AMA issues first report card on health insurers

[Omaha Steve]

Source: Associated Press

By CARLA K. JOHNSON

CHICAGO (AP) - Some health insurance companies rate doctors on their performance. Now doctors are turning the tables.

The American Medical Association issued its first health insurance report card at the group's annual meeting Monday. The primary focus is on how quickly and accurately doctors get paid.

"Physicians are spending 14 percent of their total revenue to simply obtain what they've earned," said Dr. William Dolan, an AMA board member.


Dr. William Dolan, an American Medical Association board member, right and Frank Cohen, senior analyst for MIT Solutions answer questions after a presentation on the Diagnosis and Cure for the Broken Claims Process, Monday, June 16, 2008, at the AMA annual meeting in Chicago. The AMA issued its first health insurance report card at the meeting Monday. The primary focus is on how quickly and accurately doctors get paid. (AP Photo/M. Spencer Green)


The report card is an effort to reduce the cost of claims processing to doctors and help them as they negotiate contracts with insurance companies, he said. The report card will help patients if it reduces wasteful administrative costs, Dolan added.


Read more: http://apnews.excite.com/article/20080616/D91BEET80.html

[MannyGoldstein]

1. Docs And Insurers Are Both Troublemakers

Both sides play games to put as much cash in their pockets as possible.

Everyone else suffers.

[Mojorabbit]

2. ?

You don't think doctors should be paid without having to resubmit multiple times while the insurer tries to deny coverage for the bill over and over?

[MannyGoldstein]

4. Part Of The Problem Is They Often Play Games With Billing

Billing has become an art - many docs and staff are forever trying to come up with neat new combinations of procedure codes to maximize profit. The docs say they *have* to play games to get what's due them. With the average doc making more than $200k per year after malpractice payments and other expenses, I think they're doing just fine. The insurers are also doing just fine.

The rest of us - we're fucked. Demonstrably the worst health care in the developed world, and the most expensive by far.

[uppityperson]

9. The average doc does not make anywhere near $200k/yr after expenses.

Some specialists do, but the average doc? No way.
-----------
Note that there are a lot more FP docs than others.

http://hypertextbook.com/facts/2004/TiffanyYam.shtml
able 1. Total compensation of Physicians by Specialty; 2002
Anesthesiology $306,964
Surgery, general $255,438
Obstetrics/Gynecology $233,061
Internal medicine $155,530
Pediatrics/Adolescent medicine $152,690
Psychiatry $163,144
Family Practice $150,267
------------
http://www.payscale.com/research/US/People_with_Doctor_of_Medicine_(MD)_Degrees/Salary
http://www.payscale.com/rcredirect.aspx?country=US&result=People+with+Doctor+of+Medicine+(MD)+Degrees

-----------------

Article 2006
http://www.nytimes.com/2006/06/22/business/22doctors.html
Doctors' Average Pay Fell 7% in 8 Years, Report Says
June 22, 2006

A report planned for release today indicates that the average physician's net income declined 7 percent from 1995 to 2003, after adjusting for inflation, while incomes of lawyers and other professionals rose by 7 percent during the period.

The researchers who prepared the report say the decline in doctors' inflation-adjusted incomes appears to be affecting the types of medicine they choose to practice and the way they practice it — resulting in fewer primary care doctors and a tendency to order more revenue-generating diagnostic tests and procedures.

Primary care doctors, who are already among the lowest-paid physicians, had the steepest decline in their inflation-adjusted earnings — a 10 percent drop — according to the report by the Center for Studying Health System Change, a nonprofit research group in Washington.

The average reported net income for a primary care physician in 2003 was $146,405, according to the study, after expenses like malpractice insurance but before taxes. The highest-paid doctors were surgeons who specialize in areas like orthopedics, who had an average net income of $271,652, nearly double what the primary care doctors said they earned. ...

[MannyGoldstein]

11. There Are More Specialists Than GPs/FPs

Some specialists can make north of $1 million a year.

All told, my recollection is that mean is a bit of $200k, median is a bit lower.

[Mojorabbit]

20. I am married to a

family physician and the mean is not two hundred grand. And it is like pulling teeth to get reimbursement from insurance companies. My BIL in law who works for a food distribution company makes more than my husband.

