Comments on: Should specialists spread the wealth to primary care? http://www.kevinmd.com/blog/2008/11/should-specialists-spread-wealth-to.html Tue, 14 Feb 2012 22:28:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2008/11/should-specialists-spread-wealth-to.html#comment-88131 Anonymous Fri, 14 Nov 2008 00:43:00 +0000 http://clients.emmense.com/kevinmd/2008/11/should-specialists-spread-the-wealth-to-primary-care.html#comment-88131 I see Marxism is in vogue these days. I see Marxism is in vogue these days.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/11/should-specialists-spread-wealth-to.html#comment-88130 Anonymous Fri, 14 Nov 2008 00:38:00 +0000 http://clients.emmense.com/kevinmd/2008/11/should-specialists-spread-the-wealth-to-primary-care.html#comment-88130 You are doing just what Washington wants you to do--fighting among yourselves so that they can better control you. It would just be your business if it wasn't that they also want to take the health freedom of 300 million Americans away but need to bring you boys to heel first. to make you help them do it. That is what RUC is designed to do, and like Pavlov's dogs you are salivating on cue.<br/><br/>How about just throwing out RUC altogether. Set your own hourly rate and let third parties pay however little of it they think they can get away and bill your patients for the balance according to your own lights. You are doing just what Washington wants you to do–fighting among yourselves so that they can better control you. It would just be your business if it wasn’t that they also want to take the health freedom of 300 million Americans away but need to bring you boys to heel first. to make you help them do it. That is what RUC is designed to do, and like Pavlov’s dogs you are salivating on cue.

How about just throwing out RUC altogether. Set your own hourly rate and let third parties pay however little of it they think they can get away and bill your patients for the balance according to your own lights.

]]> By: Deron Schriverhttp://www.kevinmd.com/blog/2008/11/should-specialists-spread-wealth-to.html#comment-88067 Deron Schriver Wed, 12 Nov 2008 11:25:00 +0000 http://clients.emmense.com/kevinmd/2008/11/should-specialists-spread-the-wealth-to-primary-care.html#comment-88067 JB - I'm not sure it would make sense for a patient to pay their insurance premiums, which entitle them to a $20 copay, and then go out of network to a cash-only practice and pay the $50. I like they way you're thinking, but it simply isn't feasible with all other things equal. JB – I’m not sure it would make sense for a patient to pay their insurance premiums, which entitle them to a $20 copay, and then go out of network to a cash-only practice and pay the $50. I like they way you’re thinking, but it simply isn’t feasible with all other things equal.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/11/should-specialists-spread-wealth-to.html#comment-88056 Anonymous Tue, 11 Nov 2008 23:33:00 +0000 http://clients.emmense.com/kevinmd/2008/11/should-specialists-spread-the-wealth-to-primary-care.html#comment-88056 Agreed ERP: The first should be ER docs who were in residency the same time frame as PCP's (three years), work 12-15, 12 hour shifts per month with no call, no follow up, and make $250,000-400,000 plus per year. What do you think? Agreed ERP: The first should be ER docs who were in residency the same time frame as PCP’s (three years), work 12-15, 12 hour shifts per month with no call, no follow up, and make $250,000-400,000 plus per year. What do you think?

]]> By: jbhttp://www.kevinmd.com/blog/2008/11/should-specialists-spread-wealth-to.html#comment-88052 jb Tue, 11 Nov 2008 22:06:00 +0000 http://clients.emmense.com/kevinmd/2008/11/should-specialists-spread-the-wealth-to-primary-care.html#comment-88052 Will some PCP out there please explain why you don't all go to cash practices? Instead of suffering for the crumbs that Medicare and Blue Cross drop on you, get out of their systems, and charge patients for your services like plumbers and grocers and lawyers, even. You could charge reasonable fees, greatly decrease your overhead, and spend more time in clinical matters and less on crap. I know that some have done this, and are derided as concierge practices, but isn't that what practicing medicine really is? Specialists who see much lower volumes of patients at higher cost per patient are much at a disadvantage in this scheme, but surely most of your patients/customers could afford to pay $50-60 for a decent office visit, and you could afford to do that if you did not have $100K/year in overhead each in payroll and IT costs to deal with insurance companies. Really, why not? Will some PCP out there please explain why you don’t all go to cash practices? Instead of suffering for the crumbs that Medicare and Blue Cross drop on you, get out of their systems, and charge patients for your services like plumbers and grocers and lawyers, even. You could charge reasonable fees, greatly decrease your overhead, and spend more time in clinical matters and less on crap. I know that some have done this, and are derided as concierge practices, but isn’t that what practicing medicine really is? Specialists who see much lower volumes of patients at higher cost per patient are much at a disadvantage in this scheme, but surely most of your patients/customers could afford to pay $50-60 for a decent office visit, and you could afford to do that if you did not have $100K/year in overhead each in payroll and IT costs to deal with insurance companies. Really, why not?

