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View Diary: US Health Care Unmasked: A true story (122 comments)

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  •  Doctors aren't paid (10+ / 0-)

    to write prescriptions. Sorry, there are a lot of problems with the system, but writing a Rx in an ER, to be filled at an outside pharmacy, doesn't bring a doc a penny.

    Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

    by dhonig on Mon Dec 10, 2012 at 07:41:50 AM PST

    •  I'm not so sure about that (1+ / 0-)
      Recommended by:
      Eyesbright

      But regardless, he wasn't in the ER when the medication was prescribed.

      The future is just a concept we use to avoid living today

      by MetalMD on Mon Dec 10, 2012 at 07:47:38 AM PST

      [ Parent ]

      •  It doesn't matter where he was (7+ / 0-)

        doctors don't get paid for prescriptions.

        Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

        by dhonig on Mon Dec 10, 2012 at 07:53:05 AM PST

        [ Parent ]

        •  You're incorrect (9+ / 0-)

          Doctors do get kickbacks from manufacturers. At least those that have their own practices. When they're prescribed in a hospital setting if the doctor doesn't receive the kickback, the hospital will also benefit.

          The future is just a concept we use to avoid living today

          by MetalMD on Mon Dec 10, 2012 at 08:03:28 AM PST

          [ Parent ]

        •  like MMD said (5+ / 0-)

          Prescription trackers keep pharma cos informed of what doctors write how many prescriptions of their drugs.  There are then all kinds of favors bestowed on the high prescribers - paid consultantships, all expenses paid trips to medical conferences, big stock of free samples, etc. All nice and legal like.

          •  Sorry, but you are wrong on most of that (3+ / 0-)
            Recommended by:
            Angie in WA State, dhonig, VClib

            A nice big stock of free samples is great for patients, especially those that can't afford the drugs on their own.  That is what many Physicians use those samples for.

            Paid trips, etc.... that just doesn't happen.  

          •  Honoraria (1+ / 0-)
            Recommended by:
            wilderness voice

            I've attended seminars and conferences where I, a health care consumer activist, give a talk or participate in panel discussions with clinicians who receive $700-$1,000 honorarium fees.  I never get paid, but on very rare occasions, one of the clinicians will donate part of their compensation to my non-profit.

            Docs can be paid handsomely to spend a couple of hours at a local event for "public education", etc. on their area of specialty. Free gourmet dinner at a nice local hotel or restaurant to talk for 15 or 30 minutes plus a nice fee - not a bad gig for them.

            I prefer to not receive compensation as it leaves me free to speak objectively and openly about the health care topic at hand.  

            Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

            by Betty Pinson on Mon Dec 10, 2012 at 12:29:25 PM PST

            [ Parent ]

          •  Not any more (1+ / 0-)
            Recommended by:
            VClib

            sorry, but those days disappeared. Feds have been tightening the screws for quite a while, and big pharma has paid literally hundreds of millions of dollars in penalties for these past activities.

            Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

            by dhonig on Mon Dec 10, 2012 at 02:12:00 PM PST

            [ Parent ]

        •  Beg to differ. (0+ / 0-)

          I've been in the field for 25 years.  Doctors don't get paid a direct kickback, true.  They do however get "incentives" which can range from the stock of "free samples" handed out at the regular visit of their "rep", to credits for "prizes" like swanky vacation cruises with other doctors on the company's shortlist, to "enrollment fees" for entering patients on Stage IV (postmarketing) "clinical trials" which are little more than fronts for boosting sales.  Stage III trials are also used to create a ready pool of patients already using a drug expecting near-term approval; these patients will receive known active drug and be switched to a paying basis as soon as the drug gets FDA approval.  And believe me, docs are paid for enrolling subjects in clinical trials.

          •  True (0+ / 0-)

            Thanks for sharing that information.  It also has an impact on which clinical trials hospitals choose to participate in.  Not always the best system for consumers to get a disease cured or effectively treated.

            I doubt there are many docs who get incredibly wealthy from this stuff, but its enough incentive to sometimes make them practice medicine ineffectively.

            Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

            by Betty Pinson on Mon Dec 10, 2012 at 12:33:35 PM PST

            [ Parent ]

      •  You can be not so sure, but you'd still be wrong. (0+ / 0-)

        Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

        by the dogs sockpuppet on Mon Dec 10, 2012 at 09:01:43 AM PST

        [ Parent ]

      •  See my comment (2+ / 0-)
        Recommended by:
        the dogs sockpuppet, VClib

        Dhoning is correct about this.  Docs aren't paid to write a prescription.

        •  Again, none of this matters (2+ / 0-)
          Recommended by:
          Eyesbright, SilentBrook

          Whether docs or hospitals get kickbacks for prescribing drugs is irrelevant.

          The problem here is a patient was prescribed a drug a doctor later admitted he didn't need.

          So all I want to know is why the doctor did that?

          And that was the point of the post.

          The future is just a concept we use to avoid living today

          by MetalMD on Mon Dec 10, 2012 at 10:11:30 AM PST

          [ Parent ]

          •  That actually wasn't the point of the post, and (1+ / 0-)
            Recommended by:
            dogdad

            I guarantee if you knew the backstory from the doctor's perspective, you would get a much more nuanced picture.  For all we know (and we don't), something new was discovered in the clinical picture.  

            Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

            by the dogs sockpuppet on Mon Dec 10, 2012 at 11:29:37 AM PST

            [ Parent ]

          •  Actually it does matter (2+ / 0-)
            Recommended by:
            Angie in WA State, dhonig

            You are directly calling into question the ethics and motivation of the Physician, and all Physicians, into question.  

            You are asserting that your friend was prescribed X drug purely so the Physician can be paid an additional amount because he/she is paid by:

            1. The act of prescribing the medication
            2.  Kickbacks from the drug companies

            Both of these items are false and it does very much matter.  I'm not trying to be an asshat but these are just the facts.

            If you look at my long comment, and my recently published diary, you will see my attempt at trying to explain why/how a Physician is actually paid.

            •  And that is a separate issue (0+ / 0-)

              I am keenly aware medicine is not an exact science. That is why it is so difficult to question the judgment of doctors, or even know where their motivation lies, and whether they're looking out for the best interest of the patient or not.

              Certainly there are good doctors who will always look out for the best interest of the patient, but the problem is with a system where that loyalty can be brought into action, which is exactly what the US health care

              The future is just a concept we use to avoid living today

              by MetalMD on Mon Dec 10, 2012 at 12:17:15 PM PST

              [ Parent ]

          •  Bullshit (1+ / 0-)
            Recommended by:
            VClib

            sorry, but you don't get to accuse an entire industry of being unethical criminals, then say "it's not the point" when you get called out on it.

            Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

            by dhonig on Mon Dec 10, 2012 at 02:09:40 PM PST

            [ Parent ]

    •  Thank you! This diary is misrepresenting (4+ / 0-)
      Recommended by:
      dogdad, mconvente, FG, VClib

      the problems this patient faced.

      Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

      by the dogs sockpuppet on Mon Dec 10, 2012 at 08:43:07 AM PST

      [ Parent ]

      •  ???? I think maybe you're missing the point (3+ / 0-)
        Recommended by:
        MKinTN, Eyesbright, SilentBrook

        This post wasn't about the patient, nor the condition he was facing. It wasn't even about the drug, which could have been any drug.

        The post was about the US health care system, and the perverse incentives built into it.

        It was about a doctor who prescribed a medication the patient didn’t need, and why he would do that.

        The future is just a concept we use to avoid living today

        by MetalMD on Mon Dec 10, 2012 at 09:11:02 AM PST

        [ Parent ]

        •  There was a failure of communication and there (1+ / 0-)
          Recommended by:
          VClib

          are problems with drug reimbursement, but there are not kickbacks to docs for prescribing certain meds.

          And that is what you allege here.

          Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

          by the dogs sockpuppet on Mon Dec 10, 2012 at 09:12:50 AM PST

          [ Parent ]

          •  No, and as I suspected (2+ / 0-)
            Recommended by:
            Eyesbright, Chi

            You are missing the point.

