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Wed Dec 19, 2012, 08:25 PM

 

Would it be so bad if we dropped medicare doc reimbursements by 27%

http://money.cnn.com/2012/11/08/news/economy/fiscal-cliff/index.html

Why isn't that somewhere we should be able to cut expenses?

If doctors want to stop treating the elderly I don't imagine that will go over well.

43 replies, 2671 views

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Reply Would it be so bad if we dropped medicare doc reimbursements by 27% (Original post)
dkf Dec 2012 OP
doc03 Dec 2012 #1
dkf Dec 2012 #3
valerief Dec 2012 #5
dkf Dec 2012 #6
uppityperson Dec 2012 #10
Major Nikon Dec 2012 #36
uppityperson Dec 2012 #2
dkf Dec 2012 #4
pnwmom Dec 2012 #7
dkf Dec 2012 #9
uppityperson Dec 2012 #11
RantinRavin Dec 2012 #15
dkf Dec 2012 #25
pnwmom Dec 2012 #24
DreamGypsy Dec 2012 #29
uppityperson Dec 2012 #8
dkf Dec 2012 #16
uppityperson Dec 2012 #19
MotherPetrie Dec 2012 #28
Yo_Mama Dec 2012 #33
Major Nikon Dec 2012 #37
dkf Dec 2012 #39
Yo_Mama Dec 2012 #43
banned from Kos Dec 2012 #41
Yo_Mama Dec 2012 #42
taught_me_patience Dec 2012 #34
doc03 Dec 2012 #12
uppityperson Dec 2012 #20
former9thward Dec 2012 #14
dkf Dec 2012 #17
TheKentuckian Dec 2012 #13
dkf Dec 2012 #18
uppityperson Dec 2012 #21
devilgrrl Dec 2012 #30
TheKentuckian Dec 2012 #31
Hekate Dec 2012 #22
Yo_Mama Dec 2012 #38
fadedrose Dec 2012 #23
fadedrose Dec 2012 #26
leftstreet Dec 2012 #27
Yo_Mama Dec 2012 #32
Yo_Mama Dec 2012 #35
HeiressofBickworth Dec 2012 #40

Response to dkf (Original post)

Wed Dec 19, 2012, 08:27 PM

1. There are some doctors that won't take Medicare patients already n/t

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Response to doc03 (Reply #1)

Wed Dec 19, 2012, 08:30 PM

3. Put them on a list. Shame them into it.

 

Isn't that what activism is about? Lawyers do pro-bono work. Why don't we expect more from Doctors?

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Response to dkf (Reply #3)

Wed Dec 19, 2012, 08:33 PM

5. Why shouldn't we expect more from our government? Every other civilized country has universal

healthcare. Why don't we?

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Response to valerief (Reply #5)

Wed Dec 19, 2012, 08:34 PM

6. I'm fine with that too.

 

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Response to dkf (Reply #3)

Wed Dec 19, 2012, 08:37 PM

10. Shame doctors into taking less in than they pay out in expenses? You are something.

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Response to doc03 (Reply #1)

Wed Dec 19, 2012, 09:38 PM

36. There are a lot more that treat existing Medicare patients, but won't take new ones

When you drop medicare reimbursments, the doctors that are in the most demand just aren't going to play.

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Response to dkf (Original post)

Wed Dec 19, 2012, 08:30 PM

2. Yes, it would be because they don't pay enough as it is. Cut the bloated defense budget instead.

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Response to uppityperson (Reply #2)

Wed Dec 19, 2012, 08:32 PM

4. US doctor salaries greatly exceed that of other countries.

 

What is your evidence that they don't get paid enough?

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Response to dkf (Reply #4)

Wed Dec 19, 2012, 08:34 PM

7. There are too few internists and family practitioners as it is.

Lowering their reimbursements won't attract more to the profession.

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Response to pnwmom (Reply #7)

Wed Dec 19, 2012, 08:37 PM

9. That is due to the AMA restrictions.

 

They do it it keep doctors salaries healthy. Very ironic.

