Physician Administrative Costs in the US vs. Canada
The Canadian Medical Association’s abortion policy is self-serving and lethal. BY Stephanie Gray Tweet In a contradiction of great proportion, the Canadian Medical Association (CMA) has passed a motion to foster a public debate on end-of-life care, yet they are closed to debating when the very lives some doctors may end first began. The Globe and Mail reported, At the general council meeting of the [CMA] on Wednesday, delegates called on the federal government to reject attempts by a Conservative backbench MP to amend the Criminal Code so that a fetus is defined as a human being. The CMAs own report said that Quebec physician, Dr. Genevieve Desbiens, who brought the motion, said the aim was to prevent a backdoor attempt to reopen the abortion debate. What is she afraid of? Canadians realizing that where you are does not determine what you are? Canadians realizing that since the pre-born are human and abortion slaughters those humans, that any physician involved with killing would be, uh, I guess guilty of killing? That wouldnt reflect so well on the profession that is supposed to shed blood to heal, not shed blood to kill. And people might want to pick another doctor. Oh waitthey would be forced to, for the doctor wouldnt be available to practice medicine from jail. And it seems incarceration is a concern for this Quebec physician: The Globe reported that Dr. Desbiens also warned that doctors who counsel or provide abortion services could become criminals. Wait a minute: If the pre-born are human, and if abortion dismembers, decapitates, and disembowels those humans, whats wrong with classifying those who do the cold-hearted deed as criminals? Dr. Desbiens attitude is self-serving and lethal. Dont consider whether abortion kills the youngest of our kind. No, just make sure you dont put her or her profession-betraying friends in jail. That wouldnt be very nice. Just let them continue to shred the youngest of our kind in peace. Delivering babies involves working at all hours of the night; killing them, however, is a quick way to make cash during regular business hours. If some physicians wish to choose the latter instead of the former, shouldnt they be allowed? Actually, not according to the CMAs Code of Ethics. Clause 9 of their Code clearly states that physicians must refuse to participate in or support practices that violate basic human rights. And the right to life, which abortion violates, is guaranteed in both our Charter as well as the UNs Declaration of Human Rights. Further, the UNs Declaration of the Rights of the Child goes so far as to say the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth. The UN considers that prenatal protection is so important, that in article 6 of the International Covenant on Civil and Political Rights, a document it adopted, it says capital punishment shall not be carried out on pregnant women. What makes a pregnant woman different from a non-pregnant one? The existence of another individual. And this is where Dr. Desbiens would do well to read her own code of ethics. In Policy 4 of the Quebec Code of Ethics of Physicians it says, A physician must practice his profession in a manner which respects the life, dignity, and liberty of the individual. Now perhaps Dr. Desbiens would say the pre-born arent individuals. Well if they arent, then what are they? And how is her definitionsiding with the Criminal Codethat they arent human until out of the mothers body, at all scientific? She would do well to also heed Policy 6 of the code which says, A physician must practice his profession in accordance with scientific principles. Science clearly teaches that if something is growing its alive, and if you have human parents you are human offspring. Science teaches that life begins at fertilization. Finally, it is worth noting that while some physicians seem okay with killing children, most are not okay with mutilating them: Consider the College of Physicians and Surgeons of BC and Ontario which have policies against female circumcision. Ontario goes so far as to say performance of, or referral for, [female genital cutting/mutilation] procedures by a physician will be regarded by the College as professional misconduct. Lets get this straight: Its professional misconduct to mutilate but okay to decapitate? Stephanie Gray is the co-founder and executive director of the Canadian Centre for Bioethical Reform, and author of A Physicians Guide To Discussing Abortion .
For instance, a plan could reduce co-payments for hypertension or diabetes medication to encourage patients to control these conditions, and charge higher co-payments for MRIs ordered within the first six weeks after the onset of back pain. (Many cases of back pain resolve within six weeks, so MRIs arent recommended until the pain has lasted beyond that time frame, unless there are other problematic symptoms like problems with urination.) Interactions between physicians offices and payers In exchange for the potential cost-containment and quality benefits of having many different insurance plans, patients and providers pay for the complexity inherent in such a system. Many physician practices pay multiple staff people to do nothing but bill insurance companies and go back and forth about denials and authorizations. When providers want to prescribe a drug, give a referral, or order a test or procedure, they have to think about what the patients insurance will cover and whether all the necessary requirements have been met. For instance, some insurers will only cover a branded drug or experimental treatment if a patient has tried other generic or standard therapies without success. If all the paperwork isnt filled out correctly, claims will be denied and someone from the doctors office as well as the patient, in many cases will have to spend more time going back and forth with the insurer about it. Back in 2009, Lawrence Casalino and colleagues published a study in Health Affairs that quantified the cost in both hours and dollars of physician practices interactions with insurance plans. They surveyed physicians and administrators from physician practices of different sizes (excluding HMOs, hospital physicians, and those, like plastic surgeons, with many self-pay patients) about the minutes per typical day the practices physicians, nursing staff, and clerical staff spent on specific categories of interaction with health plans: authorization, formulary, claims/billing, credentialing, contracting, and quality data. They excluded extreme outliers from their analysis, and to ensure that the survey was not capturing time spent interacting with Medicare and Medicaid they both asked respondents to report only time spent interacting with health plans and reduced the claims/billing time estimates by 38% (the percent of charges attributable to those payers). Their analysis of 895 completed surveys found the following average time spent interacting with health plans: Physicians: 43 minutes per day, or 3 hours per week (median: 28 minutes per day, 1.9 hours per week) RNs, MAs, LPNs: 3.8 minutes per practice physician per day, or 19.1 hours per physician per week (median: 1.8 hours per day, 9.1 hours per week) Clerical staff: 7.2 hours per physician per day, or 35.9 hours per week (median: 5.9 hours per day, 29.8 hours per week) The large differences between the mean and median values suggests that several (fewer than half) of the respondents reported very large time expenditures, which increased the overall average but not the median and this was after extreme outliers had been trimmed. The authors note that average time expenditures were higher for primary-care physicians than for specialists, and physicians in solo or two-person practices spent significantly more time interacting with health plans than did their counterparts in practices with ten or more physicians. The authors converted that time into dollars and arrived at an average of $68,274 per physician per year interacting with health plans (median value: $51,043). They estimate that this works out to $31 billion each year spent on physician practices interactions with health plans ($23.2 billion if you use the median value rather than the mean). This doesnt include other overhead costs (phone, fax, etc.) related to the interactions. More importantly, it doesnt include the health-plan-interaction costs of hospitals, which account for around 30% of US healthcare expenditures.
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