- Reviewed/Returned email from patient 15 minutes
- Phone call to Radiologist X who read film and reviewed with me 30 minutes
- Reviewed chart sent by PMDs office 60 minutes
- Literature review regarding disease X 20 minutes
- Phone conference with PMD re: differential diagnosis and plan 20 minutes
- Confirmed appointment with patient and discussed concerns 15 minutes
- Appointment with patient 80 minutes
- Total Hours 4 hours
- At 325$ per hour and 10% Professional Discount 1170 USD
What does insurance pay? 256 USD dollars, I hope you can see why the system is failing.........
Why in the world would any VC want to fund such a labor intensive service......Insurance sure as hell tries not to. Why do I say this? Because every single other professional in the US bills and gets paid this way but not the doctors.......in fact, for every person who pays for these services we could serve probably another 1 or 2 patients pro-bono.
So what happens when a patient wants a DTC test with a doctor interpretation?
Good question....I am not certain how one would bill for interpretation of a 1 million SNP scan. I guess you would have to take a family history and look for a diagnosis....Heck, if the patient walked in the door, you couldn't even bill for a 99245, you would have to bill for an in office evaluation which pays even less than the 256$.....
But here is the problem......most patients don't want to be hackers.....most patients want to speak with a doctor......preferably a doctor who knows what the test they just took means......
So I ask you.....Is it really greedy to ask for 1000 USD for an intake? Especially when billing insurance means you can't spend the time you would like on the case, or even worse, if you do spend that time today......will you be in business tomorrow???? A classic example.....DNA Direct charges 3456 for BRCA full sequencing, yet Myriad only charges 3120 dollars. Because they don't mark up their test, the 2 mandatory genetic ocunseling sessions at DNA Direct cost 356 USD.....if insurance paid for that it would be 120 USD.....No business can afford to use insurance to reimburse for Genetic Services........period! Interestingly Myriad cuts the cost for NIH research to 2500 USD..... So one really wonders what the test costs.....I know for sure what the manpower cost for evaluation is!
The Sherpa Says: To really get personalized healthcare we need to radically change how healthcare is funded. The paper pushing...the coding....the lack of pay......they all need to go away......or heck, maybe someone could just automate all of that crap and let us get back to caring for people, NOT ICD9's.......