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Response to dkf (Reply #9)

Wed Dec 19, 2012, 08:38 PM

11. Fewer docs are going into FP because of AMA restrictions and not because they work long hrs and

get paid too little? Edited to add HAHAHAHAHHAHAHAHHAHAHAHHAAA

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Response to dkf (Reply #9)

Wed Dec 19, 2012, 08:41 PM

15. AMA is a trade association

There is no requirement for any doctor to be a member.

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Response to RantinRavin (Reply #15)

Wed Dec 19, 2012, 09:04 PM

25. No but they influence the number of residency programs that caps the number of doctors.

 

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Response to dkf (Reply #9)

Wed Dec 19, 2012, 09:00 PM

24. Wrong. The AMA is NOT preventing more doctors

from choosing to be internists and other primary care doctors -- they are the ones choosing more lucrative specialties.

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Response to dkf (Reply #9)

Wed Dec 19, 2012, 09:09 PM

29. Phil Ochs - The AMA song (lyrics only)

Oh, we are the nation's physicians
Yes, we give to our lobbies every day
We will fight against disease when the money comes with ease
And when we get together we say
Hooray for A.M.A.
And for us doctors let's have higher pay
If you can't afford my bill don't you tell me that you're ill
'Cause that's the free enterprise way

We've divided up the sections of the body
Every day we specialize more and more
But we really love to stitch the diseases of the rich
We are sure there is a clinic for the poor
Hooray for the A.M.A
And for us doctors let's have higher pay
If you can't afford my bill don't you tell me that you're ill
'Cause that's the free enterprise way

And our waiting rooms are getting pretty crowded
It is sad to see our patients sit and bleed
But if you must use our ointment then you must have an appointment
Or who'll pay for those magazines you read
Hooray for the A.M.A
And for us doctors let's have higher pay, higher pay
If you can't afford my bill don't you tell me that you're ill
'Cause that's the free enterprise way

And now the government is getting too ambitious
Yes, we know they want to socialize us all
Well our oath was Hippocratic but with money we're fanatic
So we'll see you in Canada in the fall
Hooray for the A.M.A.
And for us doctors let's have higher pay
If you can't afford my bill don't you tell me that you're ill
'Cause that's the free enterprise way
AMALGAMATED A.M.A.!!!

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Response to dkf (Reply #4)

Wed Dec 19, 2012, 08:36 PM

8. Having worked in clinics and seeing how little medicare reimburses, that is a problem

My evidence is what I've seen. I agree that some doctors get paid overall too much, but it is in no way due to Medicare paying them too much.

Cut the bloated defense budget as it is far too large and greatly exceeds that of other countries.

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Response to uppityperson (Reply #8)

Wed Dec 19, 2012, 08:41 PM

16. Why isn't this considered a service to the country?

 

Demanding old sickly patients pay full boat seems outrageous to me.

Why are doctors the one highly paid profession that we fully support excess profits?

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Response to dkf (Reply #16)

Wed Dec 19, 2012, 08:51 PM

19. Run up huge debt in school, make barely enough to make ends meet is what you demand?

Yeah, that'll really encourage people to be doctors. Hundreds of thousands of debt, huge responsibilities and not much income "for servie to the country".


For the rest of what you claim, pshaw.

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Response to dkf (Reply #16)

Wed Dec 19, 2012, 09:06 PM

28. My best friend is a family doctor and you would be shocked how little she nets

 

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Response to dkf (Reply #16)

Wed Dec 19, 2012, 09:28 PM

33. You are living in a fantasy world

Medicare doesn't pay full freight. It doesn't generally pay anything close to full freight.

The best reimbursements are for specialists and certain procedures, but primary care/routine care reimbursements are laughable in many cases.

I posted this before - Medicare reimbursement locally for a chest X-ray would be $47.07 ($34.36 if the cut went through). About the national minimum for a chest X-ray is $200, and national average is $390.

You have not the foggiest clue about the real numbers. It's already a struggle to get Medicare patients decent care, because both doctors and hospitals are limiting Medicare patients due to not being able to cover the costs.

