Financial Reimbursement: Not the Only Measure of Value in a Physician’s Workday

One of my coworkers introduced me to a button in our EHR that has caused me no end of frustration, discouragement, and disillusionment. The button is called “financial” but should actually be entitled “the clearest illustration of everything that is wrong with our healthcare system.”

Once I complete my billing - entering the E&M code and/or any procedures I do - I can click on the financial tab to see what the bill will be for the combination of the services provided to the patient. As a family physician, I am hardly shocked by the notion that our current reimbursement approach weighs procedural work more heavily than cognitive work.  What does shock me is how much the system financially values my procedural work compared with my cognitive work.  

Truthfully, I don’t really understand all the training, risk, and “work” involved in a total hip replacement or a hysterectomy.  Maybe it really is worth $20,000 or whatever the going rate is. But, I do know the difference in the “work” I do between managing a patient with out-of-control diabetes and removing an intrauterine device. For which, by the way, I get paid approximately the same. 

I realize that it took training for me to get to the point where I can remove an IUD in 23 seconds and there is a certain element of risk in any procedure. But I also know the immense difference in training requirements and risk that exists between removing an IUD, lancing an abscess, freezing a wart, managing diabetes, differentiating between an intracranial bleed and a migraine, and evaluating a patient with chest pain. 

The financial tab button in my EHR represents the multiple manifestations of imbalance in our healthcare system. Try as I might to ignore the button and return to my previous level of happy ignorance, I can’t help torturing myself over and over again with the painful smack of just how little my hardest work is financially valued.

But, this is the take-home lesson for me. It’s not about what CMS or Blue Cross/Blue Shield values, it’s about what I value. I’m not a family physician for the money, although even as one of the lowest paid specialties, I make a fantastic living. I’m a family physician because it makes me happy and satisfied to practice this particular medical specialty. So, if I’m clicking on that financial tab as a way to measure the value of what I did in clinic that day, I am - and I mean this in the nicest possible way - an idiot. It’s the equivalent of reading People magazine to determine whether I’m doing a good job raising my kids.

In the balance of work and life, it can be difficult to see the true value of the choices we make - whether to pursue a financially-less-lucrative specialty or to choose to work fewer hours or to choose to live in a certain part of the country - if we look to external indicators of value. The only check we should make to determine the value of a choice or the work we do is the internal check we do with ourselves.

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