"How old was that last patient?"
"67. I don't think we've seen a Medicare patient for over two months. They're dropping like flies!"
"I know, but at least we get paid. With the surplus funds Medicare is building up, they can afford to pay about $1000 for a sinus film."
"Are your vaccines up to date? Don't touch the film cassette."
God I love this country! Where else can a company actually own the patent on two naturally occurring cancer genes? Myriad Genetics of Salt Lake City was granted a patent over 10 years ago by the U.S. Patent Office for BRCA1 and BRCA2. Even though other companies can do the test more quickly and for less money, because Myriad owns the patent, it alone gets to charge $3000 for each test and doesn't allow patients to get a second opinion from any other lab. Sweet! In fact, there are already thousands of human genes involved in patent claims, supposedly 20% of the human genome! How can you get in on this bonanza? Read on.
Phil Holtzman, a part-time DJ, lives across the San Francisco Bay from me in Berkeley. The May 12 edition of The Wall Street Journal reports that he is breeding in his attic viruses he collects from the sewers so that they can actually live in the higher temperature of the human body. Is that really wise, Phil? Ms. Katherine Aull, a recent graduate of MIT (my alma mater) who is mentioned in the same article, is growing bioengineered strains of Escherichia coli in her closet. Katherine, isn't E coli one of the most frequent causes of death in food poisoning cases?
Amazingly, a whole world of biohackers is out there breeding genetically engineered viruses and bacteria using cheap equipment salvaged on e-Bay that could be putting all of us at risk—at risk of getting rich, that is. Right now, you can get the entire genome of Ebolavirus and smallpox online. No, Ebola and Small Pox are not porn star names.
So what does this have to do with radiology? Well, I can't help but worry that with Medicare going bankrupt in eight years and our crippling deficit/national debt, there just won't be enough money to pay decent doctor fees. No, the government won't let Medicare go bankrupt and will eventually step in. But still, with all the baby boomers retiring and fewer workers making Medicare payroll contributions, there just won't be enough money.
The solution is either more people contributing or fewer people consuming. Genetically engineered germs will take care of the last half of that equation. I would be happy to help increase the birth rate, but there's only so much one man can do. And since I don't think the pope is going to be our next president, Congress is not going to outlaw condoms and the pill or start giving out Viagra and fertility drugs for free, so we have to find another way out of this mess. Therefore, I am myself working on a hybrid between the common cold virus and the ebola virus in my garage.
There are numerous upsides to such chimera, at least once I get the virus patented, because then I can not only charge whatever I want for the test to diagnose it, but also control any vaccine development and its fee. I love this country. There are some minor downsides, of course. One is that I am running out of neighbors' pets on which to test my viruses, and one of them now looks like Jeff Goldblum in The Fly. He may have ingested the FedEx guy.
I'm doing this because I have had a preview of what is coming in eight years, since the clinic where I have received all of my healthcare just went bankrupt. Insurance payments were just not covering their expenses—and that was with a doctor seeing patients at the rate of one every 15 seconds (God help you if you were actually sick). I think this is in keeping with the prevailing logic behind most government-based fee adjustments: that doctors will make up any lost revenue by increasing their patient volume. Believe me, a hernia exam at that rate can dislodge your fillings.
This also explains why I am now looking at one of the new concierge medical practices to replace my previous doctor. For $1800 to $2400 a year, or the equivalent of a top-of-the-line Starbucks coffee per day, I can get same-day appointments, house calls, the direct cell phone number of my doctor with 24/7 access, and appointments that can last an hour—as opposed to group appointments where patients with like symptoms are ganged together and seen all at once.
For many airlines, the difference between a money-making versus a money-losing flight may be just one first class or business class ticket, so the airlines have been some of the greatest innovators with regards to ticket pricing. They've introduced such ideas as "demand pricing," where the cost goes up based upon actual demand, as well as charging more for selected exit row seats with extra leg room, or additional fees for baggage handling and meals.
For radiology practices, appointments on Mondays and Fridays are often in high demand, as are the very early, lunchtime, and very late in the day slots, since people want to limit how much work they have to miss. Same-day appointments are also a high-demand item. Most practices always keep some emergency slots free, so why not charge an extra "premium scheduling" fee for these?
People are willing to pay all kinds of extra fees for improved service, why shouldn't radiologists take them up on it? Granted, when groups have tried to bill Medicare patients for the part of the fee that Medicare did not cover, the government has ruled against them. But that was because patients didn't have the option to choose not to participate and because of the way Medicare rules are written. With this new pricing structure, you are not refusing to do a study, and you are not charging more for the study. Instead, you could just pocket the difference between doing the study today at noon—for a $50 premium scheduling fee—and waiting till later in the week and doing it midafternoon. I am also confident that given the choice between a recycled barium enema tip and a new one, most people would be more than willing to pay for the new one. And who wouldn't want to pay for the use of a dressing room rather than changing in the waiting room?
Granted, all these ideas may not pass muster, but you need to at least start brainstorming and planning for the tsunami of changes that are heading our way, which include nationalized healthcare and a bankrupt Medicare, otherwise you will likely be overwhelmed by it. My doctor's clinic had no better plan than just seeing more patients. This didn't work, and they went bankrupt.
You might also want to invest in some industrial strength hand sanitizer and masks. And remember to keep your pets indoors—and probably mom and dad—because I need additional clinical confirmation before I file for my patent.
