Comments on: Will specialists sacrifice to pay primary care doctors? Are budget-neutral changes the only option?

By: Anonymous

Anonymous — Fri, 30 Jan 2009 19:21:00 +0000

"The "pie" refers to public funds"

So you have a fixed amount of public funds. If Paul wants more money, here are the options.

1. Take more money from Peter
2. Get more funds.

Raising medicare taxes or having individuals pay more for medical care introduces more money into the system. Call it public or private, the system needs more money. The AMA and the ACP wants more money and what you suggest is introducing more money. Now whether we should make the tax payers pay more or the individual who needs care pay more doesn't make it a neutral-budget solution.

By: John

John — Fri, 30 Jan 2009 18:03:00 +0000

>>"Balance billing is adding to the pie"

Really? I don't see how. The "pie" refers to public funds, what is paid out by Medicare and divided according to their various formula for RVUs and multipliers. Balance billing is paid with private funds and is directed to a specific provider (and competed-for by other providers by price and service.) The balance billed payment is not the government's to take and allocate to someone else.

The balance billed services can be sought elsewhere where the cost is lower or even at the level that Medicare pays (i.e. zero balance to bill.)

My extra money to spend, if I have it, isn't Medicare's to spend anywhere.

By: Anonymous

Anonymous — Fri, 30 Jan 2009 12:10:00 +0000

There you go again kevin.
Specialist’s are not some monolithic stalinist entity. Try talking with an ID doc or a general surgeon kevin

By: Anonymous

Anonymous — Thu, 29 Jan 2009 19:39:00 +0000

“permit the physician to balance bill the difference”

Balance billing is adding to the pie. And if patients choose providers that don’t exceed Medicare payments, then the same pie is being redistributed (or not.)

By: Anonymous

Anonymous — Thu, 29 Jan 2009 18:47:00 +0000

First, allow participation with Medicare as concerns assignment by procedure, not all-or-nothing. If you want, require that all participants post the applicable charge for any CPT-defined service for which the Medicare rate is not accepted. Have Medicare pay whatever the allowable is and permit the physician to balance bill the difference. That will encourage wise patients to shop around or at least request a “not to exceed” charge figure. All this is possible without enlarging the so-called “pie.”

You would not have to steal from Peter to pay Paul (which always makes Pete so peeved, . . . wonder why?) and you would have a much more normal and useful brake to wasteful consumption than the price and cost-hiding mechanism that Medicare has now.

By: IVF-MD

IVF-MD — Thu, 29 Jan 2009 17:08:00 +0000

It’s a shame that that specialists and PCPs end up fighting for increasing shares of the same pie. The problem is that the size of the pie is fixed by some arbitrary third party. So if that is the case, then there are only two ways to enlarge the PCP share and that is to move over and cut into the specialists’ share or to globally enlarge the pie. The pie is already so large and the pie bakers resources stretched so thin that enlarging the pie is not feasible. The math is simple. That leaves increasing PCP share and reducing specialist share as the only way to increase PCP reimbursement overall.

As a specialist in a field that doesn’t even compete for any of that pie, (we have our own pie, albeit much smaller), I can claim to empathize with my fellow physicians, but I acknowledge that I can’t really 100% know what it’s like to be in their shoes. I only know that I do care that efforts are made by our political leaders to address this situation wisely rather than just singlemindedly focusing on pandering for votes by giving away the fruits of the hard-working tax-paying people.