Again, as you know perfectly well (because you’ve participated in the discussions on this very website), malpractice premiums are only a small part of the defensive-medicine pie.

Stop trying to change the subject, and stop attempting to obfuscate the issue by bringing malpractice insurers into it.

Unanimity of interest is not unanimity of action… because insurers have very neatly divided physicians. Look at reimbursement for procedures versus “mental” work. One gets increased, one gets decreased, and divide-and-conquer goes on. It’s 1% here, a half-percent there… the death of a thousand cuts.

The government payors and private insurers aren’t fools. They know perfectly well that the service has already been rendered when the bill gets submitted, so the more obnoxious, labor-intensive, and byzantine they can make the process, the more bills will simply get dropped because it’s not worth the effort to collect them. The current admin-heavy system virtually guarantees that they’ll get care for some of their beneficiaries for free, because doctors will end up eating the cost. They are also famous for delaying approvals and “resubmit with X additional documentation” notices until very close to the deadline, so when it doesn’t get resubmitted in <90 days, they can deny payment because it didn’t make the deadline.

You should work in coding/billing/insurance for a spell, Matt… I guarantee your sue-the-bastards bone would be itching in about ten minutes flat.

It’s not part and parcel of most industries naturally, but they put their money together and hire good lobbyists or form good lobbying organizations. There is no reason the world’s best paid profession cannot do that. None whatsoever.

If physician salaries account for only a small percentage of the healthcare dollar, then malpractice premiums must be miniscule!

You know better than that, Matt… physicians are a many-splintered group, and “the Gold” happens to be in the hands of the government, the large insurers, and the hospitals. Physicians salaries account for only a small fraction of the healthcare dollar, as you likewise know.

As for negotiating contracts, I’ve seen physicians try to band together to get a better deal from payors, only to be sued for price-fixing and antitrust (happened to a group of orthopods I know… the insurer was UHC). If you work in an area dominated by a large insurer (like a commercial insurance, or the big blues), refusing to take that insurer’s deal gets you cut out of the provider network entirely. It can be very hard to make a living in that scenario… some doctors end up getting driven out of town.

Physicians aren’t politicos; it’s not part-and-parcel of the profession. This is distinctly different from attorneys, as evidenced how many lawyers are in legislatures compared to physicians. Most doctors are too busy with their practices to spend time lobbying, and our “professional organizations” (like the AMA) are nothing but a shell, and apart from attempting semi-successfully to hold the line on medicare cuts, represent only a small minority of physicians.

I agree there is organizational inertia, and I think it’s the physicians’. Every one of you has the power to refuse to sign those contracts. To simply say no. You don’t because you know it’s still a pretty good living.

As for having the gold, few professions have the level of wealth and the unanimity of interests you guys have and could commit toward political lobbying.

And I never suggested we were selfless or charitable as a group. We’ve got the same number of sons of bitches as any other profession, including myself.

However, for you to even suggest that any patient has their care influenced by something as trivial as their vocation makes you look a lot more ignorant than I know you are. We are quite aware that your profession is well-populated with selfless and chartible people, dedicated to improving thew world in which we live. The same goes for us too, man.

Also, lawyers may bill by the hour, since that’s how the legal profession works, but I can’t bill by the hour with most insurances… they simply don’t work that way (some psychiatrists bill by time). Insurances and various payors reimburse by diagnostic code, and that’s generally it. For instance, to use an example from one of my colleagues, Medicare pays X dollars for a surgical procedure (like an appendectomy), and it doesn’t matter how long it took the surgeon to do the case, how much extra post-op care they require, or how many follow-up visits they need… that’s ALL INCLUDED in medicare’s reimbursed amount. Like it or lump it.

My physician reimbursement goes by level of visit (1 to 5, from least emergent to most emergent), and critical care is the only area I can think of where time spent with the patient changes anything.

Ever wonder why some doctors try to crank through as many patients as possible? It’s because they’re financially penalized for spending too much time with one patient. That’s how the reimbursement scheme rewards them… in volume (eg. number seen), not in time spent. I don’t imagine it’s very dissimilar to why some attorneys pad their hours… because that’s how they get paid.

The current medical payment system has tremendous organizational inertia, and I think you’re giving us credit for waaay too much power when it comes to making changes. Those with the gold make the rules, or rest assured there are many things physicians would change.

NewGuy, if they’re medicaid, you’re still getting paid. If they’re “no pay”, I’m not sure why you’re not pursuing them for the balance, setting them up on payment plans, etc. Do you get credit when the collection companies your hospitals outsource debt collection to ultimately collect?

In simpler terms, almost 50% of the patients I see are medicaid or self-pay (ie. no-pay). I treat them the same way I treat all my other patients.