I’ve written before that there’s a good possibility that tensions between primary care doctors and their specialist brethren will get worse.
The issue comes down to pay. Congress, rightly, is trying to find ways to better compensate primary care physicians, but most proposals do so at the expense of specialists.
In an article from Investor’s Business Daily, most of the bills circulating through Congress call for a 10 percent increase in primary care pay. Where is that money going to come from?
Ideally, it shouldn’t come from specialists, and any such suggestion is meeting the predictable response:
About half of the funding for the bonuses comes from across-the-board cuts in the fees Medicare pays for nonprimary care.
Specialists, naturally, oppose this course of treatment. The Alliance of Specialty Medicine sent a letter to Baucus saying that its members could not “support your manager’s amendment that would provide additional payments to primary-care physicians at the expense of specialists … we support (the Kyl Amendment) and other proposals to ensure that any primary-care bonuses are not at the expense of specialty care.”
But it’s going to be difficult to expand the pie, especially with the fiscal environment facing reform. Politicians would like nothing else but to see physician groups snipe at each other. Divide and conquer, as they say.
I think it will take more than money to convince medical students to pursue primary care as a career, however. A 10 percent pay raise by itself isn’t going to do it, with these students graduating with mortgage-sized school loans. The work environment and bureaucratic burden will have to improve as well. Here’s my quote in the piece:
. . . the problem goes beyond financial.
“Money aside, there has to be more done to improve the work environment for primary-care doctors,” he said. “The paperwork requirement is onerous, and doctors find frustrating the restrictions both Medicare and insurance companies impose on the doctor-patient relationship.”
Related posts:
- Primary care
- Medical students want to become primary care doctors, until reality hits
- Medical students avoiding primary care, is it more than money?
- Are cardiologists going to take their reimbursement frustrations out on primary care residents?
- How to fix the primary care shortage
- Is loan forgiveness enough to convince students to choose primary care?
- Will specialists sacrifice to pay primary care doctors? Are budget-neutral changes the only option?
{ 15 comments }
Kevin,
I invite readers to consider to read my post – Pulling primary care out of insurance –
In that post and a previous one, I argue that traditional insurance (including Medicare) does not fit primary care. I agree that the paper work “requirements” induce an unnecessary burden on primary care physicians. Thus, the solution for primary care does not exist with Medicare reform, but rather developing a new model for primary care.
Perhaps they can put a windfall profits tax on med mal mega-judgements?
Agree with you, Kevin, that money is not the whole problem confronting primary care, but solving that issue would decrease the prestige problem and make the inevitable paperwork and other hoops in medicine a bit more tolerable.
The only way to solve this conundrum is delivery system reform: bundled payments, accountable care groups etc. In that environment, no one makes it without a satisfied group of primary care doctors leading the way and providing the coordination that saves money. Those subspecialist groups that plan to obstruct these needed changes do not have the best interests of their patients and our country at heart.
In db’s blog, he wrote:
“So the current system encourages physicians to see patients quickly (paying a fixed amount for a visit) and often schedule an unnecessary repeat appointment to finish the work (doubling the billing and collection.)”
This is the result one gets when you make a pact with the govt (Medicare, Medicaid) and submit your business model to political machinations.
As a result, primary care is gradually fragmenting into two distinct models:
1) the Walgreen’s/CVS/Wal-Mart model whereby PAs or NPs are assuming much of the routine primary care, or
2) the Concierge model whereby the MD can afford to break out of the mold of seeing 1 patient each 6 minutes.
Asking the govt for true medical reform means asking the politicians for reform. DB is correct – break away from the conventional model bcs in the end you cannot massage the politcal process to get the reform each of you (and MDs are not monolitic in their viewpoint as to what reform is best) want.
Medicare/Medicaid broke primary care – so why are you expecting them to repair it?
