Once upon a time, back in 1987, I hung out my shingle and opened my very own private ophthalmology practice. I had just finished my residency at the Indiana University Medical Center, armed with all the knowledge to begin practicing medicine. My eight years of medical school, internship, and residency prepared me very well for the practice of medicine but woefully lacked in teaching the business of medicine. Fortunately, the business of medicine was quite simple back then. We had three office visit charges of $20, $30, and $40 for a brief, medium, and complete exam. The patients would pay at the end of their visit, at which time we provided the necessary paperwork for them to file with their insurance. The patients would then get reimbursement from their insurance company.
During my residency, one of our patients complained that their insurance company was not reimbursing her the amount necessary to match the office visit charge. I overheard one of my professors explain it to her in this way. “I have a contract with you. You have a contract with your insurance company. I DO NOT have a contract with your insurance company. What I charge is between us. What you get reimbursed is between you and your insurance company. I have nothing to do with your insurance company, and they have nothing to do with me.”
Fast forward 34 years, and everything has changed. The United States spends more money on healthcare than any other nation in the world, yet we have nowhere near the best healthcare. Doctors spend more time filling out bureaucratic forms than practicing medicine. Our reimbursement for cataract surgery, adjusted for inflation, has dropped nearly 90%. Doctors are retiring or leaving the profession at record rates.
What is Happening?
Over the next several installments of this newsletter, I am going to try explaining these changes. I will do this by telling you my own story and what I have experienced over the last 34 years. I’ll base this on what I personally have seen and heard over these years.
Stay tuned, and I’ll show you the belly of the beast. I’ll include communications with the AMA, arguments with insurance companies, dinners at national meetings, advice from consultants, hospital board meetings, sage advice from older physicians, gossip overheard in doctor’s lounges, and 34 years of practicing medicine.
Next up, Why Can’t You Tell Me What it’s Gonna Cost?, Part 1.
This newsletter does not constitute medical advice. Make sure to contact your healthcare provider if you experience any of these conditions. Do not make any changes to your medications before consulting your physician.