Scoping for Dollars

This article in the NY Times is just another example of humans seeing what they want to see.  The title is The $2.7 Trillion Medical Bill: Colonoscopies Explain Why U.S. Leads the World in Health Expenditures and the author rips our system for being so expensive.  Agreed.

In many other developed countries, a basic colonoscopy costs just a few hundred dollars and certainly well under $1,000. That chasm in price helps explain why the United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care.

Does this not prove my point that we need to shop around so that prices come down?  Our government mandated that colonoscopies be put into EVERY insurance product yet never figured a way to bring down the price.  How about using the free market system?

She goes on:

Whether directly from their wallets or through insurance policies, Americans pay more for almost every interaction with the medical system. They are typically prescribed more expensive procedures and tests than people in other countries, no matter if those nations operate a private or national health system

Agreed.  So, let’s makes prices transparent and let people have an Amazon type method of comparing. Instead, Obamacare did nothing to fix this and allowed some specialties to constantly be rewarded for doing procedures.

Largely an office procedure when widespread screening was first recommended, colonoscopies have moved into surgery centers — which were created as a step down from costly hospital care but are now often a lucrative step up from doctors’ examining rooms — where they are billed like a quasi operation. They are often prescribed and performed more frequently than medical guidelines recommend.

Here is my biggest beef. When I need a colonoscopy for a patient, the local GI requires that a consult be done first. Why?  And it is done by a midlevel.  When I need a consult, once again it is done by a midlevel and the recommendation ALWAYS is some type of procedure (upper or lower endoscopy).  How convenient and rewarding. Here is the kicker.  Most of the time they NEVER give me a diagnosis.  They just give me procedure report.  In other words, no brainwork done.  The result is I am stuck with a patient with abdominal pain and they can’t be bothered to help me figure it out.  That’s the missing piece that the author doesn’t see.

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] 

  7 comments for “Scoping for Dollars

  1. Jacqueline Sloan
    April 8, 2017 at 11:00 pm

    Price transparency has arrived. There is a new website, MDSave.com. I priced a colonoscopy at Northwestern and I could not get a definitive price just between $6,000 to $8,000. On MDSave.com, I had a definitive price of $2,100. That with opting out of insurance and joing and healthcare ministry, Medi-Share, we have significantly saved on health care costs.

    • Jacqueline Sloan
      April 8, 2017 at 11:13 pm

      I have to edit my comment that the $2,100 price was not at Northwestern, but at La Porte Hospital, both an hour drive from where I now live.

  2. Private Doc
    April 3, 2017 at 3:46 pm

    Guys there is no charge to the patient for the preop visit for colonoscopy it is included in the global fee (unless there are more problems that need to be dealt with then it is the standard office visit).

    As for diagnosis if you have the op note you have the diagnosis. They have the pre and post op diagnosis as well as the findings. A negative colonoscopy is a good thing you may not get a diagnosis from it but you at least know what it’s not.

    • Doug Farrago
      April 3, 2017 at 6:07 pm

      Normal colon is NOT a dx for a consultation for abdominal pain.

  3. Randy
    April 3, 2017 at 1:47 pm

    Studies I’ve seen have shown that colonoscopies are one of the few preventive medicine measures that theoretically should save money, and I’m assuming they used real world numbers to calculate that. The trouble I’m seeing is there are a LOT of colonoscopies being done for questionable indications and screening scopes much more frequent than standard guidelines. Not to mention the GI that seemingly has never seen a normal colonoscopy and always biopsies something, meaning more frequent scopes down the road.

  4. Pat
    April 3, 2017 at 10:35 am

    “…to reward no-diagnosis”. That’s an interesting concept.

  5. Steve O'
    April 3, 2017 at 10:02 am

    This is an excellent example of turning medicine into a Retail process. There is no idea that procedures and interventions are instrumental. My patient had a colonoscopy FOR THE PURPOSE OF determining the source of the abdominal pain. The author is frustrated because the system engage in the following exchange – [do colonoscopy]; [COLONOSCOPY DONE]; This is a nice, IT-friendly conversation in the real world.
    And then the system slams into the cost-no-object regulatory universe. Why surgery centers? only BIG operations have a second-floor staff dedicated to the myriad regulatory contortions necessary to generate positive-cash-flow for a colonoscopy. They have to be paid. The overhead amplifies the effect of going broke. If CMS drops the reimbursement for colonoscopies by 10%, they drop the amount going to doctors and nurses by 50%, because the regulatory overhead doesn’t go away.
    The usual path of government-run anything follows. Decrease reimbursement causing shortage; causing backlog and wait times; patients complain, the scope of practice will be broadened to any licensed person with a pulse who will accept $20/scope. The procedures will be bad; all the regulatory burdens (including “cleaning the scope between uses”) will be paper-whipped; and more lousy service will ensue.
    And this is what the system drives. The original complaint will be ignored. AI will spit out the next thing in the algorithmic sequence for abdominal pain – CT abdomen, MRI abdomen, lap exploration. Then a catch-all rubbish-bin diagnosis can be placed on the problem, and it is ignored.
    The perverse incentive of the system is to reward no-diagnosis. Complex workups which find things invariably lead to diagnosis, and then treatment, likely expensive. No-Diagnosis causes No-Treatment; a cost-saving maneuver for insurers.
    We reap what we sow. In writing about those bad doctors doing colonoscopies, we continue to heap responsible on the powerless. Scapegoats are necessary when you are out to loot the system from a righteous posture.

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