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I have become fascinated, perhaps obsessed with the Health Care system in the United States today. It was something I had to learn for my everyday job of running my husband's medical practice, but that was paperwork.
I became obsessed when our health insurance went up 35% in one year. This was the year right before "Obamacare" came into play. You guys, I had GOOD insurance. I didn’t have to worry about anything. When they wanted to charge me more than my mortgage payment for it, I became obsessed.My husband and I own an alternative medical practice. We make our money from insurance companies. Patient come, pays their copay, and we file the charges and in two weeks to 6 months, we get paid. Simple.
Even only using my high school math logic, I figure that if they are raising my personal rates so much that at least as a provider, I would see increased compensation from insurance companies.
I mean it’s all gotta go somewhere right?
So I thought at least our reimbursement rates would go up to what we need to survive (cause they weren't), and maybe I could give the office girls a small raise in a few months….so I changed the insurance plan into one that was less money and less coverage thinking at least I was lucky enough to catch it on the other end as a provider.
Then we got the letter from the insurance company, our biggest payer, and the one that we held personally. As a provider, they were DROPPING our reimbursement rates 15%. WHAT? Really WTF?
"Okay, Mer. That sucks, but what does this have to do with MY healthcare?"
Don't worry, I'm getting there. I swear! Let’s do doctors math. From a doctor's office bean counter perspective:
15 minute visit now gives us $68.72 per visit. For the sake of ease, lets make it $70 per 15 minutes ok?
Let’s sat the doctor works 9-5 with a lunch break daily. So, 6 hours. All 15 minute patients in one day, that’s 24 patients. 24 x 70 = $1,680.00 a day.
Let’s break that down further.
$1,680 x 7%, because that is what the biller's take= $1,563.
$1563 x 1.5 medical assistants at approximately 13/ hr= $253.3 for the day
$1309.7 x 6 hours hourly rate of doctors pay (note this is average) $89= $534.00
$775 x 1 day rent or mortgage of facility (assuming 3000 sf)= $164/day
$611 x telephones (assuming 200 month for internet and answering services etc)= $7 a day
$604 x medical supplies (table paper, band aids, injections etc on average same as phone= $7 a day
$597 x office supplies (this has gone down due to EMR requirements but will say same as phone) = $7 a day
$590 x EMR (this varies but usually 400 a month range) = $14 day
$576 x ancillary staff (cleaners, receptionists, marketing staff) = Average salary $13/hr = $200.00 day
$376 x advertising (this number can be huge or small depends on the practice, on average $2500 a month = $82 a day
$294 x utilities, need to keep lights on (approximately $250 a month) = $8 dollars
$286.
I will stop there. I did not add in professional fees (we need lawyers and accountants), insurance of general liability and malpractice, benefits for employees (health insurance, 401K etc), association fees (AMA, local business, charities).
Point being, I’ve told my kids it’s okay to not go into medicine. This is why.
So as a doctor's office, how do we fix this?
You overbook. Your 15 minute visit is now really 10. Maybe even 5 if we have a nurse.
There are 2 people across the hallway with the same times as you.
Everyone is cranky.
The patients, the nurses, the assistants the doctor.
As my grandfather would say it’s like trying to put 150 lbs of dirt in a 5 pound bag, It just doesn’t work.
Guys, it’s not going to get any better.
Now let’s look at the what happens in that 10 minutes.
You get a prescription for what the doc thinks may be for high cholesterol. Your blood works says your number is 10 points higher than it should be. You get your script. You leave with a piece of paper telling you what you have. (Sidebar: did you know if the doctor does not hit a checkmark that you received said piece of paper the EMR financially penalizes him?)
You get the script filled. Your doctor didn’t ask your insurance so your meds are out of network and you need to pay $80.
But an older formula would cost you $5 so maybe you need to call the doctor's office to get it switched. So you go home with no meds. You get the assistants answering machine who states right on the message that she won’t even listen until tomorrow. A med switch? That’s a 2-3 day call back not top priority.
So you start researching the medicine on your own. You start reading LDL, HDL, and Triglycerides. This medicine is for high triglycerides but you have low HDL as well. Am you even taking the right thing?
Your anxiety starts to flare up thinking you have read that your condition may cause instant cardiovascular death. Damn, you think you forgot to ask him about this anxiety when you were there for your 10 minutes. So you call and leave another message for the assistant.
You forgot to tell them that your gynecologist put you on a SSRI thinking it’s going to help regulate your periods. More fear ensures. You call back the assistant and talk to the machine. Again.
You read a whole bunch online and head to the health food store. You buy every little remedy you read about. You try to ask questions to health food store owner but you are buying product so they don’t really care. You spend $200 for the prescription you didn't want to get for $80.
