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Video Transcript: How Medicare Doctors are Paid to Keep You Sick
Dr. Irvin Sahni: The bottom line is this. Doctors are incentivized the wrong way in my opinion; they’re incentivized the wrong way. So if you believe that the goal is to prevent disease to begin with rather than just simply treat it once it occurs. In other words, if you believe that being proactive is more important than being reactive, then you would agree with what I’m about to say.
If I see a patient who has Medicare, just because so many doctors see Medicare and the fee schedule is constant, I will bill Medicare based on certain variables. And some of those—it’s very complicated, of course, just like the tax code is very complicated.
But to simplify, there’s two very commonly used codes: it’s a 99213 and a 99214. A 99213 is just an evaluation visit, an existing patient I’ve been seeing them for years. And when he comes in I can bill a 992—a 12345, okay, almost never a one, almost never a five, things usually lay in the middle depending on what kind of doctor you are and how sick your patients are.
But an average, normal person comes in and I’m going to bill Medicare. If I bill Medicare at 99213 in Texas right now you get about 40 bucks. If I bill Medicare a 99214 I get about a 100 dollars – pretty big spread there. Sixty dollars is quite a bit. So if there’s something you could do to get an extra 60 dollars you’re going to do it.
One way I can convert a 99213 to a—it’s not totally simple. You have to have asked a lot of other questions, but the bottom line is at the very end you have to show medical decision making. It’s called medical decision making.
So I can sit there and ask a bazillion questions. But if I just say “take an aspirin” and I’ll never see you again, a 99214 would be inappropriate because you haven’t done anything. You haven’t used your brain. So assuming all the right questions are asked up to that last step I would then—if I make a difficult decision, okay, then I get paid more for making that difficult decision.
And if I don’t, I have to down code that. So what are the ways to convert a 99213 to a 4? One is I can sit there for exactly 45 minutes and document that and educate that patient. I can talk to them about diet, nutrition, far infrared sauna, whatever I want. I can sit there for a full 45 minutes and have a completely valid conversation that Medicare would have no problem with.
Ty Bollinger: You wouldn’t get as many patients then.
Dr. Irvin Sahni: I wouldn’t get so many patients that way. But if I simply change a drug, if I change their blood pressure medication, I change their pain medication, I change their diabetes medication, or I sign them up for a procedure. I’m a proceduralist, I do do a lot of procedures. If I sign them up for a procedure, that dictates higher level of medical decision making − I instantly I go to a 99214.
Let’s focus on the medicine side because so many doctors do that. Well, what are people going to do? I mean we all have bills to pay, right? And so if I can see ten patients an hour by simply flipping from one drug to the next and make a thousand dollars by seeing—well ten patients in an hour would be a lot so maybe I’m exaggerating. But let’s say four patients an hour. If I could see four patients an hour and just flip some drugs, I just billed out 400 dollars.
Or, I could sit there and actually educate the patient, try to help them prevent their disease, to truly find solutions, true healthcare solutions, but I’m only going to get that extra 60 dollars and I’m going to spend 45 minutes doing that.
So doctors are unfortunately put in a position where, number one… The patients also, by the way, don’t want to hear a lot of times how they need to lose weight, quit smoking, change their lifestyle. Some do, some don’t.
I mean I don’t want to be unfair, but the doctors also don’t want to take that time to do that because they can make so much more money. I’m not trying to beat on doctors here. I’m really not. This is just, you know, if you’re a mechanic and you can fix alternators for 100 dollars a pop and you can put air in tires for five dollars a pop and they take the same time… where do you think you’re going to put your efforts, right?
Certainly there’s doctors that are very altruistic and do mission work and things like that. But I mean most doctors are trying to make a living. The system is designed to create chronic disease. There’s no money in being healthy. There’s no money in being dead. All the money is in being chronically ill.
The way the remuneration works for physicians, even with Medicare, is that it encourages more drugs to be written, switch from one drug to the next. You know, “get out of here.” 15 seconds I’m done. 99214.
By design I feel like the system is flawed. And who do you think is paying the congress people money for their next election campaign? Some small town doctor who’s trying to educate people on how to lose weight… or Pfizer or Merck? And I’m not picking on any specific company here. But it’s just simply true. That’s where the money comes from.
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We are beginning to experience this – have been discussing and questioning why 3-4 month repeat visits are necessary when docs are just “talking” to you while checking info on their computers. No longer are there actual physicals done unless requested and you pay extra for al thorough exam!
