Medicare payment data: a no-win situation for doctors

Recently, Medicare released its 2012 payment data, showing that they paid $77 billion to doctors that year.

So, like many doctors, I got curious and ran my own numbers. If I’m doing the math correctly (which is always questionable), my share of it was $59,622. This is considerably less than the overall average of $87,500 that the 880,000 Medicare-accepting doctors received, and certainly nowhere near the $21 million that the nation’s No. 1 Medicare money recipient, Dr. Salomon Melgan (ophthalmology) of Florida raked in from Uncle Sam.

Now, unlike the popular press, I’m not going to knock Dr. Melgan. From what I’ve read, he uses a lot of Lucentis in his practice for macular degeneration. At roughly $2,000 (doctor’s cost) per dose, I’m sure his overhead is pretty high. I’ll leave those questions to the lawyers.

But it leaves me staring at my number and wondering if I’m doing something wrong. Granted, Medicare isn’t the only insurance I take, but still ... For comparison, that $59,662 doesn’t even cover the salaries of my two awesome, hard-working, staff members.

The trouble is that, like many other doctors, I work a pretty full schedule. Roughly 60-70 hours a week. Unlike the physicians of yore, I don’t take Wednesday afternoon off to go golfing (actually, I’ve never golfed on a real course in my life). I don’t double-book my appointment schedule. I don’t do frivolous procedures just for the billing (though I’m sure what I consider frivolous more successful doctors call necessary). I don’t charge level-5 visits for simple stuff. And I run a relatively low overhead. So why are most doctors today, including me, barely breaking even for trying to run an honest, ethical, practice?

Of course, venting this kind of thing in public is a no-win situation for doctors. We’re seen as either greedy or whiny. People in most other professions aren’t paying $30,000-$300,000 in malpractice insurance or coming out of school $200,000 in debt. Doctors who are actually charging for visits so they can pay their bills and support their families are terrible people because caring should be free.

Medicine is, in many respects, an intangible science. People may be horrified by what they’re charged for a 15-minute visit, but don’t see the 8-15 years (or more) of training behind them. And when they’re feeling better, we’re often forgotten or vilified for daring to charge them a copay.

The bottom line is that the money paid out by Medicare isn’t a fair assessment of our efforts. It’s a raw number, that doesn’t take into account the cost of drugs we have to purchase ($1,050 for a single bottle of Botox), the equipment we need to buy ($16,000 for a basic electromyogram/nerve conduction velocity machine), rent ($2,700 per month for me), malpractice insurance, staff salaries, billing services, office supplies, licensing fees. ... The list goes on, including a measure that you can’t put a price on: lives saved and improved.

Taken in this context, the $77 billion dollars is simply a tool that politicians and media pundits will twist to support whatever argument they want it to. Because, after all, most doctors are too busy helping others to defend themselves.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently, Medicare released its 2012 payment data, showing that they paid $77 billion to doctors that year.

So, like many doctors, I got curious and ran my own numbers. If I’m doing the math correctly (which is always questionable), my share of it was $59,622. This is considerably less than the overall average of $87,500 that the 880,000 Medicare-accepting doctors received, and certainly nowhere near the $21 million that the nation’s No. 1 Medicare money recipient, Dr. Salomon Melgan (ophthalmology) of Florida raked in from Uncle Sam.

Now, unlike the popular press, I’m not going to knock Dr. Melgan. From what I’ve read, he uses a lot of Lucentis in his practice for macular degeneration. At roughly $2,000 (doctor’s cost) per dose, I’m sure his overhead is pretty high. I’ll leave those questions to the lawyers.

But it leaves me staring at my number and wondering if I’m doing something wrong. Granted, Medicare isn’t the only insurance I take, but still ... For comparison, that $59,662 doesn’t even cover the salaries of my two awesome, hard-working, staff members.

The trouble is that, like many other doctors, I work a pretty full schedule. Roughly 60-70 hours a week. Unlike the physicians of yore, I don’t take Wednesday afternoon off to go golfing (actually, I’ve never golfed on a real course in my life). I don’t double-book my appointment schedule. I don’t do frivolous procedures just for the billing (though I’m sure what I consider frivolous more successful doctors call necessary). I don’t charge level-5 visits for simple stuff. And I run a relatively low overhead. So why are most doctors today, including me, barely breaking even for trying to run an honest, ethical, practice?

