Comments on: Diabetics and Bagels http://healthblog.ncpa.org/diabetics-and-bagels/ Health Care Policy and Reform Insights | NCPA Tue, 22 May 2012 20:53:53 +0000 hourly 1 http://wordpress.org/?v=3.3.2 By: David McKalip http://healthblog.ncpa.org/diabetics-and-bagels/comment-page-1/#comment-37320 David McKalip Mon, 07 Apr 2008 15:38:44 +0000 http://www.john-goodman-blog.com/diabetics-and-bagels/#comment-37320 Dr. Goodman, I have heard you speak about changing the payment system for physicians to be paid for time. I agree that physicians should be paid for their time but am concerned that such a change would do little to actually ensure physicians are paid fairly or for the actual cost of their time. Medicare currently does allow for time-based coding but the amount paid for a 60 minute visit to me, a neurosurgeon, is a mere $172.00. Today, I am seeing several “post-operative” patients within the 90 day “global period” established by Medicare (and adopted by all payers) for free care to be delivered. I will spend about 2.5 hours on that activity today and will pay a physician assistant to do some of it and will have the cost of running the administration of these visits and the liability insurance to guard against any bad outcome. The claim is that the cost of the surgery covers my services for the next 90 days. Poppycock! My time is worth closer to $500-$1,000/hour for these kinds of face-to-face service. My attorney tells me my time is worth $2,000/hr. As long as a third party (outside the patient-physician relationship) is able to determine the cost of my services, I will never be paid fairly and my patients will never be able to have a choice to pay me more for more value or another physician another amount for what they want to get for their services. I agree with time-based payment, but only if I control my charges and collections. Dr. Goodman,
I have heard you speak about changing the payment system for physicians to be paid for time. I agree that physicians should be paid for their time but am concerned that such a change would do little to actually ensure physicians are paid fairly or for the actual cost of their time. Medicare currently does allow for time-based coding but the amount paid for a 60 minute visit to me, a neurosurgeon, is a mere $172.00.

Today, I am seeing several “post-operative” patients within the 90 day “global period” established by Medicare (and adopted by all payers) for free care to be delivered. I will spend about 2.5 hours on that activity today and will pay a physician assistant to do some of it and will have the cost of running the administration of these visits and the liability insurance to guard against any bad outcome. The claim is that the cost of the surgery covers my services for the next 90 days. Poppycock!

My time is worth closer to $500-$1,000/hour for these kinds of face-to-face service. My attorney tells me my time is worth $2,000/hr.

As long as a third party (outside the patient-physician relationship) is able to determine the cost of my services, I will never be paid fairly and my patients will never be able to have a choice to pay me more for more value or another physician another amount for what they want to get for their services.

I agree with time-based payment, but only if I control my charges and collections.

]]> By: Stanley Feld http://healthblog.ncpa.org/diabetics-and-bagels/comment-page-1/#comment-23989 Stanley Feld Fri, 16 Nov 2007 16:10:04 +0000 http://www.john-goodman-blog.com/diabetics-and-bagels/#comment-23989 Excellent. I do not have a warm spot in my heart for Commonwealth Fund. I simply can not understand their thinking in terms of the good for the patient. Excellent. I do not have a warm spot in my heart for Commonwealth Fund. I simply can not understand their thinking in terms of the good for the patient.

]]> By: Doug Badger http://healthblog.ncpa.org/diabetics-and-bagels/comment-page-1/#comment-23686 Doug Badger Mon, 12 Nov 2007 21:05:02 +0000 http://www.john-goodman-blog.com/diabetics-and-bagels/#comment-23686 Brilliant! Brilliant!

]]> By: Jay Hughes http://healthblog.ncpa.org/diabetics-and-bagels/comment-page-1/#comment-23681 Jay Hughes Mon, 12 Nov 2007 20:15:52 +0000 http://www.john-goodman-blog.com/diabetics-and-bagels/#comment-23681 It had to happen sooner or later what with all of the health system stresses. John- "you're losing it!" In the crazy health care miileau, you are making too much sense. It had to happen sooner or later what with all of the health system stresses. John- “you’re losing it!”
In the crazy health care miileau, you are making too much sense.

]]> By: Bob http://healthblog.ncpa.org/diabetics-and-bagels/comment-page-1/#comment-23677 Bob Mon, 12 Nov 2007 19:35:17 +0000 http://www.john-goodman-blog.com/diabetics-and-bagels/#comment-23677 I love bagels, but they are not very complicated, unless you are talking about the myriad flavors that any true bagel afficianado would decry. I love bagels, but they are not very complicated, unless you are talking about the myriad flavors that any true bagel afficianado would decry.

]]> By: Brant Mittler http://healthblog.ncpa.org/diabetics-and-bagels/comment-page-1/#comment-23676 Brant Mittler Mon, 12 Nov 2007 19:31:07 +0000 http://www.john-goodman-blog.com/diabetics-and-bagels/#comment-23676 Nice analysis and nice challenge. Along the same lines, see Pham and Ginsburg, " Unhealthy Trends: The future of physician services" Health Affairs Nov Dec 2007 at 1586. Those authors also need to apply the bagel test. Nice analysis and nice challenge. Along the same lines, see Pham and Ginsburg, ” Unhealthy Trends: The future of physician services” Health Affairs Nov Dec 2007 at 1586. Those authors also need to apply the bagel
test.

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