Amid Nationwide Doctor Shortage, Canada Turns To DIY Pap Smears

Well you may not believe it but it’s true.
Having been a PA for 25 years that’s the way it is.

Medicare pays at 85% the MD rate unless the MD actually sees the patient as well. The first ER group I worked for billed as if the MD also saw everyone but then got nabbed when there was no documentation of the MD seeing the patients.

When I worked in the ER my billables were in the upper 15% of our group and we made 25%-30% of what the MDs made. Much of the time there were more PAs on shift than MDs.

Insurance companies pay very little for general office visits as it is, and there isn’t an unlimited supply of mid levels.

 

Mind you, I'm just trying to understand. You're telling me PA's make roughly 25%-30% of what MD's make (believable), but the doctor's office bills the patient/private insurance companies the same rate whether it's a PA or MD regardless? And if it's a PA, the medical practice pockets the difference? Sorry man, I find that truly hard to believe if that's what you're saying. Not unbelievable that physicians would look to expand their profits, but that insurance companies would miss that and still pay out benefits per the usual rate is hard to believe.

 

In Canada you can do your own Pap smear. But you’ll have to get a friend to remove your staples …

Jann Arden says Alberta hospital made her clean her own head wound | National Post

 

Drives me crazy we can’t get a cheap at home strep test kit!

 

This is really off the issue. But if you want to bring it up…you need to then look up the obesity rate for the two countries. Let me know how that goes.

If really is crazy how high the US life expectancy is considering how unhealthy our population is and the food industry that controls us…

 

I took it that if the office is contracted to get $100 for a doctor seeing a patient and a PA saw the patient the insurance would pay $85 but if a MD was there they would pay $100.

Could be wrong. But that is how I took it. Now my guess is there are two codes and the PA code is 85% of the Doctor code. So the office is supposed to bill based on the service. That is likely the technical way it is done.

I would assume that doctors are doing procedures the PAs are not doing as well and that will increase their billable to be quite a bit more than a PA.

 

I would assume it is the doctors office. For routine visits they are likely going to rely heavily on the PAs. Who are great. They want the doctors in surgery where the bigger dollars will be. But that does not mean you can’t request a doctor instead. But they probably have a lot fewer standard check slots open in a week. Just a guess.

But confident the insurance company is not determining whether you see a PA or MD/DO…

 

So glad we are in dentistry. And shifting to Integrative Dental Medicine. It is so awesome to see patients getting healthy in ways that will provide them a longer and healthier life!

Insurance is a complete mess though. In dental we are more discount plans that really only make sense if your employer offers them imo. Had a long conversation today with a patient who hates the corporate practice they are at but we stopped contracting with Delta as of May 31st last year. So they went back to the corporate. Now they are trying to figure out what to do. They are trained they need insurance. And I did my best to explain there is really not a lot of benefit in the plan they had. It is crazy sometimes what the individual plans pay! Now the corporates have surly been able to negotiate higher contracted fees. I know this from MetLife who was paying a corporate 50% to 100% as much as us a mile down the road on some of the common procedures. We stopped contracting with MetLife after we were allowed to reopen from Covid. And now most of those policies still cover our fees in preventive. Delta is a different animal though.

Sorry for the ramble lol. But I actually got caught in a discussion on the dental side today.

 

It was in direct response to another post suggesting that Canadians were dying waiting for healthcare and yes I am aware that several factors contribute to life expectancy including obesity. By the way paraphrasing one of wife's Canadian cousins, the Canadian healthcare system is very good if one has a serious condition requiring immediate care, it sucks for elective procedures because of long waits.

 

Our system is very good in both. Just a complete mess in billing. If we are looking at if from the standpoint of just care we do a great job.

Now if we back up and look at the real big picture. The root of our problem is the food industry if you ask me.

 

Just telling you how it was in the ER man.
Medicare reimbursement was 85% of the MD charge.
It’s based on the level of service and if a mid level can legally do the care associated with that it makes no difference what their degree is.

