How much did your employer give to charity last year?
Contrary to popular belief, American doctors and hospitals give away free care quite often, to the tune of $74.9 billion for 2013. That, in case you don't understand numbers, is a fuck-ton of money. Let's look at the zeros: $74,900,000,000.
Of course, most of it isn't voluntary. There are a lot of uninsured people in America, and, whether you like it or not, you're still paying for them (and always have been, long before the current health policies). Even though they don't have insurance, that doesn't mean they won't get sick or injured and land in the hospital. There they'll likely need labs, tests, medications, supplies, and (of course) doctors and nurses. Since the amount of money charged for medical services are realistically beyond what most can pay, the doctors and hospitals have no choice but to write them off as losses. So you pay for them by higher insurance rates (I've addressed this before).
But the office is a different matter. Most doctors, including me, collect payment up front. Maybe not the full amount, but we copy your insurance card and charge your $50 co-pay (or whatever) before seeing you. The rest we'll bill to your insurance company. For the record, I don't like billing people before their appointment, but it's amazing how many people have "forgotten" their wallet if you try to collect after the visit. Me and my staff have families to support, too.
My point here is that office care generally isn't free, unless previously arranged. To make an appointment you have to have insurance (or agree with our cash prices). Before you even get seen we copy your insurance card and charge you for your share.
Like most doctors, though, I still see the occasional uninsured patient for free. Sometimes as a courtesy to someone else, sometimes because I genuinely feel bad for someone and am trying to help. Most doctors do.
So how much free office care are U.S. doctors voluntarily giving up? Well, for 2013 it was $10.5 billion. $10,500,000,000. I'd still call that a shitload of money (shitload < fuck-ton).
For comparison, let's look at America's biggest retail company: Walmart. According to their own website, last year they gave away roughly $1 billion in cash and merchandise to various charities.
That's a lot, but it's not even 10% of the amount that doctors like me provided. Sam, you're a cheap-wad compared to us (but I love the way your shoppers dress).
Keep that in mind next time you hear some politician or "patient activist" talking about how doctors are all greedy bastards who don't really care about people. Maybe you should ask that person what they gave up to help others.
Odds are they don't have a 6-figure educational loan hanging over their fat heads, either.
And all of that doesn't include the volunteer work that we do. Many of us spend a couple evenings a month at a free clinic, or go on medical mission trips to the third world, I spend a week every summer at a camp for kids with cancer. Service is a big part of why most of us go into medicine and continues to be a big part of our careers. Even if the free stuff often goes unnoticed
ReplyDeleteIt's relatively easy to calculate the cost of running an office practice, and thus to calculate the cost of providing an office visit at no charge.
ReplyDeleteHospital charity, otoh, - what is the true value there? When they say they give it away are they calculating that at the Chargemaster cost or the discounted rates to insurance companies, or at the Medicare or Medicaid rate?
A lot of independent pharmacists give away medications to indigent patients as well. I wonder how we could get this annual figure? Ive seen by old bods give away $500 in meds at one clip to an indigent patient. It wasn't an irregular occurrence either.
ReplyDeleteThank you all.
ReplyDeleteWe give away our services for free, and we do it out out of compassion, not to make ourselves look better. Most of what we do goes unnoticed and never receive gratitude. The patients I serve are all uninsured and most are not legal citizens who don't speak any English. I go out of my way to personally make phone calls on their behalf to obtain vaccination records for their kids, or help them fill out paperwork, and have things translated,so their children can go to school. I don't get paid extra to do that. It actually really hurts when the general public sees all doctors as greedy money driven people.
ReplyDelete"Like most doctors, though, I still see the occasional uninsured patient for free. Sometimes as a courtesy to someone else, sometimes because I genuinely feel bad for someone and am trying to help. Most doctors do."
ReplyDeleteJust be sure to bill the patient. Whether or not they pay is irrelevant. We are obligated by Medicare to bill and try to collect to avoid Medicare fraud charges and fines. By law, we are not allowed to charge anyone a lower rate than we charge Medicare. So nope, we're not allowed to give away free care to poor people unless it's sanctioned under some kind of charity clinic-type setting (and I don't know the laws for this).
It is my understanding that you can offer a "prompt pay discount" that results in a lower rate, but I haven't seen anything in writing that expressly allows this.
I'm a therapist, and I work at a mental health agency in rural Ohio serving three counties w/ three clinics. Every year we give away about $350k worth of services; my clinic alone does about $12k each month. We even help people cover their Medicaid spend-downs each month, "billing" people then forgiving their debt, so that they can get their COPD meds and insulin without anxiety.
