Medicaid Pay by Val Jones MD

Medicaid

A physician friend of mine posted a copy of her Medicaid reimbursement on Facebook. Take a look at the charges compared to the actual reimbursement. She is paid between $6.82 and $17.54 for an hour of her time (i.e. on average, she makes less than minimum wage when treating a patient on Medicaid).

The enthusiasm about expanding Medicaid coverage to the previously uninsured seems misplaced. Improved “access” to the healthcare system via Medicaid programs surely cannot result in lasting coverage. In-network physicians will continue to dwindle as their office overhead exceeds meager reimbursement levels.

In reality, treating Medicaid patients is charity work. The fact that any physicians accept Medicaid is a testament to their generosity of spirit and missionary mindset. Expanding their pro bono workloads is nothing to cheer about. The Affordable Care Act’s “signature accomplishment” is tragically flawed – because offering health insurance to people that physicians cannot afford to accept is not better than being uninsured.

After all, improved access to nothing… offers nothing. Inviting physicians to work for less than minimum wage so that politicians can crow about millions of uninsured Americans now having access to healthcare, is ridiculous. Medicaid expansion is widening the gap between the haves and the have-nots. The saddest part is that the have-nots just don’t realize it yet.

Val Jone’s Original Article Here

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  101 comments for “Medicaid Pay by Val Jones MD

  1. Jack Brown MD
    February 1, 2015 at 11:26 pm

    A lot of vitriol is spewing from the keyboards of the anonymous. Let me first explain that I am a young physician completing my fellowship in a sub-specialty. The grave landscape of the medical field is one that keeps me up at night, not only because of my own selfish reasons (monetary), but also because I worry what is going to happen as more and more physicians are denying access to medicaid patients. I’ve read most of these comments and some were more elegant than others, but the general mood is one of patient vs practitioner. This is an issue that needs a civilized forum, one that requires delicate touch to understand the true core. The system is broken. The new laws don’t seem to understand that we as physicians not only have a duty to our patients, but also in a capitalistic society, a duty to our families to provide. Physicians are introducing new tools to help better meet their monetary goals, such as fee for service. This will inevitably leave our less fortunate compatriots out in the cold. We have to band together and come to a reasonable decision. I don’t know what the answer is. God knows there are people much smarter than me to help answer that question. But I strongly urge people to avoid the bickering that is so pervasive in our government, and begin to develop new ideas to help change the system.

    • Doug Farrago
      February 2, 2015 at 6:17 am

      I do Direct Primary Care. See Dr. Keith Smith in Oklahoma and his transparency. These are real answers. Remove the third parties and then giving away 10% of care for free would be a great start. I do that now.

      • February 3, 2015 at 6:14 pm

        Agree, Doug. And frankly, if the IRS allowed us to claim the free healthcare (we already provide) as a charitable deduction on our taxes, we’d make more than Medicaid reimburses – and wouldn’t have to spend all that time on paperwork.

    • tzugidan
      February 2, 2015 at 1:23 pm

      Jack..every single problem in America can be traced back to the same source…..Americans. It’s much more convenient and easy to blame an anonymous “system” or the President, or Congress, or Santa Claus. Costs are going up…because of a simple factor…demand. We take less care of our bodies, do more stupid things with them, burden the system…look for a pill to fix what we’ve done, a surgery to repair our damage…then blame someone else… Sure…things happen to healthy people…wonder if what we’ve done to our soil, our water, the chemicals we ingest every day… have anything to do with things..or our lack of knowledge…how many here can read a nutritional label, know what it means, and abide by it? How many of us ate at McDonald’s for lunch…no, all our problems, belong to us…when we decide we’re going to demand more health and fitness in our education and less other “stuff” that gets forgotten when the class is over…maybe we’ll turn the corner…when parents care enough to feed their kids real food instead of chemical laden absolute garbage…well… blame whomever you want…or whomever the rest of you want to blame…but trust me…the problem…is in the mirror.

    • Jamal
      February 2, 2015 at 10:42 pm

      Being too helpful can cripple human initiative to help themselves. Unfortunately Medicaid has reached that stage in our healthcare system.
      A simple co pay may deter patients coming in to ask for a prescription for Tylenol. On the other hand same patient do not have any problem buying a carton of cigarettes

  2. Marcy
    February 1, 2015 at 7:43 pm

    i work in an emergency room…. Of the 100 plus patients we see in a 24 hr period only a handful should be treated there, the rest are either urgent care or physician office cases. I wish those with Medicaid would be required to pay a co-pay at the door.. I know for myself , I would be thinking of the cost for the e.r. visit if it were not atrue emergency. We all need to be accountable for our health care costs.

    • DrWally
      February 2, 2015 at 7:41 pm

      I am by no means an expert on this stuff, but Indiana just got the OK from the Feds (after at least 2 years of no decision) to begin their own HIP (Healthy Indiana Plan). This is the state plan for some medicaid folks on Obamacare.

      They MUST put money into a savings account monthly and also pay a co-pay at each ER or Doctor’s office visit.

      This brings some accountability and responsibility into their lives. This is a start…

      By the way, I am STILL wanting to know which state the medicaid payment sheet that started this thread came from….

    • HopDoc
      February 3, 2015 at 8:53 am

      new study out of hopkins this week demonstrating that copays don’t decrease ED utilization by Medicaid patients. it’s not as simple as saying, “make ’em pay!”