Most FP docs aren't making much. We have a situation in which some FP docs are practicing without being able to pay for their own insurance and make payroll.

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Response to Yo_Mama (Reply #33)

Wed Dec 19, 2012, 09:40 PM

37. ^^^^^^^^^^^^^^^ +1

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Response to Yo_Mama (Reply #33)

Wed Dec 19, 2012, 10:00 PM

39. How much is "not much"?

 

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Response to dkf (Reply #39)

Thu Dec 20, 2012, 08:37 PM

43. In solo practice, often between 50K & 75K

Net. This is the reason most sole practices are trying to consolidate into group practices. The other common strategy is to sell the practice to a hospital, which then uses it as a feeder chain for its profitable lines of business. Sales of practices have been rocketing up since Obamacare was passed.

In rural areas where it is hard to do the group practice thing, there are a bunch of solo practices that are so bust the doctors might get paid a net of 30K a year, if that.

Don't take my word for it - take a look around the web at listings for medical practices for sale - look at the nets for the different types.

Here's some listings for CA:
http://www.bizben.com/business-for-sale/medical-practices-for-sale-type-california-ca.php

And here's Practice World:
http://www.practiceworld.com/realestate/

Take a look at this sample:
http://www.practiceworld.com/realestate/DisplayAd.asp?id=1055

Here's a more prosperous one, but if the asking price is $200K the practice can't be netting more than 150K
http://www.practiceworld.com/realestate/DisplayAd.asp?id=1050

Here's a wonderful opportunity!
http://www.practiceworld.com/realestate/DisplayAd.asp?id=1030
If it is grossing 120K the net is probably something on the order of 40K.

Take a look at the family practices listing:
http://www.practiceworld.com/realestate/Browse.asp?cid=13


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Response to Yo_Mama (Reply #33)

Wed Dec 19, 2012, 10:56 PM

41. A chest X-Ray has no cost other than the attendent and some electricity

 

and a tiny bit of depreciation on the machine.

All less than $2 for that $47 procedure.

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Response to banned from Kos (Reply #41)

Thu Dec 20, 2012, 08:34 PM

42. There's the film

Around here at the most commonly used clinic you will walk out with your films, which do indeed cost something. I know, I know, it is shocking that X-rays still use films, but they do. They also put the stuff in an electronic db so that if a doctor is hooked up they can log on and look at electronic copies of the images.

Then you have to pay a radiologist for interpretation.

In Australia it will cost you around $60 at an outpatient clinic like that:
http://www.bobinoz.com/blog/2784/the-australian-health-service-getting-an-x-ray/

But everybody is basically insured in Australia, so there isn't much of the free care cost-shifting. There is in our system.

When you walk into the clinic there are two people manning the desk. They will have you fill out a bunch of paperwork and then copy your ID, so they can prove in an audit that it was really you. They will then enter all this info into their system, and check your insurance eligibility, if any. Then someone will come back to take you to the prep room, instruct you to disrobe, ask you a bunch of questions to ensure nothing bad will happen, and leave you in the waiting room for the X-ray tech to pick up in their queue. Then the X-Ray tech gets you.

Perhaps in your world all these people work for free. In the rest of the world they do not. After the X-Ray is completed (two views), as I said they will give you copies in a big manila envelope. Then they will have the radiologist read the film and do an interpretation, which will be faxed to the doctor, and copies will be put up on their electronic db. If something looks really bad, they will generally call the doctor to ensure that it doesn't get lost in the clutter and the patient doesn't get improperly treated. They have liabilities too - they pay malpractice insurance for each radiologist. Malpractice insurance is calculated on how many patients you see.

Then the clinic will file for payment with the insurance company. They pay a fee for each claim filed through the intermediary (claims submitter). Eventually, the insurance company will pay - probably something on the order of $100-130. There are various software systems that cost money.

Dream on.

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Response to dkf (Reply #16)

Wed Dec 19, 2012, 09:32 PM

34. Here's a little tip for you: Nobody works for free n/t

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Response to dkf (Reply #4)

Wed Dec 19, 2012, 08:38 PM

12. Ask one he will tell you it's hard to make your mortgage payments on your

million dollar house, $20000 Country Club fees, Lexus and boat on a doctors pay..

