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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?


To: John Koligman who wrote (8219)8/13/2009 12:12:38 AM
From: i-node  Read Replies (1) | Respond to of 42652
 
>> I'm curious if you can shed any light on how doctors and surgeons determine rates.

You didn't ask me, but we usually set the physician's fees for them when we install a system in their office. For the most part because new physicians have no idea where the fees ought to be set. Unless, as happens on occasion, they can get a fee schedule from wherever they previously worked. The vast majority of physicians have no idea what to charge.

Our normal procedure is to use 130-150% of Medicare allowables unless the doc wants to use a higher or lower figure. I normally encourage a higher figure, but there is a tradeoff since self-paying patients have to actually pay this full amount -- so setting fees too high creates a burden for the self-pays.

One of the biggest problems we find in physician's offices is that fees get set and never get changed. They should be increased every year but I find offices where the fees haven't been increased in 5 years or longer. They end up cheating themselves out of money.

We have them inspect their fee schedules and anytime their fee is being paid at 100% by ANY insurance company, recommend they increase that fee. Otherwise, they're leaving money laying on the table.



To: John Koligman who wrote (8219)8/13/2009 8:24:59 AM
From: skinowski  Respond to of 42652
 
I think i-n gave you a good answer. The most important "pacesetter" for fees is Medicare. Some time back in the mid-80's they introduced a "scientific" way of pricing services, the so called "Relative Value scales". Most insurance companies more or less follow Medicare. The net result was a price control regime which we can thank for certain dislocation, like the accelerating demise of Primary Care.