Thursday, May 13, 2004

No Free Lunch

Today I am attending the Pri-Med West Conference in Anaheim, CA.

First, I've got to say how amazing ibuprofen can be. A few hours ago, my ankle was throbbing and each step was exquisitely painful. A couple of Advil and hours later, I can walk almost normally with only mild pain. As a physician who is constantly prescribing medications, it's nice to know that what we tell patients to do actually works. At least, some of the time.

This past week I've seen two more patients, and I have another appointment set up for next week. One difference from previous patients is they all have insurance, Blue Cross, in fact. And that means I can submit my "customary and usual" fees, rather than the "time-based" fees that I have been charging people without insurance. Hopefully, this means increased revenue, not because I can charge the insurance companies more, but because I've been giving a large discount to uninsured patients.

I think I've got it figured out, at least for Blue Cross. At first, when patients used to call for an appointment, I'd get their name and schedule a time for us to meet. End of phone call. Now, I ask who their insurance is with and what their ID number is. I also ask for the toll-free number on the back of their insurance card because that is how I find out their eligibility and exactly what is covered, whether there is a copayment, etc. It makes things a lot easier when I know what to ask for in payment, or whether to even ask.

In the past, I've calculated that for my practice to break even, I need to see about 3 patients a day, assuming an average charge of $78 per patient. In terms of money, it's actually $257/day. I'm a long ways away from that, but I have hopes that business will pick up. This past week has felt different to me, like people in the community are finally starting to think of me for their medical needs.

I arrived at the Conference late today because I wanted to send off an application form to Cigna. I'm starting to get the hang of these forms. They all ask for pretty much the same information, so I now keep my documentation (medical license, DEA, board certification, proof of malpractice insurance, etc) together for easy copying.

By the time I arrived (11:20 am), the morning lectures were ending with a 2 hour lunch session. So I have spent the last hour walking the exhibition area. That's where rows and rows of booths from pharmaceutical companies, recruiters, electronic medical records companies, medical equipment makers are set up, hawking their wares. There are the usual freebies (pens, notepads, totebags, soft pretzels, yogurt, magnets), but not so many as in past years, in my opinion.

It's an amazing sight to see physicians on the exhibition floor carrying bags and bags of mostly useless freebies in both hands as if they were at a flea market. Fortunately, I didn't see any today, but I have in the past. I suppose there are people with no shame in all walks of life.

I've always felt uncomfortable about all the freebies that drug companies hand out, because I know that they are not really free. For that same reason, I stopped accepting drug samples from the drug reps many years ago. I was bothered to think that the free giveaways ultimately meant higher drug prices for consumers. And invariably, the free samples were always for the newest, and consequently most expensive products. They figure, once they get a patient started on a drug (even a free one), they are likely to continue with it, especially if their insurance pays for it. And that drives up the insurance premiums, and then the patients and employers have to pay again.

It was even more evident to me what a waste drug samples were when several years ago, I cleaned out the cabinet where I kept my samples. Because I never remembered to give out any, almost all of them had expired, and were useless. I felt badly at having wasted hundreds of dollars of expensive medications, but I realized then that giving out free samples was not my style, and not compatible with the Kaiser system.

As they say, there's No Free Lunch.

Okay, I'm not that pure. I did take some free pens, 2 notepads and 1 totebag. Plus I did get my lipid profile checked, like I do every year at these things. My LDL is still low at 108, and HDL still high at 60. Hallelujah! I can keep eating In-n-Out for another year...