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Response to doc03 (Reply #12)

Wed Dec 19, 2012, 08:53 PM

20. Most FP docs I know have none of that. You are talking specialists.

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Response to dkf (Reply #4)

Wed Dec 19, 2012, 08:40 PM

14. Their expenses greatly exceed that of other countries.

Other countries don't sue their doctors at the drop of a hat. Malpractice insurance is more that most doctors even make in other countries. In other countries doctors don't have to battle insurance companies for every thing they submit. Other countries don't have the cost of medical education as in the U.S.

But go ahead and keep cutting their reimbursements. Medicare patients will continue to be cut off. I take it you don't know any seniors if you don't think this is a problem already.

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Response to former9thward (Reply #14)

Wed Dec 19, 2012, 08:43 PM

17. I'm in Hawaii where I understand doctor and dentist reimbursements are significantly lower than the

 

Mainland.

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Response to dkf (Original post)

Wed Dec 19, 2012, 08:39 PM

13. Just cut it to zero then, dfk. What difference does it make, right?

How much shame would it take for you to permanently operate at a loss and how eager would you be to take on more and more patients at a loss on top of that.

I bet you won't call for the student loans to be forgiven to offset or to subsidize their staffs.

Of course they work for a living and those high wages is money not going into a banker's pocket.

Holy fuck!

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Response to TheKentuckian (Reply #13)

Wed Dec 19, 2012, 08:45 PM

18. You love raising their taxes but won't cut their reimbursements.

 

Funny.

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Response to dkf (Reply #18)

Wed Dec 19, 2012, 08:55 PM

21. Cut the bloated defense budget instead. A fraction of it would solve the problems. Why do you ignore

this fact?

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Response to dkf (Reply #18)


Response to dkf (Reply #18)

Wed Dec 19, 2012, 09:13 PM

31. Taxes are offset by expenditure, see. First, they pay expenses THEN if they have income

it is taxed at the appropriate rate.

That way they can hire other people and provide proper service.

My logic is far from mystifying.

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Response to dkf (Original post)

Wed Dec 19, 2012, 08:58 PM

22. My doc is already going to drop us when we get on Medicare

Doctors have certain feelings about the reimbursement rates. It's a free country, according to some, and mostly what it is is a for-profit medical system.

My late mother contracted rheumatoid arthritis when she was about 80. She lived far away from all of her children, though my sister and I tried hard to fly in and check on her. What we found was that in Salt Lake City there are 5 rheumatologists, and none of them accept Medicare patients. None. Zip. Nada. Now, she might have taken her Master Card and paid up front, but frankly -- no she wouldn't.

But as to Medicare savings: there are many, many ways to save money besides doing something that hurts patients. For instance, do what the VA does and use the power of the purse to bring the cost of drugs down. Same thing with durable medical products and medical supplies. Bring the cost of hospital stays into something resembling sanity: currently there are identical procedures whose cost varies dramatically by hospital, and no one can give a rational reason why.

It's not doctors per se who are costing us so much; it's hospitals, drug manufacturers/sellers, medical products...

Hekate

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Response to Hekate (Reply #22)

Wed Dec 19, 2012, 09:41 PM

38. Medicare already provides fixed reimbursements for hospital charges

It goes by condition, basically. So if you treat an elderly stroke patient, you may get $2,700 whether the person is in the hospital for 2 days or five.

Because of this, my doctor's practice has been having increasing trouble getting Medicare patients admitted to hospitals.

More detail:
http://www.nber.org/bah/fall03/w9972.html

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Response to dkf (Original post)

Wed Dec 19, 2012, 09:00 PM

23. My family MD

charges $105 for a visit . . .

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Response to dkf (Original post)

Wed Dec 19, 2012, 09:05 PM

26. I'm too old that it would do me any good...

But maybe they should put a lot of young people in medical school, pick up the tab, and have them doctor Medicare and Medicaid patients for at least 8 years.

