Comments on: Geriatricians on the decline, and why physician payment needs to be reformed http://www.kevinmd.com/blog/2008/12/geriatricians-on-decline-and-why.html medical blog Mon, 23 Nov 2009 01:35:28 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2008/12/geriatricians-on-decline-and-why.html/comment-page-1#comment-88984 Anonymous Thu, 01 Jan 2009 18:45:00 +0000 http://clients.emmense.com/kevinmd/2008/12/geriatricians-on-the-decline-and-why-physician-payment-needs-to-be-reformed.html#comment-88984 The whole public versus private debate is a sham. Right now, there is a very unholy alliance between the public (medicare, medicaid) and private (insurance companies)spheres of influence.<br/><br/>Examples:<br/>1) insurance companies almost always set their reimbursements as a percentage of medicare. Therefore, they have significant interest in keeping reimbursements low.<br/><br/>2) insurance companies set to benefit from alternatives to medicare and medicaid, such as medicare advantage and medicaid managed care programs.<br/><br/>3) health policy wonks fequently have backgrounds in private insurance, similar to the revolving door politician/lobbyist system on the infamous K Street in D.C.<br/><br/>Back to the issue at hand. The outlook for geriatrics as a specialty is bleak because income is dependent on non-procedural, ie cognitive, cpt medicare reimbursements which are kept low by a cabal of the following: a specialist dominated but AMA sponsored RVU system, penny pinching but short sighted politicians, private insurance companies who want to smell rosier than public insurance and an indifferent and under-appreciative public.<br/><br/>Starting in January, 2009, my family practice in upstate New York will stop accepting new medicare patients. I encourage all pcps out there to do the same. Let those selfish baby boomers have nowhere to go. Then maybe there will be some change. The whole public versus private debate is a sham. Right now, there is a very unholy alliance between the public (medicare, medicaid) and private (insurance companies)spheres of influence.

Examples:
1) insurance companies almost always set their reimbursements as a percentage of medicare. Therefore, they have significant interest in keeping reimbursements low.

2) insurance companies set to benefit from alternatives to medicare and medicaid, such as medicare advantage and medicaid managed care programs.

3) health policy wonks fequently have backgrounds in private insurance, similar to the revolving door politician/lobbyist system on the infamous K Street in D.C.

Back to the issue at hand. The outlook for geriatrics as a specialty is bleak because income is dependent on non-procedural, ie cognitive, cpt medicare reimbursements which are kept low by a cabal of the following: a specialist dominated but AMA sponsored RVU system, penny pinching but short sighted politicians, private insurance companies who want to smell rosier than public insurance and an indifferent and under-appreciative public.

Starting in January, 2009, my family practice in upstate New York will stop accepting new medicare patients. I encourage all pcps out there to do the same. Let those selfish baby boomers have nowhere to go. Then maybe there will be some change.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/12/geriatricians-on-decline-and-why.html/comment-page-1#comment-88977 Anonymous Thu, 01 Jan 2009 13:46:00 +0000 http://clients.emmense.com/kevinmd/2008/12/geriatricians-on-the-decline-and-why-physician-payment-needs-to-be-reformed.html#comment-88977 It seems to me this is more an example of Government having given up its influence to the medical profession, whose goals and priorities are not in line with the general public interest. <br/><br/>I'd much rather spend more to have Grandma off 6 medications and able to move around without falling and breaking her hip -- but the medical profession has set it up to get a fat fee for replacing her hip after she breaks it. <br/><br/>It's time for the public to set priorities, not the medical profession.<br/><br/>Not to single out Physicians, there are plenty of other parties who benefit - device makers, drug companies, hospitals. Keeping someone well and functioning is not as profitable as fixing them up after the fact -- for individual parties. For the public as a whole it is. <br/><br/>I'd like to think that the new leadership in this county has the backbone to stand up for the public and straighten priorities out, but I don't think it's something that can be done overnight. It seems to me this is more an example of Government having given up its influence to the medical profession, whose goals and priorities are not in line with the general public interest.

I’d much rather spend more to have Grandma off 6 medications and able to move around without falling and breaking her hip — but the medical profession has set it up to get a fat fee for replacing her hip after she breaks it.

It’s time for the public to set priorities, not the medical profession.

Not to single out Physicians, there are plenty of other parties who benefit – device makers, drug companies, hospitals. Keeping someone well and functioning is not as profitable as fixing them up after the fact — for individual parties. For the public as a whole it is.

I’d like to think that the new leadership in this county has the backbone to stand up for the public and straighten priorities out, but I don’t think it’s something that can be done overnight.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/12/geriatricians-on-decline-and-why.html/comment-page-1#comment-88974 Anonymous Thu, 01 Jan 2009 10:31:00 +0000 http://clients.emmense.com/kevinmd/2008/12/geriatricians-on-the-decline-and-why-physician-payment-needs-to-be-reformed.html#comment-88974 If the government isn't paying for health care for the elderly, who will? I don't see any way to keep the government out of providing health care for elders. The majority of them can't afford to pay for their own health insurance. It's like when you see people holding up signs that say, "Keep the government away from my medicare." Guess what? The government IS your medicare. How do you propose we keep government out of it? If the government isn’t paying for health care for the elderly, who will? I don’t see any way to keep the government out of providing health care for elders. The majority of them can’t afford to pay for their own health insurance. It’s like when you see people holding up signs that say, “Keep the government away from my medicare.” Guess what? The government IS your medicare. How do you propose we keep government out of it?