Of course, venting this kind of thing in public is a no-win situation for doctors. We’re seen as either greedy or whiny. People in most other professions aren’t paying $30,000-$300,000 in malpractice insurance or coming out of school $200,000 in debt. Doctors who are actually charging for visits so they can pay their bills and support their families are terrible people because caring should be free.

Medicine is, in many respects, an intangible science. People may be horrified by what they’re charged for a 15-minute visit, but don’t see the 8-15 years (or more) of training behind them. And when they’re feeling better, we’re often forgotten or vilified for daring to charge them a copay.

The bottom line is that the money paid out by Medicare isn’t a fair assessment of our efforts. It’s a raw number, that doesn’t take into account the cost of drugs we have to purchase ($1,050 for a single bottle of Botox), the equipment we need to buy ($16,000 for a basic electromyogram/nerve conduction velocity machine), rent ($2,700 per month for me), malpractice insurance, staff salaries, billing services, office supplies, licensing fees. ... The list goes on, including a measure that you can’t put a price on: lives saved and improved.

Taken in this context, the $77 billion dollars is simply a tool that politicians and media pundits will twist to support whatever argument they want it to. Because, after all, most doctors are too busy helping others to defend themselves.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently, Medicare released its 2012 payment data, showing that they paid $77 billion to doctors that year.

So, like many doctors, I got curious and ran my own numbers. If I’m doing the math correctly (which is always questionable), my share of it was $59,622. This is considerably less than the overall average of $87,500 that the 880,000 Medicare-accepting doctors received, and certainly nowhere near the $21 million that the nation’s No. 1 Medicare money recipient, Dr. Salomon Melgan (ophthalmology) of Florida raked in from Uncle Sam.

Now, unlike the popular press, I’m not going to knock Dr. Melgan. From what I’ve read, he uses a lot of Lucentis in his practice for macular degeneration. At roughly $2,000 (doctor’s cost) per dose, I’m sure his overhead is pretty high. I’ll leave those questions to the lawyers.

But it leaves me staring at my number and wondering if I’m doing something wrong. Granted, Medicare isn’t the only insurance I take, but still ... For comparison, that $59,662 doesn’t even cover the salaries of my two awesome, hard-working, staff members.

The trouble is that, like many other doctors, I work a pretty full schedule. Roughly 60-70 hours a week. Unlike the physicians of yore, I don’t take Wednesday afternoon off to go golfing (actually, I’ve never golfed on a real course in my life). I don’t double-book my appointment schedule. I don’t do frivolous procedures just for the billing (though I’m sure what I consider frivolous more successful doctors call necessary). I don’t charge level-5 visits for simple stuff. And I run a relatively low overhead. So why are most doctors today, including me, barely breaking even for trying to run an honest, ethical, practice?

Of course, venting this kind of thing in public is a no-win situation for doctors. We’re seen as either greedy or whiny. People in most other professions aren’t paying $30,000-$300,000 in malpractice insurance or coming out of school $200,000 in debt. Doctors who are actually charging for visits so they can pay their bills and support their families are terrible people because caring should be free.

Medicine is, in many respects, an intangible science. People may be horrified by what they’re charged for a 15-minute visit, but don’t see the 8-15 years (or more) of training behind them. And when they’re feeling better, we’re often forgotten or vilified for daring to charge them a copay.

The bottom line is that the money paid out by Medicare isn’t a fair assessment of our efforts. It’s a raw number, that doesn’t take into account the cost of drugs we have to purchase ($1,050 for a single bottle of Botox), the equipment we need to buy ($16,000 for a basic electromyogram/nerve conduction velocity machine), rent ($2,700 per month for me), malpractice insurance, staff salaries, billing services, office supplies, licensing fees. ... The list goes on, including a measure that you can’t put a price on: lives saved and improved.

Taken in this context, the $77 billion dollars is simply a tool that politicians and media pundits will twist to support whatever argument they want it to. Because, after all, most doctors are too busy helping others to defend themselves.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.