Wednesday, April 23, 2014

Big Bucks Medicine

Dr. Luis Benavides takes issue with the Times' story concerning medical reimbursement.  He wrote in to the Op/Ed page today.
Your timing of the sensationalist report about physician earnings on Easter morning is only matched by the lack of comprehensive reporting.There is significantly more data that could help the taxpayers understand.
Start with the fact that the numbers represent gross payment, not “take home” pay.Even the most efficient office has a 50-60% overhead expense. Most of that expense is for employee salaries and benefits.If you take into account all the money the Laredo Doctors are re-investing in our community in staff salaries, the public would understand better.Some of us have invested in technologies that assist our patients and save them and their pay or source (Medicare, etc.) a significant amount of money.
Another issue not discussed is the fact that we are in a healthcare shortage area.This skews the numbers because of the many patients we see, not to make more money but to care for a population with complex problems.
Not taken into account is the amount of training we have gone through, the mountains of paperwork we do and the time we sacrifice from our families to be with our patients, including holidays and weekends.Your front page target was Dr. Ricardo Cigarroa, a well respected hard working physician who chose to return to his hometown and invest a large amount of money in a state of the art medical facility that cares for his cardiology patients.
In my 10 employee office, I spent over $350,000 on salaries and benefits.He has employees with certain expertise.That does not include the overhead for his office, the equipment, insurance and all the other expenses every businessman has to pay.He is at the hospital frequently (I sometimes make rounds in the morning and see him there; I sometimes make rounds in the evening and see him there).
Also he responds to my calls when I have an emergency and promptly sees my patient (as do almost all physicians). One can appreciate the amount of time he devotes to his patients.Another mention was of Dr. Benson Huang, also a hard working, well respected physician, who works tirelessly with critical patients and at times not even appreciated by the health care institution he does it for.
Dr. Eduardo Miranda, previously maligned by your newspaper, provides oncology services and has large overhead to provide appropriate medications for his patients.He has never refused to see my patients regardless of ability to pay.
And when he used a very useful medication and by simple human error ordered it from the wrong place, a location within the U.S., he is placed under scrutiny and made to look like a criminal.I ask anyone who read this article to keep an open mind, read between the lines and look for “the rest of the story.”
Sincerely,Luis M. Benavides, M.D. F.A.A.F.P. PresidentWebb-Zapata-Jim Hogg County Medical Society
My initial take on the news that Dr. Ricardo Cigarroa took in $3.5 million in 2012 was that that is a lot of money; and that just accounts for what he billed Medicare for.  Add to the 3.5 the payments made to him from private insurance plans.  I also took into consideration the fact that he practices a specialty in medicine, (invasive) cardiology.  A lucrative field to immerse oneself in, especially in our culture.  

I agree with Dr. Benavides' assessment, that doctors sacrifice a lot to care for their patients.  I can especially vouch for Dr. Cigarroa as being a workhorse in and around Webb County.  He puts in the long hours, partly because that's what his job demands, and because that's what he has put on himself.  He has a drive and ambition that few could match.  But prestige also plays a big part.  In his office lobby you'll find a picture of Dr. Cigarroa posing with then-Governor George W. Bush.  The elite hobnobbing with the elite.  Hell, the name of his practice alone, the Cigarroa Heart and Vascular Institute, commands compensation in the millions of dollars.  

Many years ago Dr. Roberto Cantu, an orthopedic surgeon, commented to a young man that the manipulation of bones was an easy task; the point was knowing when and how to utilize the expertise competently.  (Paraphrasing)  He was referring to the significance of his years of training and experience.  Doctors go through extensive training, and with that, rack up a lot of debt as they learn their craft.  And their practices are businesses.  Like Dr. Benavides said, they have to worry about their overhead.  But I have to wonder sometimes if medical charges aren't set arbitrarily.  

Does setting a wrist bone from an uncomplicated fracture really cost $4,000.00?  Is that reasonable for the 20 minutes it takes to accomplish the procedure?  Is it considered surgery when an opthalmologist swabs your eye with a Q-tip to remove a small piece of debris?       

The point of the Medicare numbers being made public (and the LMT story) was to offer a hint of transparency to consumers.  Dr. Benavides does well in trying to add some perspective to the story, but it's not like Dr. Cigarroa, Mr. Highroller (that's his name from now on), didn't have a chance to explain himself.  The cost of doing business is an issue worthy of discussion.  One article won't paint the full picture.  But I think we can give LMT readers more credit and think they can process a story critically and fairly.  Oh fuck, what am I thinking?  I've seen the public comments on LMT social media feeds.  Nevermind.

Related stories that shed light on billing practices are how different hospitals charge different fees for the same diagnosis.  And a recent story in the Texas Tribune speaks of one Laredo doctor who bills the patient directly to avoid the red tape.       

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