| HUMANA | |||||
| Humana Network | |||||
| Current rating for PRIMARY CARE PHYSICIAN REIMBURSEMENTS--> | B | ||||
| Their payments for OFFICE VISITS are--> | FAIR | ||||
| Their payments for LAB WORK are--> |
FAIR | ||||
| ---CURRENT RECOMMENDATION--- | |||||
| THE HUMANA NETWORK USED TO TREAT US FAIRLY; HOWEVER, NOW THAT THEY'VE PURCHASED PCA, WE'LL SEE WHAT HAPPENS | |||||
| - | |||||
| ---COMMENTS--- | |||||
| 2/17/98 | The HUMANA network just lowered its payment for an SGOT (Liver Test) from $12 to $7.92, a drop of 34%. If we assume, doctor, that you perform two of these tests a
day to monitor your patients who are taking medicines that might
irritate the liver, then HUMANA just stole another $1,877 from you and added it to their corporate profits the year. -------------- |
||||
| 1/13/98 | HUMANA has lowered its fee for a Complete Blood Count (CBC) from $26 to $24, a drop of 7.7%. Since we assume that you do 1,150 of these a year, doctor, Humana just stole
another $2,300 of your takehome pay and added it to their profits for the year. -------------- |
||||
| 12/10/97 | HUMANA just reduced its payment for a Wet Mount (for fungi) from $11 to $10, a drop of 9%. If we assume you do two of these a day, doctor, Humana just
stole another $460 from you and added it to their corporate profits. -------------- |
||||
| 12/6/97 | HUMANA just lowered its payment for Flu Vaccine for $21 to $12, a drop of 43%. We assume your office will be giving 500 of these shots this
year. Thus Humana just has just stolen another $4,500 right out of your pocket, doctor, and added it to their corporate
profits. To rub salt into this wound, remind yourself that you're the one who has invested the time to educate and remind your patients about the importance of this
immunization; but if those patients have fewer bad cases of flu
because of your conscientiousness, it will be Humana who saves the money they would have spent on treating those flu cases that were avoided
because you did your job right. Humana is thus giving doctors another disincentive (click) to providing proper care; because doctors could be making more money if they didn't "waste
time" encouraging patients to take Flu Vaccine, just let them
get the flu, then charged Humana for taking care of the complications.
America's doctors go right on providing conscientious patient
education and care despite Humana's disincentives while Humana
rakes off more and more profits because of our efforts. It is only because American doctors are committed to excellence,
professionalism, and ethics that Humana can remain profitable.
Humana gets richer: doctors get poor. We save Humana money by doing our jobs well, and they reward
us by cutting our incomes still further. What's wrong with this
picture? -------------- |
||||
| 12/3/97 | HUMANA just lowered its payment for a Pulmonary Function Test from $61 to $45, a drop of 26%. We assume you do 230 of these a year, doctor; so Humana just stole another $3,680 from you and added it to their profits for the year. -------------- |
||||
| 11/5/97 | HUMANA dropped its fee for a 80080 Prostate Panel (PSA) to $69.08, not very much above our actual cost for this test. -------------- |
||||
| 10/30/97 | Humana just lowered its reimbursement for a Tetanus/Diphtheria Booster from $21 to $12, a drop of 43%. If you give one of these shots every other day, doctor, Humana
just took another $1,035 out of your pocket this year and added it to their profits. -------------- |
||||
| 10/16/97 | HUMANA just dropped their payment for a Chem-28 Profile from $25 to $22, a 12% drop. Since we assume you do 1,150 of these a year, Humana just took another $3,450 off your annual take-home pay, doctor, and added it to their
profits. ----------- |
||||
| 9/10/97 | The Humana Network just purchased PCA. This is probably going to mean more Bad News for doctors and patients. |
||||
| 8/18/97 | Humana is not a great payer, but they've been fair up to now; and we haven't seen any fee decreases so far. They pay a fair reimbursement for lab work which helps offset the modest income for Office Visit fees. | ||||
| ----------- | |||||
| PLEASE BOOKMARK http://home.earthlink.net/~austintxmd and check often for updates | |||||
| NET PHYSICIAN INCOME | |||||||
| EMPLOYERS HEALTH INSURANCE | |||||||
| Humana Network | |||||||
|
|
|||||||
| Maximum Number of Each | Click to see ASSUMPTIONS on which these figures are based | ||||||
| You Could Perform | Fee They Pay |
Totals For Year |
|||||
| ___Service____ |
Per Year
|
||||||
| Office Visits (99212) | 4,140 | 35.00 | $144,900 | ||||
| Physical Exams (99215) | 690 | 117.00 | $80,730 | HOURLY | |||
| Total Possible Income from Office Visit Charges--> | $225,630 | $196.20 | Income | ||||
| Total OFFICE OVERHEAD (click)--> | -$206,600 | __-$179.65 | Overhead | ||||
| Net ANNUAL PHYSICIAN INCOME--> | $19,030 | $16.55 | <-- Net HOURLY MD Income | ||||
| Hourly Physician "Wage" (based on an 8-hour day)--> | $10.34 | ||||||
|
(including patient copay) |
||||||
| CPT Code | Description | 1995 Payment | Current Payment | CHANGE | ||
| 99211 | Office Visit, MInimal | 20.00 | 20.00 | Payment For <-- 4 Office Visits |
||
| 99212 | Office Visit (10min.) | 35.00 | 35.00 | $140 | ||
| 99213 | Office Visit (expanded) | 53.00 | 53.00 | |||
| 99214 | Office Visit (detailed) | 79.00 | 79.00 | Payment For One <-- Physical Exam |
||
| 99215 | Physical Exam (40min.) | 117.00 | $117.00 | |||
| 93000 | Electrocardiogram | 46.00 | 46.00 | -$23.00 | <-- What the doctor loses every time he does a thorough physical exam. See "Disincentives to Good Care" | |
| 94010 | Pulmonary Function | 61.00 | 45.00 | -26.2% | ||
| 85025 | Complete Blood Count | 26.00 | 24.00 | -7.7% | ||
| 81000 | Urinalysis | 9.00 | 9.00 | |||
| 80061 | Cholesterol/LDL/HDL | 56.00 | 56.00 | |||
| 80019 | Chem-28 Profile | 22.00 | 22.00 | |||
| 88150 | Pap Smear | 17.00 | 17.00 | |||
| --------- | ||||||
| Reprinted from: http://home.earthlink.net/~austintxmd | ||||||