You start teas, take capsules with Latin names you don’t know, you take your pharm meds, you start sniffing bottles.
Then you throw up. Have constant headaches. Diarrhea. You have no idea what is going on. You ignored the assistants call when they finally called back because you got this naturally, you’ll show them.
You call and talk to the receptionist. She squishes you in that day, warning you politely that you'll have to wait. You don’t care. You need to feel better.
From your symptoms the doctor's office knows that you will be over 15 minutes, and have to reshuffle the schedule. We may need to move Mary until tomorrow as she is just a med check, Mary is pissed and screams at receptionist. This is real behind the scenes people…
The assistant comes in and asks you questions.
She knows enough that there are some interactions going on here and knows that she needs to get a nurse in ASAP. So now the NP or RN comes in and ask you more pointed questions about what you took, when you took it, all med history.
She’s in there for 20 minutes. You are now at 30 minute appointment. Doctor finally comes in and looks at you like you are bonkers for doing all this. He gently tells you Dr. Google isn’t a doctor and that natural medicine isn't always good for you.
He tells you to stop taking all natural and changes all your prescriptions. You are there for an hour.
Due to your “mistakes” some are not in your formulary. May only be a month you need to take them to get you on track but now you have no choice. Meds with copay $200.
You still don’t feel good.
You figure out you are having side effects to the meds. Call assistant. They know you went to a pharmacy and that there are no dire consequences for these meds together and basically tell you to suck it up. You still feel like shit.
And so it goes.
It doesn’t have to.
Let’s change direction. Let’s go to the part where you get the script for $200 and call the assistant.
After you call the assistant, you call your Aromatherapist and/or Herbalist otherwise known as a Phytotherapist (or plant therapist). You have worked with her before on your children and decided that it may be a good choice.
You call and explain the situation. She makes a consultation with you and asks you to bring your lab work. A ½ hour is $50. Well, that’s your copay so okay.You fill out your paperwork which is lengthy and asks a lot of questions.
She gets you in within 24 hours. The assistant still hasn’t called back. She explains cholesterol to you. She explains what LDL, HDL and triglycerides are and how it affects you.
She may not be able to order blood tests or diagnose problems, but she has been trained to understand and treat these issues. She looks at your med list as you are explaining your anxiety. She tells you that there are certain herbs you should not take and why.
She spends the first 30 minutes educating you on your condition based on YOUR symptoms and YOUR bloodwork.
Your 30 minutes are up. She keeps going. You go with the flow. She suggests certain herbs and teas and oils to help all these conditions. You can buy them from her or at store. If you buy from store she will go to the minute detail what you need.
You decide to buy from her. She tells you the cost is also $50.00. She charges you a total of $100.00 for advice and herbs/oils. She requests you follow up with her in 3 weeks.
You get home and take out the directions and realize there is an actual prescription in there and tells you to check your email within 24 hours of visit. You check your email and there is a report all about you and what was prescribed to you and why. It has safety info, dosing etc.
You follow the procedure and you start to feel good. The doctor assistant calls and you say you are fine, never mind. She reminds you that you need bloodwork in 3 months to check to see if medicine is working. She emails you bloodwork.
You see the herbalist/aromatherapist a few more times. You do fill the medicine and ask if you should take it. She says that the doctor prescribed it and that she cannot diagnose conditions and that it is your choice. She assures you that you are not dying, as did the medical assistant. So you decide to take the natural route.
3 months later after your bloodwork, you do to see the doctor for your 10 minute visit. He comes in looks at your labs, and says medicine is working, great news here is a new script and see you in 6 months.
You stop him and say wait, I didn’t take the medicine, I did this instead, and hand him your papers from the Phytotherapist.
He is quiet for a minute. He can see the references from respected institutions on the paper. He asks if he can keep it. He tells you that he doesn’t mind you doing what you are doing if you feel well and your labs look good. However, to be on safe side he wants to see you in 3 months instead of 6. You agree.
You keep on your regime. Seeing the Phytotherapist once every 6 weeks now or when you need refills, 3 month bloodwork (now on 6 months) comes out great again.
You feel well. Doctor asks you to bring Phytotherapist cards next time. He dismisses you until next year.
Phytotherapist dismissed you until you need her again.
Husband goes to doctor, sugar comes back as pre-diabetic. Doctor wants to put him on Metformin, and you ask if you can see Phytotherapist first. Doctor wholeheartedly agrees. That was a 10 minute visit. Doctor is happy that treatment can be positive and knows that he can now stay on schedule.
He also knows that you will be back if it doesn't work because aromatherapist knows to stay in scope of practice and that there is a place and time for ALL types of medicine.
So who is in your phone book?
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