  3. John
    February 1, 2015 at 3:07 pm

    I am more interested in the “cost” column than anything else on this bill. If I am doing my math right, the “cost” amounts to $4,001.98. What exactly was the service that was provided? Seems to me that you need to know this before deciding to be outraged…

    • brook s
      February 1, 2015 at 3:44 pm

      Thank you

    • Percy
      February 1, 2015 at 5:15 pm

      John just for your knowledge. The charges are irrelevant because all that matters are what they allow. Cost for care would include the rent, utilities, time of the medical assistant, person answering the phone, time of the physician, the time the billers had to work on the claim to receive payment, lost time that the physician has to wait to receive payment usually 30 to 90 days (how would you like to wait 60 days to get paid for work you’ve done) etc…

      • John
        February 1, 2015 at 7:01 pm

        Percy – I think your comment that charges are irrelevant is at the very heart of the problem with today’s healthcare system. We need to understand what these costs are and manage them very carefully to ensure that affordable care can be delivered. For example, if this bill was for a routine checkup, I think we would all agree that the “cost” column would be outrageous and not credible. However, if it were for a complex surgical procedure, we would feel quite differently. I also question whether the ancillary costs you refer to amount to much – if you take the ratio of a administrative assistant focused on bill collection divided by the total annual costs incurred, this must represent a very small fraction of overall costs. And what, exactly, is the “cost” of a doctor waiting 30 to 90 days to get paid? What is this “lost time”? Are you saying physicians stop working while they are waiting for their payment? This doesn’t make very much sense. If it is time value of money, this is negligible. I wish I really knew and understood the costs underlying a healthcare service, but the transparency in the system is horrible from the perspective of a consumer.

        • J
          February 1, 2015 at 11:32 pm

          you are missing the point of the article, which is that Medicaid does not reimburse enough to even cover the actual break even cost of service delivery much less turn a profit. Regardless of bill transparency.

    • mel
      February 1, 2015 at 5:17 pm

      Amen!!!!! People on medicade are not charity cases who ever wrote this is very jaded

      • Ethan
        February 1, 2015 at 5:40 pm

        People on medicade are LITERALLY charity cases. Like by the definition of the word charity!

    • Stewart
      February 1, 2015 at 7:02 pm

      Yeah – charges are irrelevant. Who cares if I charge $1Million for a service, if all Medicaid pays per their contract or fee schedule is what amounts to minimum wage. Healthcare reimbursement is not intuitive, and ignorant people who reference ‘charges’ are just that – ignorant.

      • Shane
        February 2, 2015 at 3:46 pm

        A little education. Medicaid rates are set by a panel of doctors and reflect reasonable reimbursement, allowing for profit. These rates only seem paltry in comparison with the egregiously overpriced bills these institutions, and individuals, get away with charging. No doctor in this country is paid minimum wage, and it is insulting to those who actually earn a minimum wage to suggest that is the case. How many doctors do you know that are giving up their miserable practices to take jobs in retail because it pays above minimum? Do you know of anywhere in this country where medical offices are not springing up like fast-food chains. Get real!

        • Doug Farrago
          February 2, 2015 at 3:57 pm

          Shane, I am sorry but you are clueless. You know nothing of what you speak. Unless you are a Federally Qualified Health Center or owned by a hospital then you cannot afford to take on Medicaid patients. It is a loss.

        • Dr. Meg
          February 3, 2015 at 9:01 pm

          Shane, I can definitively say you are incorrect. I am an orthopedic surgeon. Every insurance company has a fee schedule with an allowed amount for any procedure code/office visit billed. Medicaid rates are set by each state, and the rate is not set by physicians in any state that I am aware of. Medicaid pays less than half (often less than 20%) of other insurance companies for the same surgery. I still take medicaid, but that is because I view it as my charity work. I lose money every time. You see, I have to pay a lot of people and rent just to submit a claim. Medicaid then denies that and we have to turn around and appeal the claim. It typically is then paid, but again 60-90 days later. That money could have been used to pay for my employees, their insurance premiums, retirement, etc. (BTW I get paid after everyone else has received their salary and benefits – doctors in private practice make what is left over.) Food for thought – what other field do you receive a product, fail to pay your bill, and still have the expectation of continuing to receive more product without any punishment or threat of punishment. Normally that is considered stealing. That does not even count the frustration and limitation put on physicians by medicaid. The patient’s tend to be sicker and less compliant. I am not allowed to use medical equipment (fracture boots, e.g.) because they are not paid for by Medicaid. So everyone gets a cast which costs more time, but I do not get paid for materials or the person who puts on the cast. Really, how is Medicaid good? My practice will likely stop taking Medicaid in the near future. At that point, there will be ZERO orthopedists at my hospital (3 groups) taking Medicaid. I assure you, if we could survive on Medicaid, a lot more people would accept it.

    • Sean
      February 1, 2015 at 11:27 pm

      The cost column is a line item of billed Medicaid charges for this provider & shows what the provider billed Medicaid for all of their patients that month. It is NOT a line item billed to one patient. What you are looking at is 13 separate billable patients that this provider saw that month. To put this in perspective, a small family practice physician may only see 15-20 patients per day. This equals almost one full day of visits that the office received no reimbursement on. The power, water, sewage & other utility bills accrued during this time. The office staffs’ payroll time accrued during this time. The only thing that didn’t accrue was revenue to keep the office open. This is why with changes in healrhcare you are going to see fewer & fewer offices accepting Medicaid patients. We in the Medical field want to help those in need but we have to pay our bills & feed our families just the sane as you. The only people that truly benefited from the new healthcare laws are the major insurance companies & administrators.

    • Shane
      February 2, 2015 at 3:39 pm

      I can’t recall that last time a physician gave me an hour of his/her time. Most often, it is around five minutes. At the lowest rate of $6.82 per five minutes, I believe that is a fair assessment at $81.84/hour.

