The current trends, if allowed to continue, will change the practice of medicine as we know it, even for employed physicians. In this article, we provide an overview of the current macroeconomics of health care, how they affect practicing urologists, and what steps you can take now to ensure you receive a fair share of the health care dollar.
Cost shifting has been a major concern for health insurance companies for many years. Hospitals have used cost shifting to remain viable but this is not as easy for physicians to do under the current payment rules. Private insurers pay only what they have contracted to pay, and Medicare pays only what it has determined each individual service is worth. When you provide a service for a patient and are not paid for it, that is lost income. The time has come for every patient to be covered by insurance or have the financial capability to pay for services. Fortunately, most physicians continue to provide "charity" care. However, we deserve to know the truth upfront, allowing us to make choices about such care.
Today, however, you can no longer afford to provide the same amount of care without pay. Private and government payers have cut your pay for each service considerably. Payers have increased both the number and complexity of payment rules to block payment for additional services and have increased their post-payment review programs. Physician fee schedules have been adjusted to the highest payer, requiring large adjustments to charges when payments are posted. Health insurance policies have been adjusted to require patients to pay a significantly higher contribution for services, forcing physician offices to become directly involved in patient collections, including for those with insurance.