Being a woman of a certain age, I dutifully went in for a “routine” colonoscopy a few weeks ago. My doctor came to see me before the procedure. She spent about 5 minutes reviewing the procedure and asked me to sign the consent form. I was in the procedure room for about 10 minutes and then we were done.
A few days ago, I got the bill. The hospital charged $2,252.00 for her time and was paid $1,126.11. This is only the charge for the physician. The other costs were billed at $2,721.39. I was in the hospital for about an hour and the charge was $5,010.56. They were paid $3,074.85.
I am glad I had a competent physician who did not perforate my bowel and I respect the technical expertise required to safely perform this procedure. But it got me to wondering about the reimbursement for the work I do.
This is how it compares.
If I spend 15 or 30 minutes with a patient on a routine cursory visit, my agency is paid $58.14. If we were to book our psychiatrists with a patient every 15 minutes, we could charge $232.56/hour but this does not account for the phone calls between visits or the discussion with other colleagues or family members. Recently, I have been trying to have longer network meetings. These often last an hour and some of them last longer. The most my agency can bill is $115.88 and this is regardless of how many clinicians are in the room. And in contrast to my gastroenterologist, there are no extra charges for any of our other staff who work to help our clinic run smoothly – the receptionist, the staff in our records department, the nurse who might be available to handle calls at other times of the day, the IT department, the people who send out these bills.
Now I realize that many who visit the MIA website, think psychiatrists are worth a lot less than $58.14. But there are others who complain that psychiatrists do not spend enough time with their patients.
So if you are a hospital or an outpatient clinic, what are you likely to offer? Routine colonoscopies on healthy people where you schedule people every 10 minutes and charge $5,000 a person or 15 minute psychiatry appointments where you can charge $232.56 per hour or extended 1-2 hour network meetings where ambiguous and complicated problems are discussed with multiple clinicians for a total charge of $115.88?
This is a fact of modern medicine – at least as practiced in the U.S. – that has to be addressed if we want to talk about reform. Procedures are highly valued, clinical relationships are not. This is not an argument for a medical centric system. It is one of the reasons I have argued for marginalizing medicine. I would add that I have no complaint about my salary but my wonderful colleagues who work by my side are not paid well at all. They leave their jobs and this leads to a fracturing of our most valuable commodity – the relationships we strive to build. And I am a big supporter of hiring people with lived experience but they also need to be paid a living wage and, as you may have read elsewhere on this site this week, they are as vulnerable as any of us who work in less technical ways. This is a part of the story that is hard to ignore.
While I am glad I am polyp-free for now, I have to say that doing things to healthy people is pretty good business in medicine these days.
Do the math.