Tuesday, September 1, 2009

How to save on health care costs

This lady wrote an article on how to save health care costs.

Articles like this always leave me split. The progressive in me says, "right on"; the physician in me says, "bullshit". There is a mixture of both in this article.

Firstly, unless you are a radiologist or a pathologist who owns a lab; you don't make money by ordering tests. If you are a radiologist or a pathologist you aren't allowed to order tests although certainly radiologists often come very close to doing so. I agree there are too many tests ordered and what she has cited certainly sounds eggregious. However as a nurse practitioner, she could simply look at the lab req. and tell her family doc, "no I don't want all these tests".

Likewise when she had the swollen knee, why didn't she just tell her FP, "all I want are some anti-inflammatories or physio". If her doctor is like me, he will find it a hell of lot easier to write an Rx for diclofenac than to fill out an MRI requisition.

There are some reasons why doctors like their patients to come in at regular intervals for prescription refills rather than phoning it in. In her case it sounds unnecessary but her FP probably can't tell the less controlled, less compliant diabetic in his practice, " You have to come in every 3 months but she doesn't" Actually he can. As someone who now takes regular medication, my FP also only gives me 3 months supply and won't refill over the phone. And it pisses me off. So I fax him to get past his secretary and he does a refill. Professional courtesy.

When I was an FP years ago and there was a small glut of FPs. Those of us starting our practices used to call patients in far more than necessary to build up their patient numbers. Now that there is a doctor shortage maybe this needs to be reviewed.


25 years ago if you told me I was going to be on fee for service 25 years later, I would have said you are nuts. 25 years later, still on FFS.

No question salary would save $$$ possibly at the expense of patient care and convenience, however I am still waiting for an offer.

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