How Your Health Care Works, Part I

The point of writing a book about the health care in the US was to educate the population and, hopefully, in doing so motivate the population to advocate change. In light of the fact that the publication of my book to any public forum seems, well, unlikely, I thought I would start a series on my hardly read blog about how health care works. Because it took 200 pages to discuss this in my book I will have to give a more "readers digest" version here in my BLOG. Health care in the US is, in most cases, a business, granted there are community health centers and hospitals that operate with Govt subsidies and grants, the majority of the health care system in the US operates under a free market, capitalistic, business model. Accepting this as the basic rule, one must then first understand there is income and expense, that is it, this is basic. The way any medical practice works is the work performed by the doctor is the only work that generates income, everyone else in that office is an expense, the nurse, secretary, medical records, IT, maintenance, billing person, etc are all expenses supported by the work of the Doctor. On the income side, for the most part, the doctor only gets paid for face to face interaction with patients. There is no reimbursement for phone calls, lab interpretation, talking to consultants, talking to family members, script writing or calling, reading current medical literature, night calls from the hospital and so on, none of these crucial tasks generate income, they are generally non billable, and Medicare calls the "bundled services" that is, suppose I saw you in the office and prescribed a new medication, two days later you call me because you are having problems with it, I call back, we discuss the problem, I prescribe a new medication, and if I am good, I discuss the risks, benefits, costs and side effects of the new medication. Medicare considers the payment from the original visit to cover this interaction. There are billing codes for phone service, but non of the insurance companies include them in covered services, which means I would have to bill the patient, and, as you will see when I get to the specifics, this is not a small undertaking. So very basically the expenses of a medical practice are personnel (note nurses and billing personnel make from $17-$25/hr,) plus benefits, rent or lease, medical supplies, state, federal and board licensure fees, liability insurance, utilities, computer/software and of course my own pay. Income comes from insurance companies and patients. My practice cost approximately 20K a month to run and I kept a low overhead. I am happy to answer any questions at this point, or anywhere along the way.