Medicare fee cuts

It backs PCPs into a corner:

When costs go up, Medicare cuts fees across-the-board. Specialists respond by performing more procedures, but PCPs can’t do anything but see more patients in less time.
The divergence between primary care and specialists’ income is increasing, and it’s troubling to see some physicians react by doing things beyond their scope of training.

Comments

Aggravated DocSurg
“Specialists respond by performing more procedures, but PCPs can’t do anything but see more patients in less time.”
Just to let you know, I can’t perform more procedures without having patients to perform them on. Which means, just like PCPs, I have to see more patients, which takes more time, and perform more procedures, which takes even more time. My office days have significantly lengthened in the past 10 years, as have my OR days. Please do not assume that specialists have a free lunch with Medicare cutting reimbursement.
Anonymous
Amen, Doc Surg. It gets a little old listening to this constant drumbeat on this site. It flies in the face of reality as you point out,and secondly it is really a not-so-subtle impugning of the ethics of surgeons and procedure oriented internists.
It’s like saying that those extra patients that PCP’s will have to see to make up the shortfall will have issues which don’t REALLY need a very in depth work up, but they’ll get it anyway. Just to make ends meet, you know.
Justin
So it sounds like all physicians are in the same boat as far as being affected by declining medicare reimbursements. They have to work longer hours, or work “faster” to see more patients, or both. It is wrong for medicare to decrease reimbursements.
Incomes increase because of inflation. A loaf of bread today costs more than it did last year because the dollar is worth less now. I don’t see congress giving themselves pay cuts, but that’s essentially what they’re doing to physicians when they approve medicare reimbursement decreases. For some reason, everyone is fighting to “stop” medicare decreases. I think they should be fighting for medicare increases. Doctor’s salaries should at least keep up with inflation.
Anonymous
The only answer is to have the ability to post your own prices and balance bill.
Anonymous
There’s one big thing you guys are missing. Every year, more and more “non-doctors” get the “privilelge” of billing Medicare.
NPs can already bill Medicare. PAs can bill at 85% of doctors rate. Pharmacists are starting to bill Medicare for “drug counseling” services. Audiologists, chiropractors, naturopaths, acupuncturists and others are clamoring for billing rights as well.
The bottom line is that we have more and more people billing for an overall pie that is only alllowed to increase slightly every year due to inflation.
We need to cut down on all these charlatans trying to bill Medicare. That would mean more money for all of us.
jb
Another absurd allegation by a media know it all. I can do a procedure only once on a typical patient- most have 1 gall bladder, 1 breast lump. How many hysterectomies can a gynecologist do on a woman? Generally one per lifetime. Contrast this with the internist managing a typical patient population with diabetes, HBP, arthritis, coronary disease, and other chronic ailments. If she wants to increase her gross income, it can be done by seeing Mrs. Sixpack every 3 months instead of every 4 (33% annual increase in revenue from that patient) or twice per year instead of annually. Yes it will take more time and effort, but a good EHR will mitigate that, and an “extender” can be a profit center. They can also start doing more level 4 visits, as opposed to level 3- much easier with the EHR. I’m not accusing anyone of doing that just to make a buck. I’m calling bullshit on the author of that article, for stating that specialists have ways of increasing their incomes while primary care docs are powerless.
We all work hard for our money, and we should not hesitate to criticize anyone who tried to set us against each other.
Anonymous
The whole point of RVS is to set the house of medicine fighting among itself, like a pack of dogs in a cage thrown short rations. So fractured and set against each other, we have become easy prey for those who see our professionalism and ethics as the barrier to their schemes to take over medicine and use it as a vehicle to power and riches for themselve.
Stop taking the bait. Your problem is not your fellow mongrel with his teeth on the other end of your bone. It is the man with the keys to the cage.
The record of debate in Congress and the testimony in the hearing there is clear: Their measure of an adequate payment rate is a politically tolerable level of access to care. Therefore, with additional professionals added to the roles, and the public taught to accept them as “real doctors”, there is an attempt to prevent us from doing the only thing we can do about the problem–but they are wrong and we can act.
The only way we can act, is to define a personally acceptable level of care (which includes adequate time to provide that care), figure out what fee is needed to provide that, and refuse to participate in any program that doesn’t provide that fee. Period. It may require so substantial sacrifice on our parts, but freedom is worth sacrifice. People have given up their lives for you freedom. It is worth trading down to a smaller hourse, an older car, and even sending the kids to public school, to be a free man standing on your feet rather than a caged one fighting your fellow slave over a bone.
Anonymous
As another example of non-doctors screwing docs over with regards to reimbursement, take a look at hte UK>
UK has drastically slashed doctor reimbursement every year. Yet at the same time, they have the audacity to use public funds to pay acupuncturists and homeopaths for their “services.”
Paying those frauds means that real doctors get less money because the overall pie is split up more ways.
Justin
” Anonymous said…
As another example of non-doctors screwing docs over with regards to reimbursement, take a look at hte UK>
UK has drastically slashed doctor reimbursement every year. Yet at the same time, they have the audacity to use public funds to pay acupuncturists and homeopaths for their “services.”
Paying those frauds means that real doctors get less money because the overall pie is split up more ways. “
I agree, these are elective health interventions, they shouldn’t be covered any more than my tummy tuck or LASIK eye surgery.

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