Anti-physician rhetoric from Rep. Stark, who lays down the gauntlet:
Some on Capitol Hill expect Congress to slap a similar payment patch on Medicare in June, although one prominent House Democrat would prefer to let the Medicare cuts happen. “I’m inclined to do nothing,” Rep. Pete Stark, D-Calif., told CongressDaily. “My colleagues, my staff say, ‘Oh, dear, the doctors would all drop Medicare.’ I don’t believe it. I don’t believe that doctors are willing to give up half their income.”
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{ 27 comments }
Dear Pete (D-insanity)
Please be careful what you wish for.
They all don’t have to drop Medicare. All that is necessary is for a large number of doctors to elect to stop taking any new Medicare patients, and allow natural attrition to reduce the numbers remaining in their practices. The heat will turn up when patients can’t find a doctor when they move, or if they have a habit of practice hopping and get caught out. Dropping Medicare won’t be necessary at all to make the public scream for relief.
The 13th congressional district of California would be a great place to test this idea.
Is it any wonder that America’s physicians feel like they have no support in Washington, DC? The head of a congressional committee that so directly impacts the profession talks to them like children. Docs need to stay united.
Great web site KevinMD!
Greg Kelly
Editor
Physicians’ Financial News
http://www.pfnlive.com
I wish Congress would do exactly what Stark suggests already and see once and for all what physicians are prepared to do. At that point we can seriously talk about comprehensive health care reform.
Pretty arrogant of him to risk my parents access to care with his pissing contest.
As much as I hate to say it, Stark is right. Most docs would not drop Medicare. Why? Most docs already accept fees significantly lower than Medicare on Medicaid patients.
The volume of the whining will increase, but timid docs would still take what they can get.
Part of the answer is in a news item on that same page, where the ACP foolishly endorses single payer. Well, if organized medicine is already willing to turn our livelihoods over to the government, we shouldn’t complain when there are cuts. This is the price we all must pay for a socialist paradise, comrade.
A spoke with a local physician the other day. I wasn’t aware, but a memeber of the House Ways and Means was giving a presentation at another hospital in our town. Numerous physicians in my community showed up to discuss their concerns with multiple issues.
The physician told me that this beaurocrat simply doesn’t get it. Any concern by a physician was met with smug discontent.
That’s what happens when you get those who don’t know try to run things on people who know.
Stark has showed nothing but disdain and animosity for physicians his entire career. His disdain is probably well-founded in this case. I doubt many will stand up on their hind legs.
Stark’s comment shows the lack of understanding the average politician has of the health care system.
He’s right, if they stick it to the average IM doctor, they probably will have to bend over because of lack of leverage.
But guess who doesn’t have to? ENT. Plastics. Ortho. Derm. Etc. It doesn’t matter if every IM doctor in the country keeps taking medicare, when the specialties that CAN drop medicare DO drop it, the shit will hit the fan. Look at how hard it is to find a plastic surgeon or ortho with medicaid. Wait until that happens to people who actually vote (i.e. 65+ and not poor), and then you’ll see Honorable Master Stark change his tune in a hurry.
If they pull their cuts now, there’s enough of us in private practice at this point that there’ll be a crisis when many of us drop Medicare or , at least, stop taking more Medicare.
If they wait until after private practice has withered and died to pull this, then there may not be enough of us left to have a sufficient impact.
-Medicare is not “half my income”. It is about 20% of my income and about 30% of my time.
-I heard the same thing from medicaid in my state when I dropped it four years ago. I have never regretted that decision.
-I see medicare patients for only one reason. I like them the most. People of that generation are the most grateful, thoughtful, and patient. I will miss them when they are gone. The next generation of medicare patients will be very different.
-There is a limit to how far this enjoyment on my part can be tolerated. Medicare is my lowest payor. There is a lot of hand-wringing on the part of the PCPs on the blog about how the specialists are cheating them out of their Medicare fair share. That is pure BS. My payment for a lumbar laminectomy in a medicare pt is 800.00 That is for a two hour surgery, plus several days of hospital care, plus three months of postop care. Oh, and during that time, I am their doctor. I do all of those PCP things like filling out their forms and answering there phone calls. How about an acoustic neuroma – an all day co-surgery with ENT? About 1500.00 Nobody is getting rich off medicare.
-I cannot be replaced by a nurse, a PA, or a FMG. People need what I can do, and they always will.
-I can and will drop Medicare at some point. The effect on my income will be modest and temporary. I might even drop the program but continue to see the patients. I’ll ask them to pay me what they can. Those that can’t pay, I’ll see for free. And I’ll tell Rep Stark he can keep his measly payments and his onerous regulations and shove them up his arse.
Heck why not just cut payments to zero. The Easter bunny will continue to pay our rent and the tooth fairy will pay our employees. And Santa Claus will bring a big basket full of toys to the good little girls and boys at the end of the year instead of another reimbursement cut.
Now there are just a few minor items to consider, namely that the government will no longer be collecting over 50% of my gross income in taxes (FICA, Medicare, and income taxes). Why, the fact is that I pay back to the federal government just about the same amount I receive in Medicare receipts. Isn’t that ironic?
Why doesn’t somebody prove him wrong and run for that seat in California? It surely has better than Medicare health insurance benefits and you can rest assured you will get regular pay raises.
Thinking of quiting? Check out the Society for Innovative Medical Practice Design at http://www.Simpd.org and see how different life can be when you’ve dropped CMS!
