Nothing that hasn’t been discussed here recently:
In 2005, for example, Medicare paid a typical primary care provider practicing in Chicago, Ill, $89.64 for a typical, half-hour office visit for a patient with a moderately complex condition (CPT code 99214). That same year in the same city, Medicare paid $226.63 to a gastroenterologist taking the same amount of time to perform a colonoscopy in an outpatient department and $422.90 to do it in a private office . . .. . . The resulting income gap between specialists and primary care providers has serious consequences. Primary care providers may resort to shorter patient visits, with adverse affects on the satisfaction and well-being of their patients. Medical students carrying heavy student-loan burdens shun primary care careers, increasing the pressures on already overburdened primary care practitioners. And health care costs continue their relentless rise.
Related posts:
- Stuart Sutton: Supplementing the primary care income
- When specialists provide primary care, and why patients aren’t complaining
- Primary care and the elderly
- Should specialists be re-trained as primary care physicians?
- Once you hit Medicare age, good luck finding a primary care doctor
- Op-ed: Shortage of primary care threatens health care system
- When primary care refuses to accept Medicare
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{ 20 comments }
Oh Gawd. Here we go again….
To Anonymous 2:31
Stay healthy friend. You never know when you might need a primary care physician.
Next time I am in the OR and cutting/stapling the renal vein with a laparoscopic endovascular stapling device while doing a lap nephrectomy for renal cell carcinoma and my BP is 200/100 I will be thinking about the poor internist in the office seeing patients for $200/hour…
Believe me, there are days when I think about going to a 100% office-based practice. The bottom line is that surgeons deserve the moderately higher salary that they command. As for the GI guys, that is another story…
Actually, friend Anon 3:53, I have already had need of my primary care physician: to open up the referral gate so I can see the specialists I need.
Muchas gracias.
I am sure your PCP loves to see you, since you regard him only as the gate keeping you from the care you know you need.
Perhaps that care includes our surgical friend sweating over his lap nephrectomy.
I will finish my primary care career soon enough; as will most of us. Perhaps only in hindsight will our value be known. {cue the dramatic music}
Your friend, anon 3:53
I don’t see how any fiscally minded individual could expect Medicare to pay one cent more than what is necessary. If they reimburse $89 and internists are accepting it, then why should Medicare change anything? The whole mantra of managed care is that they cut costs by paying only as much as it takes to get a decent number of drs to see their patients. If you accepted $89 for this service, I don’t see how you can complain.
It’s not based on what is fair, it’s based on supply and demand. If GI docs are paid $200 for the same amount of time, you can bet that is the very least amount Medicare thought they could offer. If they thought they could offer GIs $89 for a colonoscopy and enough GIs would take it, you better believe they would have reduced what they pay for a colonoscopy.
This might demonstrate a lack of foresight into a looming primary care shortage, but since when has the government been organized enough to deal with future changes?
The payment for the specialist includes postoperative visits for no charge because it is in the global period. You are not comparing apples to apples here. It could end up being the procedure and a few postoperative visits for no charge. Its not like the patient disappears after the procedure is done never to be seen again.
Yeah, that $450 lap chole will come with at least three or four postop visits included in the global fee period, so the discount should reduce that by at least the value of three E/M level two followup visits, at a minimum, as well as an equivalent charge for the time spent in the OR and in the PACU and talking to the family and patient. So that is really about two Level 4 visits in office time value. Surgery time means a lot more than time in the operating room.
i definately agree that primary care should receive higher reimbursement. as for the surgical colleague on the post above… you must think we are all so gullible to think your blood pressure rises so high during a procedure. i can certainly imagine your heart beating faster. but to confuse that with blood pressure…. if you have a medical problem see your local internist.
Primary care provider shortage?
What are the doctor NPs and PAs for…and their minute clinics? As long as there are MDs/DOs who will offer “oversight” and sign off on their charts, primary care reimbursement will continue to fall and find a lower floor. Its the same MDs/DOs bringing this onto the profession…great for those who have gone to retire ahead or will be retiring soon; the mid-careers are really getting squeezed in tighter spots. But, no primary care provider shortage will EVER happen as long as there are pimps and prostitutes offering services to the lowest bidding johns…
Oh please!!! Delete this tired, childish, and divisive thread.
Stop complaining and SET YOUR OWN PRICES.