]]> By: ERPhttp://www.kevinmd.com/blog/2008/11/should-specialists-spread-wealth-to.html#comment-88049 ERP Tue, 11 Nov 2008 15:14:00 +0000 http://clients.emmense.com/kevinmd/2008/11/should-specialists-spread-the-wealth-to-primary-care.html#comment-88049 Honestly I think a slight redistribution is necessary. Some specialties are paid WAY too much. I am sorry, but a neurosurgeon does not need to make over a million a year. Honestly I think a slight redistribution is necessary. Some specialties are paid WAY too much. I am sorry, but a neurosurgeon does not need to make over a million a year.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/11/should-specialists-spread-wealth-to.html#comment-88042 Anonymous Tue, 11 Nov 2008 00:44:00 +0000 http://clients.emmense.com/kevinmd/2008/11/should-specialists-spread-the-wealth-to-primary-care.html#comment-88042 Deron, it's the RUC (RVU Update Committee of the AMA). The AAFP has only 1 seat out of 29 (and there are only 4 primary care seats total). The rest are specialists...the vast majority of whom do cash-generating procedures or imaging. So it's not surprising that trying to work within the system (i.e., organized medicine) has been futile. Time for a complete overhaul. Deron, it’s the RUC (RVU Update Committee of the AMA). The AAFP has only 1 seat out of 29 (and there are only 4 primary care seats total). The rest are specialists…the vast majority of whom do cash-generating procedures or imaging. So it’s not surprising that trying to work within the system (i.e., organized medicine) has been futile. Time for a complete overhaul.

]]> By: Deron Schriverhttp://www.kevinmd.com/blog/2008/11/should-specialists-spread-wealth-to.html#comment-88041 Deron Schriver Tue, 11 Nov 2008 00:11:00 +0000 http://clients.emmense.com/kevinmd/2008/11/should-specialists-spread-the-wealth-to-primary-care.html#comment-88041 What is the AAFP role in all of this? I'm hearing that specialist societies are preventing the necessary RVU realignment. Are PCPs and the AAFP not speaking up? What is the AAFP role in all of this? I’m hearing that specialist societies are preventing the necessary RVU realignment. Are PCPs and the AAFP not speaking up?

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/11/should-specialists-spread-wealth-to.html#comment-88040 Anonymous Tue, 11 Nov 2008 00:08:00 +0000 http://clients.emmense.com/kevinmd/2008/11/should-specialists-spread-the-wealth-to-primary-care.html#comment-88040 This is excellent. It's about time that PCPs finally strapped on a backbone and took it to the overpaid procedurists and imagers. It's also about time that they realize the AMA represents the economic interests of specialists. Representing "doctors" means nothing when you have this degree of income disparity.<br/><br/>The last thing that worries me is the hollow threat that specialists will be unwilling to work for significantly less. After all, oversubscription to their residency programs (2 US grads per spot in some specialties) guarantees that replacement of their laborforce will continue despite deep cuts. This is excellent. It’s about time that PCPs finally strapped on a backbone and took it to the overpaid procedurists and imagers. It’s also about time that they realize the AMA represents the economic interests of specialists. Representing “doctors” means nothing when you have this degree of income disparity.

The last thing that worries me is the hollow threat that specialists will be unwilling to work for significantly less. After all, oversubscription to their residency programs (2 US grads per spot in some specialties) guarantees that replacement of their laborforce will continue despite deep cuts.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/11/should-specialists-spread-wealth-to.html#comment-88039 Anonymous Mon, 10 Nov 2008 23:44:00 +0000 http://clients.emmense.com/kevinmd/2008/11/should-specialists-spread-the-wealth-to-primary-care.html#comment-88039 Specialists should care.<br/>Once they succeed in replacing primary care doctors with cheaper, less trained "providers", they are going to come for you next. Afterall, do you really need to be trained in GI to do a scope? Why can't a PA or NP be trained to do colonoscopies? How about a cath? Or an appendectomy? Specialists should care.
Once they succeed in replacing primary care doctors with cheaper, less trained “providers”, they are going to come for you next. Afterall, do you really need to be trained in GI to do a scope? Why can’t a PA or NP be trained to do colonoscopies? How about a cath? Or an appendectomy?

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