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Medical Forum / Diseases and Disorders / Prostate Cancer / March 2005BMW and bone scan
In another post I mentioned, tongue in cheek, that perhaps the doc was recommending a bone scan in order to make a payment on his BMW. While I intended the comment to be a joke, I feel there is a lot of truth in the implication and a lot of unnecessary testing done in the name of "just to be sure" when in fact the purpose is twofold: 1. Bring in more money from insurance/medicare, and 2. Have a sufficiently long paper trail/tail to completely cover one's heiny in case of a claim of malpractice. I have no statistics on this but I bet physicians who are on salary such as those working in university medical centers request far fewer tests than docs in private practice who receive a cut one way or another of every test they perform and who have to pay their own malpractice premiums. For instance, my uro who did the surgery has me leave a urine sample every time I visit the office, even the consultation visit and once when I just went in to get a prescription. You can bet each time he checks off a box on the form and gets another $50 for "lab work". My 86 year-old mother in perfect health goes to a private physician every six months at her doctor's request for a "check up". Every time the doc finds "something" requiring a test, x-ray, ultrasound or in one case a lymphoderma clinic which was nothing more than a glorified massage parlor that caused my mother's skin to practically fall off from a rash she got from the lotions they used. Cost to insurance for that fiasco - $1500 to the clinic plus a bunch more visits to the doc to cure the rash. While the doctor may not get direct cash for the tests ordered, she does get to charge insurance/medicare about three times as much for each visit because she found or treated something of concern, not just a check up for which she is paid quite a bit less (the reason many docs don't accept medicare patients). Since I am a taxpayer who supports medicare and also a payer of premiums for private insurance, I don't think I want my money spent on willy-nilly testing just because the doc needs to make the car payment. I know doctors in private practice often have a tough time covering expenses but to subject patients to endless testing "just in case" or to catch the 1 in 100 or 1 in 1000 who is "positive" is not the way I want our limited medical resources utilized. Dave Perry OK, medics are overpaid, US healthcare is crap, but don't overestimate the value of that bone scan. If you want an improvement in US healthcare, speak to your politicians and pay more taxes. > In another post I mentioned, tongue in cheek, that perhaps the doc was > recommending a bone scan in order to make a payment on his BMW. While [quoted text clipped - 31 lines] > the way I want our limited medical resources utilized. > Dave Perry Never said medics are overpaid, in fact many are underpaid considering the necessity of having to run tests to stay in business what with all the overhead of a private office, tens of thousands of dollars in student loans, the costs of insurance which is certainly one item to review with my politicians. Also, never said US healthcare is crap, in fact it may well be the best in the world although I do have concern that some countries manage to do as well with a whole lot less resources. My intent was to offer individuals a little insight and inspiration to educate themselves and to ask a few questions when their doctor suggests ever more tests. Of course, if the insurance pays for it, "who cares", right? To me, that's not much different from setting a clunker of a car on fire to collect the insurance. Oops, I forgot one difference, one's illegal, the other isn't. If the purpose of a bone scan is to look for metastic prostate cancer in a guy with a low PSA and Gleason 6 followed by an MRI to investigate the "hot spot" in a rib, then yes there is no value to the bone scan or the MRI and someone is either incompetent or is milking the cow. These things are unbelievably expensive (I had an MRI done on a shoulder injury about 5 years ago and the cost was over $1000) and I don't believe these costs, either the bone scan or peeing in a cup, should be incurred on a whim with no medical benefit. Dave Perry > OK, medics are overpaid, US healthcare is crap, but don't overestimate the value > of that bone scan. If you want an improvement in US healthcare, speak to your [quoted text clipped - 35 lines] > > the way I want our limited medical resources utilized. > > Dave Perry I am sure that the system is abused, but I can find no fault with docs covering all bases. It is OUR problem. We are such a litigious society, that I don't blame the docs. I blame John Doe who sits on some jury and thinks that a fat man should collect millions from a fast food chain simply because he ate three meals a day there for 20 years. Or, the woman who was initially awarded several million dollars because she spilled hot coffee on her crotch because it spilled out of the cup between her legs while she was driving! Or the 400 pound woman who takes up two (or more) seats on an airline and expects to pay for only one seat. My secretary had a car back into her in a parking lot. The woman sued because of a "sprained neck", and her husband sued because his wife could not perform her sexual duties. I could go on, but ............. The short of it is that we, as a society, have allowed all of this to happen. While I know that my health care is the very best in the world, it is expensive simply because of the insurance premiums docs must pay to protect themselves. I fly fish with a couple of urologists (one assisted in my RRP 9 years ago), and in Massachusetts, they are paid far less than other docs. But their insurance premiums are very high. God Bless 'em all. People, even excellent docs, make mistakes. While I would have no problem sueing for a mistake that costs a life, I would not sue for something minor, something that did not effect my general health. Dave (who hasn't met a doc he didn't like) As a physician in private practice, I just have to respond to this one. There are those of us who are just as, if not more, opposed to the kind of self referral generation of income you describe. The ability of physicians to order tests which are performed at a facility in which they hold a financial interest should be, but is not, illegal. On the other hand, when a urologist orders a bone scan to be performed at a hospital or imaging facility that they do not own a part of, it IS illegal for him or her to receive any kind of a kickback. This is a huge paradox and is part of what is rapidly sinking our health care system, in my opinion. It has been proven beyond a shadow of a