Alejandro Badia, MD

I love Dr. Oz. His admirers spent this week hunting for waste in American healthcare and somehow all arrived at a physician's office. I own the expensive building. Nobody rang. @mitchellvii wrote an imaginary conversation in which a physician confessed to ripping off Medicare. He even supplied the patient, the physician, the confession, and the applause for Dr. Oz. An entire investigation without the inconvenience of contacting anyone. His post carried a "Paid partnership" label. I appreciate a man who collects for his work while explaining why physicians deserve less for theirs. I hope his sponsor paid separately for the patient, the physician, and the confession. I would hate to discover overlapping services. @BuzzPatterson Patterson called the billing a healthcare rip-off.Grage thanked the administration for cutting unnecessary spending. My twin brother, Dutch, insists on discussing the billing rules, which I consider an unnecessarily hostile response to a perfectly good headline. According to Dutch, Medicare already pays for routine evaluation inside a minor procedure's payment. Separate payment requires significant, separately identifiable work. Dutch says a great many things. 𝐔𝐧𝐟𝐨𝐫𝐭𝐮𝐧𝐚𝐭𝐞𝐥𝐲, 𝐞𝐱𝐩𝐥𝐚𝐢𝐧𝐢𝐧𝐠 𝐚𝐧𝐲 𝐨𝐟 𝐭𝐡𝐢𝐬 𝐭𝐚𝐤𝐞𝐬 𝐥𝐨𝐧𝐠𝐞𝐫 𝐭𝐡𝐚𝐧 𝐬𝐚𝐲𝐢𝐧𝐠 "𝐜𝐫𝐨𝐨𝐤𝐞𝐝 𝐝𝐨𝐜𝐭𝐨𝐫𝐬." For 2027, CMS proposes that when a physician performs a procedure and a separate office evaluation on the same day, the highest-valued service gets full payment. The others get half. I admire a policy that makes finishing the appointment financially questionable. Imagine a woman who needs both. Her physician can complete them today. Her daughter has already taken the afternoon off to drive her. Complete the work today, and the reduction applies. Schedule it on different days, and it disappears. The calendar has cured the duplication. The woman gets another trip. Her daughter gets another conversation with her supervisor. Her lost wages do not appear in Medicare's payment table. Very thoughtful of her. Of course, there is another place the patient could go. Mine. MedPAC's 2024 example showed about $165 for a skin-lesion procedure in a physician's office and $404 in a hospital outpatient department. The hospital total included $97 for the professional service and $307 through the hospital outpatient payment system. I encourage readers to linger over the $307. It has a lovely view. This cut can reach the physician's payment in my hospital, too. It does not touch my separate hospital payment. My building continues to make a contribution to the encounter. It stands there. The American Hospital Association opposed the cut. It warned that paying less for same-day care would fragment care and reduce access. The association also wants to preserve restrictions on physician-owned hospitals. Keeping a competing hospital from opening while explaining your commitment to access takes a command of English that I will never stop respecting. Fortunately, the internet is busy investigating the mole. 𝐌𝐲 𝐛𝐫𝐨𝐭𝐡𝐞𝐫 𝐰𝐚𝐧𝐭𝐬 𝐭𝐡𝐞 𝐰𝐨𝐦𝐚𝐧 𝐭𝐫𝐞𝐚𝐭𝐞𝐝 𝐢𝐧 𝐨𝐧𝐞 𝐯𝐢𝐬𝐢𝐭 𝐚𝐧𝐝 𝐭𝐡𝐞 𝐩𝐡𝐲𝐬𝐢𝐜𝐢𝐚𝐧 𝐭𝐨 𝐫𝐞𝐦𝐚𝐢𝐧 𝐢𝐧𝐝𝐞𝐩𝐞𝐧𝐝𝐞𝐧𝐭. 𝐇𝐞 𝐢𝐬 𝐞𝐱𝐡𝐚𝐮𝐬𝐭𝐢𝐧𝐠 𝐚𝐭 𝐟𝐚𝐦𝐢𝐥𝐲 𝐠𝐚𝐭𝐡𝐞𝐫𝐢𝐧𝐠𝐬. If the physician eventually gives up, I would be delighted to discuss employment. We could put my name on the door. The patient might even recognize him. And when she asks why receiving care through a hospital costs more, I will explain the complexity of American medicine until she apologizes for asking. Nobody will call that a confession. Thank you, Dr. Oz. Your admirers have made the physician's office the most suspicious building on the street. Please tell the woman we can see her next Tuesday. Bring her daughter. We validate parking. -Rojas out.