How American physicians should be paid

How do you think American physicians should be paid?

I think many of the current methods are insane. Case in point:

In the 1980s, during a meeting of the board of trustees of the American Medical Association, I experienced sudden unexpected unilateral loss of hearing. You might say that was lucky. But I was scared and went right to my ENT’s office.

He looked in my ear and extracted a large wad of wax, instantly restoring my hearing. I was happy.

But that began an odyssey of visits to ERs and otolaryngologist offices in many states to periodically get my auditory canals cleaned out, a situation that exacerbated when I began to wear hearing aids.

Most Otos told me not to put anything into my ears; some said to come back monthly for an ear canal cleaning. After some years, my nonphysician audiologist told me that her grandmother found that by running shower water forcefully into both ears she was able to keep her ears clean.

So, I tried that and it helped. Later one Oto said that was okay, and that I could dry them out afterwards with rubbing alcohol, followed by a canal lubricant.

Later another Oto told me to drip mineral oil into both ears at bedtime once a week, use a cotton plug and that would lyse the wax.

By using all these methods, I have cut my visits to an ENT office to about once every six months.

Good thing. After my last visit, I received a statement from Blue Cross Blue Shield that handles my primary Medicare.

Amount billed for a medical visit and diagnostic medical exam $537.00; what?; not covered $423.71; covered $113.29; deductions $22.65; total approved $90.64; total approved after Medicare payment $00.00; amount I may owe $22.65.

What a bunch of gobbledygook.

The competent and caring otolaryngologist spent about seven minutes with me, cleaning my ears. $537.00?

Can we blame the mess on the AMA’s increasingly infamous RUC? What if I were a poor bloke with neither Medicare nor other insurance? Oooooo.

So, two questions.

Tell me and our readers in the comments section below (or by e-mail to me at g.lundberg@medpagetoday.com) how you keep your and your patients’ ear wax under control; and tell me how do you think physicians should be paid? Have at it.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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