About ten days ago I was feeling really bad and started having chills. By the next morning I had a fever and obvious symptoms of a urinary tract infection. I’ve had a half dozen or so of these over the years so had little doubt what the problem was. In case of doubt, there is a little home test kit available now at pharmacies to check for this common malady.
I called my family doctor’s office and they squeezed me in around noon so I drove out there and got the expected diagnosis and a prescription for Cipro. It was good prompt service and I saw the doctor at the promised time and had a brief discussion with him. They also weighed me. I guess all the things they did are on the Medicare Physician Fee Schedule so with the proper filing and handling of paperwork they will be reimbursed at some rate for what they did. There was no charge to me, and the doctor said that I could get the Cipro free at Publix Pharmacies. After the visit to the doctor, I skipped the Publix option and drove to CVS and waited around 15 minutes or so while the pills were counted. I always end up buying something extra at CVS in such cases, so I’m sure that is part of their strategy. My cost for the Cipro was about $8.
I took the Cipro as prescribed and, except from some really nasty fever blisters, recovered nicely from the infection. Pills are gone and just one little fever blister scab remains. I feel very good this morning.
So, that all worked out fine but, it seems to me, was unnecessarily complicated and expensive and generated completely unnecessary travel, paperwork, and Medicare claims. It may not seem like a big deal, but multiply this small incident by the millions of times a year it happens with Medicare patients in doctors’ offices all over the country, and you get some significant costs.
Here is my suggestion: Get rid of 80% of the stuff on the Medicare Physician Fee Schedule and just let patients deal directly with doctors, sometimes even by phone and email for minor issues, and then pay the doctors directly for time spent. I could have sent a quick email describing my symptoms, and the doctor, who knows me well and knows I am not a Cipro abuser, could have spent five minutes making a quick note on my file and then forwarding the email back to me and to my pharmacy with a prescription. At a $500 per hour charging rate, the doctor could charge my credit card $40 for that simple service and incur almost no overhead cost in doing it. If he really needs to know how much I weigh, he could just ask me.
But, unfortunately, my doctor can’t make a living doing that because Medicare won’t reimburse him for it and there is really no practical way he can charge me for it directly though I would be glad to pay. It would have saved me the trip and would have pleased Al Gore by reducing my carbon footprint. As I wrote a few weeks ago, let’s Free the Doctors.