You are an idiot Elliot. Do you know what fraud is? How about the Stark Law? Collusion anyone? Whistleblowers? Skirting the law is asking for the end of your practice and license revocation. You know nothing about the business of medicine and you are showing it right now.

You might leverage into good will, equipment, prime OR time, positions within the hospital, shared advertising, or other similar perks. However, any hint that the hospital is paying you directly for this business is completely illegal. Both the hospital administrator and the physician are open to whistleblower claims which reward the reporter with a percentage of the government’s take. Heavy fines, dismissal from medicare, and jail are the potential penalties. Just because some are willing to skirt around this point and take these risks doesn’t mean that we are all “bad businessmen” if we choose to obey they law. I’m sorry, Elliot, but you are being ridiculous.

Some valid concerns. Yes, I have dealt with running a business. No, I do not frequent lawyer sites and criticize because I’m not interested so much in judicial policy as I am in healthcare policy. If I did, I’m sure that I would have some comments that were less than complimentary. With regard to minimum wage debates, I can’t recall specifically saying nasty things to a MacDonalds owner about it although I have commented about opposition to minimum wage in rather harsh terms. If you point me in the right direction, I’ll gladly take potshots since I think not wanting to raise the minimum wage is pretty egregious for people like that specifically and bad policy generally. As for competing for business, if someone specialized in Medicare reimbursed bariatric surgery, I imagine that word would get out quickly and that this would be a marketing niche that would require very little additional effort to attract patients. (Finding your niche is part of being a good businessman.) Finally, the “study” is ridiculous because of its basic dishonesty in trying too hard to be propaganda. Instead of the rather ridiculously low number of $71,000, the result could have been a much more realistic and honest $121,000 and proven the same point that Medicare alone was not renumerative enough to be attractive to your average surgeon. That’s a different argument and one that this doctor did not want to have. (Even 121k is a good living, I have no illusions that it would not represent an economic sacrifice vs. an alternative type of practice on the part of the surgeon who chose that route.) What riles me is the hypocrisy of the doctors who poor mouth on the one hand, but want to have some special social status because they provide healthcare. I get upset at teachers, police, firemen, and nurses who make similar arguments, but I don’t hear that consistently from these professions (except during union negotiation times and then much more mildly than the BS thrown around here).

…there are many ways to skin that cat…

That’s what they thought at UMDNJ.

My impression and recollection is that you are an academic (Economist?) Do you have to deal with overhead, cost-of-living increases for employees, struggling to meet your payroll expense, dealing with time-sapping bureaucracy designed to discourage otherwise profitable acitivities in your business, and harangues from economists (and lawyers!) who have never run a business?

Why are you so angry with physicians? You have said that as a group they are one of the highest paid, but you fail to acknowledge that the means are skewed by outliers at the high end. The bulk of us make scarcely more than the average PA (Surgical PAs often make more than Internal Medicine MDs). Do you browse blogs aimed at attorneys or small retail business owners and criticize them for complaining about the cost burden of the regulations they have to meet? Are they whiners, too, when they do? When the owner of the local McDonalds franchise complains about increasing minimum wages, do you harass him? He makes more than most physicians.

And why shouldn’t a Medicare practice have a nice location in a nice building? Medicare patients live everywhere and come from every walk of life. Why do you think they deserve less than anyone else? Do you not think the physician has to compete for business? You say they are bad businessmen, but when they do smart things to compete for business you claim they don’t have to because you perceive their customers as something less than deserving. Why does any business need class A real estate? If I live in a high demand area, and the nearest cheap real estate is 15 miles away, why would I travel for the doctor, when there is a closer one who happens to be in class A real estate? Nice straw man.

I understand your criticism of the article, and you do make some good points. But please don’t forget that you are not viewing it through the clearest of lenses either.

“Table. Surgeon Reimbursement For 292 Bariatric Patients Under Medicare
Total reimbursement $516,158 “

This number is fixed as people have observed. The other numbers are fact-based, but fictitious. For any of those expenses, there is a range, and the numbers chosen by this study are designed to make sure that the bottom line is sufficiently low to justify a lot of whining about how bad things are. For example, why would a 100% Medicare practice need class A real estate.

I do drop by here once in a while just to see if the environment has changed; it hasn’t. One thing I have noticed is that my respect for doctors in general goes up when I am not reading this site and plummets when I do.