This is an explicit way to pressure physicians who order too many tests. Think of Medicare as just another large health insurer looking to cut costs:
CMS has the data and computer capacity to identify physicians who are inefficient compared with their colleagues and as early as mid-2008 might begin to contact those physicians and ask them to become more efficient . . . Kuhn said that identification of inefficient physicians, or “profiling,” would involve a comparison of the number of tests ordered by physicians for certain types of patients with the number ordered by colleagues in cases that have the same outcome.
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{ 17 comments }
Little by little CMMS is beginning to overplay its hand. When many primary care doctors are restricting admissions of new patients with Medicare to their practices, and are happy in some ways to see a Medicare census attrition, where is the leverage? Who cares if Medicare doesn’t like that you order tests and imaging? What exactly do they think they are going to do about it that won’t result in more doctors just telling Medicare to get lost?
You dont get it. Medicare has ALL the leverage here, docs have none. Medicare currently accounts for over half of all healthcare dollars spent in the US. By 2020 that number will be 70%.
The day of docs having leverage against Medicare by refusing new Medicare patients is over. Only those docs living in the most affluent areas can do that. Everywhere else, Medicare is such a big piece of hte pie that no doc could afford to not see Medicare patients.
Regardless of wheter we get a “universal” health care system or not, by 2020 Medicare even in its current form with no changes will have virtual de facto monopoly power.
I agree w/anon 5:56 –
here in the NYC metro area, medicare is finally catching on to what the big commercial insurers realized a long time ago – doctors have almost no choice but to accept any fee cuts they dish out. Around here, medicare is just about the HIGHEST payer with the LEAST administrative hassles, compared to aetna, oxford, cigna, united, ghi, & blue cross.
The real risk isn’t doctors’ not accepting medicare patients – it’s the future probability of not having enough primary care doctors.
The big boys aren’t worried about that–other countries do with far fewer providers so they figure out of work specialists will retrain and fill the gap.
We can all thank the internist that I know who boosts his reimbursement by getting an EKG on every single patiient on every single visit, even if they are every 3 months with no cardiac symptoms. We can thank the neurologist I know who ordered enough EEG’s to generate nearly a million dollars in reading fees in one year!
Last time I checked Medicare does not have a license to practice medicine. If a doctor wants to order tests for a patient they should not be able to stop it. This is another encroachment of big government into the doctor-patient relationship. Where is the AMA?
“…internist…boosts his reimbursement by getting an EKG on every single patiient…the neurologist…who ordered enough EEG’s to generate nearly a million dollars…”
What part of the country are you in? I am moving there!
Or you can be employed like me and bonus off of RVUs then you could give a crap what Medicare says. The hospital sure doesn’t care if I order less tests.
quite the contrary
This profiling plan is MARVELOUS! It makes my job so much easier. I look for a doctor who the Medicare bureaucracy profiles as ordering loads of care for his patients. VOILA That is the doctor I want!
A Doc who does 3 month EGDs on every patients? Why would any patients who has no heart disorder or no risk factors ever agree to that?
Sorry, I meant EKGs!
A Doc who does 3 month EGDs on every patients? Why would any patients who has no heart disorder or no risk factors ever agree to that?
Are you kidding? See Anon 8:10
Rich, MD…Anon 8:10 may well be one patients perspective, or the guy may just be acting sarcastic, who knows. But, I know if my Doc. did 4 EKGs on me in a year, I most likely would be believing that something drastic was wrong with my heart. I probably would call in the guys from Cleveland Clinic or some where, And tell them, “my Doc has done 4 EKGs on me in a year and I want to find out what is wrong with my heart”..just for a second opinion, and then the gig would be up.
Anon 6:35
Don’t move here. We don’t need anymore docs with pure busines “ethics” dragging down the profession here.
Anon 12:58
No, the gig wouldn’t be up. At worse, the guy just loses one customer. Behind that one will be ten more who are trusting to the point of gullibility and ignorant enough about medical care to think more is better and doctor knows best. When other internist sees this guys patients because he is out of town, they complain “why didn’t you do and EKG. Doc —- always does and EKG? ” They think he really cares about them and sees it as doting on their health. If they, instead you and I were paying the bill, they would see it for what it is.
It is a vicious cycle:
Third party payment and excessive government intervention has erroded professionalism (if you wonder how, I suggest “The Road to Serfdom” by Hayek),
then erroded professionalism creates a need for more government intervention.
EKG’s??? Thats what people are upset about? The thing takes 5 mintues, is completely uninvasive , and I dont need a cardiologist to help me read them. Who craes! EKG’s dont cost the system anywhere NEAR as much as stress tests/EGD’s/PFT’s/etc etc.
EKG’s arent the problem, even if I got TEN of them in a year.
the idea that internists are unethical in ordering frivolous ekg’s for monetary gain is IDIOTIC:
A small office (as opposed to a large one, where more likely the internist is employed & thus has no financial incentive to do in-office tests) spends about 5-10 minutes in doctor/staff time for an ekg. The reimbursement for this is from zero (some plans include this in their monthly “capitation”) to about $25. Not to mention it eats up exam room time, that could otherwise be spent on the next patient for a more lucrative E&M visit.
Mike, you are right on! Anon 6:18 – if EKG’s piss you off, look up the medicare reimbursement for ECHOs!
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