doubt, by well performed studies, that when physicians profit from the studies they order, they order more studies...duh. This contributes to unneccesary testing, obviously. This in turn drives up health care costs for everyone. It would be so easy to fix...I could even come up with the wording for the law..."YOU CANNOT PROFIT FROM DIAGNOSTIC TESTS ORDERED ON YOUR PATIENTS." Unfortunately, this will not happen because of the lobbying efforts of many powerful industry and medical groups. It has been estimated that the elimination of "self referral" testing would cut health care costs by 15-20 billion dollars annually just by doing away with the "extra", unnecessary exams. Rant, rant, rant. CPW For those of you who are wondering...I'm a radiologist in private practice and have no financial interest in any imaging center. I have worked my entire career to insure the appropriate utilization of imaging studies...and have been fighting a losing battle. > As a physician in private practice, I just have to respond to this one. > There are those of us who are just as, if not more, opposed to the [quoted text clipped - 22 lines] > worked my entire career to insure the appropriate utilization of > imaging studies...and have been fighting a losing battle. Three cheers for you. I have two physicians in my family, by marriage, and both support reforms to lower the cost of healthcare and extend coverage to all residents of the US. So you are hardly alone, and some day when people realize how lobbying and the money beyind it distorts our politics, we may get somewhere in these matters. Keep up the good fight. > In another post I mentioned, tongue in cheek, that perhaps the doc was > recommending a bone scan in order to make a payment on his BMW. I don't know if anyone has pointed this out, but the doctor who recommends the bone scan doesn't get paid for doing it. He has essentially no incentive to suggest a bone scan as far as his income is concerned. You could argue that he is trying to help his buddy, thr radiologist, out, but this is doubtful. > While > I intended the comment to be a joke, I feel there is a lot of truth in > the implication and a lot of unnecessary testing done in the name of > "just to be sure" when in fact the purpose is twofold: 1. Bring in > more money from insurance/medicare, See above. > and 2. Have a sufficiently long > paper trail/tail to completely cover one's heiny in case of a claim of > malpractice. That could be a factor. If we had a medical system which insured on the one hand that people who were hurt by medical mistakes were adequately compensated and on the other hand that incompetent doctors were actually disciplined, that might be less of a problem. With the preseent system, most people who are injured don't get any compensation, and many incompetent docits for "pain and suffering" will do little to remedy the situation and will probably prevent some deserving cases from getting adequate compensation. > I have no statistics on this but I bet physicians who are > on salary such as those working in university medical centers request > far fewer tests than docs in private practice who receive a cut one way > or another of every test they perform and who have to pay their own > malpractice premiums. I don't know for sure how these things function, but I don't think in these days of managed care that the referring doctor gets a cut. If you know specifically that such practices occur today, please give us some details. > For instance, my uro who did the surgery has me > leave a urine sample every time I visit the office, even the > consultation visit and once when I just went in to get a prescription. > You can bet each time he checks off a box on the form and gets another > $50 for "lab work". My urologist always collects a urine sample when I see him. But he looks at it himself and as far as I know he doesn't charge specially for it. In any event his bills for my regular visits are not specially high, and Medicare and my secondary insurance between them don't even pay him the full amount. I think he has a medical reason to do such tests and they don't add significantly to his income. > My 86 year-old mother in perfect health goes to a > private physician every six months at her doctor's request for a "check [quoted text clipped - 15 lines] > in case" or to catch the 1 in 100 or 1 in 1000 who is "positive" is not > the way I want our limited medical resources utilized. What you describe does sound excessive. I think this may vary somewhat in different parts of the country and with different physicians. Where I am, they don't seem to order many unnecessary tests. Of course, the nominal fees they do charge for certain tests seem inordinately high, but those charges are seldom paid by Medicare or insurers. It is the poor patient who is trying to pay for it himself that gets stuck with inflated bills. > Dave Perry Leonard, Never meant to suggest the doctor gets any kind of cut or kickback for recommending tests. What the doctor gets is a larger reimbursement from insurance/medicare for boxes checked off on the form submitted. Simple office visit/check up results in low reimbursement. Find something in the visit to investigate, higher reimbursement. I don't know what a checked box is worth but I'm guessing somewhere between $20 and $50. At 4 patients per hour times 8 hours per day times --- well, you get the picture. Dave Perry > > In another post I mentioned, tongue in cheek, that perhaps the doc was > > recommending a bone scan in order to make a payment on his BMW. [quoted text clipped - 23 lines] > most people who are injured don't get any compensation, and many > incompetent docits for "pain and suffering" will do little to remedy > the situation and will probably prevent some deserving cases from > getting adequate compensation. [quoted text clipped - 6 lines] > > I don't know for sure how these things function, but I don't think in > these days of managed care that the referring doctor gets a cut. If you > know specifically that such practices occur today, please give us some [quoted text clipped - 10 lines] > it. In any event his bills for my regular visits are not specially > high, and Medicare and my secondary insurance between them don't even > pay him the full amount. I think he has a medical reason to do such > tests and they don't add significantly to his income. > [quoted text clipped - 22 lines] > I am, they don't seem to order many unnecessary tests. Of course, the > nominal fees they do charge for certain tests seem inordinately high, > but those charges are seldom paid by Medicare or insurers. It is the > poor patient who is trying to pay for it himself that gets stuck with > inflated bills. > > > Dave Perry |
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