The $$$ will come from specialists like me. However, there will still be a substantial wage gap between primary physicians and specialists, even with a 10% pay raise for primaries. This won’t be sufficient to drive folks away from cardiology, GI or orthopedics. This zero sum game issue will exacerbate existing tensions within our profession at a time when we desperately need to be unified. Many of us do not feel we are adequately compensated for the work we do. In any profession or trade, Is anyone actually paid what he thinks he is worth?
I think it is likely we will see a tax on physician income as was just passed recently in the Michigan state legislature. The tax that was passed there is a 3% tax on gross physician practice income. The government will use the money raised to reward doctors they see as beneficial to the system.
The money raised from the tax in Michigan will be redirected to doctors seeing high percentages of Medicare patients, but this could easily be changed to primary care physicians if elected officials felt this would be beneficial. This has been suggested by some Congressman for nationwide use, but most are waiting until the new health bill is passed before really pushing this idea since it may meet some resistance.
A state tax on gross physician practice collections would be a disaster. It is a sales tax except that the tax cannot be passed onto the consumer.
This will result in an accelerated withdrawal from Medicaid and every other managed-care plan that is presently seen by doctors as having questionable merit.
You must also believe in the tooth fairy if you think “government” is going to give a turnback of those taxes to practices for any purpose. That won’t happen.
I am with the others who think outpatient primary care should shrug off the insurance model, including Medicare. It has failed and abused them.
“The money will come from eliminating waste and from the savings you get by converting to electronic medical records.”
…..heh……..
I find it interesting how a 10% increase in medicare payents has been translated by the press into a 10% pay raise. Get 66 cents on the dollar rather than 60 cents for medicare services is certainly not going to give me a 10% raise.
~Mark
3rd year Family Medicine Resident
Physician Tax article Some democrats are planning to push this nationally once a health care reform bill is passed.
Where are people getting the idea that there will be a 10% increase to primary care physicians? This was talked about initially, but this is not in the current bill. Everyone should contact their congressman to find out exactly what they are planning with regard to this. It seems like a lot of physicians think that this bill will mean an increase in primary care reimbursement, but I have been following the bill pretty closely and to my knowledge this is not true. I have seen the 25% reduction in medicare reimbursement to all physicians. A 10% increase after a 25% decrease for everyone would not be a victory. Does anyone here have information about a possible increase in reimbursements that I am unaware of?
Obviously, the above commenter needs some remedial work in Congressional Math (CM). Of course, when they announce a 10% increase in something to our benefit, this is the ‘gross’ estimate coming before various fees, shipping & handling charges and other nickle and dime pickpocketing. Works on reverse also. When a tax break is rescinded, this is NOT a tax increase. Better hit the books if you want to understand this stuff.
A recent op-ed in the Wall Street Journal mentioned that Medicare funding will shift from specialists to primary care. They noted examples such as cardiologists will get paid 19% less and oncologists 11% less. Procedures like echocardiograms will have their reimbursements reduced by 42%. That’s how this zero sum game will end up.
The price will be paid in access. Marginally profitable practices will be closing up shop. Availability of all kinds of care will be diminished, not increased, that includes specialty care and general care. Procedures that are money losers under the new regime will become less available as those doctors who have made very little providing them under current reimbursement find it no longer feasible to provide that service. Crappy insurance plans will go begging for participating practitioners (they already do, but there will be more crappy plans soon.)
Congress can write whatever legislation they want, but they can’t change the laws of the market.
Money? Doctors get paid money? Really? This is news to me. Why not just run medicine on the IMF fund? Or better yet, we start our own health care currency!
-Steve
Dividing the house of medicine primary care vs. sub-specialty is based on a false premise. It’s not just about reimbursement per procedure but total volume as well. Our only hope is to re-engineer health delivery systems to decrease the total volume of high intensity services by increasing prevention and chronic disease management. This can only be done with robust primary care. Let fewer CT surgeon make a million+ a year doing coronary artery bypass surgeries. We just a need a system that decreases the total volume of procedures due to a healthier population.
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