Monday, January 16, 2012

Bad Journalist Feels Sympathy for Bad Doctors

This CNN Money article about doctors going broke
has been making the rounds online. Even from the little snippet on Facebook, the story seemed dubious. After reading the whole thing, I'm reassured that my bullshit detector is still well calibrated. I'm not sure which is more disturbing--the shoddy journalism or the shady doctors.

The article starts out with this:
Doctors in America are harboring an embarrassing secret: Many of them are going broke. This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.
At this point, a competent journalist would include some sort of data to back up those rather extraordinary claims. A competent editor would demand such evidence before publishing the story. Exactly how many doctors are going broke? How are you measuring this nationwide spread? Unfortunately, Parija Kavilanz is not a competent journalist, and CNN Money is lacking competent editors, so I'll have to step in.

Based on the evidence presented, the number of doctors in America who are going broke is 3. The claim that this "quiet reality" is spreading nationwide is because those 3 are comprised of 1 doctor in Pennsylvania + 1 doctor in Minnesota + 1 doctor in Nevada. The claim that this quiet reality "is claiming a wide range of casualties, including family physicians, cardiologists and oncologists" is because those 3 are comprised of 1 family physician + 1 cardiologist + 1 oncologist. No wonder their reality is so quiet.

The article is clearly aimed at generating sympathy for doctors whose Medicare reimbursement rates have fallen, yet CNN Money does a piss-poor job of this by their selection of doctors. Far from making me sympathetic, the thought of these so-called professionals going broke makes me rejoice.

One of the three doctors is an oncologist. His problem:
He owes drug companies $1.6 million, which he wasn't reimbursed for.
What? That seems strange. Why would the oncologist owe money to the drug companies?
Until the mid-2000's, drugs sales were big profit generators for oncologists. In oncology, doctors were allowed to profit from drug sales. So doctors would buy expensive cancer drugs at bulk prices from drugmakers and then sell them at much higher prices to their patients. In 2005, Medicare revised the reimbursement guidelines for cancer drugs, which effectively made reimbursements for many expensive cancer drugs fall to less than the actual cost of the drugs.
Oh. Who knew that oncologists were allowed to profit from the drugs they prescribed to cancer patients? No conflict of interest there. For example, surely a doctor wouldn't prescribe a Pfizer drug over a Merck drug just because he had a warehouse full of bulk-rate Pfizer drugs. After all, medicine is a noble and honorable profession.

Now, after years of gouging his cancer patients...his CANCER patients!...he's complaining because he got stuck with a warehouse full of drugs whose street value dropped.
"I grew up in that system. I was spending $1.5 million a month on buying treatment drugs."
Notice the sense of entitlement. He grew up in a corrupt system, so it's just unfair to change it now -- as if the unethical conflict of interest was forced upon him, rather than greedily embraced.

The family practice doctor from rural Nevada is nearly as bad. His solution to his financial problem, in his own words, is to intentionally compromise the level of service provided to his patients.
"I will see more patients, but I won't check all of their complaints at one time," he explained. "If I do, insurance will bundle my reimbursement into one payment." Patients will have to make repeat visits -- an arrangement that he acknowledges is "inconvenient." "This system pits doctor against patient," he said. "But it's the only way to beat the system and get paid."
He admits it's "inconvenient" for the patient, but beating the system and getting paid--that's what it's about.

These two are perfect examples of why our health care system needs massive reform. If doctors like these are going bankrupt, we just might be making progress. If we ever see drug company profits merely approaching single digits, we'll really be getting somewhere.