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posted by martyb on Friday April 07 2017, @11:16AM   Printer-friendly
from the what's-up,-doc? dept.

This salary ranking might be of interest to Soylentils contemplating careers in medicine:

Not all doctors take home the same amount of money. Orthopedists — doctors who treat bone and muscle problems — make the most on average. Pediatricians, or those who take care of children, earn the least. And white doctors take home significantly more than their equally qualified peers of color, regardless of specialty.

This data comes from the WebMD-owned medical resource Medscape, which crunches the numbers on self-reported annual income from more than 19,200 doctors across 27 specialties for its annual Physician Compensation Report.

Friends in residency programs have often aspired to Radiology as a high-pay, low-risk specialty, but YMMV.


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  • (Score: 3, Informative) by All Your Lawn Are Belong To Us on Friday April 07 2017, @08:34PM (2 children)

    by All Your Lawn Are Belong To Us (6553) on Friday April 07 2017, @08:34PM (#490506) Journal

    Yeah. You really don't have a clue what you're talking about. It's that simple.

    So. Why you're being told things like that:

    A) When you walk into the office for a first visit, there are five levels of classification for how much the charge for your services will be. Five. And while there are general principles, there are NOT any absolute "hard and fast" rules as to what requires something to be coded at Level 2, say, versus Level 3. There are guidelines - number of pertinent body systems reviewed, overall length spent in face time with the patient, whether a major decision (like "I'm going to cut you") is made.

    That's five different dollar amounts, ranging from $100 to about $350. Would you like to be told seeing us will cost you $350 every time? Of course not, especially when it ain't true.

    B) Once the physician settles on a course of treatment for you, if it involves your return, testing, or a procedure.... Where it goes from there depends on what is found when. Let's say you're getting a surgery, as it is the simplest case to say: The physician has an idea of what procedure he's doing, but has lots of options to consider during the procedure. It may be possible that you have five or six possible codes that would be billed out on you. Maybe one will be billed. Maybe six different ones. The point is: Rarely does your physician know in its entirety the sum total of things he'll have to do before he's completed the last stitch and dictated the note. And he sure as hell doesn't keep fifty different reimbursement schedules for each of those procedures in his head.

    C) Medical coding. It's huge. It's vast. Many doctors have some clue, some have things like "superbills" with services listed. But no physician can know ALL the possible procedure codes and diagnosis codes. It is why there are highly trained specialists called Coders, who interpret what the physician has done and translate it to the codes that will actually be billed.

    D) Doctors do NOT have money to burn. The insurance companies see to it that they're paid the absolute minimum, collectively, that they can possibly have and not say Screw You to a group of patients. There is CONSTANT, and unending, pressure to find new ways to do more in the office with less people. And that doesn't even begin to cover the enormous expense that is Electronic Medical Records. Hint: EMR companies typically take a good 25-33% of that salary per year in maintenance and support costs, let alone costs for the system proper.

    We'd love to have someone hired to meet with you personally, spend fifteen minutes with you, and outline all the possible costs and reimbursements with you. We can't afford that.

    E) Finally, insurance itself. It does NO good to you to be told, "Yeah, I'm going to charge you $500 for that," if you're not also told, "But you'll only have to pay $200 of that, period." It ain't the Doctors who came up with ten thousand insurance plans with different reimbursement rates... And, by the way, the amounts that the insurance companies pay out are not public because the INSURANCE COMPANIES demand that their reimbursement schedules are confidential information which cannot be shared with the public.

    It's also complex because if we tell you, "The charge is $500 but you should pay about $100 of that," and you're then billed $101.50, you will scream and complain about how we told you it would be $100 and therefore you don't owe a penny more than that. We can't AFFORD to tell you what you'll end up paying. And that doesn't cover the times when you have a special snowflake of a provider panel and while we're "in network" with the insurance company *you* are not covered for seeing *our* provider. These stories happen ALL the time.

    Your insurance company should know what you'll have to pay. They know YOUR contract, they know OUR contract. They know EVERY penny we've ever billed that insurance and what they pay out in analogous situations. But THEY won't tell you either, will they....

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  • (Score: 2) by bzipitidoo on Friday April 07 2017, @10:31PM

    by bzipitidoo (4388) on Friday April 07 2017, @10:31PM (#490569) Journal

    On the contrary, you don't need to be an expert to see that there is a lot of gouging, recklessness, and outright dishonesty in medical billing in the US. "You don't know what you're talking about" is exactly the kind of useless criticism I'd expect from medical people who know very well that their billing practices will not withstand scrutiny. I have personally experienced and witnessed enough of medical billing to know it's full of unethical practices.

