While flipping through the channels last night, I ran across the movie “Knocked up“. Although unable to watch for more than a couple of minutes (it seems to be a very high concept movie about a guy, a girl, a one night stand, and a lot of pot) there was a scene which illustrates the “Less is More” concept. The Katherine Heigle character, after spending what must have been $1,000 of home pregnancy tests, collects her “baby daddy” and goes to the doctor for a offical diagnosis. The doctor had 3 choices. 1) Believe the patient and proceed as if the patient was pregnant. I’m not saying that people would lie about such a thing, but I wouldn’t feel comfortable proceeding in this manner. 2)Gather objective evidence (a pregnancy test in the office) and proceed on the information obtained from that test and an assessment of risk factors, obtaining an early ultrasound if the patient had risk factor for an ectopic (tubal) pregnancy. 3) Do an ultrasound on every pregnant person, perhaps  in fear of missing an ectopic (tubal) pregnancy (2 out of every 100 pregnancies, almost all of which have symptoms before problems occur). Katherine got an ultrasound and saw a cute baby with a heart beat (how cute!)

The doctor fees for these visits are as follows. Lets say that the office visit for an OB intake is reimbursed by the insurance at $200. The pregnancy test might be reimbursed at $10 and cost the office $4 to administer, a profit of $6 to the practice. If you practice based on option 3 some would say that it is cheaper because the ultrasound is “free”. However, the office does have to pay for the machine and the time of the sonographer. If the physician charge the insurance separately for the ultrasound because the patient has “pain”, you can charge an extra $200 per pregnancy. This goes to pay for the machine and gives the patient “peace of mind” in addition to increasing the physician’s bottom line.  What’s a doctor to do?