Jeff Smith says
I fully agree. I am 100 years old Canadian and keep myself extremely fit and rarely see a doctor, because of that I am penalized and pay for health care. The government does not give a choice to get out of the system and save health tax to better look after myself. Obviously, Doctors, Drugs and capitalist politicians work hand in hand.Proud of you doctor for speaking up
Randi nowell says
Thanks for publishing this video article.. Even though I’m not on Medicare my parents are. Knowledge is power!!!!
No new information here. Allopathic medicine has always been about the money; wellness isn’t even on the radar. That’s why patients who do get well, usually do all the research and experimentation themselves.
Or like me, even diagnose your own selt. I figured it out myself and had my doctor run the tests, which confirmed my diagnosis. And I had gone to this doctor for 20 years! I had the condition for many more years, starting at the age of 9 and none of the quack pediatricians twigged on it either.
Silvia Logan says
The chemotherapy, radiation therapy, and all the cancer drugs that doctors prescribe to their patients just make them sicker and the cancer does not disappear. Their cancer just grows and gets worse. I have heard that many terminal cancer patients who have done a lot of research online, did much better with their alternative therapies than with the conventional therapies. They have said that when they have tried vitamin B-17 supplements, apricot seeds, probiotics, cannabis oil, hemp oil, a raw vegan and fruit diet, juicing, acupuncture, yoga, meditation, alternative treatments in Mexico, holistic music, 2 tablespoons of cottage cheese with one tablespoon of flax seed oil, frankincense oil, saunas, one teaspoon of baking soda with one tablespoon of molasses, wheatgrass, and essiac tea, all their cancer in many parts of their body has disappeared and never came back. I have heard that they are trying immunotherapy and viral therapy in clinical trials that are much milder than chemotherapy and radiation therapy, because the immunotherapy and viral therapy attack cancer cells and leave healthy cells alone. With those gentler therapies, you do not lose your hair, feel nauseous, vomit, feel numbness in your feet and hands, nor develop cold sores in your mouth. Some people with stage 4 cancer tried them and all their cancer had disappeared and felt well again.
this is scarey. I feel blessed to live in UK with an NHS where doctors are salaried, rather than paid per procedure. I had a rare tumour cut out of my scalp. My dermatologist sent me to an oncologist who asked me why I had requested chemotherapy!! I told him I hadn’t, and wouldn’t want it if offered, because everyone knows that’s what kills you. He is not supposed to admit this, but he looked me in the eye and silently nodded in agreement. He then said he was very pleased that I didn’t want it. On subsequent follow-ups, he has been very generous with his time, and we discuss how ridiculous it is to have the oncology shop selling sweets and crisps, and we also discuss chemo and his other patients in general. He agreed that chemo kills good cells and anyway stops working after a while, then they try a different chemo drug, and after the third chemo drug the patient dies! I’m so glad I choose to go along the good nutrition route, with info found in TTAC.
I also read that the new immunotherapy costs $150,000 and you know insurance will balk at that. Also the text of Obamacare that was just released states that those who are over 76 will have cancer treatments rationed. Also good luck getting an organ transplant at that age even if you are strong . Remember people are losing kidneys, livers & hearts from reactions to pharmaceuticals everyday.
Yes very true. I’m vegetarian for now eighteen years. Never been sick. Not even a cold. Eat well drink a lot of water it will prevent disease’s. God Bless us all.
Nafsica Kelly says
I am not a vegetarian. My health is my wealth. I am what I eat. I advice using all your options, which include your inner ability to heal as well as what science can offer. Readers should further recognise that the information and material presented in books and the internet is not intended nor implied to be substituted for professional medical advice, it is provided for educational purpose only. Readers should promptly consult thier family GP or other health care providers and never disregard medical or professional advice or delay seeking it, because of something they read on the facebook page. Our creator has given us five senses to help us survive therats from the external world, and the sixth sense our healing system, to help us survive internal threats. There is must that we can do, as individuals, to activate or impede this healing system, just as we can choose to confront danger or close our eyes.
H Bruce says
So it is obvious to me that we have to fight this. Sitting back and letting them kill us, is that really an option? NO!
Richard Flynn says
Stop letting big money and groups like ALEC write any policy period.
Teresa Werner says
It’s just outrageous. I was told after the first biopsy that the cells were benign. (Oh, but they didn’t feel certain, so they insisted that I have another biopsy). Yes, of course they found cancer. About that time, after spending almost $2,000 on co-pays, (I have ‘good’ insurance) I dumped the ‘medical industry’ encouraged by Ty’s “Truth about Cancer” series. I now see a Homeopathic doctor who is willing to help me with my alternative therapies. Thankfully, I saw the series before they had a chance to cut and poison me. I knew I couldn’t go through with even MEETING the oncologist. I am very grateful for Ty’s work on our behalf.