            A doctor prescribed a medication the patient didn’t need.

            Why do you think he did that? Out of concern for the patient? Out of concern for the drug manufacturer? Out of concern for himself.

            I don't know this doctor, and I can't perceive to know what was on his mind, but I find it difficult to believe he was thinking about the patient when he did so.

            And there in lies the problem.

            The future is just a concept we use to avoid living today

            by MetalMD on Mon Dec 10, 2012 at 09:29:00 AM PST

            [ Parent ]

            •  No, often times there is an "ideal" medicine, (0+ / 0-)

              alternatives, and then the least interventional.  I wish there was an easy right and wrong, but there is just not.  I wish medicine was that cut and dry.  This is why communication is so important.

              Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

              by the dogs sockpuppet on Mon Dec 10, 2012 at 11:17:10 AM PST

              [ Parent ]

            •  MMD - out of concern of being sued for malpractice (0+ / 0-)

              It's what drives much of how medicine is practiced in the US.

              "let's talk about that"

              by VClib on Tue Dec 11, 2012 at 01:48:14 AM PST

              [ Parent ]

    •  Well, yes and no... (3+ / 0-)
      Recommended by:
      SilentBrook, cynndara, Chi

      The Rx is tracked by the pharma company and the doctor is credited for writing it. The doc isn't allowed a specific payment, but doctors know full well that writing a lot of scrips for certain drugs gets them free vacations, expensive toys, and all sorts of free perks from the pahrma companies. Yeah, yeah, that's illegal. But, hey, this is America, illegal is just another word for only if you haven't paid off the right congress critter or are poor.

    •  it does, if they doctor's billing person (1+ / 0-)
      Recommended by:
      Chi

      files the proper ICD-9 and CPT codes for the time the doctor spent:

      1. in a visit with the patient, in person

      2. in a visit with the patient, or the patient's proxy or guardian, by telephone or facsimile

      3. determining which diagnosis applies

      4. determining which medication is appropriate

      5. Determining which category of visit was involved, short (5 mins); intermediate (15 mins) or complex (30 or more minutes)

      But make no mistake, doctors ARE paid for the time they spend writing prescriptions, if they submit the properly completed billing forms for the services rendered.

      Hospital billing staff would most definitely bill for this time.

      They are some of the nation's best Medical Coders, and they attend regular training to ensure they have the best and newest information on how to code the newest medical procedures properly for re-payment by insurance sources like Medicare and Medicaid and the plethora of private insurers.


      "I like paying taxes...with them, I buy Civilization" -- me

      by Angie in WA State on Mon Dec 10, 2012 at 12:27:10 PM PST

      [ Parent ]

      •  No (0+ / 0-)

        you don't get a pop from one E&M code to another for adding a prescription or for writing a more expensive prescription.

        Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

        by dhonig on Mon Dec 10, 2012 at 02:13:54 PM PST

        [ Parent ]

        •  You are wrong & right in the same sentence (1+ / 0-)
          Recommended by:
          Chi

          Because they do not get paid specifically to "write a prescription".

          That is absolutely true.

          What they get paid for, is the time spent using their knowledge base and the patient's symptoms, current medications and any testing results, and coming to a diagnosis - or in the event nothing has changed, and the patient is asking for a refill, the time spent to ensure nothing in patient chart is new or cause to not order the refill, or to inform the patient they must return for a visit (and likely some basic blood & urine testing prior to the visit) before a refill can be authorized.

          All of this time spent IS billable. This time is the basis for the why the doctor then writes an Rx or a refill for one.


          "I like paying taxes...with them, I buy Civilization" -- me

          by Angie in WA State on Mon Dec 10, 2012 at 04:28:29 PM PST

          [ Parent ]

          •  Nope (0+ / 0-)

            time is used as a summary shorthand to explain E&M coding, but when it comes to actual coding, it does not make a difference. The other time you describe goes into the formulation, but the writing of a single Rx during a visit won't make a difference. It won't raise an office visit from a level 4 to a level 4.

            Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

            by dhonig on Tue Dec 11, 2012 at 06:01:22 AM PST

            [ Parent ]

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