the average physician needs to net $500 per session after all overhead costs.

To make the math simple, let us assume a 66% overhead which would require about $1500 in revenue per clinical session. Let us assume that each of the sessions is scheduled for 6 hours which translates to 8 hours of clinical work. If one is living off the E&M codes, the most common code used in the 99213 code with the 99214 code catching up. One can assume that the average payment will be between the two. I think we can liberally assume a revenue of about $100/patient. That means you need to schedule 15 patients per half day session to make the $1500 to pay yourself and cover your overhead. That means  you need to see about 4 patients per hour. That translates to a total of 15 minutes per patient and perhaps if you are lucky you can spend half of that time in actual face to face time with your patient. This boils down to 7.5 minutes face time.

How many doctor's offices are up front with you when you make the appointment. "You have 7.5 minutes to complete all business. Please be prepared with an appropriate agenda which can fit into 7.5 minutes." Do you want to spend more time and are you willing to pay more for your time? Sorry, not allowed according to the contractual arrangements in place. You don't pay the bills so you don't make the rules.

So you say that your insurance pays for your visits. No they don't. They just take your money and pass it on taking a generous cut. The math of reality is shown above. Through your insurer this is what you purchase. It may be said that cross subsidies should offset such a payment plan. Talk about lack of transparency. Why should we advocate for overpaying for something in order to offset for stinting on another. Furthermore, those closest to the game and having the most at stake quickly figure out how to game the system, providing only over compensated services.

The public needs to understand what they have bought into. When you get sick hope that the 7.5 minutes is enough.

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