We’ve been indoctrinated (for several+ generations) that when you get sick, see a doctor and get a pill to take care of it. We’ve allowed ourselves to be dummyed down in every way possible from public education to all the marketing ploys (and outright lies) to get us to buy their products. The medical profession is for all intents and purposes controlled by Big Pharma. Why else would lifetime type drugs be given to 6 year olds? Why are thresholds for various body readings lowered that results in putting millions more people on drugs? When they say, “Follow the money”, that’s exactly where it leads. Until people begin realizing doctors aren’t gods and take personal responsibility for their own health, this mess will continue.
I have suspected something like this was going on. I am an overall very healthy 67 y/o woman and my doctor is forever trying to write prescriptions for one thing and another. I do not get the benefit of discussion regarding alternatives and am made to feel like I am the crazy one, ‘playing Russian Roulette with my health’. How do I find a doctor who won’t do this?
Marian Black says
Read the book: “Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients” Jun 23, 2006
by Ray Moynihan and Alan Cassels
Sandy Barringer says
I am 72 and do my own diagnosing since allopathic medicine did not find the cause of the problems I was having. I found the cause. My doctor says I am the healthiest 72 year old he knows while noting from my records that I don’t do vaccines, nor any diagnostics that use radiation, am on a Celiac’s diet because I “supposedly” have Celiac’s disease. He says supposedly because I did not allow the tests they use to confirm the Celiac’s disease as this required that I consume gluten containing goods again. NO THANKS! It took years to clear my system of gluten and as a result no longer have any symptoms that go with Celiac’s. Think I’ll start eating gluten again so that they can “prove”, by their measure, that I truly do have Celiac’s . Ain’t gonna happen. Bottom line. do your own thinking and research (answers are out there) do NOT rely on anyone in allopathic medicine. they truly do want to keep you sick.
Sounds like you are talking about my experience! $%#!&! doctors can no longer diagnose by symptoms, they think numbers on a lab test sheet are all that matters.
Dhrubajyoti Kashyap says
Like to thank Natural News for keeping us updated with Natural stuff .
Friends start now go natural, Aloevera (detoxifying, cell generation) Omega 3, Bee pollen(complete nutrition )
Dude….any old person with a brain on Medicare will not go to your office or in any other quack’s office as they instantly know they are being taken for a ride. The key ? stay away from the medical community. Take care of yourself, educate yourself and forget the ” doctor ” will fix my problem attitude.They do not but simply make a living out of your problems. You still have your problems…..but they capitalize on your vulnerability and ignorance.
Bebo Gracin says
Does anyone disagree with anything this website says? The fact I don’t see anyone disagreeing with any of this makes me a a little suspicious of this website’s content and the remarks made by everyone here.
Dorothy Derakhshani says
I do not agree that all chemotherapy and cancer surgery is a bad idea. I was stage 3C ovarian cancer and was too fearful to hold off treatment while I researched alternatives. I did however, have a integrative physician who helped me while I was doing the chemo and afterwards, and his recommendations are part of why I am still here 7 years later, but my gyn/onc also did a great job with my case. It takes guts to completely go alternative medicine alone. We hear great success stories, but have no idea if the are the exception or the rule because no one asks us what we are doing and keeps stats on us.
Doctors should be paid on outcomes-people living healthy lives…not prescribing drugs!!!!
Seth Farber says
Oh yes we are all conspiring to try to get doctors to make less money, to try to expose the pharmaceutical industry and reduce their profits, and we are trying to warn people, so they do not become chronically ill. Does that makes us “Communists”, Bebo.?
Apparently Bebo you’d rather see people chronically ill–and are suspicious that the few of us on this website put life over profit.
Very suspicious. Very odd.Fishy. This is a website for people who know how the medical profession has been corrupted by money
and drug industry domination. Except you. Except you’re here and you disagree with us.
Would you rather see people sick so industry can make money?.