      • Doug Farrago
        February 2, 2015 at 3:55 pm

        My visits are 30 – 60 min long. I do direct primary care. The third party system is what makes your visits so short.

        • Shane
          February 4, 2015 at 8:45 am

          Dr. Farrago,

          I love the idea of direct primary care and respect the physicians who engage with this. However, such is not available where I live. In the past ten years, any trip to a medical professional has meant lengthy periods of time speant in waiting rooms, and providing information and vitals to nurse assistants and “venipuncturists’, capped by a short cursory meeting with a doctor. The charges are normally on the order of $130-$200 for the visit. In the case of my hyperthyroidism diagnosis, an initial 20 minute meeting with the doctor (the longest to date) was followed by telephone feedback on test results from and office assistant. The doctor was too busy to share those test results and their implications over the phone…but I could make an appointment to see her. Of course, that would be another $170 charge. Maybe my experience is exceptional, but I rather think yours is the exception, and mine is closer to the rule.

          • Pat
            February 4, 2015 at 10:02 am

            Shane, I appreciate your bewilderment over inflated charges (and they are). But your doc and the great majority of us are dragged down with extraordinarily high overheads resulting from taking any third part insurance. Your doc has to pay the nurses asst’s, venipuncturists, biling manager, receptionist – and that’s in a small office – before seeing a dime (see the orthopedist’ comments below, which are spot-on). Go over results on the phone? What if you have questions? What if you have a complication not apparent in a 5-min. phone chat, but one over which you will be happy to sue later? Oh yes, part of that overhead is also malpractice premiums. So your doctor should talk with you on the phone, a non-revenue event, while five other patients are backed up in the office, angry at having to wait? Why is the doc so slow? Because he is forced by Medicare/Medicaid to take too much time entering all this crap into an electronic health record, forced to do so under pain of financial penalties for non-compliance. Then he can fill out more billing forms, and sit on the phone waiting for Blue Cross, or Medicaid, etc to preauthorize the next patient’s thyroid panel. And you wonder why you need to make another appointment? The doc is paying for those exam rooms, staff, light bills, etc. every day, whether you come in or not (in my former clinic days 12 years ago, it cost me average $40 just to put a patient in a room, before recouping a single dime). So he should lose money for your convenience?

            This post topic has been about how Medicaid forces those docs who take it to lose money, and they do. The arguments to the contrary posted here are made by those who are ill-informed and speaking on the basis of emotion rather than fact.

            Like you I greatly respect Direct Primary Care, and state (again) that it’s practitioners are the only truly honest physicians in practice. The rest of us are corrupted by any involvement with 3rd party insurance, especially the government kind. Of course we must defer to Doug et al here, but were I they, I would be leery of ever treating a Medicare or Medicaid patient again and allowing the corruption of gov’t rules in the door where it could infect the entire practice.

      • Kristy
        February 4, 2015 at 10:15 am

        Shane, maybe you need to find a new doctor. Those of us who DO spend a VERY LONG TIME with our patients then have to use our time that we should be with our families documenting everything. My avg time with a patient is about 35 minutes. By that time, I have to go on to the next patient and not sit there documenting everything I did in that 35 minutes–which is usually a lot! I wind up then later spending about 10 minutes very minimum documenting. So that then wound up a 45 minute “visit.” So, when people are complaining that their doc doesn’t spend enough time with them, find another doctor.

    • February 3, 2015 at 6:05 pm

      Hi John,

      This bill was for ophthalmologic services in New York City. The doctor explains her bill in the comments section of the original post on my website. Please read the comments there for more details. http://getbetterhealth.com/why-would-any-doctor-accept-medicaid/2015.01.26

  4. james Biddy
    February 1, 2015 at 10:57 am

    I’m not a doctor but I don’t care how much they earn. They had up to 8 years of edicts too AFTER college. If you failed to finish high school and/or lacked enough personal ambition to actually attend college and now sit on your sofa collecting welfare including your free healthcare paid for by people who actually do work you have forfeited your right to bitch and moan about what other people make. If you want to be a perpetual drag on society try to do it quietly.

    • Amy
      February 1, 2015 at 1:34 pm

      Well said!!! Doctors, nurses, and all medical professionals earn every dime we make and more. Because the schooling required is hard as hell. If you want it, you work hard to get it. We did, losers didn’t. Didn’t choose to do ANYTHING. So, as you said much more nicely- shut up about it. You want it? Get out there and earn it like we did!

      • brook s
        February 1, 2015 at 3:46 pm

        Wow, I’m really glad you are not my doctor. What a terrible attitude. Jerk.

      • doc h
        February 1, 2015 at 10:29 pm

        As a medical professional, I find your comment extremely embarrassing. What an awful attitude.

      • Joel
        February 2, 2015 at 3:06 pm

        Lawyers do pro bono work, salesmen work on straight commission and don’t get paid if they don’t make a sale after spending considerable time with a tire kicker. Doctors have to give back too. If they’re going into medicine for the money that’s what creates a problem. Providers need to be compensated for curing people, not just for seeing them.

        • Doug Farrago
          February 2, 2015 at 3:54 pm

          Compensated for curing? OMG. Are you delusional? Is there a cure for hypertension? Depression?

      • Shane
        February 2, 2015 at 4:32 pm

        I like your spunk Amy. But, you know that everything in your field is inflated, including your own sense of self-value. LOTS of people work hard, get good educations, and have good jobs–but they don’t work in the one field in this country that is sending good, decent, hard-working people into bankruptcy on a regular basis. You are wolves circling the herd: if everyone joined the pack, then who would be left to give over their worldly possessions to ensure your coats stay sleek and your bellies fat?

