Friday, March 14, 200812
My take: ER naming rights, grading data, salary disparity
1) There is a possibility that Abercrombie & Fitch will have its name attached to a pediatric emergency room.
My take: The financial troubles that medical institutions are going through have been well documented. Public hospitals like Grady Memorial and MLK-Harbor are teetering on bankruptcy. Maybe taking corporate money and selling naming rights is the last desperate move financially-strapped hospitals can make.
2) Poor data continues to plague doctor grading programs.
My take: Insurers are using data from captured insurance claims. Any physician can tell you how stunningly inaccurate that source can be. One reason why it's so difficult to capture data is the lack of a unified electronic medical record system. Until this comes to fruition (good luck), any grading or rating attempt will be fatally frought with errors.
3) It takes eighty 25-minute visits (99214s) for a PCP to make the equivalent of a cardiologist doing five heart catheterizations.
My take: I have previously written that primary care and specialist salaries should be fairly reconciled. Not equalized, mind you. I believe that specialists should indeed be paid more, but the current salary disparity is ridiculous by any measure. Medical students go to where the money is - and it's not primary care.
My take: The financial troubles that medical institutions are going through have been well documented. Public hospitals like Grady Memorial and MLK-Harbor are teetering on bankruptcy. Maybe taking corporate money and selling naming rights is the last desperate move financially-strapped hospitals can make.
2) Poor data continues to plague doctor grading programs.
My take: Insurers are using data from captured insurance claims. Any physician can tell you how stunningly inaccurate that source can be. One reason why it's so difficult to capture data is the lack of a unified electronic medical record system. Until this comes to fruition (
3) It takes eighty 25-minute visits (99214s) for a PCP to make the equivalent of a cardiologist doing five heart catheterizations.
My take: I have previously written that primary care and specialist salaries should be fairly reconciled. Not equalized, mind you. I believe that specialists should indeed be paid more, but the current salary disparity is ridiculous by any measure. Medical students go to where the money is - and it's not primary care.
Comments
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jb
Dr, Pho, you may have a point, but you will never convince anyone by repeating bullshit data like that.
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Anonymous
I don't disagree with you that hospitals -- especially public hospitals -- are fcing significant financial challenges. However, I do want to correct one fact. MLK-Harbor is no longer an inpatient facility. It's loss of CMS accreditation was not a result of not having enough funding. It was a result of incompetent administration. MLK-Harbor was funded 25% more per bed than its sister facility Harbor-UCLA and still could not deliver care that met basic CMS standards.
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Anonymous
Great article in yesterday's USA Today.
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Anonymous
I'm sorry Kevin. But your comment about the primary care versus cardiologist is intellectually dishonest on so many levels.
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Evan
Jb,
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Riddleberger
I completely agree with you regarding the financial constraints public inner city hospitals are facing in todays society with the number of non-insured individuals in our country. Hospitals are being hit hard with increased cost of medicine with a decrease in reimbursement from the government. I have been telling colleagues, friends, and family in the not so far future we will see corporations (IT, Financial, etc) placing naming rights on hospitals/medical centers to provide financial need/backing to the institutions, while they benefit from the marketing aspect. I whole heartedly believe the benefits would out weigh the negatives not only for the patients, but the community as well. I could continue on and on about this topic, but I figured I would give a short blurb about my viewpoint.
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Anonymous
Once again, Kevin shows how much he loathes specialists. Rather than rising above bickering and rhetoric, he attacks specialists as the root of our country's health care problems. He falls right into the hands of the bueaurocrats with infighting rather than addressing reasonable reimbursement for all.
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Anonymous
"primary care and specialist salaries should be fairly reconciled."
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Anonymous
Oh boy.
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Anonymous
I love cathing. I would cath for free...I do cath for free all the time on self pay patients. How much does Kevin think a cath should pay? Is $240 too much? Maybe $50.
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jb
Jb,
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Anonymous
Kevin,
Post a Comment »The comparison of 5 caths = 80 office visits conveniently neglects to account for the fact that the cardiologist, after training twice as long as a primary doc after medical school to learn his craft, would have to invest over a million dollars to build his cath lab to get both the professional (-26) and technical (-TC) revenue that you are saying he “makes.” Then he has to pay nurses, xray techs, insurance, utilities, etc., for his cath facility. What is left over is what the cardiologist “makes.”
