Thursday, October 25, 2012

Not Enough Money for Payroll

     My bookkeeper tells me the clinic bank account is short $7,000 for payroll this week.  I'll have to deposit personal funds to make up the difference.  Most weeks we aren't getting enough insurance payments to cover the clinic's operating costs.
     It's not that we aren't busy.  Yesterday, there were so many patients that we had to reschedule five. Several others walked out after waiting two hours.  We can't keep up with demand for our services--the shortage of medical providers is going to get much worse when Obamacare covers millions of currently uninsured people.
     The problem is, insurance companies are not paying.  Specifically, Medicare stopped paying me altogether, after the raid, as though overnight I had turned into a dirty character.  They began paying this year--for services rendered a year ago, picking and choosing items on the claims they felt like paying and items they felt like denying.  The result has been substantial reductions in the overall payments, so that the cost of providing care to Medicare patients is not covered by the payments.
     "What Medicare feels like paying," really does express the arbitrary nature of the "decisions" from on high.  There can be no explanation whatsoever for Medicare's refusal to pay for flu shots, or IV's in patient's with pneumonia, or ultrasounds to measure a pelvic or thyroid mass.
     No business can stay afloat if revenues can't be predicted, and controlled.  Working hard and working smart no longer seem to affect payments.   
     When I opened Colasante Clinic in February 2010, I was correct in predicting that half the practice would consist of Medicare patients.  This is Florida, after all, the retirement state.  And my patients in Hawthorne had been fifty percent retired folks, on Medicare.
     Therefore I purchased equipment geared toward evaluating the health problems of people over sixty-five. Since older patients have more cardiac problems, I bought a stress test unit and echocardiogram apparatus.  Since they report dizziness and have more falls, I installed vestibular testing equipment.  Since people over 65 get osteoporosis, I thought it would be convenient to own my own bone densitometer, saving patients a trip to a radiologist.  X-rays have been invaluable for diagnosing fractures, cancer, arthritic deformities, and pneumonia.  On-site lab equipment gave us instant readings on warfarin levels, potassium, blood counts, and illicit drug use.
     Now this equipment is mostly lying dormant, because I can't afford to do studies for which no payments are likely to be forthcoming.  When I do studies on Medicare patients, I'm able to diagnose and treat them promptly, but Medicare doesn't pay me promptly--if it pays at all.  I don't even know why.  The EOB's are vague, saying, "no medical necessity."  What are they talking about?  Since when is a chest x-ray not necessary for a patient with pneumonia? 
     How many businesses could wait a year or more for payment?  How many could rely on a Medicare billing specialist's decision about whether they deserve to be paid or not?  How many could survive in a system where non-payment is acceptable, and the appeals process essentially nonexistent?
     Why is it okay for the government to steal my patients' charts, take my clinic assets, refuse to say why, and decline to pay for legitimate work for the next year, under the guise of protecting my patients and the American people?  How is it protecting patients to put me out of business in this underhanded way?
     The government can't put me out of business outright, or it would have done so.  Government officials with legitimate suspicions could take my license, close my business, remove me from Medicare's approved provider list.  They could indict me.  They could give me reasons.  But after twenty-eight months of "investigation" they haven't done any of these things.  They don't have legitimate reasons.
     My Medicare patients are, in effect, authorizing the government to use their saved-up Medicare tax money to pay for medical services at my office.  They can't believe the EOB's they get in the mail saying I was not paid.  "Why are they refusing to pay for what you did?" they ask.  I tell them I'm turning the office into a free clinic.
     No one else gets away with stealing and mismanage money in this way--why should Medicare, and other insurance carriers?
     Sooner or later a system that allows such government perfidy will catch up with itself.  Maybe there are plenty of other places for patients to get treatment, if I'm forced to shut down.
     I'm one lonely solo doctor--no big deal.  But my message is not unique.  Living in fear, not getting paid, and having no workable mechanism to appeal unfair treatment doesn't make doctors want to stay in business.
    We doctors can, of course, take refuge in giant organizations, and wait for our Thursday paychecks like factory workers.  We can dispense treatments the way factories dispense toothbrushes and candy bars.  We can let our government-mandated software systems tell us what to do, and when to do it.
     But that's a different version of medical care--one where doctors become bureaucrats, the free market disappears, and the medical system works as well as, for example, our bankrupt U.S. postal service, and all the other government and corporate institutions where we get put on hold, talk to computer answering systems, wait for hours in lines to get medicre service from bored civil servants.
     Small solo medical clinics have been one of the last holdouts--next to friendship--for humanity:   places where one person could actually count on another person to listen and respond in a non-programmed way.  It's sad to watch this holding-place for human connection--with all its healing potential--being forced out of existence.

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