      • Pat
        February 2, 2015 at 6:00 pm

        Shane, that is pure class warfare, low-rent envy. You are an utter fool if you want your family member or yourself to get a $185 surgical procedure; and you want the surgeon to skate room to room cramming in a bunch more? The first time there is a complication, you will be the first one in line to sue him, claiming that he didn’t take his time. Your “Plenty would like to make that” is just crying the faux working man’s blues when you have not the slightest idea what a surgeon does, or had to do to get to the position where he can do his job. At the root of your comments is your belief that you have a right to care, which is to say, that you own a piece of the doctor.

      • Pat
        February 2, 2015 at 6:02 pm

        Who were you describing, lawyers?

        Wolves circling the herd? You really believe you have the moral authority to order others around. Shane your rhetoric is right out of St. Petersburg, 1917. My recommendation is that if you think doctors cheat you, then do without them.

  5. J RICHNER
    February 1, 2015 at 9:51 am

    We certainly need reform but the two groups causing the biggest burden to health care is the poor and the old. Sadly, both groups are getting larger and I can’t see things getting better for either your profession or the patient. I work for Social Security and the amount of baby boomers applying for Medicare is mind numbing. Factor in a near majority of them didn’t probably live healthy lifestyles and soon we have a Titanic problem. Frankly, I don’t see anything better until the system sinks. You professionals here in this forum are heroes as far as I’m concerned but in many circles you’re blamed for the problems which clearly is bunk. If the Government could focus on cleaning out the Medicare fraud that would be a help. Additionally, food stamp card holders must be required to eat healthy foods, and I’m sorry but healthy standards must be mandatory. Additionally, certainly healthy standards must be placed for our old population too. You smoke or grossly overweight you must share in costs! Free lunch must have rules as it’s not fair to the working middle class and your profession that is being demonized and expected to work for peanuts.

    • Pat
      February 2, 2015 at 12:11 am

      The two groups that are the greatest burden – the poor and the elderly – are growing in large part because they are subsidized, even as additional overhead taxes those who provide the care. You get more of what you subsidize, less of what you tax.

    • Marlene
      February 2, 2015 at 2:23 pm

      I will most likely become one of those burdens in 2016 when OPERS changes it’s insurance because they can’t afford to pay coverage for their retirees anymore. I worked full time, on a walker due to a Dr. that botched up a knee replacement. I retired when I was 73 only because I had a very demanding job and my company would not hire anyone to help. I seldom had time to go to the bathroom. I attended a seminar recently and it scared me to death to think of where I may wind up. Believe me, as a young widow, I went to work part time and wound up as the Manager of my Department. I don’t think anyone who knows me would call me lazy. So, please, don’t lump everyone as one of your “burdens”. I will be glad to pay a reasonable fee for service but please don’t bill an injection as surgery. Yep, you know you do that so you Dr’s have a degree of responsibility in all of this.

  6. Sharon
    February 1, 2015 at 8:03 am

    The angry posting people need to really get a grip! This is not, as mentioned earlier, a bash on MD’s and the luxuries they have. It it to change a system that is terribly flawed. MD’s have no choice but to hire PA’s and NP’s to keep there business afloat thanks to healthcare mandates!! Thank you Mr President.

  7. Y
    January 31, 2015 at 8:42 pm

    How about that plumber coming to fix my clogged toilet for 5 min and charged me $160? Doesn’t that amount to like $1000 an he and he didnt even go to college…

    • brian
      February 1, 2015 at 9:08 am

      That plumber if verified spent at least four years going through schoolingto get certified so you’ll know he’s trained in what he does versus hiring Joe blow who had no schooling or training and most of the time will not do the job right…I’m not going to school for 4-5 years to make minimum wage …do doctors?..NO..so just remember if he’s got that state card he has went to school for it or at least worked in the field for 6-8000 hrs….that’s what you’ve got to have in order for the state to let you take journeyman test.

      • kun kim
        February 2, 2015 at 10:44 am

        What a professional charge for his services is fair and reasonable for that profession in that area of the time. How much should a doctor get paid for removing your tonsils? We charge about 800 dollars but Medicaid pays us 185. That is for pre op visit, surgery, and a two week post op visit. I no longer accept Medicaid because it just can’t pay for all my expenses. Should a doctor with 9 years of post college education get less amount of money than an oil change job of a European automobile? The third party pay system is at fault. Imagine going to a restaurant and ordering what you want to eat but all you have is a 2 dollar Co pay. That is Medicaid system.

        • Shane
          February 2, 2015 at 4:04 pm

          You charge $800? Is the the entirety of the charge? That covers the hospital stay, the anesthesiologist, the whole shebang, or is that just your take on the overall $6,500-$22,000 pie? In a good eight hour day, how many tonsillectomies could you do? Six, eight? At six, that $185 amounts to over $1,000.00 per day–which is not pocket change. Plenty would like to make that per week, even if it meant 60 hour weeks. BTW, a typical oil change costs $20-$30. You are seriously overpaying.

    • T
      February 1, 2015 at 12:15 pm

      Fix your own sink after all you went to college smartass

    • Eliz
      February 1, 2015 at 2:29 pm

      That is such an uneducated statement, did you even finish high school??

    • retired master plumber
      February 1, 2015 at 3:37 pm

      Next time buy a plunger and do it yourself! That plumber or his bosshave 5years apprenticeship and 10 years as a journeymanso they can unplug the toilet u plugged up.

    • Chris
      February 1, 2015 at 5:28 pm

      I am a plumber ,, 2years trade school 6 years apprentice-journeyman time , and the willingness to work in a persons waste,, looks like a bargin too me

  8. Paul
    January 31, 2015 at 7:47 pm

    Until we move beyond for profit health care, everyone suffers. There are about 330 million people in this country and about 850,000 doctors. If we paid every doctor $200,000 per year, it would only cost each person $515 per year.

