Published: 2009-10-20 14:33:53
Author: PATRICK J. SCARPITTI | Newark Advocate | October 6, 2009
Oftentimes, my patients ask me why it costs so much for a doctor visit. In fact, one of my patients stated when he was 10 years old, his parents went to a physician in town that only charged $10 for an office visit.
This year, it will be 26 years since I started office practice. I took over for a physician who was retiring. Indeed, his office charges were somewhere in the neighborhood of $10 to $20 per office visit. He kept all information regarding the patient's visit on a 3-by-5 index card. These were filed alphabetically so it could be found easily by his one and only employee, who also doubled as receptionist, nurse, office organizer and, at times, billing clerk. They took cash at the time of service and would see about 60 people per day.
In those days, his office was in a private home with one employee -- cash at the time of service and simple medical index cards used as charts seemed to be a very efficient system. He admirably did house calls, deliveries and some surgeries. That was when Licking Memorial Hospital was on Everett Avenue.
At the time I first started practice, insurance companies, Medicare and Medicaid laws and directives forced changes in the way physicians practiced. The need for better information flow, liability concerns and complex documentation required better charts to be used. The 3-by-5 index cards no longer did the job.
We started to be reimbursed at a flat rate under something called MAC (which was a government-controlled cost-reimbursement system standing for Maximum Allowable Charge.) MAC had to be computed on a yearly basis and checked by the government to make sure we were in compliance. They essentially froze reimbursement levels for cost-containment purposes. To receive the maximum allowable charge, we had to submit paper claims with specific codes, which matched specific diagnosis codes. Patients no longer paid the bill at the time of service (if they did, it would be in much fewer numbers than that of my predecessors). These changes required the hiring of multiple employees to process all the extra paperwork and ICD-9 and CPT codes.
We also had a nurse who helped us with our schedules. We were required to maintain acceptable office practices and were often inspected for compliance by various government and health care organizations. The average number of employees per physician at that time was about three to 3 1/2. We could only see about 25 to 30 patients per day.
During the past 26 years, increasingly complex directives have been mandated by the United States government regarding Medicare, Medicaid and insurance companies for doctors and hospitals as well. Some of these programs are: OSHA, HIPAA, Billing Compliance Plan, Red Flag Rules, CLIA and COLA regulating our lab and the Ohio Department of Health setting rules and regulations for our X-ray machine.
Also, we now have to pre-certify almost every outpatient test or procedure we order and pre-authorize about 30 percent of all prescriptions we write (due to requirements from the patient's insurance plan). We now require four to 4 1/2 employees per doctor.Full story