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Physicians Don’t Profit From Tests And Prescriptions

Physicians don’t make money from the tests, prescriptions, procedures and admissions they order, according to a new survey by the staffing and technology company Jackson Healthcare. At most, 6.2% of physicians’ total compensation comes from the doctor’s orders, the survey reported.

Direct income from medical orders comprised:
–0.5% from charges from prescriptions,
–1.0% from charges from lab tests,
–1.1% from charges associated with hospital admission,
–1.3% from charges associated with facility fees for surgeries, and
–2.3% from charges from diagnostic imaging.

The survey of 1,512 physicians challenged claims that physicians won’t stop practicing defensive medicine because they profit from their medical orders, the company stated in a press release.

“Many outside the industry believe that physicians make a lot of money on the tests, prescriptions, procedures and admissions they order,” said Richard Jackson, chairman and CEO of Jackson Healthcare. “The reality is that most (82%) do not make any money from their orders. For the remaining that do, it constitutes a fraction of their total compensation.” Read more »

*This blog post was originally published at ACP Internist*

Why Do Surgeons Avoid Breast Reduction Procedures?

For years I have avoided Medicare breast reductions for a number of reasons:

(1) Poor pay for hours of work. An average breast reduction when done to a high standard usually takes 3-4 hours. I do not staple the closure.
(2) Medicare patients due to their age are at higher risk for wound healing problems.
(3) 90 day global fee period – These patients routinely need follow-up care and that care is not billable.

Recently I ignored my better judgment and performed the operation for a lady in whom back pain (ICD-9 724.5) and back surgery had been long term problems. She also had a pretty nasty rash (ICD-9 692.89 Dermatitis and eczema [in the infra-mammary fold]) under her right breast that just wouldn’t go away. These of course were all in addition to the usual diagnosis of large breasts (ICD-9 611.1 Hypertrophy of breast.)

Medicare showed me yet another reason for my hesitation to do these cases when they denied payment for the operation saying it was not medically indicated. They will probably pay on appeal, but the thought that I should have to appeal the case adds insult to injury.

*This blog post was originally published at Truth in Cosmetic Surgery*

Physician Salaries Increase In Academia And Primary Care

Academic faculty physicians in primary and specialty care reported slight pay increases, according to the Medical Group Management Association.

Go. by Shayne Kaye via Flickr/Creative Commons licenseThe organization’s Academic Practice Compensation and Production Survey for Faculty and Management: 2011 Report Based on 2010 Data, annual compensation for internal medicine primary care faculty physicians increased by 6.84% since 2009, and increased 4.46% between 2008 and 2009.

Median compensation for all primary care faculty physicians was $163,704, an increase of 3.47% since 2009, and median compensation for specialty care faculty was $241,959, an increase of 2.7% since 2009.

Department chairs and chiefs received the greatest compensation, $292,243 for primary care faculty and $482,293 for specialty care faculty. Primary care professors received $190,815 in compensation and specialty care professors received $268,786. Read more »

*This blog post was originally published at ACP Internist*

Will Health Insurers Do Anything To Save Primary Care?

A few days ago I received an email from a general internist about my posts about concierge practices. I have known this physician for over 20 years, and he has great insight into the challenges facing health care. This email was no exception; he had this to say how his group took the “middle way” of pursuing private funding for the Patient-Centered Medical Home (PCMH):

“My practice includes 3 primary care physicians and has invested heavily in IT infrastructure. We have re-engineered our workflows and have achieved benchmark levels of quality and service. We have won NCQA certification for our PCMH. Yet so far no payer has stepped up to underwrite our investment. So we have joined Privia Health in forming a ‘membership practice.’ Patients are asked to pay a small monthly membership fee. In return they receive some special attention . . . Plan sponsors and payers are invited to pay the fee on behalf of their employees. . . Patients like having same day access. They like secure email communication with their doctor. They like having a personal health record. They like having a case manager helping them navigate the system. And they like going online in the evening to make their own appointments. ACP policy supports the medical home but is silent on the question of what a medical home is to do before local payment realities catch up. I owe my patients my efforts to assure that when I retire an eager young internist will welcome the opportunity to take over my practice. Absent public or private funding for the medical home that is just not going to happen.” Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

KevinMD Suggests Insurance Companies Pay Primary Care Physicians More

I’ve often given doctors too little credit when it comes to business decisions.

But, in an op-ed published at Reuters, physician Ford Vox argues otherwise.

He notes that doctors, indeed, have tremendous business sense:

How can anybody say that doctors don’t have business sense, when not only do most American physicians forge their way in small private practices, but new doctors lay their cards on the table every year? The competitiveness of residencies, where doctors train to become a pediatrician or a cardiologist, correlates strongly with the field’s earnings potential. Read more »

*This blog post was originally published at KevinMD.com*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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