Reimbursement Skews Treatment, Doctor Confesses in WSJ

Insurance reimbursement creates a " bias to pay doctors more for performing a test or procedure than for using our heads to make a diagnosis or manage a disease."

An MD writes candidly in the Wall Street Journal about the differing financial incentives for various procedures.

"Obtaining a thorough history and physical exam and reviewing tests to make a challenging diagnosis pay much less than conducting a battery of tests or performing a diagnostic procedure. If I spend 30 minutes in an extended office call for a patient with diabetes, high blood pressure and heart disease, I get paid an average of $69. If I remove a skin cyst off the patient's back in that same time, the minor surgery would bring $110. If I do a screening colonoscopy at the hospital to check for colon cancer for the same patient in the same time, my average reimbursement is $478 with essentially no office overhead. It's no wonder that medical students want to go into procedural specialties like gastroenterology and fewer want to pursue cognitive specialties such as general medicine.

"When I do a 15-minute office visit for managing high blood pressure, the average reimbursement is $45. If my nurse drew a panel of four common blood tests in the same time, it would bring about $50, on a patient with private insurance, after paying the lab company. (With the government's Medicare program, I get paid $3 for blood work; Medicaid, nothing.)"

The doc notes that he tried to "take the high road" but found it financial not feasible. The medical reimbursement 'system' forced various diagnostic and treatment paths. Fortunately for patients, this MD concludes it's still his "job" to "walk the ethical line and make sure we only proceed when it's appropriate for patients." Safety, first.

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