[MannyGoldstein]

22. FPs/GPs Median Is About $150k

Which is still 5x or so what the median US wage is.

It's not a bad living.

[Mojorabbit]

25. No it is not a bad living

but considering the amt of education needed to do the job and the fact that one deals in life and death situations it should pay more than a middle manager at a food distribution company.

[uppityperson]

12. I agree that there are billing problems. Bill for a large amount, write off a good chunk.

Then, if you don't have insurance, you get to pay the full amount, or beg/grovel/plead/fill out forms showing you are poor and they will maybe write off some of it. But that is usually only for things like hospitalizations, lab work, so on. Payment at time of service discount for regular visits isn't a lot since legally they cannot have 2 payment schedules (1 for insurance, 1 for private pay) as that constitutes fraud.

That part is bad.

[eggplant]

3. This seems a gross generalization

My doctor is amazingly responsible and chooses to serve his patients rather than load up his pockets. I know many doctors who share this trait.

Insurers, on the other hand...

[MannyGoldstein]

7. Some Docs Are Excellent

A lot are just trying to grab what they can. Just like the insurers.

This is why privatized medicine costs more and performs worse - docs and insurers are primarily motivated by money. If docs are paid a salary rather than a bounty, they do much better work.

[AdHocSolver]

26. You make a lot of generalizations that indicate you don't know what you are talking about.

I worked for several years in hospitals and I prefer doctors in private practice. Doctors who are salaried work for "corporate" hospitals. Part of their job, especially if they want to get raises and promotions, is to increase business and revenue for their corporate employer.

That means more unnecessary tests (got to keep those scanners busy), referrals only to "specialists" who work at the same hospital, even if there is a better doctor who works at a "competing" hospital, pushing more expensive treatments, even though more conservative, less expensive treatments would work as well. Moreover, creative billing is raised to an art form at the corporate hospitals, using techniques that your independent practitioner couldn't dream up in a million years.

I have witnessed it behind the scenes and I have experienced it as well. The independent medical practitioner often must wait months to get paid for his or her services, and argue endlessly over how much they can collect from insurance companies. The large clinics and hospitals have whole departments of clerks to deal with the myriad insurance companies and forms (which boosts the cost of health care enormously), while the smaller clinics struggle with this morass.

[uppityperson]

5. As a small business/health care provider, have had to bill 3 times,

send chart notes twice, spent over an hour on the phone trying to get paid on 1 person recently. The person at the insurance company told me the reason I got paid for only 1 visit, and not the other 5, was because 1 visit was on 1 bill/piece of paper, and the others were on another bill/piece of paper and I had erred in putting both pieces of paper in the same envelope. Along with the 15 pages of chart notes.

"the person in the mailroom" sent on only one sheet of paper since he isn't trained to evaluate what to pass on. And, coincidentally, it was the one with only 1 visit on it, not 5.

I want to get paid for my time. Insurance companies are out to make money and hope that if they stall and stall, that I will give up. It has been over 3 months, and I still haven't gotten paid. It is not uncommon for me to not get paid for over 3 months. Then, if the insurance co denies it, the person doesn't want to pay since it was so long ago.

Another case is 2 yrs out, but that is a car accident and I knew I would have to wait.

[MannyGoldstein]

8. Do You Get Paid For Your Time?

The average doc makes more than $200k per year. Are you earning substantially less?

Actually, I just realized that you might not be a doc. But I'm guessing that you still make a pretty good living. Rare is the person that leaves the medical world because they can make more elsewhere. (That applies to me too - I'm part of the medico-industrial complex.)

[uppityperson]

10. I'm not a doc. See above for that "average doc makes" as nowhere near that.

Show me a reputable source, I posted a couple.

I am not a doc and make under $25k/yr. I left a higher paying nursing job to do massage therapy on my own. Less income but wayyyyyyyyy less stress which was killing me. No night shifts, no body fluids, have to deal with a nasty boss though (self employed).