Why don’t you propose an AMA resolution to allow this for ALL doctors, take it to court, and be proactive!
why not get the government to compensate the health professionals. socialize medicine. and increase the number of specialists. a little more education doesnt hurt.
id rather live in a town with more than 2 neurosurgeons. why are we capping the number of doctors we let subspecialize..?? because of economics. id rather see more peopel in neurosurgery and surgical specialities than doing somthing like rheumatology.. but we have more rheums in town than neurosurgeons.. more training is better. and theres so much to learn!.
As a non-doctor, I can say I am genuinely proud of the folks at Medicare for attempting to contain costs. Most government organizations do not attempt to do this. These are my tax dollars that are being spent and if $89 for a 1/2hr visit is enough to get docs to see patients then I dont want the gov using any more of my money than necessary. Someone at Medicare had the foresight to say,
“You know, if we lower the reimbursement to $89, I think enough doctors will continue to provide high quality care to our patients”
and they were right!!! kudos to them. Doctors do have a voice in this, if you are getting ripped off opt out of Medicare, or just see less of their patients. Until this happens I am an advocate of further reimbursment lowering to ensure that taxpayers are getting the lowest possible price for their dollar.
“more training is better” says anon 7:12;
well i have news for you – the length of training in neurosurgery & rheumatology differ by like a year! so i don’t know what you’re talking about, you’re comparing apples to oranges. And if you think more is better, let your local neurosurgeon manage your diabetes (assuming he even WANTS to) since he has several more years “training” in medicine.
that’d be like letting an airplane mechanic fix your beemer.
People are getting exactly what they deserve – an NP to give them a z-pak on command when they have a cold, but nobody to adequately manage coexistent diabetes, hypertension, coronary disease, chf, etc.
The surgeons on these threads seem to be misinterpreting the PCP gripe with “procedures” to include surgeries – NO internist I know envies the tragically declining reimbursements for things like appys & lap.chole’s nowadays – it’s the echos and such (outpatient elective procedures reimbursed by medicare) that are the problem.
anon 5:04’s implication that medicare’s formulas for reimbursement have ANYTHING to do with market forces is just totally incorrect, and grossly uninformed. This has been highlighted time & again, and is the result of the RVU committee being composed mostly of procedural specialists.
Thank you for the clarification Happyman. It seems that all too often the epithet of “proceduralists” is aimed at surgeons. ‘m glad to hear that (at least in your own opinion) that does not include surgical specialists
You’re welcome. I can’t think of any of my internal med colleagues who doesn’t sympathize with what surgeons are putting up these days – if possible it’s even worse than what’s happening w/primary care:
1- taking ER call mandatory (hospital administrators getting away with being slavemasters)
2- crappy reimbursement for EMERGENCY operations like appys & ortho surgeries, and potentially NO reimbursement e.g. the drunk a–hole with no insurance who gets a femur fracture in a car wreck
3- malpractice, clearly a higher risk for surgeons than for me
I think that the general surgeons are getting REALLY screwed by all the 3rd parties in medicine. The only way this will change is if a critical mass, e.g., refuse taking ER call for free. Hospitals get money from the gov’t to cover the costs of dealing with the uninsured/medicaid population, then hospital ceo’s consciously choose to pass on NONE of that to those doctors taking call. I have stopped taking call for that reason, and am much happier for it. I lose a little business, but not enough to make up for the hassle of admitting an uninsured patient to the ICU in the middle of the night.
But I guess it’s harder to divorce yourself from the hospital if you’re a general surgeon & it’s not really feasible to rely solely on an outpatient surgi-center (?am i right on that – that’s what i hear from the gen surg folks in my area).
Wow, do primary care Doc’s ever moan, groan and whine. If you make 89.00 for every patient you see then you know you are well paid. I have not ever been to a promary care Doc who spends anythihg close to 30 minutes with me. So if you bill that code and then see 1 or 2 other patients in that half hour then you have just made out pretty good..
If the GIs have it so good then why didn’t YOU become one?
$180 per hour… OH NO!!! How will the poor allopaths survive on such a pauper’s pittance?
The only people that downplay a surgical residency are those that have never been in one. The push for the 80 hr workweek was not because FP and rheumatology residents were driving off the road from exhaustion after a shift.
Anon 11:34pm
Equating a medicare reimbursement to the doctor’s take home pay is ridiculous. Just like any business, there are costs involved and only a fraction of that is profit. Money has to go to pay the nurses, administrative staff, overhead, malpractice. It’s like saying that a car salesman makes $30k for every car he sells. You should direct your browser to wikipedia and look up the entries on revenue and profit.
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