Seth Farber, PhD
haha this must be the most ignorant AND funny comment i’ve seen in awhile.. If you are capable of any critical thinking then why would you disagree with this? this is what the mainstream medicine has been about for a long time. why don’t you educate yourself a bit more so you will understand what is going on around you. haha omg this made my day! seriously 😀
Evelyn Scott says
Not all doctors are greedy bastards trying to keep you sick. it is just the system and the way our society has learned to rely on pills or other the types of manufactured medicines. While I don’t all doctors are evil, I do believe all pharmaceutical companies are. They are corporations and corporations disappear any semblance of personal responsibility, and as Nestle’s CEO said: “We work for the bottom line, money. You do what you have to do and we do what we have to do.” Unfortunately, it’s a David versus Goliath fight. I believe the juicing diets on organic vegetables and fruits can free someone of cancer; but I don’t believe that every researcher out their or prescribing oncologist is seeking to do you harm. They are generally busy and in a rut. They need to be re-educated and set free from thinking that they have to be money making machines.
Why are people required to have 15 vials of blood drawn now for Medicare? It always used to be 1 or 2 before Obamacare.
Exactly. Please avoid allopathic, Big Pharma trained doctors and keep on keepin’ on. My mom is 91 and my dad 96.
Nafsica (Sasa) Kelly says
Medicine is the study of disease where nutrition is the study of health .Our health is in our hands ,few disease become a problem when we have knowledge and motivation. Other can make suggestions but no one except ourselves can eat the foods of value to us.The health we enjoy or the amount of sickness we must endure therefore,is largely of our own making.When one sincerely wants health and is willing to work patiently toward the rewards are usually forthcoming.Researches have forged the link between mind ,emotions,and health.A sense of helplessness,hostility,distrust ,cynicism,or despair can depress the immune response and increase the risk of illness and death.In contrast ,a sense of control,openness to change,and a attitude of involvement can increase resistance to disease.Healing yourself ;A step by step program for better health through imagery by Martin L.Rossman ,M,D.(Walker ,1987)
Excellent piece. This piece focuses on Medicare reimbursements to healthcare providers. I want to mention that I am sure the same sort of coding/billing considerations occur when healthcare providers are treating patients with private health insurance. Thank you Ty and Charlene and Dr. Irvin Sahni for exposing the truth about the U.S. mainstream healthcare system.
daniel morgenstern says
Confessions of a Medical Heretic Dr Robert Mendelsohn M.D. You will find it to be a very interesting and maddening book on the church of modern medicine and its fraud. Get off Amazon.
I have been saying for years that doctors are no good. But people have to learn for themselves. Usually it takes a cancer diagnosis and the side effects of radiation and chemotherapy to achieve this. Also, why is Fentanyl still on the market? It kills people. Get rid of it, Big Pharma, and every antipsychotic that does more harm than good.
Dorothy Derakhshani says
I have a family member who survived a near fatal car crash with multiple vertebrae shattered and reconstructed. A few years later she was rear ended at a stop light and reinjured. She was in so much pain she could not function at even a basic level. Fentanyl patches were prescribec and now she has her pain in check enough to get by. Yes it is strong and there are abuses, but let’s not over react and take it away from legitimate patients who are dealing with constant pain on a level that most of us fortunately will never experience. The same goes for other pain medicines. If you take it away, people will either search out illegal less safe substitutions like heroin or will commit suicide. So please be careful what you ask for. One day that person in horrific pain may be you or your loved ones.
Customer Support says
Hi Dorothy –
Thank you for sharing this with us. And we’re so sorry to hear about your family member’s condition. This must have been extremely painful and traumatizing to bear (for her and her family).
Please know that we’ll definitely keep her in our prayers.
And thank you so much for sharing this perspective with us.
We don’t deny at all that there are doctors who do prescribe medications for severe conditions like this correctly or to alleviate excruciating pain. But we are aware that for the average person, most doctors prescribe pills like candy. It’s not just specific to the US or to a certain state. This is the story of millions all over the world.
In this video above you can see Dr. Sanhi discusses that it’s the system that needs a reform because most people who come in to see the doctor really need guidance rather than a prescription to alleviate symptoms.
Hope this helps clarify our message a bit more.
Please feel free to share more feedback.
Blessings and love!
”THE PERFECT DRUG,FROM THE POINT OF VIEW OF A DRUG COMPANY,IS ONE THAT DOESN’T CURE PEOPLE, BECAUSE PEOPLE NEED TO TAKE THE DRUG FOR A LONG PERIOD OF TIME IN ORDER FOR IT TO BE PROFITABLE.’
THE PHARMACEUTICAL INDUSTRY DOES NOT CREATE CURES THEY CREATE CUSTOMERS’
Customer Service says
That’s exactly right! A patient cured, is a customer lost. Thank you so much for your comment.