Video Transcript: How Medicare Doctors are Paid to Keep You Sick
Dr. Irvin Sahni: The bottom line is this. Doctors are incentivized the wrong way in my opinion; they’re incentivized the wrong way. So if you believe that the goal is to prevent disease to begin with rather than just simply treat it once it occurs. In other words, if you believe that being proactive is more important than being reactive, then you would agree with what I’m about to say.
If
I see a patient who has Medicare, just because so many doctors see
Medicare and the fee schedule is constant, I will bill Medicare based on
certain variables. And some of those—it’s very complicated, of course,
just like the tax code is very complicated.
But to simplify,
there’s two very commonly used codes: it’s a 99213 and a 99214. A 99213
is just an evaluation visit, an existing patient I’ve been seeing them
for years. And when he comes in I can bill a 992—a 12345, okay, almost
never a one, almost never a five, things usually lay in the middle
depending on what kind of doctor you are and how sick your patients are.
But
an average, normal person comes in and I’m going to bill Medicare. If I
bill Medicare at 99213 in Texas right now you get about 40 bucks. If I
bill Medicare a 99214 I get about a 100 dollars – pretty big spread
there. Sixty dollars is quite a bit. So if there’s something you could
do to get an extra 60 dollars you’re going to do it.
One way I can convert a 99213 to a—it’s not totally simple. You have to have asked a lot of other questions, but the bottom line is at the very end you have to show medical decision making. It’s called medical decision making.
So
I can sit there and ask a bazillion questions. But if I just say “take
an aspirin” and I’ll never see