[renodoc]

To Pons and Utah etc:

The problem is multifaceted.

The biggest issue is the infiltration of third party payers which have destroyed the traditional doctor-patient relationship. The government is the largest transgressor. Physician payment from treating medicare patients is based on a list of codes (which are owned by the AMA) and then translated into a "resource based relative value scale" This number is then multiplied by a magic formula that congress comes up with each year and the fee is then created. The patient usually pays 20% of this number (or they have a secondary insurance that picks it up)

This is price-fixing at the highest level. Sometimes there are treatments that are new and it is unclear whether or not medicare will pay for them. I am not allowed to accept cash from a medicare patient if they want to pay out of pocket. I am not allowed to charge a medicare patient *less* than the fee schedule also. The Commisars would be most unhappy if I did so.

The fee schedule, run by the gov't, makes little sense. For example, say I get paid $1100 for performing a one hour surgery consisting of procedure X. Another procedure, Y is also sometimes done for the same condition and it pays me $1000, about the same. In fact, there are some patients who get procedure Y first, it fails, and then sometime a month or two later they need procedure X. In this case I would get paid for both. Now take the case where I determine that the patient needs both procedure X and procedure Y at the same initial surgery. Payment is the same $1100 as if I just did procedure X.

Does that make sense?

I strongly believe that our lawyer friends are causing a lot of the problem also. If we can truly move into a situation with real limits on malpractice awards I think it will help. This is another discussion.