Thursday, October 15, 2015

Do doctors charge too much?

We all know that some doctors’ fees are excessive. I have blogged about this myself citing a neurosurgeon’s $117,000 charge for assisting on a case.
We also know that doctor bashing is a popular sport right now.

In an otherwise reasonable article about high-deductible health insurance on, reporter Sarah Kliff’s second paragraph read as follows:

The bolded text was hyperlinked to a Washington Post piece about a study that showed wide variations in hospital charges for appendectomies in California. The study was not about physician fees. No matter how difficult the case was, no surgeon would ever have been paid $186,955 for performing an appendectomy.

Yesterday, I twice asked Ms. Kliff to please correct this grossly misleading paragraph. She acknowledged my request that evening, but as of 9 AM today, nothing had been changed.

Even if Ms. Kliff had correctly identified the hospitals as the culprits, using appendectomy as an example of why patients should shop for the lowest prices was a poor choice.

Nearly every patient with appendicitis does not know he has it until he has gone to an emergency room, seen an ED physician, and had some tests. I doubt most people in this situation would A) ask how much it’s going to cost to have an appendectomy and B) decide to go to another hospital for care. The fact is, hospitals are so secretive about their charges that a patient would be unable to comparison shop especially if the emergency department visit occurred outside of normal working hours.

Even trying to find out the charges for elective surgery remains difficult in 2015.

Physicians—particularly surgeons—have taken a lot of heat recently. We don’t need articles like this to inflame patients (and journalists) even more than they already are.

ADDENDUM 9:45 AM 10/15/15

The article was just changed. The bolded mistaken passage was corrected, but the next sentence (underlined in red) remains the same. Still blaming those "really expensive doctors."


Anonymous said...

CMS 2014 for appendectomy $654
Medicaid in Michigan $399
Private insurance around $800
These are global surgeons fees

Skeptical Scalpel said...

Those numbers seem about average for the whole country. It would be hard to get rich doing appendectomies.

Why are we fighting to keep appendicitis a surgical disease? Maybe we should just go ahead and give antibiotics to everyone with appendicitis.

artiger said...

Scalpel, the President never bothered (to any serious degree) to correct his remark about $50000 amputations, so why should we expect anything different from a reporter?

frankbill said...

Appendectomies are cheep compared to having your car repaired.

Skeptical Scalpel said...

Art and Frank, I agree with both of you.

Anonymous said...

I have a good idea how much these layers of admin make. The medical community has done the worst marketing job on the planet for not showing where a lot of money is going to. Drug companies also. If you beat the stuffing out of that, there would be less yapping on docs. Docs are also front line you see, not these admin. Put their collective keisters on the firing line.

First things first. Do docs make a lot, more than some specialties should? Absolutely. However, I have to say we need to do a lot more about the admin than we need to do on docs. We do need a redistribution of wealth though. Those ROAD docs should never ever make what they do. They should be paid less than PCP's.

Skeptical Scalpel said...

Yes, administrators and CEOs make a lot of money and don not save any lives. Good luck sorting out the way specialists are paid.

frankbill said...

It isn't that they charge to much. Should we pay for a wrong Dx because they fail to keep up on current research.

Anonymous said...

I once read a statistic that only 4% of healthcare dollars go to physicians. Even if all the doctors worked for free, it would hardly put a dent in the overall cost of healthcare. The public needs to be educated about where the money is actually going. Physicians make an easy target, because of the common misperception they make too much money, but nobody blinks an eye when administrative CEO types get multimillion dollar "productivity" bonuses.

Skeptical Scalpel said...

That's a good question. But how do you know the diagnosis was missed because the doctor didn't keep up on current research? It is possible to arrive at the wrong diagnosis even if you do everything right. We are humans, and we sometimes make mistakes.

Note: Please do not comment that doctors will be replaced by computers. Until we get a computer that can do a physical examination and perform surgery by itself, there will need to be doctors.

Anonymous said...

Don't be too sure that everyone doesn't blink an eye. We know it, trying to get legislators or the like to DO something about it is the problem.

and Skep, I've seen that more than once. I don't mind honest mistakes, but how the doctor acts after you bring up the mistake is going to tell you a lot about their attitude.

frankbill said...

Here is one thing that most Dr don't keep up to date on.

Hyperaldosteronism is something that is misunderstood by most PCP. About 30% of there patients have hypertension. Current research is that about 10% of the 30% have Hyperaldosteronism. Yet most PCP every test for it. In fact they still believe they will only see one case in there life time.

This is from Up To Date

Older studies suggested a prevalence of primary aldosteronism of less than 1 percent of hypertensive
patients. However, newer studies suggest that the prevalence is considerably higher. In the
retrospective, multicenter review cited above, more widespread use of the PAC/PRA ratio as a screening
test in hypertensive patients resulted in marked increases (1.3- to 6.3-fold) in the annual detection rate of
primary aldosteronism, and in the proportion of hypertensive patients in whom primary aldosteronism was
detected (1 to 2 percent before screening to 5 to 10 percent after screening)

All you need to do to see how many Dr are up to date on this is just ask.

Skeptical Scalpel said...

"1 to 2 percent before screening to 5 to 10 percent after screening" suggests that way less than 30% have hyperaldosteronism. Where are you getting the 30% from?

frankbill said...

30% of the US population have high blood pressure This should mean that PCP are seeing and hopefully treating at least 30% of there patients for hypertension.

I did not say 30% had hyperaldosteronism but out of the 30% with high blood pressure current research is that at least 10% have hyperaldosteronism.

frankbill said...

One study on pubmed

This from wikipedia

Renard Moreau said...

[ Smiles ] Yes, I agree that doctors charge way too much.

And, that is why I am not going to allow myself to get sick!

Skeptical Scalpel said...

Frank, I clearly did not read your comment carefully. Thanks for straightening me out.

Renard, excellent plan. Good luck with it.

Sartorius said...

The costs are not determined by the physician but by the insurance companies.

I would not be surprised if that 100,000 dollar appendectomy was due to some out-of-network drum-up by an insurance company. I can tell you that no physician would ever dream of charging that much.

These businesspeople are shrewd and have devised ways of profiting handsomely by making handshake deals with hospital networks.

I read a story about a surgical center in California that's owned by some immigrant and has been drawing doctors out of networks, much to the chagrin of the insurance companies and hospitals. The center pays the docs the nominal insurance rates rather than the "in-network" discounted rates agreed upon by the handshaking executives, and gives a bigger percentage to the physicians. The hospitals are now losing business and the insurance companies are making less profit because they're paying their regular rates. I see no problem with this.

It's that kind of stuff that physicians need to do in order to bring the fight back to the medicine-industrial-complex.

Skeptical Scalpel said...

Sartorius, thanks for commenting. I agree most rates are set by insurance companies. A doc can charge whatever she wants but the fee will usually be decided by the terms of participation by the insurance provider. This reporter, who is usually quite god, clearly missed the point twice.

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