]]> By: Bad Medicine, Good Solutions http://www.kevinmd.com/blog/2008/12/geriatricians-on-decline-and-why.html/comment-page-1#comment-88972 Bad Medicine, Good Solutions Thu, 01 Jan 2009 01:38:00 +0000 http://clients.emmense.com/kevinmd/2008/12/geriatricians-on-the-decline-and-why-physician-payment-needs-to-be-reformed.html#comment-88972 The current debacle you speak of is the byproduct of government influence on medical care. <br/><br/>The government is everything but the solution to our nation's medical problems. The current debacle you speak of is the byproduct of government influence on medical care.

The government is everything but the solution to our nation’s medical problems.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/12/geriatricians-on-decline-and-why.html/comment-page-1#comment-88969 Anonymous Thu, 01 Jan 2009 00:11:00 +0000 http://clients.emmense.com/kevinmd/2008/12/geriatricians-on-the-decline-and-why-physician-payment-needs-to-be-reformed.html#comment-88969 IANAD, but IMHO primary care doctors need to be compensated more fairly for what they do. Those who are concerned about the impending doom of 'income redistribution' might wish to relocate to a climate more favorable to their opinion. "We, the people" have had it with the current health care debacle and have made our desire for change known. IANAD, but IMHO primary care doctors need to be compensated more fairly for what they do. Those who are concerned about the impending doom of ‘income redistribution’ might wish to relocate to a climate more favorable to their opinion. “We, the people” have had it with the current health care debacle and have made our desire for change known.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/12/geriatricians-on-decline-and-why.html/comment-page-1#comment-88964 Anonymous Wed, 31 Dec 2008 23:39:00 +0000 http://clients.emmense.com/kevinmd/2008/12/geriatricians-on-the-decline-and-why-physician-payment-needs-to-be-reformed.html#comment-88964 Geriatricians work in a government run single-payor system--and unless they graduated before 1966, they knew that is what they were choosing to do. Are they complaining about it now? Are they complaining about the predictable outcome of that scenario now? Should we pity them. I think rather we should hold their plight up as an example to all the the other collectivists out there who advocate single-payor. Geriatricians work in a government run single-payor system–and unless they graduated before 1966, they knew that is what they were choosing to do. Are they complaining about it now? Are they complaining about the predictable outcome of that scenario now? Should we pity them. I think rather we should hold their plight up as an example to all the the other collectivists out there who advocate single-payor.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/12/geriatricians-on-decline-and-why.html/comment-page-1#comment-88961 Anonymous Wed, 31 Dec 2008 22:21:00 +0000 http://clients.emmense.com/kevinmd/2008/12/geriatricians-on-the-decline-and-why-physician-payment-needs-to-be-reformed.html#comment-88961 What's REALLY crazy is that people who opt for a fellowship in geriatrics can expect to make LESS money as a reward for their extra time. So much for specialists claiming they should get more money because their training is longer. What’s REALLY crazy is that people who opt for a fellowship in geriatrics can expect to make LESS money as a reward for their extra time. So much for specialists claiming they should get more money because their training is longer.

]]> By: daccarte http://www.kevinmd.com/blog/2008/12/geriatricians-on-decline-and-why.html/comment-page-1#comment-88951 daccarte Wed, 31 Dec 2008 15:40:00 +0000 http://clients.emmense.com/kevinmd/2008/12/geriatricians-on-the-decline-and-why-physician-payment-needs-to-be-reformed.html#comment-88951 Please see my blog post on this topic. I also pose the question, "can Elderly Wellness Centers in communities be established"? I am not in the medical field but am the daughter of an aging parent in a retirement community...and have seen the wonderful benefits of my mother's access to a Wellness Center onsite.<br/><br/>I'd love to hear feedback from others on this idea?Thank you. Dale <br/>http://daleblogg.blogspot.com/2008/12/facing-critical-decline-of.html Please see my blog post on this topic. I also pose the question, “can Elderly Wellness Centers in communities be established”? I am not in the medical field but am the daughter of an aging parent in a retirement community…and have seen the wonderful benefits of my mother’s access to a Wellness Center onsite.

I’d love to hear feedback from others on this idea?Thank you. Dale
http://daleblogg.blogspot.com/2008/12/facing-critical-decline-of.html

]]> By: thecountrydocreport http://www.kevinmd.com/blog/2008/12/geriatricians-on-decline-and-why.html/comment-page-1#comment-88950 thecountrydocreport Wed, 31 Dec 2008 14:21:00 +0000 http://clients.emmense.com/kevinmd/2008/12/geriatricians-on-the-decline-and-why-physician-payment-needs-to-be-reformed.html#comment-88950 Very good point, but is the surgeon willing to give up some of his or her procedure reimbursement so primary care physicians and geriatricians can be compensated more appropriately? Very good point, but is the surgeon willing to give up some of his or her procedure reimbursement so primary care physicians and geriatricians can be compensated more appropriately?

]]> By: scalpel http://www.kevinmd.com/blog/2008/12/geriatricians-on-decline-and-why.html/comment-page-1#comment-88948 scalpel Wed, 31 Dec 2008 14:06:00 +0000 http://clients.emmense.com/kevinmd/2008/12/geriatricians-on-the-decline-and-why-physician-payment-needs-to-be-reformed.html#comment-88948 Medicare is going to go bankrupt anyway no matter how they apportion physician charges. Medicare is going to go bankrupt anyway no matter how they apportion physician charges.

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