    • Ken Ng
      January 31, 2015 at 10:25 pm

      Because health administrators and the rich people who are running health care business are getting a much larger cut.

    • Rip
      January 31, 2015 at 11:11 pm

      Not for profit health care? Sign me up! I want my own personal physician slave. In fact I’ll take a whole team of slaves.

    • Pat
      February 1, 2015 at 12:05 am

      And who exactly is going to endure a punishing seven-year surgical specialty residency for your arbitrary salary? I don’t want a bypass from a Cardio-thoracic surgeon who feels cheated.

    • Marc K
      February 1, 2015 at 1:31 am

      Interesting, but keep in mind that doctors make 10 to 20 cents of every dollar spent on healthcare. This would mean spending some $2500 to $3000 per person – or $10-$12 thousand annually for a family of four for complete care. With a median household income of on $50k annually this is still a significant sum of money and far from a solution.

      • Dr. Keith
        February 1, 2015 at 9:06 am

        Please site your source for the 10-20 cents of every dollar on healthcare to physicians. I want to work there…

    • janna
      February 1, 2015 at 6:31 am

      That doesn’t include the cost to keep a facility running, nurses, desk jobs, medical supplies, pharmacists.. Ect. It takes more than one doctor per pt to help someone.

    • February 1, 2015 at 8:12 am

      Thats still about $200/month for a family of 4. And we haven’t even touched on the cost of medical supplies or testing. Who pays the nurses? The receptionist?

    • Tom
      February 1, 2015 at 10:15 am

      Vastly oversimplified. Doctors only get 19% of the pie. See the chart.
      http://www.boyleheightsbeat.com/wp-content/uploads/2012/05/pie-chart.jpg

      • Dr. Keith
        February 1, 2015 at 11:07 am

        Please read your chart. It is physicians and clinical services. That is a very nebulous term that likely encompasses a whole lot more ancillary services that happen from a physician visit, a much smaller amount will actually make it to the physician…

        And another question: do any of these charts take into account physician overhead or is it simply pay to their practice? I would love to see the real breakdown and compare it to practices in the real world including malpractice, costs of staff, physical overhead, etc. the percentage that hits a physicians pocket of the overall dollars is much smaller.

        • Tom
          February 1, 2015 at 2:51 pm

          I agree, Dr. Keith.

    • Tom
      February 1, 2015 at 10:40 am

      Paul,
      You’ve fallen into a common trap. ALL hospitals and health care systems aim for a profit. The only difference in non-profits is that they are taxed differently than for-profit systems. It doesn’t remove the fact that all businesses need to make money to survive and expand capability. In fact, I would venture to say that if all hospitals and health care systems operated on a mandatory non-profit basis, your taxes would actually rise substantially.

    • Shane
      February 2, 2015 at 7:19 pm

      I like your thinking. Let’s do just that. We’ll call it universal health care and pay the doctors instead of the bureaucrats and insurance companies.

    • Shane
      February 2, 2015 at 7:21 pm

      I like your thinking. We pay the doctors instead of bureaucrats and insurance companies.

  9. MRS
    January 31, 2015 at 7:31 pm

    I am a lawyer, not a doctor, but I see similar issues with public defenders verse partners at big law firms. Partners at top firms are the lawyers charging $500 an hour, and I promise they have to have worked hard and know a lot of law to be there. Same with doctors who are specialists (and I would count an er dr in that list), hard work, a lot of knowledge, earned it. But 70% of lawyers and doctors don’t make that much. Lawyers working in any 501c3, or public defender, or hanging their own shingle on criminal defense, family, probate, or traffic cases don’t make near that much. Nor the average family doctor. Today, school costs the same, about a quarter of a million in debt for that doctorate. And the paycheck when you get out and are hired (IF you can find a job!) won’t cover everything plus loans. The whole system of “free” professional services does not work because of the cost to attain the level of professionalism. Side note- for professional malpractice insurance, doctors do take the cake on costs- it is ridiculously expensive for doctors compared to lawyers.

    • Shane
      February 2, 2015 at 7:23 pm

      And yet EVERY advanced developed nation on Earth besides the US manages to do it better and a fraction of the cost.

  10. Brian
    January 31, 2015 at 6:05 pm

    I get charged 450.00 per month for dialysis…that is for the doctor only. I see this doctor once every couple months for about five minutes. I see his P.A. about once every six weeks for less than five minutes. $450.00…of that, Medicare pays almost $300. I pay $53.56. That doctor sees 10 patients at the dialysis clinic on my shift alone. There are three shifts on MWF and two shifts on TTH. So that doctor gets paid about $2100 per hour to see me. Now keep bitching about how little doctors get paid. It’s funny all these doctors that don’t get paid shit can afford to drive a Lexus and a Range Rover. Oh, and quit telling folks about how much your student loans are. Try going to school for five years and not having a job post graduation.

    • Doug Farrago
      January 31, 2015 at 6:43 pm

      Brian, you really are on the wrong site. You need to find a “I hate doctors” blog. No one hammers the disparity of doctor pay more than me but this site is about changing the system by putting us back in charge. I am a family doc. We are the grunts and don’t paid that well. That being said, no one here wants to see your ridiculous calculations that have no basis in reality. Lexus? Range Rover? I have a Saturn with 110K on it. My oldest kid just finished college last and still no job. You come off bitter with those types of accusations.

      • Jk
        January 31, 2015 at 9:15 pm

        Good job Doc. I’m a nurse and see you all work very hard and many above and beyond expectations. Maybe people like Brian would like their neighbor to be their doctor instead. Jealousy and resentment does not become you, Brian.

