The CMS is that department of the federal government that determines what services will be allowed and how much your physician will be reimbursed when those services are provided. That department is unfortunately highly influenced by the medical specialties that are procedurally oriented. This leads to some significant problems in the healthcare industry. Simply put, those medical specialties that tend to do more surgeries and procedures get paid far more than those that don’t. For example, a General Surgeon, Ob/Gyn, or a Urologist will make a lot more money than those in primary care such as an Internal Medicine, Family Medicine or Pediatric physician. Society will need to make a decision whether that is proper or not based upon the final outcomes. One of the results, is that very few of our new physicians will be choosing to practice primary care. Why spend half-an-hour seeing a patient for their diabetes, hypertension, and reflux disease for $115.00 when you can see a patient for a quick procedure in the office and get paid $680.00? One of my medical partners recently saw a patient for just the above. The patient complained that the charge for his primary care issues was $117.50 while the charge for freezing off a small lesion that took 2 minutes was $286.00. Exactly!!! When physicians subsequently choose to avoid the primary care fields of practice, no one gets seen for routine medical care. Who does more good for the overall population? Is it those who see people for primary medical issues such as diabetes, hypertension, reflux disease, childhood care and immunizations or a Urologist who cares for the prostate of an elderly man? Society needs to decide and decide quickly because it takes at least 11 years to produce a physician.

So how exactly does the government control the practice of medicine through the Medicare program? One way is by “allowing” or “not allowing” services. They of course don’t necessarily come out and say that “you can’t have that procedure.”  They just refuse to pay for it. So if a Medicare patient comes to me and has a lesion that is bothersome (but not obviously malignant) and the patient wants me to remove it, they must first sign an ABN (Advanced Beneficiary Notice). This is meant to inform the patient that Medicare will most likely not pay for the procedure so you are on your own for payment. When most procedures are relatively expensive–also determined by the government through the CMS office, (I’ll talk about that tomorrow) the patient usually bails and says no thank you. This of course, works exactly as planned and decreases the services that Medicare must pay for. That’s not so bad I guess if it is a trivial procedure or request but you would be surprised at just what isn’t covered. Especially when some of these patients are in a lot of pain from whatever needs to be addressed but isn’t under the procedures they will accept financial responsibility for. How many of you have thickened toe nails from a fungus that causes severe foot pain when you put on a pair of shoes? Not covered. How about that mole that sits right under the strap of your bra? Not covered. You get the picture. Tune in tomorrow for the CMS issue.

Maria said that famous line as she began teaching the Von Trapp children how to sing in The Sound of Music. So let me use it here to begin my new blog that I hope will teach people about the business and practice of medicine.  I remember falling in love with the idea of becoming a physician at the age of about ten. I remember sitting in the elementary school library and first reading about William and Charles Mayo–the eventual founders of the famous Mayo Clinic in Rochester, Minnesota. They weren’t famous at that time, they were just two brothers who loved to care for people. That’s what I wanted to do. This was long before I knew anything about the money or prestige that might eventually come with the profession. I wanted to care for the physical needs that people suffered. The idea of setting a broken arm, delivering a newborn child, or suturing an open wound was more than just invigorating to me. How I came to eventually fulfill that dream is another story for another time. Now, I find myself entrenched in a battle for the very survival of the profession itself. The practice of medicine has evolved from a profession where, rather than caring for people’s needs, we are being forced to micromanage their lives. And unfortunately, it is being destroyed from within as much as from without. Over the next few years, I hope to start a conversation with those of you who truly want a physician who cares about your physical, mental, and spiritual lives more than the intrusive directives of a governmental panel that has decided what medicines you should be taking, what procedures you are allowed or not allowed to have, and how and when you will die. So let’s start at the very beginning. Join me as we travel that road together.