I have been a Neonatologist, for twenty years or so, And have always felt secure about the things I really know. At 600 grams with RDS. I could write a thesis, PFC or PDA and even Gastroschisis. I spend the time, put in the hours, sometimes without sleep, A multidisiplinary approach, the company I keep. The challenge remains, ideals still high, sometimes sad or funny, But somehow through this experience, I need to earn some money. As I grew up, I placed a charge and never did feel nervous, A UAC, an ET tube, simply “Fee for Service.” Standby section, H &P, bill without confusion, Figure out a market price, for Exchange Transfusion. Then the task grew difficult, I can tell the tale, In 1970 came along, the “Relative Value Scale.” The AMA devised a term, which enlarged all my nodes, You are all familiar with the CPT word codes. 99431 or two, do these numbers jive? Do I charge for standby? When did I arrive? Was my original consultation, limited or not? Is 99252 the code? Tell me what I've got. The charge sheets are so complicated, brings out all my wrath, A simple task in '75 now takes a “Billing Staff.” Bills are sent, evaluated, with the proper guide, We wait and wait and wait and wait … finally, it's denied. Signed up too late, not eligible, tell me what to feel, It's OK, Doc, perhaps you'll win, on the third or fourth appeal. I charge this, and you pay that, who decides the rules? In the scheme of bill and pay, the Docs appear as fools. Discounted fees, per diem, bundling, RBRVS, Current Procedural Terminology, it really is a mess. Then IPAs and HMOs came upon the scene, Further discounts, what to do? Make us lean and mean. Lesser payments, more paperwork, should I cry or laugh? I hired a practice consultant and increased billing staff. Overhead goes up, employees too, life's become a wreck, Working harder, much less fun and with a dwindling check. A new word crops up, we will be saved, with great anticipation, Take weekend courses, learn the lingo known as “Capitation.” How many lives are in your group? I need the enrollment disc, Length of stay turns my hair gray, for now I am at risk. The future doesn't seem too bright, what happened to the fees? Soon, neonatal care will develop many DRGs. At risk for one, and one for all, will be our battle cry, Bill correctly, with proper codes, promise you will try. Place the statement in the envelope, post it, do not fail, Hope that when you follow-up, you won't get a “voice mail.” Try and try and try again, this isn't “Poppycock,” A better term is FUTURE FINANCIAL NEONATAL SHOCK THE PERINATE<sup>20 The Perinate Future financial neonatal shock J Perinatol 1996 ;  16 : 230

Cliquez ici pour aller à la section Références</sup> (From Martin G: Future financial neonatal shock. J Perinat 16:230, 1996; with permission.)

In years past, the economics of practicing medicine and “earning a living” was second to intellectual stimulation and personal satisfaction. Medical schools never taught economics, and it was believed that with dedication and service, financial rewards would be forthcoming. Many of these beliefs have changed as medical reimbursement to hospitals and physicians have decreased. Job and financial security are uncertain. Professional goals are in jeopardy, and the future is unclear.