Thursday, December 13, 2012

Shell game

A family member just had a recent medical procedure and I reviewed the bills this morning.  Since this has become a rather routine procedure for two members of my family, and because we have a high deductible insurance policy, I have become astute at looking at the claims.  For this procedure, there are always four statements: One from the endoscopy center, one from the anesthesia provider, and two from the physician for both the procedure and the medical assessment justifying the need for the procedure.

In round numbers we paid $200 for the medical assessment.  For this my husband sat in the doctor's office for 45 minutes, answered a questionnaire, got weighed and blood pressured before his 5 minutes with the doctor.  The procedure itself cost $1200 and took 15 minutes of the doctor's time.   He did spend another 5 minutes explaining what he had done but multiply that by the 15 procedures he preformed that afternoon and I believe you will see why every medical student wants to subspecialize.

Now, least you think that is all the income this physician had from his afternoon (1:30 to 5:00 PM) worth of work, let me explain about the anesthesia and endoscopy center.  This endoscopy center is owned by the doctor and 9 other doctor's who do similar procedures.  They built it because of the money they saw the "not for profit" hospital system making in a similar fashion.  The final piece is anesthesia.

When I inquired, I was told there was no anestheologist on the premises.  This is a free standing center, 5 miles from the nearest hospital.  Five miles in city traffic.  The "anesthesia" is IV sedation.  You can sometimes get this in a dentist office (but I would not recommend it).  It is two drugs, fentanyl and versaid.  The first is a pain killer that makes you go to sleep and the second is a short acting valium type drug.  It makes you forget.

The person pushing these drugs is a certified nurse anesthetist.  I use them all the time in the hospital, where there is an anesthesiologist (read that one doctor who has been to medical school and done a residency in anesthesiology).  I have no problem with nurse anesthetists.  This is not the reason I am writing this.

My problem is that the doctor supervising this anesthetist is the same one doing the endoscopy.  He may (or may not) have had any anesthesia training.  He may or may not know how to take care of the patient should his heart or breathing cease.  For this we will pay the same $1500 that we would have if we had been in the hospital.

I ask where the money goes.  While I am asking, I am multiplying the $1500 by all the people I saw leave the waiting room while I waited on my husband.  This is probably somewhere in the neighborhood of 30.  We were only there for 2 hours.  Well, it's complicated, I was told.  Discuss it with the doctor.  Actually, he was quite happy to brag to me that this was the most lucrative operation he had been apart of in his 20 plus year career.

Before, the hospital got the money.  Now he gets a lot more of it.  Which demonstrates what medicine is all about:  Getting the most money possible from each patient.
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