Comments on: Where’s the money to better pay primary care doctors going to come from?

By: Taejoon Ahn MD MPH

Taejoon Ahn MD MPH — Wed, 21 Oct 2009 23:31:59 +0000

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.

By: Steven Murphy MD

Steven Murphy MD — Thu, 15 Oct 2009 23:56:29 +0000

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

By: Okulus

Okulus — Thu, 15 Oct 2009 14:02:33 +0000

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.

By: ZMD

ZMD — Wed, 14 Oct 2009 18:09:59 +0000

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.

By: Michael Kirsch, M.D.

Michael Kirsch, M.D. — Wed, 14 Oct 2009 11:29:32 +0000

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 When a tax break is rescinded, this is NOT a tax increase.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.

By: T Steadmon

T Steadmon — Wed, 14 Oct 2009 04:53:53 +0000

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?

By: Mark McAllister MD

Mark McAllister MD — Wed, 14 Oct 2009 01:29:20 +0000

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

By: ninguem

ninguem — Wed, 14 Oct 2009 01:25:25 +0000

“The money will come from eliminating waste and from the savings you get by converting to electronic medical records.”

…..heh……..

By: Okulus

Okulus — Wed, 14 Oct 2009 01:09:15 +0000

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.

By: T Steadmon

T Steadmon — Tue, 13 Oct 2009 20:31:38 +0000

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.