      • James
        February 1, 2015 at 4:29 am

        Doc you all work hard I agree. Did your job to a point in the military and as satisfying as it was I couldn’t see me doing it nowadays. I’m a truck driver now and I complain what little we get paid. After all without trucks people don’t get their stuff. Anyways, here in Canada the pay is worse. The so. Called medical system really sucks. Fight. Get rid of it before it ruins health care like it did here.Go back to the old ways. Make house calls. Charge your fees.

      • Brian
        February 1, 2015 at 4:07 pm

        No I don’t hate doctors at all…i respect mine and what they do. But it seems doctors are the ones complaining the most about what they get paid.http://www.forbes.com/sites/naomishavin/2014/08/13/the-10-best-paying-jobs-of-2014/

        7/10 are healthcare
        General Practice Physicians make $187,200 on averag per year.
        If you put in 80 hours week = $45.00/hour

        Those are facts…No matter what you spend your money on.

        • RMM
          February 1, 2015 at 10:38 pm

          More to the point, why is the biggest consumer of free healthcare on this thing complaining about the problem with healthcare costs? Why don’t you just cut back to once a week dialysis? You’ll survive- lots of people who don’t have welfare benefits (Medicaid) do it. If you’re so bothered by inequity, how about you donate your other 2 sessions to a migrant worker who can’t afford it? He’s at least not sitting on the couch all day staring at his computer.

          • Brian
            February 1, 2015 at 11:42 pm

            See, making assumptions about me that you have no clue about. I work everyday…except my skill didn’t take eight years to learn…its taken my whole life. I design and make high end custom furniture. But i am reasonable about my prices. If it werent for overcharging doctors i would be able to afford private insuance. Guess i need to make what doctors make to afford my healthcare. So Shut the fuck up about what I do every day.

          • Brian
            February 1, 2015 at 11:58 pm

            You dumb fuck…I’m fat…no I’m not…dumb life choices…please explain to everybody what dumb choices ive made. Until you know me and what ive been through, shut the fuck up. You sound like your butt hurt because some finally said what needed to be said about money hungry doctors. It was my original nephrologist that made a wrong call and put me on dialysis in the first place. It was that same piece of shit that said a transplant would be my best option. My mother gave me one of her kidneys, it lasted six months, i transferred to a better hospital to have it removed, first thing the nephrologist said was i never should have had the transplant in the first place…then showed me all the research to back him up. So tell me, should I not be bitter that I have to pay the same nephrologist that put me in this position every month to sign a god damn piece of paper saying he authorizes my treatment? At least I bring facts to the conversation…not ignorant assumptions!

          • Doug Farrago
            February 2, 2015 at 6:38 am

            Hey, Brian, I am going to have to ask you to tone it down. Don’t need this to be a pissing match. Yes, I have seen a few bad docs but this article was NOT about that. This was about the joke that is called Medicaid and how no doctors will take it in the future. Let me correct that – the only ones who will will be like the doc who messed you up. That being said, your assumptions are/were just as bad. You ripped on doctors for being greedy but you really have no idea about us. Imagine you making your high end custom furniture, like a chair, and trying to sell it for $300. But wait. The insurance company or government says no. You can only sell that it $30. Or $3. That is what we do. Personally, I sell my care now for $75 a month per person, $125 per couple, or $150 per family. And I treat families that are as big as 8. It’s reasonable. No insurance. No government. That is called Direct Primary Care and it is the only way for me to continue in family medicine. Patients love it. I love it.

          • Brian
            February 2, 2015 at 7:17 am

            First of all you need to tell the person ripping on me to tone it down as well…i didn’t start with language until they did. Second, i apologize for the comments. It is the wrong site and wrong topic. I don’t hate doctors nor am i against them. In my nine years on dialysis i have met and friended many of wonderful healhcare professionals. I just get upset that mine is spread so thin i never see him. I also get charged every month for nothing…truly nothing. He comes into the clinic (which he has 6 of and two methadone clinics), tells me how bad my football team is (which i agree with) and leaves…does not look at my chart, blood pressure trends, bloodwork, curent meds or anything else related to my healthcare. Here and gone in less than five minutes once every couple months. Im in a small town and have mo options but him. So once again i apologize for taking out my frustration about him on this thread.

            Here is an article one of the greatest doctors I’ve met shared the other day. It sounds similar to what you do Dr. Farrago. Thoughts on this?
            Just want to mention this as well. I have been looking for two years for a job that 1. Will work around my dialysis and 2. Pays enough to pay my bills. I don’t like being on Medicare, am not lazy at all, and take care of my health…but with the cost of kidney failure my options are not that great. I am in the interviewing process to work in a factory, so hopefully that will work out. Anyway, here is the article…http://time.com/3643841/medicine-gets-personal/

            To show you I’m not full of shit about truly respecting and appreciating healthcare professional, here is something i posted two weeks ago…

            It doesn’t get said enough…not near enough. I’m not sure why either. But they are owed it. To all my healthcare working friends out there…YOU ARE GREATLY APPRECIATED. I see and understand the hours you put in, the people you put up with (I know exactly how difficult a patient can be at times), the emotional situations you keep your calm through…I see it. It takes special kinds of people to do what you do…so very sincerely…THANK YOU!

          • Doug Farrago
            February 2, 2015 at 8:43 am

            I appreciate that, Brain. And that TIME article is exactly what I do. The guys at Atlas.MD, at the end of the article, are my mentors! Also, a little secret, many of us doctors are pissed at docs like the one you describe who is raking it in for doing little. I normally slam them on this site so stay tuned. The problem, however, is that these dudes are truly outliers. Like I said, I am a grunt in the trenches but 3 months ago I changed the playing field. I am now in a new trench and the patients are appreciative of what I do. We are all in the same trench together.