    It's all too common for hospital emergency rooms to charge not a mere 10% above cost, or even just 2x cost, but over 100x. $307 is what this one place charged me for a 1L bag of saline solution, which Medicare says is worth less than $2. I received 3 bags, and where it got really weird was the insurance rate was wildly different for each bag, being $151, $64, and $27 respectively. Over and over I asked the hospital and the health insurer to explain the billing, convinced it had to be a mistake, and they could not. They had all kinds of justifications and reasons that were incorrect, and moreover, were unacceptable. There was of course the usual one that they have to charge more to make up for all those deadbeats who don't pay their medical bills. Yeah, right, pretty much every business has to deal with losses from theft and spoilage, yet they don't jack the prices up over 100x to compensate. One rep thought the different prices had to do with the day of the week, and that care was more expensive on the weekend. No, wrong. The $151 bag was on a Thursday, and the $64 bag was on a Saturday. Another rep thought it reflected the cost of drugs that were added to the saline solution. Wrong again. All drugs are separate line items. Yet another rep asserted that the prices on the line items in the bill were meaningless and that the real prices are set in a secret contract between the insurer and the hospital, and that neither he nor I would be allowed to see this contract. Wrong again. Two other reps couldn't understand the difference either, had no explanation, and tried to set the price of all 3 bags to $27 each, only to have the computer system reject the changes.

    Now, with such laughably incompetent understanding of the bill, by those whose job it is to understand it, why shouldn't anyone suspect the situation is ripe for waste and fraud, and in fact is deliberately overcomplicated to better hide fraud and discourage inquiry? I persisted and finally learned what I think is the correct reason. The price of everything depends on the level of care the emergency assigns patients, which ranges from 1, minor, to 5, need help immediately to avoid death. The 3 different prices for the 3 bags are the level 4, level 3, and level 1 prices respectively. There's an additional wrinkle. For level 4 and 5, the hospital is not supposed to charge separately for a bag of saline. That is included in the facility fee as it is understood that at that level of severity, saline will be needed. In any case, I see no good reason for such a complicated system. Maybe that one rep who said the prices were meaningless was right, for the wrong reasons.

    I spoke with one of the hospital's higher ups in their billing department, and he lied. He played stupid, pretended he didn't know what a Chargemaster is. He gave me the usual bull about the hospital being forced to charge high prices to compensate for losses elsewhere. He was one of the most dishonest persons I have ever spoken with.

    That's hardly all. There was another occasion in which my mother had a broken ankle. She was getting around fine with a walker, but the hospital pressured her to take a wheelchair anyway. In fact, the doctors discouraged the use of the wheelchair, as exercising her leg muscles was vital to a swifter recovery. They thrust a form at her that said she would pay for the wheelchair if health insurance refused to do so. I told them, over and over, that a friend had a wheelchair that we could borrow if needed, and I was ignored at first, then treated to a standard scare tactic. Said they couldn't guarantee her treatment if we didn't get their wheelchair. Well, Mom is a total sucker for that one, and I knew I was beaten. I asked what the wheelchair cost, and no one could tell me, supposedly no one knew. Got the old "don't worry, it's covered" line.

    US medicine gouges the public, and most people know it. Daraprim. EpiPen. Big Pharma trying to scare people away from Canadian pharmacies, and even persuading our government to confiscate prescription drugs at the border.

  • (Score: 0) by Anonymous Coward on Saturday April 08 2017, @12:11AM

    by Anonymous Coward on Saturday April 08 2017, @12:11AM (#490621)

    While I appreciate the time you took to explain the doctor's side of the system (or maybe you are part of the doctor or hospital office staff), this really annoyed me:
    > highly trained specialists called Coders, who interpret what the physician has done and translate it to the codes that will actually be billed.

    They may be highly trained, but nearly every hospital bill I've seen has wrong codes on it (specifically when looking at my aging parents' bills). When we've had the energy to follow up we can sometimes get these removed. But more often we get the pat line, "Don't worry, that code is taken care of by your insurance." Which means more cost for everyone--but we only can chase this fraud so far personally.

    I've been lucky, haven't been an inpatient since 1984 when I had a minor motorcycle accident and was transported to the local ER. Eventually I was seen by a sharp young intern who was OK (although later I found out my X-rays had not been read correctly--common with recent injuries). When I got the bill it was from the surgeon that he was interning for. I asked for the report and they produced a signed statement from the surgeon who described a conversation with me -- which was completely fabricated. Total BS from that doctor's office. I think I sent them a check made out in the name of the intern...