By that time more students will have become doctors, and they will serve their time and this rotation would take care of everyone - You might even get some people who actually want to help cure people instead of just make money....

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Response to dkf (Original post)

Wed Dec 19, 2012, 09:06 PM

27. Yes. Let's pit working class people against each other

Dumbest idea ever

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Response to dkf (Original post)

Wed Dec 19, 2012, 09:18 PM

32. Yes, because fake insurance is a scam on the elderly

Many doctors don't accept new Medicare patients anyway, or they limit the number in their practices. Cut reimbursements 27%, and you'll find that this practice will rocket up.

About six weeks ago I was in my doctor's office (I do work for him for free because he does a lot of free care) and this 80 year old woman called desperately trying to find a doctor to see her. She was going through the phone book calling all the doctors. Her regular doctor (an endocrinologist) would not see her for a week, and she had come down with a bad virus and was developing severe chest congestion with fever. After three days she was worse.

It was after five, so I asked the doctor if he would let her come in the next day (Sat). She did. Because of her age and being an unknown patient, we had to take a very thorough history. She was very capable, but the long and the short of it was that the doctor ended up taking about 50 minutes with her and a full exam, eventually doing an electrocardiogram to verify that she was not in trouble (she had an endocrine complication). He prescribed an antibiotic and tons of fluids and let her go.

He was pissed as hell that her regular doc would not see her and that he got stuck with it, and for that 50 minutes and the prescription and all the charting (about 20 minutes of a staffer's time), he may get paid $66. Maybe. The ECG has been refused, but he felt it would be malpractice not to do it under the circs.

If you really think that a doctor should have to provide that level of service for $48 ($66-27%), then you are quite clueless. Already we have local hospitals refusing to admit Medicare patients.

Older patients generally require a higher level of care. But they also need high quality primary care, because an infection like that could take a totally competent 80 year-old (which she was) and cause major complications.

Reimbursements for things like some X-rays and so forth are already less than the cost of performing the test. For example, if he had tried to send her for a chest X-ray on an outpatient basis, he would have had trouble getting it because the total reimbursement for that under Medicare would have been $47.07, which would be broken down as $23.83 for the test, $14.98 for the tech, and $8.85 for the reading. Do you really think we are going to be able to get our Medicare patients in for chest X-rays at all if the reimbursement total is $34.36?

The national average cost for a chest X-ray is $390. The minimum at a cash clinic is about $200. Insurance will pay at least $250.
http://www.newchoicehealth.com/Directory/Procedure/77/Chest%20X-Ray

One of the reasons costs for private insurance are so high is that Medicare and Medicaid services are under-funded, and so costs are being shifted to private payers.

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Response to dkf (Original post)

Wed Dec 19, 2012, 09:34 PM

35. Further data

http://www.forbes.com/sites/scottatlas/2012/12/18/lets-be-honest-medicare-is-insolvent-and-doctors-soon-wont-accept-it/

An increasing proportion of doctors are already not accepting Medicare patients, and the primary reason is low payment for services. A 2008 report by the Medicare Payment Advisory Commission, an independent federal panel, said that 29 percent of Medicare beneficiaries who were looking for a primary care doctor had a problem finding one. In the 2008 HSC national survey, more than 20 percent of primary care doctors accepted no new Medicare patients (only 4.5 percent accepted no new privately insured patients) and about 40 percent of primary care doctors and 20 percent of specialists refused most new Medicare patients. Today, in some states, more than half of doctors already do not accept new Medicare patients.

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Response to dkf (Original post)

Wed Dec 19, 2012, 10:52 PM

40. I see this as a part of the RW long-term planning

to eliminate Medicare entirely. Starve the Beast. When fewer and fewer doctors/hospitals allow Medicare patients, the RW can declare Medicare an utter failure and eliminate the program. THAT's the long term goal. To get rid of Medicare. They have not been successful in privatizing it, in voucherizing it, or defunding it outright, so the back-door plan is to force it's failure.

As medieval as it sounds, I also think the long-term plan is to cull the herd -- allow attrition -- just as Alan Grayson said, if you get sick, die quick.

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