    • Pat
      January 31, 2015 at 7:52 pm

      Brian, at the root of these problems is the growing socieatal presumption that health care is a right. Your dialysis should be no more a right than my “right” to have a plumber fix a house flood in the middle of the night.

      “Medicare pays…” you said? Well news flash, most folks on Medicare rapidly burn through whatever money they contributed to the program in their productive years, leaving the rest of the bill for the rest of us to pick up. This has led to grotesque cost overruns which in turn have led to deceitful mechanisms like coding, “quality”, medical homes, and “pay-for-performance” whose purpose is to cut costs by shorting those that do the damn work. And every bit of that applies to Medicaid as well.

      I’ve worked damned hard in my life, and I’m good at what I do, but I would be worthless trying to treat your condition. You pay less than $60 dollars a month for a physician who had to do nearly a decade of postgraduate work to manage your case, and you are complaining about however much you claim he makes? And you have the further gall to bitch about whatever ride you believe the doc takes to work? I’ve seen friends from med school who slogged through grinding, sometimes awful years in surgical residency or specialty fellowships, and now amidst very hard work and long hours, they live materially well. How dare you criticize them for their efforts?

      I’m sorry you have kidney failure, but that does not justify the class warfare that you are preaching here. I love driving my Ford F-150, and I wish I could get a plumber for less than $60.

    • TexasNP
      January 31, 2015 at 8:39 pm

      First, you haven’t the slightest clue as to what you’re talking about. Your ideas of their reimbursement are ridiculous.
      Second, you are an enormous drain on taxpayers with your never ending medical care and said nephrologist/PA is keeping you alive so instead of bitching, show show some gratitude ya freakin’ money sucking leech.

      • Jackie Aldridge
        January 31, 2015 at 11:09 pm

        There are no procedure codes, so we can’t determine what the physician did. Second, there are no adjustment or denial codes so we can’t tell if these are full payments or only adjustments. Third, if this physician is only being reimbursed for reasonable bills then he billing services are incompetent.
        As to those people piling on the dialysis patient… The average payout by Medicare is $ 55,000 per year per patient. Treatment is fairly straightforward. Regulations require a nurse at the dialysis clinic and there are blood tests. But realistically… Given the long time that dialysis had been going on, I am very surprised that a patient can’t buy a new dialysis filter for a dollar or two.

        • Tom
          February 1, 2015 at 10:30 am

          What does “the average payout” mean? The average charge? The average overall reimbursement? Is that what a nephrologist gets paid? No. You are mixing apples and elephants. What about overhead/equipment/insurance/salaries/utilities/mortgage/supplies? Do you run a business?

          Per person per year Medicare ESRD costs rose just 1.4 and 1.7 percent for hemodialysis and peritoneal dialysis in 2010, to $87,561 and $66,751, while transplant costs fell 1.1 percent, to $32,914.
          https://authenticmedicine.com/medicaid-pay-val-jones-md/#comment-16746

        • Brian
          February 1, 2015 at 5:32 pm

          Thank you. I should not be charged $450 per month for a doctor to walk in once every two months and say “do you need anything”. If I needed something from the doctor I understand getting charged, but nothing changes. If it wasn’t for needing authorization for dialysis treatment I could do without the Nephrologist and just call them when needed…pay $450 for that visit and that be that.

          • RMM
            February 1, 2015 at 9:55 pm

            Hey all- you know who pays for this jackass to get his dialysis folks? You are. You know what would happen if said jackass does not get his dialysis? He would die. You know who ultimately is responsible for his life? his nephrologist. That’s right- he is bitching about paying $50 a month to stay alive. Poor sorry SOB. Why don’t you lose some damn weight, take better care of yourself, and take some goddamn personal responsibility instead of bitching about how much WE pay your damn nephrologist? You want to fix a broken system? Ok, fine. You get 8 months on dialysis. After that, you’re on your own. Then we take all the money we saved on fixing your terrible life choices and vaccinate every kid in Utah, and take the savings we’d get from you not eventually getting a transplant (also being covered by the rest of us) and go vaccinate 10000 Afghani kids against polio. It’s not your fault you’re on dialysis? Yeah, well it’s not the Afghani kids’ fault either, and I have no qualms about letting you die to save one of them. I don’t even care if they say thank you- just as long as they don’t bitch about how much it costs to save them.

    • Anthony
      January 31, 2015 at 11:30 pm

      That doctor is keeping you alive
      What is that worth to you ?
      You are an idiot
      You seem to be a person that blames the world for the situation your in
      If you want to bitch call your president who you probably voted for
      You wanted change well you got
      Ask him for a job

    • Tom
      February 1, 2015 at 10:21 am

      Brian, You pay $53.56 per month to get dialysis three times a week to keep you alive, you are on Medicare by the grace of the taxpaying people and you complain? I would call that ungrateful and unappreciative. Try paying out of pocket for actual costs. Then, we’ll see how much you complain. When you go through medical school and residency training, then let’s talk.

  11. bob
    January 31, 2015 at 4:07 pm

    No one is going to mention the $500 charge for one hour of service? Perhaps if the payment structure was more realistic we would not have this problem in the first place.

    • SGB
      January 31, 2015 at 6:34 pm

      Is it really so outrageous? What do you think attorneys, accountants, and other post-college degree professionals charge per hour for their services? The only difference is an attorney is not going to provide services first and worry about getting paid later.

      • Brian
        February 2, 2015 at 12:18 am

        An hour of an attorneys time equals one hour of actual work.

