Dropping Medicare

“The authors of HIPAA thought the threat of losing the ability to participate in federal programs was a terrifying prospect for physicians. And, in fact, it is for some physicians – specialists”
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A lot of specialists grudgingly accept Medicare because the pcp’s who refer to them take Medicare (A pcp isn’t going to send privately insured patients to a specialist who doesn’t also take the pcp’s medicare patients). If enough pcp’s drop medicare, specialists will also.

You are missing Kevinmd’s new theme. Primary care doctors are getting screwed because the evil specialists who worked harder in school to get better standarized tests, volunteer time, and grades in addition to training from 2-5 more years are holding the primary care doc down. Those evil specialists are screwing the whole system. Hey Kevin, way to help the government with the divide and conquer strategy. Get them fighting over the pie and we can screw them all. Why don’t you fight for higher pay without taking pot shots at specialty medicine.

PS: If you haven’t started to notice your daily articles on evil specialists screwing the poor primary care doc are starting to wear thin on a lot of people. We’re all in this together, but your constant linking to this type of article makes me want to demean the primary care docs by telling people just how much more community service, better rotation grades, higher USMLE, etc. I got than the people who chose family med, internal med, etc.

I would be curious as to how many of the contributors to Kevin’s blog are specialists. I am a surgical specialist who regularly contributes because I believe the issues pertain to ALL physicians.

Within my surgical single-specialty group, we have a ten-fold spread of income based on subspecialty. And guess what, general/cognitive specialists and pediatric specialists in my specialty bring up the low end and garner no respect because they don’t pay as much of the overhead. In fact, the generalists may work longer hours and see more patients than the more highly compensated subspecialists.

It is a microcosm of medicine and most of our business is Medicare or on RBRVS-based reimbursement. The reimbursement is patently “unfair” by almost any measure. That means that most codes are undercompensated, while others are grossly overcompensated. We routinely are paid less than Medicare rates by private insurance companies. We compete with non-M.D. “providers” who want to practice medicine without a degree.

Believe me that I am envious of the primary care doctors who can drop Medicare and most insurance. This is not the case for any specialist I know with the exception of plastic surgery.

I don’t know who Dr. Kranky is quoting–I don’t see that said anywhere–pretty over strawman tactic.

Anyway it got the thread onto an internecine quarrel which is exactly the problem. The whole purpose of RVS was to divide (and conquer) the medical profession and you guys are cooperating beautifully.

Ummmm, Anon 5:12 PM. Did you bother to READ the article??? What I cut and pasted was right there in the first paragraph. What strawman have I created?

The author in an otherwise straight up complaint about Medicare and the advantages of not accepting assignment, opens his piece with that particular piece of stupidity. I was merely pointing that out. And that particular piece of stupidity has nothing whatsoever to do with his argument, but everything in the world to do with YOUR complaint that I started “an internecine quarrel.”

I’m open to your apology.

-Dr. Kranky