Dr. Tom Gross: Paying the price for the high cost of medical care

Dr. Tom Gross

WE HAVE all read recently how it is becoming more difficult to obtain medical care. The care is out there, but our access to it is evolving. The science of medicine is doing well, but the business of medical care is imploding.

In Santa Rosa, the old Community Hospital, now a Sutter facility, is closing soon. Sebastopol’s Palm Drive Hospital, reluctant to squeeze its district’s voters for a third parcel tax increase, has its palm out for help in its fiscal crisis, in which only 25 percent of its outgoing bills are being paid.

Marin General Hospital needs a seismic retrofit, and Sutter is leaving because of disputes over a long-term contract; that is, money, not medical care.

On top of that, physicians are starting to refuse payment from insurance companies and are billing their patients directly. It’s no wonder.

Last year, the surgeon who saved my life, by expertly removing a life-threatening tumor from my kidney, was paid by my health insurance company the same amount that I paid to the Chevy dealer to have my car’s fluids and filters changed.

There are many calls to fix the amounts that physicians should be paid. There are many physicians who would settle for just that, because the fees paid to physicians by Medicare are steadily decreasing. However, the costs of their business are increasing.

I know of one office with four physicians, in which they employ several billing experts. To bill Medicare alone usually takes one full-time employee, to send the invoices to Medicare and to keep up with the changes. There is another full-time person for Medi-Cal billing. Then, there is one other full-time person to bill the health insurance companies. Medical billing is a moving target. The rules keep changing; consequently, claims get rejected. Physicians are paying their office employees by putting the payroll on a personal credit card.

It’s no wonder that physicians are asking for retainers, just like other professions have done for decades. It’s no wonder that they are switching to a cash business, like the legal profession or public transportation.

Federal law says that you have to treat all Medicare patients alike; that is, you cannot pick and choose. It is an all-or-nothing lottery. If you stop billing all Medicare and the insurance companies, then you can reduce the cost of your business by three full-time employees per year. Then, you can pay the lights, the rent, the nurses, the hazardous waste surcharges and the exponentially increasing cost of malpractice insurance.

The only downside for physicians is that their patients might not come and then their business might fail. Well, guess what? It’s already failing, so no great risk. But the health insurance companies have succeeded in making the providers look like the villains.

What surprises me is not that physicians are charging for their services, but that they are bothering to stay in medical care at all. Aside from some very few specialties, the pay is not that good.

A friend with two children in high school is getting out of the medical profession. I asked him what he is going to do instead. His answer was, “Anything.”

The irony is that he still loves to practice medicine. He is very good at what he does. He is really at the top of his game. He donates two days a month to a free clinic.

Another physician told me that he is going to leave the profession and write children’s books. Well, I guess that we have enough physicians in Marin County, and we can always use a few more children’s books.

Please understand that the physicians are not whining; they’re just leaving. It’s OK to be angry at the physicians for refusing to take medical insurance. But if you are going to get angry with them, you’d better do it soon. If you wait too long, they’ll all be gone.

Dr. Tom Gross is the emergency medical services director for the Novato Fire Protection District. His column appears every Monday.
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