    • Tom
      February 1, 2015 at 10:35 am

      Bob, I believe it was $500 for the MONTH, TOTAL CHARGE. Not all of it goes to the doctor. There are significant costs of doing business that need to be considered.

  12. Jared Reeves, MD
    January 30, 2015 at 12:34 am

    The last Medicaid patient t treated paid Me $2.50 …
    Services I rendered 2 x-rays and 60 minutes of examination and workup planning time, and 3 Rx’s
    Breakdown $.50 for Two x-rays and $2.00 for 60 minutes of My work day
    I practice in Louisiana …..

    • Keri
      January 31, 2015 at 6:31 pm

      If your gma is critically ill, comes into my ER completely unresponsive, and in the course of an hour, I intubate her, administer antibiotics, put in a central line to administer meds to keep up her blood pressure and figure out what’s wrong from a history of “I don’t know, we just found her this way” then you better believe my life saving expertise will be billed as such. Or don’t you think your gma’s life is worth $500?

  13. January 28, 2015 at 9:34 pm

    I remain of the belief that it would be far easier to expand Medicaid and fix its issues than to fix the for-profit health care system. It would also result in far fewer administrators, and those at lower wages.

    • Doug Farrago
      January 29, 2015 at 7:10 am

      Talk about being blind. Look at those prices. Or are you delusional?

      • Steve O'
        January 30, 2015 at 12:28 am

        Not delusional, perhaps – senile. A member of a society that can imagine that it can do what functional civilizations do. A whifty wave of the wand, and sh-zam! Medicare – issues fixed! Why stop there? Sh-zoom! Racism fixed – all people with a well-paying and rewarding career – no more hunger or suffering! Perhaps a younger, more flexible and reasonable society could do it. We are bound up by our neurofibrillary tangles, and struggle with fiscal continence. We’ve been working on the Federal Deficit for a hundred years – on hunger in America for fifty. We are not, by any means, a nation of magicians.
        We are a nation of whiners. Go to Ferguson and blame the cops. To McMaster, and harangue the child-care workers. ACA, and beat the greedy doctors. We refuse to fix institutionalized problems, and instead blame those on the front line. Very well then – off with the cops, the doctors, the blameable suckers who cannot deliver the unbroken string of protection that we consumers cry for. We sow what we have reaped.

        • J RICHNER
          January 31, 2015 at 9:14 am

          You my friend made my morning – Well Stated!

        • Jess
          January 31, 2015 at 3:08 pm

          Greedy doctors? Ha! You work your butt off for 8+ years after you graduate from college and rack up over a quarter million dollars in debt to provide health CARE to individuals in order to live a longer, healthy life to only get called greedy! It is your freaking HEALTH !!! A physician works HARD for their money and it is well deserved ! Imagine having to deal with patients who do not care about taking care of themselves, yet they feel entitled to everything !! Greedy? You’re funny! I hope you don’t have children who decide to become physicians!

          • Dr Keith
            February 1, 2015 at 1:19 pm

            And the best part of being a physician is you get to spend hours of the day telling patients what they know they need to do to help themselves, of which most won’t listen, and then come back and try to fix their problem when they don’t listen. It is an industry that has no personal accountability. When a patient can continue to smoke, eat poorly, not exercise, and then after years of self neglect come and demand to be fixed, then complain that the doctors and hospitals charge too much when most of the issues we treat are preventable, it is broken. My patient can’t afford his medicines but can smoke 2packs per day. Too many like this and there goes all of our time and energy. Many good patients out there, many in difficult times, but in general there is no personal accountability….

        • Shane
          February 2, 2015 at 7:39 pm

          Every other advanced nation has beaten this problem. Unbridled capitalism (aka greed) is the culprit that has wrecked our system. There is a fix. End corporate lobbying and restore accountability in Washington.

    • Matt
      January 29, 2015 at 12:24 pm

      Medicaid is riddled with the most impenetrable bureaucracy of any of the insurance providers. Trying to get any information out of them is impossible by both doctor and patient. Only a moron who never has worked in healthcare would ever suggest Medicaid is a fixable problem that is better than commercial insurers

  14. Dr. Brewer
    January 28, 2015 at 7:52 pm

    Illinois Medicaid pays me $74 for assisting with an emergency c-section. An average office visit pays $28.30 before expenses. That really means $25 from Medicaid and $3.30 from the patient if you can collect it. My professional insurance costs for FP/OB is $43,000 per year. At that rate I would have to see 1519 Medicaid patients in the office just to cover my insurance.

  15. mitzibeth
    January 28, 2015 at 7:23 pm

    IMHO, the “excess greed” of insurance companies is a huge part of the problem. And, as a pt., I’ve found their self-initiated involvement (e.g., when a UHC nurse contacted me after I saw an orthopod for a knee problem I should have known better than to cause) a waste of time. Having interacted with them doing UR & verification of benefits when I worked in a few hospitals, I think they’re the pimps of American healthcare. Get them out of the way, increase Medicaid reimbursements & a lot more MD’s might accept it. (My state–Misery, er, Missouri–can’t find $ to increase health care for the indigent yet it & other states pay Centene Corporation $$$ to “manage” Medicaid.

  16. Pat
    January 27, 2015 at 2:00 pm

    But she can make it up on volume!

    • Jess
      January 31, 2015 at 3:10 pm

      Of course ! As long as everyone else has to work twice as hard to make the same amount of money I am all for seeing more patients!! Which means I must go from 20 patients a day to 40, in an 8 hours shift. You know math? Do it! How long would I get to spend with a patient?

  17. DrWally
    January 27, 2015 at 7:28 am

    OK, I’ll bite. What state? I see she is in Virginia, but there are mentions of Arkansas also.

Comments are closed.