| ANTHEM (most plans) | ||||
| Anthem Network | ||||
| Current rating for PRIMARY CARE PHYSICIAN REIMBURSEMENTS--> | F | |||
| Their payments for OFFICE VISITS are--> | POOR | |||
| Their payments for LAB WORK are--> | NONE | |||
| ---CURRENT RECOMMENDATION--- | ||||
| ANTHEM HAD ALREADY BECOME MARGINAL WHEN THEY STOPPED PAYING FOR LAB WORK. THEN IN THE PAST FEW MONTHS THEY LOWERED MOST OF THEIR OTHER FEES SEVERAL TIMES! THERE'S NOW NO INCENTIVE WHATSOEVER FOR PHYSICIANS TO WANT TO PARTICIPATE IN THIS PLAN EXCEPT OUT OF LOYALTY TO LONG-TIME PATIENTS. |
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| - | ||||
| ---COMMENTS--- | ||||
| 5/23/98 | ANTHEM just reduced its payment for a Tetanus/Diphtheria Booster from $13.80 to $12.42, a drop of 10%. They thought no one would notice, but Ben Dover notices everything. If we assume that you're a good doctor and are thus giving perhaps
three of these important immunizations each week, then Anthen
has just stolen another $185 from you this year and added it to their profits... and they
did it so stealthily that you'd never have realized it without
this web site. ----------------- |
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| 4/27/98 | ANTHEM has lowered its payment for a Wet Mount (for fungi) from $14.80 to $9.60, a drop of 35%. If we assume that you do two of these a day to diagnose skin
conditions or vaginal infections, doctor, then Anthem has just
stolen another $2,392 from your family this year and added it to their profits. A little
here, a little there, the fee decay moves inexorably onward... ----------------- |
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| 2/12/98 | ANTHEM just reduced its payment for a Blood Sugar (Glucose) Test from $18.50 to $12, a drop of 35%. If we assume that you do one of these tests every day to monitor
your patients with diabetes, doctor, then Anthem just stole another $1,495 from your family this year and added it to their corporate profits. ----------------- |
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| 2/12/98 | ANTHEM just reduced their payment for Pneumonia Vaccine from $20.70 to $18.63, a drop of 10%. Perhaps you only give 50 of these immunizations each year, doctor;
but Anthem still took another $103.50 of your hard-earned income and added it to their profits for the year. A few dollars here, a few more dollars there -
it's just like being eaten to death by ants. ----------------- |
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| 1/22/98 |
ANTHEM just reduced their payment for a 25-Minute Detailed Office Visit (99214) from $83.84 to $62, a drop of 26%. Although this is not one of the E/M codes in our Standard Assumptions spreadsheet, obviously a loss of $21.84 for each such patient visit adds up to a lot of money over a year. Anthem pays $37.26 for a 10-Minute Office Visit (99212), and it's interesting to note that this rate of reimbursement would yield $93.15 if we see 2.5 patients during the same 25-minute time period. Anthem thus skews the reimbursement schedule to put overwhelming pressure on doctors to rush more patients through our offices faster because they pay us $31.15 more for seeing 2.5 patients in 25 minutes than they do for seeing just one single patient for the entire 25 minutes. (See "Disincentives to Good Care") Patients, do you understand now why your doctor seems to be rushing
you in and out of the office these days? Doctors HATE doing that (we love to spend time with our patients), but your insurance company now forces us to pracitce that way. |
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| 1/5/98 | During the past year ANTHEM has lowered its payment for a 40-Minute Physical Exam from $134.55 to $96 (in several smaller increments that we weren't supposed to notice)
for a total drop of 28.7%. Since we assume that you do 690 Physicals annually, that means that during the
past year Anthem has stolen another $26,600 from your family and added it to their corporate profits. ------------------- |
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| 1/5/98 | During the past year ANTHEM has reduced it fee for a 15-Minute Office Visit (99213) from 62.10 to $48, a drop of 22.7%. This is not one of the E/M codes in our Standard Assumptions spreadsheet, but that $14.10 drop on every 15-Minute visit for
an entire year obviously adds up to Big Bucks! ------------------- |
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| 1/5/98 | Anthem just reduced its payment for an ECG again, a total drop from $53.82 to $35 during the past year, or a loss of 35% for the year. Doctor, we assume you do 690 of these a year; so Anthem has stolen a total of $12,986 from you for this one item alone! ------------------- |
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| 1/5/98 | ANTHEM just reduced their payment for Audiometry (Hearing Testing) for the second time in the past year. This means that they've
dropped from $24.15 to $20 during the year, a loss of 17%. We assume that you do 230 of these test a year, doctor; so during this
year you've been forced to contribute another $955 to Anthem's corporate profits. ------------------- |
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| 1/5/98 | ANTHEM has reduced its fee for a Pulmonary Function Test from $65.25 to $40, a drop of 44.8%. Doctor, if you do five of these a week to monitor your asthma
and emphysema patients, Anthem just stole another $5,808 out of your takehome pay this year and added it to their profits. ------------------- |
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| 1/5/98 | ANTHEM has dropped its payment for a Urinalysis (UA) again. The total drop this year was from $12.95 to $5, a loss of 61.4% for the year. We assume that you do 1,610 of these every year; so Anthem just stole another $12,800 from your family this year and bumped up their corporate profits
by that amount. Anthem knows we must continue to do urine tests
in our offices in order to take proper care of our patients, even
if they're not paying near enough to even cover our cost of supplies
and staff time to perform the tests. The slimey B-----ds intend to bleed us dry! ------------------- |
