Business Insight presented by Arlington Dermatology The Cost of Healthcare Working as a medical provider and running a medical clinic independently can be quite challenging at times when all institutions are supposed to grow continually and always make money. That is the model of our economic system: growth and profit. This is also a model that all large multiple clinic groups took over. They buy out many practices, they remodel their operations, often cut personnel, all of it to boost income and profit. I am not against money and profit in general, but, in healthcare, there has to be some moderation and some balance between profit and ethics. Medical clinics cannot be run exclusively to make money unless they put equally strong focus on quality of what they do. Usually, doctors are limited in how they charge patients. We all participate in networks established by insurances and all of them base the payments on Medicare fee schedules. In other words, Medicare fees are programmed and attached to the codes that are universal. If the code indicating a biopsy or excision of a mole is leveled by Medicare at, let's say, $400, Medicare will pay 80% of it and a doctor can only charge the remaining 20%. Even if a doctor feels he or she spend more time performing this procedure, or did it with better skills than other doctors, the code is equal to $400 and there is no other way to bill it. If the amount billed is $600, the $200 will be a write off amount. Some institutions take advantage of the fact that patients without insurance cannot have write offs. Nobody processes their bills, so, theoretically, you can bill them whatever amount you wish. Many clinics use it as a 'cash cow' and bill higher amounts, at the same time penalizing uninsured patients rather than discount. Our clinic uses Medicare fee schedule as a base for all payments and never overcharges patients with no insurance or high deductibles. There are, however, some charges that patients may not fully understand. For instance, when we do a biopsy, the procedure itself has a code we bill it with. But the procedure itself has no value have insurance, the pathologist charges us, and we charge the patients. Again, those fees are at Medicare fee schedule level and we never 'make money' off uninsured. Some patients may feel that the cost of services are very high. And sometimes they are. Especially when it comes to diagnostic procedures or lab tests, they may go into hundreds of dollars. There is really not much we can do about it. Diagnostic technology is pushing the pricing with more novel testings and more advanced equipment. The same concept applies to medications. We develop new drugs, but we have no control or influence over the pricing. Sometimes it is a big challenge for us, because we want our patients to get the best possible remedy. And often, patients simply cannot pay for that. We always try to substitute with the more cost effective option, but sometimes it does not work. One of the reasons we continue conducting clinical studies is the fact that they are an option to receive free medical care and free medication. That of course happens if patients qualify for the studies and follow the rules we introduce to them. unless it is read by a pathologist. Our clinic Newer drugs also offer samples, which we is too small to have a pathologist on staff. Thus, we sub-contract with pathologists from a hospital who receive the biopsied utilize as much as possible. The bottom line is: healthcare is costly. But we can work to find options that may samples and do the reading of them for us. make it more friendly. We just need to They obviously charge for that service. If the patient has insurance, they charge the insurance directly. If the patient does not work together. Michael Bukhalo, MD Arlington Dermatology 5301 Keystone Court Rolling Meadows, IL 60008 Tel. 847 392 5440 | www.arlingtondermatology.net Business Insight presented by Arlington Dermatology The Cost of Healthcare Working as a medical provider and running a medical clinic independently can be quite challenging at times when all institutions are supposed to grow continually and always make money . That is the model of our economic system : growth and profit . This is also a model that all large multiple clinic groups took over . They buy out many practices , they remodel their operations , often cut personnel , all of it to boost income and profit . I am not against money and profit in general , but , in healthcare , there has to be some moderation and some balance between profit and ethics . Medical clinics cannot be run exclusively to make money unless they put equally strong focus on quality of what they do . Usually , doctors are limited in how they charge patients . We all participate in networks established by insurances and all of them base the payments on Medicare fee schedules . In other words , Medicare fees are programmed and attached to the codes that are universal . If the code indicating a biopsy or excision of a mole is leveled by Medicare at , let's say , $ 400 , Medicare will pay 80 % of it and a doctor can only charge the remaining 20 % . Even if a doctor feels he or she spend more time performing this procedure , or did it with better skills than other doctors , the code is equal to $ 400 and there is no other way to bill it . If the amount billed is $ 600 , the $ 200 will be a write off amount . Some institutions take advantage of the fact that patients without insurance cannot have write offs . Nobody processes their bills , so , theoretically , you can bill them whatever amount you wish . Many clinics use it as a ' cash cow ' and bill higher amounts , at the same time penalizing uninsured patients rather than discount . Our clinic uses Medicare fee schedule as a base for all payments and never overcharges patients with no insurance or high deductibles . There are , however , some charges that patients may not fully understand . For instance , when we do a biopsy , the procedure itself has a code we bill it with . But the procedure itself has no value have insurance , the pathologist charges us , and we charge the patients . Again , those fees are at Medicare fee schedule level and we never ' make money ' off uninsured . Some patients may feel that the cost of services are very high . And sometimes they are . Especially when it comes to diagnostic procedures or lab tests , they may go into hundreds of dollars . There is really not much we can do about it . Diagnostic technology is pushing the pricing with more novel testings and more advanced equipment . The same concept applies to medications . We develop new drugs , but we have no control or influence over the pricing . Sometimes it is a big challenge for us , because we want our patients to get the best possible remedy . And often , patients simply cannot pay for that . We always try to substitute with the more cost effective option , but sometimes it does not work . One of the reasons we continue conducting clinical studies is the fact that they are an option to receive free medical care and free medication . That of course happens if patients qualify for the studies and follow the rules we introduce to them . unless it is read by a pathologist . Our clinic Newer drugs also offer samples , which we is too small to have a pathologist on staff . Thus , we sub - contract with pathologists from a hospital who receive the biopsied utilize as much as possible . The bottom line is : healthcare is costly . But we can work to find options that may samples and do the reading of them for us . make it more friendly . We just need to They obviously charge for that service . If the patient has insurance , they charge the insurance directly . If the patient does not work together . Michael Bukhalo , MD Arlington Dermatology 5301 Keystone Court Rolling Meadows , IL 60008 Tel . 847 392 5440 | www.arlingtondermatology.net