Irks and Quirks

Bite This: Insurance companies.

I know I have been gone a while, but you’ll get over it. I did.

What is inspiring me to write is a topic that I have thought of for a while now, but it’s gotten to the point that it’s starting to fester in my brain, so I better just tell you how it makes me feel so that I do not have to think about it anymore.

As part of my current research project, we are comparing different approaches to obesity counseling out in the medical world, more specifically, out in rural communities. One of the arms of the study is the obesity counseling approach that is already in place (however, rarely used) and is a billable service by Medicare. This service is Intensive Behavioral Counseling (IBT) for obesity.  What this entails - and the only way Medicare will reimburse for this service - is 15 minute face-to-face counseling between a primary care physician (or nurse practitioner) and the patient up to 22 times per year. Dietitians may be able to perform this service as well as long as the primary care physician (“supervising physician”) is in the clinic at the time of service and “co-signs” the dietitian’s note and bills for the service himself. (Meaning that the dietitian alone cannot bill for the service.)

There are several aspects to this that seem wrong and if corrected, this service could be utilized a lot more. First of all, the fact that this is only billable if performed by a physician (or NP) and not a dietitian (with some exceptions if billed as “incident to” physician) seems dumb to me.  I mean, this is what dietitians do, yet we are not credible enough to bill for this service and have to have the physician sign off on our notes (which is basically saying, “hey, see what I did here? Do you agree?”)? By the way, physicians typically get TWO nutrition classes during their entire medical training. So we’re saying here that he/she is more qualified to provide obesity counseling than a dietitian? Heck, half of the physicians are overweight or obese themselves! (Okay, some dietitians are too, but just work with me.) As a patient, would you rather see a dietitian for counseling on weight issues or your primary care physician who barely acknowledges you’re there before giving you medicine instead of addressing your underlying issue?

Second of all, this type of service is only billable for 15 minute counseling sessions. How are you supposed to even scratch the surface of weight loss topics in 15 minutes – including getting the patient’s weight history and all of that information? You know how many patients can talk for 15 minutes about anything BUT their issue at hand? Not to mention, how many patients want to come to their doctor’s office weekly (for the first month) for only 15 minutes?

Third of all, the reimbursement rate for this type of service by Medicare is only $25, which is one reason why physicians don’t even bother. Reimbursement rates for visits involving diabetes care, hypertension, hypercholesterolemia, etc. are a lot higher, so instead they just bill for this. Guess they make more money when they can treat a disease versus prevent it. A lot of this just doesn’t make sense.

It’s all backwards to me. I think it’s a conspiracy theory – all of it. Advertising and marketing companies help the food industries to promote cheap crap foods filled with chemicals that make you fat and sick to help the pharmaceutical companies, which help the hospitals and doctors and insurance companies. How about instead, we focus on good quality food which can decrease the incidence of the top 2 diseases – coronary artery disease and stroke? Why can’t the focus be on preventive medicine and why can’t the service be provided by the experts who know how to prevent these diseases with health and nutrition? (Because it doesn’t make anyone money. BUT it would SAVE money!)

(okay, that went a ways down the street and turned the corner and came back around, but you catch my drift.)

While we’re at it, you know what else irks me? Paying for parking at your place of employment - and not just a little but a lot. You should not have to pay for your parking where you work! That’s like saying, “hey, you pay me this and I’ll pay you back this much just to be there.” Not to mention this is even worse when the parking situation is that you park, walk 30 minutes,  and you’re there! Or park, wait for a shuttle, ride for 10 minutes, then you’re there!

Maybe it’s the pregnancy hormones, but I sound pretty irritable, huh? I have many more irks about insurance companies that we could get into, but I'll save that for a rainy day. 

Sound bite: I don't even know anymore.