Friday, October 23, 2009

Sticking It In Our...

Local mom told me today:

That her son was sick last week. She thought he had strep throat. Took him in to the doctors who ruled that out. They wanted to give him a flu test, but not for the pig flu, for the regular flu.

So mom held her four year-old on her lap while they jammed a swab up his nose. Blood went everywhere and the kid started screaming - but that's neither here nor there.

Miffed, the mother asked her friend, a pediatric nurse herself, what happened. The nurse said obviously the swabber was incompetent - pushing it up too far. Also, they shouldn't be doing that test in the first place because the result is not actionable. She asserted that doctors are ordering up unnecessary regular flu tests simply because they can these days; because they reap $175 from the insurance companies for each swab!

Now, this story sounds a little fishy to me. There has to be some basis for performing a regular flu test - even if it's just so bought-and-paid-for government agents, aka *doctors*, can prescribe some ineffective, expensive drugs! But I'll let my pedantic doctor readers elaborate on that technical issue.

The central point is that in the fog of pandemic bubblemania, with Big Government writing checks left and right, the door hangs wide open for scamsters - just as it was trafficked with subprime lending, Wall Street bailout monies, welfare,....and now *green* energy.

The government steals from you....and then these clowns rob the government.

Don't let the smiles, office jokes, ties, and white lab coats distract you from the reality of this larceny.


Taylor Conant said...


Doctors are more noble than us because they take the Hypocritic Oath.

Just like govt employees and politicians are more selfless than us because they only join govt to work towards the Common Good.

Apparently you have never taken high school civics.

CaptiousNut said...

I don't remember it being called *civics*.

I'm not that old!

Mark said...

The doc is not getting 175 bucks for the test.. that's BS...
That RN is being ridiculous.
Here's the billing deal... there are 2 parts to every bill generated... a facility fee (ie, hospital) and "professional" fee which is what the provider gets...
There are specific codes for a health care encounter; we have 5 basic codes in emergency medicine denoting the complexity of the case and the "work" it required.... same thing for an outpatient visit, in this case a pediatric visit.
Now ordering a test may move a visit code up a notch (from a "level 2" visit to a "level 3") which in the outpatient world means maybe 10-15 bucks I'm guessing...
The amt of $ paid for each code varies for each insurance plan, is tagged to the medicare rate (at least for all pts in ED; a common third party insurance company like BC/BS paying 115% of what medicare would pay and is subject to negotiation between the hospital, physician group, etc.
Now the pediatrician for that kind of visit is probably getting 30-40 bucks..
Pediatricians in Boston area earning in the 100k range (for 11 years of schooling and maybe 250k in debt.. principal mind you, that has perhaps grown to over 300k by the time they start to pay it down... at the earliest, age 29-30). Anyone want to sign up for that cashcow profession?!
Now I know there are doctor jobs out there where the bill can be padded... I'm very skeptical about the dermatologist that biopsied 17 (seventeen!) of my 30 yo sister's moles.. the surgeons that are making ridiculous money lasering everyone and their mother's varicose veins (with some sketchy medical necessity statements to insurance companies)... but the vast majority of docs I know are not doing it to shake the system down for $.
In short, areas where "billable procedures" are done are the areas where abuse can happen. A pediatrician taking a flu swab is not in this category.
Now I totally agree with the RN statement questioning the medicine behind the test, "actionability" of it. No tests need to be done for viral illnesses. If the kid clinically has the flu and is significantly ill (a <1-2% event so far in this flu season) , just treat them! All others, send home with "reassurance". Understand that perhaps the mom is this case wanted testing (I don't know why people think tests replace clinical judgement) or maybe the doc felt he/she had to do something. Either way, it's an unneeded expense.