THE COST OF CARE

The ad in the paper read, “LZFTC – $15 school and sports physicals.”  I’m not kidding you.  Office visits ran $22 – $32 dollars.  Everything was cheap.  Most office fees were less expensive than today’s copays. On one Thursday during the summer of 1985, I saw 106 patients.  I started at 7:30 a.m. and locked the doors at 8:30 pm. The last patient was discharged at 9:45 pm.   Most of the patients were seen for sports physicals. The last patients to be seen were football physicals.  Boy, did those kids stink!  They came from their first practice and had been told that they couldn’t play tomorrow if they didn’t have their physicals documented.  One kid stunk so badly that I sent him home.  I couldn’t handle it.   He was my first patient the next morning.

For the most part, I loved sports physicals.  They were a fantastic chance to do some real preventative medicine, talk about VD and unwanted pregnancies.  Of course, none of my patients were sexually active (lol).  None of them drank or did drugs (lol).   So, how could the cost of a sports physical soar from $15 to $150 or more?

In the good old days, everything was on paper.  We collected far less information at the front desk.  My notes were short and sweet.  They included the pertinent medical findings, the diagnosis, and the treatment plan.  All of the information fit on 1/2 of a page of paper.  I wrote anything important in block letters. I wrote the diagnosis and charges on another piece of paper and the patient went to the front desk and PAID, sometimes in cash but mostly by check.  For those of you who don’t know what cash is, ask an elder.  Transactions were straight forward.

The invasion of the insurance aliens screwed up everything.  They promised you better care at a lower price.  You got worse care at a higher price.  They threatened me. In previous articles, I’ve written about the Suits who came into my office and demanded that I sign their contract.  They sat in my office, demanded my signature on their contract or they would take my patients away.  Big, brave doc that I was, I threw them out.  OOPS! They won and everybody I know lost. 

I take that back.  I took care of one of the insurer’s hotshots. He did quite well for himself.  Like a character in a spy movie, “G” came to me at the end of the day and warned me that my name was on a “burn” list.  I had a successful blog that focused on the insurers’ attack on doctors and patients and the ever-worsening effects of giving in to them.  Frankly, the world had just demoted me from doctor to provider and I was pissed.  I turned “Milo” loose and he started writing some pretty inflammatory stuff.  He published the annual salaries of the CEO’s of the big three, as well as the value of their bonuses and stock options.  In response to “Milo,” Big Blue threatened to cancel all of my contracts.  I would have gone bankrupt immediately.  Obviously, I pulled my blog and all of my articles and did not write again until I retired.

The golden days of medicine were over.  Prices soared and profits crashed.  Patients who would never think of leaving their doctors left their “provider” every time their insurance changed.  Instead of being PAID for services rendered, providers were reimbursed by insurers according to complicated contracts that nobody could understand.  My billing staff grew from one biller to five FTEs.

The next big attack on the doctor/patient relationship was the dread REFERRAL/PRIOR AUTHORIZATION.   During the early years of practice, I wrote an order and it was done. With the onslaught of REFERRAL/PRIOR AUTHORIZATION, I wrote an order and then everyone waited to see if the insurer would pay for it.  The whole medical complex geared up to process more paper; and, once again, the cost of providing care went up and the quality of care went down.  Insurers are clever.  They never tell you that you can’t have a procedure/test /medication, they tell you they won’t pay for it. 

The insurers’ battle plan worked and PAPER WORK clogged the pipes.  The answer was obvious.  Everyone had to buy computers and modern medicine became modem medicine.  As the world became engrossed in the promised benefits of the ELECTRONIC MEDICAL RECORD (EMR), the doctors and medical staffs that used the EMR became helplessly enslaved.  The companies that made EMRs sold customized versions to hospitals and their physicians, insuring that EMRs would not talk to each other.  Software upgrades became dreaded events requiring expensive training and fixes as the EMR companies never got it right.

I learned to be an efficient clicker.  Unfortunately, the computer proved to be a success at billing and collecting money, further insuring its place in medicine.  IT DID NOT IMPROVE PATIENT CARE.  IT DID NOT IMPROVE PROVIDER TO PROVIDER COMMUNICATION.  WE GOT SCREWED, AGAIN.  I dreamt of putting the defibrillator paddles on my computer and yelling, “Clear!”  I wanted to kill it.  I secretly hoped we would be attacked by ransomware.

Towards the end of my practice of medicine, I spent an inordinate amount of time satisfying the computer.  I gave up newborn hospital care because the computer program used by the newborn nursery was a bottomless pit.  Thirty minutes of patient time was followed by 45 minutes of computer time.  My notes were full of useless, but computer required, information.  By the time you got to my diagnosis and plan, your hair had turned grey and you needed a nap.

My specialists’ reports were even worse.  I learned to read their notes from the back forward.  My rheumatologist’s notes were the only one that could be called excellent.  Her notes told you what she thought, what she was going to do and what she wanted you to do.  How she got her computer to obey her commands remains a mystery to me.  When I reviewed her chart note, it was like looking at notes doctors used to write back during the golden years of medicine.  Perhaps there is hope for the future.

Your joke for the day is:

My grandad asked me how to print on his computer…

I told him it’s Ctrl-P. He says he hasn’t been able to do that for ages.

A husband and wife are trying to set up a new password for their computer.

The husband puts, “Mypenis,” and the wife falls on the ground laughing because on the screen it says, “Error. Not long enough.”

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2 Replies to “THE COST OF CARE”

  1. I see little hope for the future as the big groups (Advocate, Northwestern,etc) gobble up and dictate to the smaller private practices. The docs are no longer allowed to be people, the patients are only numbers on the bottom line. I have observed this recently as my primary became part of the Advocate System. I see this as an additional effort to line the pockets of the executives and limit the quality of care provided to patients. Physicians are backed into a corner. Very sad 😢

    1. Well said. The first step in nationalizing healthcare is to organize the medical field into fewer but much larger groups and break the doctor patient relationship/bond. When they demoted me from physician to provider they demoted you from patient to cost center and consumer of healthcare benefits. Then they started managing both, maximizing profits. What’s really confusing is how many of these mega medical corporations are “not for profit.”

      I was on Good Shepherds staff for 34 years. When they were negotiating buying my practice they were kind enough to tell me I was not going to be happy working for them.

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