June 18, 2010--Dr. Hyppocratous

As the health care reform bill was making it's slow way through Congress, a physician friend of mine told me about a conversation he had with some of his colleagues. It was not about expanding coverage to the uninsured or the effects of the potential new program on the federal deficit or the public option. Rather is was about their own personal concerns, about how much it would cost them in lost fees. In other words, how much less money a year they would make if it passed and was signed into law.

My friend said that most of his colleagues were doing very well. One average they were making at least $300,000 a year. Some, especially the surgeons, radiologists, anesthesiologists, and urologists were earning between $500,000 and a million a year. In fact, one of the most vigorous complainers about the health care legislation had just bought a garage full of Ferraris. Six of them. It seems he collects Ferraris. Like I used to collect stamps. He was moaning that if the cuts in doctors' reimbursements were to go through he might have to sell one or two of his prized cars.

it seems, though, that he has little need to worry. According to a new study reported about in yesterday's New York Times (linked below), many doctors have already figured out what to do in the face of potential cuts in Medicare. A federal program the medical profession furiously opposed back in the 1960s, labelling it socialized medicine (sound familiar?), which ironically quickly became their bread and butter. Very lucrative bread and butter at that.

What then did this new study reveal about how limits on doctors' billing affected their bottom lines? Not very much at all. In fact, many studied are doing better than ever.

How might that be since lawmakers for some years have been passing legislation to cut how much Medicare will pay doctors and hospitals? By scaling back on the time they spend with patients so they can cram in more each day; and, if that doesn't get the income-generating job done, by over-prescribing tests and treatments.

The study focused on how doctors treated cancer patients in a changing billing/reimbursement environment and found that when under cost-cutting pressure doctors also routinely made up the difference by increasing the amount of chemotherapy they administered. The authors of the study looked at the records of more than a quarter of a million patients with lung cancer and found chemotherapy treatments increased to 18.9 percent of the patients seen as compared to 16.5 percent the year before the cuts went into effect.

Further they found, doctors discovered that they could buy the chemotherapy medication for 20 percent below the price Medicare set for the drugs, which meant they could buy cheap and get reimbursed high.

And if even that didn't add enough to these doctors' income there was one other thing they could do--and did: switch to more expensive options. For example, in the case of these oncologists, order up Docetaxel for which doctors were paid by Medicare about $2,500 a month rather than considerably less than they would get paid for other, less expensive drugs.

But, is Docetaxel a better, more effective drug that would justify its use? To quote Dr. Craig Earle, director of health services at Cancer Care Ontario, "The financial incentive seemed to have an effect where there's not strong evidence of more than one equally good treatment program" (My italics.)

Neat. Just what Hippocrates had in mind when he authored the oath named for him and which all physicians swear to follow when they graduate from med school.

Even the doctor with all the Ferraris.