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| 11/24/97 | On 10/2/97 we reported a drop in ANTHEM's payment for Flu Vaccine
from $20.70 to $18.63, a drop of $2.07 or exactly 10%. Today we
detected a further drop in the Flu Vaccine fee down to $16, a total drop of $4.70 or 23% since 10/2. Doctor, if you've taken the time in the past to do a good job of educating your patients about the value of Flu shots, we assume you give 500 of them during flu season. With this latest Anthem
reduction, your annual net take-home pay from this one service
alone has gone down by another $2,350 in the past two months while Anthem's profits increased by the
same amount. ------------------ |
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| 11/19/97 | ANTHEM just lowered their payment for a Urinalysis from $12.95 to $8.40, a drop of 35.1%. Since we assume that you do 1,610 of these a year in your office, doctor, Anthem
just stole another $7,326 from you this year and added it to their corporate profits. ANTHEM
knows that you must have these results in order to take proper
care of your patients; so they know you'll keep right on doing
them even though they're paying only a pittance. What's the definition
of extortion? ------------------- |
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| 11/5/97 | ANTHEM lowered their payment for an allergy shot from $15.53 to $9.00, a drop of 42%. If you give three of these shots in your office every day, Anthem
just stole another $4,506 from your family this year, doctor. ------------------- |
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| 11/3/97 | ANTHEM just lowered their reimbursement for Audiometry (92552) from $24.15 to $21.74, a drop of 10%. We assume you do 230 of these tests a year, doctor; so Anthem just deducted
another $554 from your annual income and added it to their own profits. ------------------- |
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| 10/16/97 | ANTHEM dropped the fee for a Throat Culture from $16 to $8, a loss of 50%. You do 1,150 of these a year; so Anthem just added another $9,200 to their profits right out of your take-home pay. ------------------- |
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| 10/16/97 | ANTHEM reduced their payment for a Pap Smear from $17 to $7, a
drop of 58.8%. Your lab cost on these was probably about $10; so Anthem just stole your $7 "profit" on each of the 1,150 of these tests you do every year, another $6,900. ------------------- |
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| 10/16/97 | ANTHEM just cut their payment for a Stool Guaiac from $5.73 to $4.00, a drop of 30.2%. We assume you do 690 of these tests a year; so Anthem just gouged
your take-home pay by another $1,193.70 and added that to their profits, doctor. ------------------- |
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| 10/16/97 | ANTHEM cut their payment for a Urine Culture from $27 to $12 which is below our cost for this test. There goes another big
slice of lab profit. ------------------- |
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| 10/2/97 | ANTHEM just lowered its payment for Flu Vaccine from $20.70 to $18.63, a drop of $2.07 or exactly 10%. Doctor, if you give 500 of these shots during flu season, your
annual take-home pay just went down by another $1,035 while Anthem's profits increased by the same amount. ------------------ |
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| 9/22/97 | ANTHEM just dropped its reimbursement for Pneumonia Vaccine (90732) from $20.70 to $18.63, a loss of $2.07 or exactly 10%. Doctor, if you give one of these shots every week, Anthem just
made another $95.22 annual profit at your expense. ----------------- |
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| 8/18/97 | Anthem is one of those plans that's been cutting back on physician reimbursements little by little over a long time, slowly; so it's more difficult to detect. Initially they were paying for lab work, then they stopped altogether. Now they've started eroding their Office Visit payments, too; and that bodes ill for the future. Notice the nice, "tidy" 10% reduction. What's next, another 10%? | |||
| ----------- | ||||
| PLEASE BOOKMARK http://home.earthlink.net/~austintxmd and check often for updates | ||||
| NET PHYSICIAN INCOME | |||||||
| ANTHEM (most plans) | |||||||
| ANTHEM NETWORK | |||||||
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| Maximum Number of Each | Click to see ASSUMPTIONS on which these figures are based | ||||||
| You Could Perform | Fee They Pay |
Totals For Year |
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| ___Service____ |
Per Year
|
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| Office Visits (99212) | 4,140 | 37.26 | $154,256 | ||||
| Physical Exams (99215) | 690 | 96.00 | $66,240 | HOURLY | |||
| Total Possible Income from Office Visit Charges--> | $220,496 | $191.74 | Income | ||||
| Total OFFICE OVERHEAD (click)--> | -$206,600 | __-$179.65 | Overhead | ||||
| Net ANNUAL PHYSICIAN INCOME--> | $13,896 | $12.09 | <-- Net HOURLY MD Income | ||||
| Hourly Physician "Wage" (based on an 8-hour day)--> | $7.55 | ||||||
|
(including patient copay) |
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| CPT Code | Description | 1995 Payment | Current Payment | CHANGE | ||
| 99211 | Office Visit, MInimal | 24.15 | 21.74 | -10.0% | Payment For <-- 4 Office Visits |
|
| 99212 | Office Visit (10min.) | 41.40 | 37.26 | -10.0% | $149.04 | |
| 99213 | Office Visit (expanded) | 62.10 | 48.00 | -22.7% | ||
| 99214 | Office Visit (detailed) | 83.84 | 62.00 | -26.0% | Payment For One <-- Physical Exam |
|
| 99215 | Physical Exam (40min.) | 134.55 | 96.00 | -28.7% | $96.00 | |
| 93000 | Electrocardiogram | 53.82 | 35.00 | -35.0% | -$53.04 | <-- What the doctor loses every time he does a thorough physical exam. See "Disincentives to Good Care" |
| 94010 | Pulmonary Function | 72.45 | 40.00 | -44.8% | ||
| 85025 | Complete Blood Count | None | ||||
| 81000 | Urinalysis | 12.95 | 5.00 | -61.4% | ||
| 80061 | Cholesterol/LDL/HDL | None | ||||
| 80019 | Chem-28 Profile | None | ||||
| 88150 | Pap Smear | None | ||||
| --------- | ||||||
| Reprinted from: http://home.earthlink.net/~austintxmd | ||||||
