“Incident-To”... The Bourgeoisie of License and Title

[fandantium]

For those of you who don't know; I'm a psychotherapist. Much of the work I do is group counseling for the chronically mentally ill which is billed to Medicare. Under the Medicare system, there is a structure in place called “Incident-To”. Basically what this means is that a medical doctor is allowed to bill Medicare for services other professionals have provided even though Medicare does not accept billing directly from those professionals. Basically, other professionals are deemed competent enough to provide Medicare patients services on their own at a fee the doctor himself would charge, but they are not allowed to bill for those services themselves. As an interesting aside, Incident-To providers are prohibited by law from being paid any more than 50% of what the doctor receives for the services. Originally these provisions were intended to cut medical costs by allowing professionals who were not doctors to perform many functions rather than the doctors themselves. In reality what happens with many doctors I know.. They have dozens of other professionals working for them and billing medicare for countless services at doctor rates that they really had practically no involvement in. In my case, we get close to $220 for doing a group. I get $75 for actually doing the work and the doctor gets the remaining $140 for signing the paperwork. For you budget hawks, that's $140 of tax payer money spent which provides zero value. For those who think the value of the oversight from the doctor is value, I present two facts. First, practically every other insurance company in America is just fine with me billing them with no such oversight due to my doctoral equivalent license. Second, none of these supervising doctors I've ever worked with has ever had any formal training in counseling, therapy, or group therapy what so ever. It's a lot like saying a dentist can't bill medicare for doing a filling unless a medical doctor is looking over his shoulder.

So... Much like Marx complained about the major flaw of capitalism being that the Bourgeoisie make their living by owning the means of production, contributing no actual value/labor and getting their money from the value produced by the Proletariat. With Incident-To, the state granted license of medical doctors allows them to profit through the exploitation of other professionals, provide no value and help bankrupt medicare, all at the same time. At least the Bourgeoisie provide the means of production; with Incident-To, the medical doctors provide nothing.