I do a fair chunk of insurance work since, with my nursing background, the paperwork is normal. But, waiting to be paid is a pain. No, I don't get paid for any of the time spent on the phone, copying, paying receipt requested to make sure an insurance co gets my bills. My blasted billing program recently put the yr signed as 2000 so they all got denied since the billing date was before the visit date. I very much appreciate insurance companies that pay reasonably quickly for their insured visits.

[MannyGoldstein]

13. Your Sources Don't Refute My Contention

Here's one source that supports my figure: http://content.healthaffairs.org/cgi/content/full/21/3/169?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=cross-national+comparison&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

"Physicians’ incomes are much higher in the United States than they are in other OECD countries. In 1996, the most recent year for which data are available for multiple countries, the average U.S. physician income was $199,000.27 The comparable OECD median physician income was $70,324."

Another: http://www.massmed.org/AM/Template.cfm?Section=MMS_Physician_Practice_Environment_Index&CONTENTID=21533&TEMPLATE=/CM/ContentDisplay.cfm

"Specifically, it was only in 2006 that the nominal median physician income broke through $200,000, while the national median compensation rate passed this same level in 2003."

Yes, and I could see that a professional in your line of work would get screwed.

[uppityperson]

14. If I had 3 wishes, I'd wish for

1. someone to do my billing
2. someone to vaccum my house once a week
3. someone to come in and give me a massage before bed

[sakura]

16. Problem with your data...

It compares mean data for the US with median for OECD. Those two values can't fairly be compared.

[MannyGoldstein]

21. True - But It Does Show That The Mean Is As I Described n/t

[Overseas]

6. National Health Systems have much lower administrative expenses

[Aragorn]

15. physician income vs healthcare cost

Some of the posts here are as ignorant as anything I've ever read on DU. Please don't use statistics in an invalid way!

Some physicians try to make every penny they can. Others try to help everyone they can no matter what they get paid. When you add up everything they all make and then divide by how many physicians there are, you get an average!

Insurance company "report cards" emphasize which docs make the highest profit FOR THE INSURANCE COMPANY. That happens when they ignore medical needs. Hospital "report cards" emphasize which docs make the highest profit FOR THE HOSPITAL. That happens when they try to order tests for every possible (insured/covered) condition. In my state it is illegal for a physician to work for a hospital or other for-profit company but the medical board ignores that issue altogether.

Bottom line: patients get screwed from both ends.

But a lot of docs don't play this game either way. I note that I work 32-35 hors per week and still make 90+% of the "average" for my specialty. And I don't bill insurance for>50% of my office patients, I charge them $25 per follow-up instead, without the overhead of billing/trying to collect/etc.

AMA "report cards" emphasize which insurance companies make it hardest for doctors to get paid. However, the rate is determined long before the doc sees the patient. So the focus is on what Michael Moore's movie focused on - which "insured" patients get shafted. Again, in this state the successful lawsuits against insurance companies are under racketeering laws. You know, pay us protection but you don't actually get anything in return.

[L0oniX]

17. Nice of the docs to always charge the insurance companies more than they would...

charge the person. I see this happen all the time. Docs and labs both charge insurance companies at one rate and the individual person at another rate which is much lower. It's no wonder that health insurance is so expensive when docs charge them much more.

:evilfrown:

[Aragorn]

18. technically,

that is illegal. I charge less to uninsured/out-of network - under LEGAL guidelines. In fact, most docs/hospitals charge MORE to uninsured/out-of-network patients, not less.

[L0oniX]

19. My wifes lab bills show otherwise. She received a blood test lab bill for $315 and...

the doctor had told her the bill would be $180. When she called the doctor the receptionist said that the bill amount was for insurance and that if she were paying it then the cost would be $180. I was pissed when I saw the bill and realized what was going on.

[Tracer]

23. Notice who has the BEST payment to doctors?

UnitedHealthcare had the lowest rate of contract compliance, according to the AMA report. About 62 percent of medical services billed were paid by UnitedHealthcare at the contracted rate, compared with 71 percent for Aetna and 98 percent for Medicare.

[annabanana]

24. "98% for Medicare! No wonder the PNHP is gaining support!

Physicians for a National Health Care Plan!.. Good group

http://www.pnhp.org/