They will never cut the payments to zero. If they did, the program would still be bankrupt and they would have no one to blame anymore but themselves.
At the rate things are going, Mr. Stark, my Medicare population is about 33% of my practice, while the income might be 25% of what I generate. I’d be more than happy to stop seeing new Medicare patients, or drop out entirely. Your call.
Agree with anon 5:22, a little less access will cause real hurt and attention
Though I agree with much of what you have to say anon 8:45 your swipe at PCP’s is uncalled for (editorial comment: I am a medical subspecialist)
re: “There is a lot of hand-wringing on the part of the PCPs on the blog about how the specialists are cheating them out of their Medicare fair share. That is pure BS”
The fallacy is you can and do refuse medicaid pt’s and shortly medicare. With the exception of the boutique docs most PCP’s don’t easily have that luxury. The payment scale hurts us all. However, it is killing the PCP’s at the bottom of the payment ladder. Also as you well know most insurance key’s off of some variation of medicare rates. Again the same result. Also do you referrals come out of thin air? My don’t. I have relationships with PCP’s. I take their medicare not just because of the patient’s (and I agree I definitely like seeing the appreciative members of the depression/WWII generation more than “some” of the self-entitled prebaby boomers), but because they make the other referrals to me. I understand that these primary docs are in a bind with subspecialist coverage. We are collegues after all right? Additionally, depending on your insurance contracts you might want to think long and hard about “refusing” medicare, as I have seen PCP’s just stop sending all patient’s to subspeicalist’s who start cherry picking. Food for thought. Pete Stark is a jackass who has no clue as to what is really going on in medicine. If the other members of congress follow suit with his line of thought then they all will have a shock in June.
PS: About FMG’s, some of the brightest docs I have ever met were “FMG’s”. They have already been self-selected by getting in to this country in the first place…get over yourself.
Have you guys considered that people like Stark, inside the beltway for a generation and drunk on the power and privilege, isn’t worried one little bit if you do drop Medicare, because he would love the excuse to simple legislate that you HAVE to take it?
No offense intended to FMGs. But the fact is that you can’t be board certified in this country without a US residency. And the US residency programs don’t accept FMGs in large numbers. I stand by my point to policymakers: you won’t replace recalcitrant surgical specialists with FMGs.
Also, I agree that “we’re all in this together”, but if you aren’t aware of the class envy tone of this blog, you haven’t been here very long. We get quite a few pokes from Kevin, and it gets a little old.
Many physicians are not in the financial position due to “keeping up with Dr. Jones”, nor do they have the business sense to bail on Medicare and have the same standard of living. Stark is right.
“US residency programs don’t accept FMGs in large numbers. I stand by my point to policymakers: you won’t replace recalcitrant surgical specialists with FMGs.
“
That is pure BS. I trained in one of the largest teaching hospitals in NYC, something like 100 residents/year across all specialties. And probably 60% were FMG’s. Not just in Internal Medicine, but also in general surgery, ob/gyn, psych, neuro, ortho, & urology.
Granted it was slanted towards internal med, but then those grads funneled in to the IM subspecialties: cardiol, GI, heme-onc, etc. were almost exclusively FMGs. And they were about the brightest trainees in the hospital.
And as far as specialists’ cherry-picking, most internists maintain a relationship with a VERY SMALL group of specialists, so it’s quick & easy to refer when necessary. So the cardiologist or GI who refuses insurance X generally gets crossed off the list quickly, in favor of someone who makes the PCPs life easier. After all, for them to see a medicare patient on a “referral” basis versus without a referral increases their reimbursement dramatically (you knew that, right?)
Those specialists that had any inkling of superiority are generally blackballed from referrals by the IM community in my hospital, and are starving for business. In my area there is a tremendous surplus of certain specialties (4 dermatologists & at least 6 ophthalmologists in my building), versus about 5 internists taking new patients.
Everett (WA) Clinic, and Polyclinic in Seattle started limiting their Medicare patients:
http://tinyurl.com/378vwq
Corvallis (OR) clinic limits Medicare:
http://tinyurl.com/3942xp
also covered here on this blog in 2007. And that’s just the Northwest. It’s already happening.
Of course, this just shows the profound ignorance of Pete Stark.
One of the largest multispecialty medical groups in Houston, Kelsey-Seybold, is no longer accepting new Medicare patients (http://www.kelsey-seybold.com/Insurance_Accepted/InsuranceAccepted.cfm). Their slogan is “Your Doctors For Life”. Get a clue, doctors ARE opting out and access IS becoming more limited.
My inlaws just moved to Dallas. The doctor I see will not take any new Medicare patents. Note they have company retirement medical but that is secondary to medicare. This is the case for ALL retirees who are elgible for medicare.
Oh, Mr Stark, as an ObGyn I am profoundly scared of dropping Medicare! As are my pediatric colleagues. And I even have a plan to drop more third party payers, to be exact, all those who pay me less than it’s worth.
Referrals from PCPs may change, but my practice and my life will be a lot easier and more fulfilling
Consider the medical insurance Congress provides for itself (surprise! Not Medicare) and the yearly increasing (illegally according to the Constitution) pay raises. And all of this they get the rest of their lives, by golly. There won’t be a single Congress retiree begging for a doctor who takes Medicare patients.
But, we get what we vote for, and we had better not forget it.
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