Go look at some bills from your doctor and see if there’s a difference…

 

Medicare was the only “insurance “ that paid at a lower rate for mid levels.
Now if the MD charts they had any interaction”face time”it’s bill at the MD rate.

If you’ve been to an ER look at the bill the provider is almost always listed.

 

Are there two codes for Medicare (one for mid level and one for MD/DO)? Just curious…

 

Quite a bit of the health care in my small town is done by PA. Doctors come here but leave as soon as they can find a job in a larger town. My wife and I have lived here 4.5 years and between us we have had 5 doctors and 3 PAs. Wife is PA strictly PA now.

 

And this is also about Alberta.

HINTON, Alberta — When Bryan Keith was diagnosed with prostate cancer three years ago, he underwent a blizzard of tests, specialist consultations, a month of radiation treatment and a surgical procedure. His out-of-pocket costs? Zero.

Residents of rural Hinton give their system high marks, with several recounting complex medical ordeals that cost them nearly nothing out of pocket — but that might have set back American consumers by thousands or tens of thousands of dollars, depending on their coverage.
There was Samantha Ellen Gordon’s premature daughter who needed three surgeries and a nearly six-month hospital stay two years ago, and then the May delivery of her second daughter via emergency Caesarean section. There was Rick Zroback’s eye surgery to remove “floaters,” or spots in his vision, and Morris Archibald’s full hip replacement. And there were Helena Christensen’s C-sections, and multiple emergency room trips with one of her sons, including a three-week hospital stay for pneumonia.
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Even a Canadian with a relatively bad experience with the Canadian system still wouldn't trade it for the American system of healthcare:

Morris Archibald, 66, a retired forester, waited nearly a year for his hip replacement. He said he could not walk a block, and he grew depressed because he could not participate in the outdoor sports he loves and that are his main pastime. “It got to the point where we worried about his state of mind,” Jodi Archibald said

The couple even explored having the surgery in the United States but abandoned that idea after discovering that it would cost tens of thousands of dollars. Despite that experience, Morris Archibald said he would never trade his Canadian health care for U.S. health insurance. “I still think our system is far superior,” he said.

Canada has better health outcomes than the United States while spending far less on care. Canadians’ life expectancy is 82 on average — more than three years longer than Americans’, according to a 2019 report from the Organization for Economic Cooperation and Development (OECD) based on 2017 data. It [Canada] also boasts a far lower rate of deaths from treatable causes, at 59 per 100,000 residents, compared with 88 per 100,000 residents in the United States. The infant mortality rate in Canada is 4.5 per 1,000 live births, compared with the U.S. rate of 5.8.​

https://www.washingtonpost.com/heal...71c78e-d4d6-11e9-9610-fb56c5522e1c_story.html

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The role of a PA is to assist a Doctor not pretend to be one (not that your wife dies that). Many PA’s think they are physicians.

 

Codes are typical diagnostic codes going to the illness and then there are also modifier codes.
procedures have codes as well.
Never in any of our numerous in-services did the billers discuss different codes for mid-levels vs MD.

Our bonuses were based on an RVU metric where various level of care was given so many points.
Guys that saw more patients and did more procedures always had way more RVUs than others.
Fast track which was only ever staffed by a PA always had very high RVUs because the volume of patients and often that’s where stuff like lacerations and fractures were seen.

One of the PA’s I worked with years ago was able to look up his Medicare billing over a few years time and tried to negotiate his pay on a %, TPTB were none to happy when he started talking about how much they were billing for our work…

Link regarding PA reimbursement.
https://www.aapa.org/wp-content/uploads/2017/01/Third_party_payment_2017_FINAL.pdf

 

Please tell us you don’t know what you are talking about without just saying it out loud.

 

I’ve certainly identified one of the pretenders.

 

I don’t think anyone has a handle on why America’s life expectancy is less than peer countries. Similarities cut across all age, income and ethnic groups.

I posit the elephant in the room: healthcare*

*not a lack of it, rather too much of it.