It’s coming soon to Medicare.
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- Profiling Jay Parkinson
- Primary care and the elderly
- Excessive police force, as seen in the emergency room
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{ 8 comments }
This is another form of b.s. I suppose they should offer some tort reform to stop the practice of defensive medicine. I am a family physician in NYS, a crisis state defined by the AMA. When will it end? When physicians can no longer afford to stay in practice. When my income drops to employment level income prior to starting private practice, thats when i get an employed position again. I am very close now.
As long as doctors are paid per procedure, they are going to game the system and give unnecessary, inefficient care.
So how does Medicare respond? They cut the individual fees for each procedure to keep overall spending down, thus screwing all doctors in the process, even those who are not “gaming” the system.
If you dont like it, then start speaking out against htose idiots who do 15 CABGs per day on people with minimal CAD blockages. They are the people screwing the system over.
I think docs would be better off on a flat salary system instead of FFS. That would keep the # of unnecessary procedures down.
That might help with one aspect of over-utilization. Then we could move on to another: getting the diagnosis right to begin with. In other words, how about getting the diagnosis of simple stuff like otitis media right the first time, not three times later plus a specialty visit resulting in a correct diagnosis (e.g. TMJ) and the right treatment??
“As long as doctors are paid per procedure, they are going to game the system and give unnecessary, inefficient care”
absolutely. dare i say we should capitate procedures (how many specialists can i piss off with that suggestion)?
but imagine the decrease in the number of echocardiograms if there weren’t a financial incentive to do them? or nuclear stress tests? endoscopies?
Capitation certainly has drawbacks, but with reasonable rates that reflect the additional training required to subspecialize, one would be likelier use clinical judgment to decide when someone needs a diagnostic test. Right now there is no disincentive to perform tests for even minimal symptoms.
just to give people a real world idea, I’m a PCP whose starting a mobile imaging company where I lease out my echocardiogram. I will make 2 times more, with none of the headaches with this practice. Gaming the system, asbsolutely. But just telling it like it is. Just another sign of how dumb we are as physicians and not standing up to anyone.
“Just another sign of how dumb we are as physicians and not standing up to anyone”
No. just another sign that your are ripping off the system – you are precisely what’s wrong with medicine and the current reimbursement system.
Your point is clear. but that doesn’t make you less of a thief. I’d prefer to bitch about the system until it changes, and forego the extra income to be had by ripping off medicare (ie. the taxpayers).
but i appreciate your honesty, uh, anon. your shame tells me that at least you know it’s wrong.
Just to clarrify my previous post about my mobile imaging company and some of the incorrect analogies.
Remember, I don’t order the echos. It’s the vast majority of PCPs country wide and young cardiologists that do. So I’m not stealing, nor practicing defensive medicine. I’m jsut leasing out my machines and techs to those PCPs.
“Gaming the system” – absolutely. They pay for echos, they don’t pay enough for PCP medicine. So, I spoke to the PCPs in my hospital and general area & many wanted to add this service to their practice.
So I’m not stealing. Talk to every PCP in their office that does these procedures, they’re stealing.
Oh, and I do know it’s ultimately wrong. I’m not aiding the effort to change the system. But hey, if all these PCP who orders my ancillaries drive our system into bankruptcy faster, maybe I’m contribute to reform faster than originally suspected.
Keep ordering PCPs. I’d put up my website except I don’t want to get fire bombed by the Osler purists and idealists.
Just to clarrify my previous post about my mobile imaging company and some of the incorrect analogies.
Remember, I don’t order the echos. It’s the vast majority of PCPs country wide and young cardiologists that do. So I’m not stealing, nor practicing defensive medicine. I’m jsut leasing out my machines and techs to those PCPs.
“Gaming the system” – absolutely. They pay for echos, they don’t pay enough for PCP medicine. So, I spoke to the PCPs in my hospital and general area & many wanted to add this service to their practice.
So I’m not stealing. Talk to every PCP in their office that does these procedures, they’re stealing.
Oh, and I do know it’s ultimately wrong. I’m not aiding the effort to change the system. But hey, if all these PCP who orders my ancillaries drive our system into bankruptcy faster, maybe I’m contribute to reform faster than originally suspected.
Keep ordering PCPs. I’d put up my website except I don’t want to get fire bombed by the Osler purists and idealists.
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