ReplyDeleteYet these same clients don't understand why we ask them to come back for more services later in the month (so we get paid for something), or they get so mad when we have to change something or cancel an appointment because a clinician gets sick. They don't understand why we can't get a bigger office space and hire more clinicians.
Thank you Grumpy for giving a s$%t. Not many MDs seem to these days and it's sad.
ReplyDeleteWe have too many people watching TV and thinking, "I can sue someone and make money." (hospitals, doctors, and even, nurses)
When you work for the Govermint, they think they are sticking it to Uncle. They are sticking it to every other taxpayer supporting their care, too.
I'm just the stiff who could lose my license if I don't document the hell out of everyone, just in case. Have seen it happen to wonderful, seasoned nurses who are very good at what they do.
It's nice to see kindness once in a while.
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ReplyDeleteI like the photo. My husband used to read Cosmos and another one by the author for a bedtime story for my sons.
ReplyDeleteI know that some practices are very expensive to set up and maintain. Gone are the days when simple equipment will do. I was almost shattered by the amount my cousin spent establishing her practice and most of it was equipment.
ReplyDeleteYes, I fondly recall the stories my Grampy told me of setting up his prairie clinic in 1879 with nothing more than a piece of string and two bricks. Them were the days!
DeleteSo here is my story for today. I called my ophthalmologist's practice last week to make an appointment. I have a retinal scar and my symptoms could have indicated a retinal detachment so I was given an appointment for today. Unfortunately, my insurance company was bought out, effective yesterday. I received a letter last week from the new insurer informing me I could still use my old insurance card until my new one was mailed out. I showed up on time for my appointment and then had to deal with the front office staff trying to determine what to do about my insurance status. I was in the exam room being seen by the doctor when two members of the billing staff entered saying that the insurance company wouldn't accept my old insurance card and they didn't know whether to charge me for the entire visit or just the co-pay. I finally told them to bill me and I'd deal with it later just to get them out of the room so the exam could be completed. That wasn't sufficient and the doctor finally had to tell them to get out. I understand the need for payment, etc. and have worked in the healthcare field in the past, but this was so over the top I really don't know what to say.
ReplyDeleteI truly feel for those of you still in the healthcare field who want nothing more than to provide good care to your patients.
On behalf of the heroin-addicted ex-girlfriend of my late father, I say thank you to all of us who paid for her 15-day stay in the ICU when she injected her carotid with a mixture of heroin and rat poison. Not enough to kill her, dammit, but enough to cause permanent neurological damage (mostly motor skill shit).
ReplyDeleteWhen it came time to discharge her, Dad asked about the bill and was told it was extreme, but not to worry about it because since he was on SS and she was a homeless addict..yeah, the collective *we* paid for it.
Grrrrrrrrrr.........
I plan on bartering services (yeah to being a medical illustrator!) with my doctor(s) if they ever become out-of-network due to insurance changes. Well, not all of them, only select few I'd never want to switch.
ReplyDeleteI've number of free/discounted visits in my younger years when I was under/uninsured. People forget nice gets you further in most interpersonal settings.
If I was a physician, I no doubt will be far more likely to write off the copay for a sweet old lady vs. angry old lady that tells me I'm ripping her off...
@Outre: Your doctor can't legally write off the copay. That's fraud and Medicare gets pretty angry about that. By law, doctors must bill you for your copay and make a reasonable attempt to collect.
ReplyDeleteGreat post. I had a hand surgeon see me for free before because I had no insurance at the time. I badly injured my finger and ended up in the ER. They had to call the hand surgeon in at 11 pm to do an immediate repair. He knew I had no insurance, and told me that I was to come to his office for my followups and there would be no charge. Repeated over and over again that he would not charge me, and I better show up for my followups lol. I appreciated that SO much.
ReplyDelete(btw, it was my middle finger on my left hand. And no I couldn't bend it with the dressing. I also changed up the color of the outermost dressing (vetwrap/coban) every couple days. So I guess I gave a lot of people the (colorful) bird over 3 months)
We don't have a health CARE problem, we have a health care COST issue.
ReplyDeleteI'm insured. I had broken my leg earlier this year and had to have an operation which landed me in the hospital for four days. The hospital bill was 60K and the orthopedist surgery fee was 4.5K. Under contract with my insurance company, the hospital received 10K and the surgeon 900.00. The remainder is a write off.
If doctors and hospitals are willing to accept these contracted rates, then that is all they should charge an uninsured person. You are more likely to collect 900.00 than 4.5K.
Anon 8:39, the 4.5K bills to the uninsured are what allow the insured to skate on by paying $900. It's supposed to motivate you to get insured, just like a supermarket club card gets you discounts on ice cream and (if you live in the right states) vodka.
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