I’ll be the first to agree that cardiologists actually do earn a much higher wage than primary docs, but please, let’s use real numbers.
The cardiologist who does the cath in a facility that he does not own (e.g., a hospital), “makes” $246.08 gross revenue for his time and effort. That’s before practice expenses such as insurance and billing expenses. And yes, despite twice the training after med school that you had, he brings in the same amount that you do for the office visit when he sees the patient for a follow up visit (9921x). Where is the fairness in that?
I’m not saying that you don’t deserve more money, but trying to convince anyone that a cardiologist earns 80X what you earn is just plain wrong.
11:58 AM
1:27 PM
3:29 PM
1. What the previous poster said about having to own the 1,000,000 cath center.
2. I am 90 percent sure that the cath covers the global fee of seeing the patient pre operative and post operative, whereas a primary care doc gets to bill for each separate appointment (note there is no global fee for bringing someone's hypertension down).
3. I am sure there are some other points, but I am tired of typing.
Kevin, I love your blog, BUT you are observely not a disinterested third party in this debate. If I didn't know any better I would say this intellectual dishonesty on the topic is because you are biased. I hope I am wrong and I hope I do not see posts with poor logic like this in the future. Otherwise, love your blog and agree with 95 percent of what you have to say.
3:37 PM
Your assumption is that primary care physicians have no overhead either.
Just as flawed an assumption.
5:30 PM
Regarding your other comment regarding the pay discrepancy between primary care and specialties in todays market is a tough argument. I believe across the board everyone is affected by the decreased reimbursements, and the increased cost of running a profitable healthcare practice.
5:53 PM
How about the mention of the excessive radiation to which cardiologists are subjected? I personally know several cardiologists with lymphoma and cataracts from the radiation. Are you poisoned with radiation in the office seeing patients? Also, are all these caths taking place during daylight hours or is the cardiologist in the cath lab all hours of the night?
PLEASE, Kevin, stop these attacks!
6:19 PM
Sounds like communism to me. The RVS is a means of an all-knowing all wise central committee setting payment now. You can't force equality by arbitrary power 1. It never works just as it isn't working now--some pigs are always more equal than others. 2. It just results in escalating levels of more and more control--like now.
Let the free market set the rates. Open up Medicare to balance billing for all on a case by case basis and let the chips fall where they may. If people value cardiology so much more, then so be it, go to a communist country if you don't like it. I suspect that wouldn't be the case, that you would see cath labs competing on price.
7:17 PM
Here we go again.
When primary care doctors complain about being underpaid, we are told that we are letting "them" divide and rule us, or we are called "socialist" or "communist."
The truth is things are horrendous in primary care. Practices are starting to close, not because the partners want to "get out" but because they are going under.
And stop with the free market nonsense; with the exception of cosmetic procedures, medicine does not obey free market dynamics. It just does not. Is someone not going to have their cancer treated or not get a cardiac cath because they cannot afford it? Is that the country you want to live in?
Comerade Underpaid
9:37 PM
I may love my job but there is no way that I am getting out of bed for $50. Sorry.
9:49 PM
Your assumption is that primary care physicians have no overhead either.
Just as flawed an assumption.
Not even wrong, Evan.
The cardiologist has similar overhead in his office, just as every physician's office has- rent, utilities, computer, employees pay and benefits. After paying for these expenses, just as in primary care, he then has to put up the cath facility at a million plus, and pay extra employees, insurance, utilities, etc., if he wants the full facility fee that is under discussion.
Every medical student knows about the disparity in specialist income. If they choose primary care or another relatively low paid specialty, they are trading a shorter/easier training period, or a less competitive specialty, for lower income in the future. Am I to believe that any senior student is unaware of this when she fills out her match form?
9:28 AM
Your petulant whine about specialty pay is so tiresome. You sound like a whining liberal in that your plight must be because somebody else has more.
The answer lies in doing something for yourself, advocating for yourself, lobbying for yourself, reinventing yourself. The answer does not lie in some type of socialist redistribution. It does not help that a large part of primary care could be done by midlevel providers.
Also as others have pointed out, most primary care people are not sweating bullets on an emergency case at 230am on saturday and sunday mornings.
12:14 PM