% of bussiness coming from Medicare?

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While lurking I see a lot of concerns from people about medicare cuts in so and so specialty and how it is going to hurt their pay/profession blah blah.

What % of patients or maybe % of cashflow comes from these government sources?Specialty dependent?
If so which specialty is most "free market" and which is most "socialist" (or most controlled by govt if you like a better term)?

I get the obvious like Plastic surgery is prob not covered by Medicare and hence probably has the smallest Medicare component but maybe some other examples that aren't as obv to a noob.

While I don't know the numbers off the top of my head, I can tell you that Plastic Surgery is very dependent on how your practice is setup. Aside from the cometic stuff, plastics does a lot of reconstruction work, which, in many if not all cases, does not pay nearly as well as the cosmetic work. Many plastic surgeons do mostly reconstruction because that is what they like. Competition for cosmetic work is fierce and income goes up and down with the economy.

Originally Posted by LoLCareerGoals

While lurking I see a lot of concerns from people about medicare cuts in so and so specialty and how it is going to hurt their pay/profession blah blah.

What % of patients or maybe % of cashflow comes from these government sources?Specialty dependent?
If so which specialty is most "free market" and which is most "socialist" (or most controlled by govt if you like a better term)?

I get the obvious like Plastic surgery is prob not covered by Medicare and hence probably has the smallest Medicare component but maybe some other examples that aren't as obv to a noob.

The simple answer (from a gross perspective): 835B/2.2T. So 40-50% of US healthcare spending if from a governmental payor. This will be increasing. I have heard estimates of 80% from Medicare by 2020-2030.

The structure of your practice, area you work in, payor mix, et cetera, will determine how much "free market" you will have. As of now, with the exception of Medicare, you can negotiate with insurance companies over your rates and reimbursement.

Additionally, I am also seeing the trend of hospital, health-system revenue sharing. For example, a private Pulmonology group provides 12/hr day staffing in the ICU. They get $1000/day for this. This revenue for the practice comes from hospital revenue, which is mostly going to come from reimbursement via Medicare and other sources. The physician group will still be reimbursed from Medicare/Other insurance companies/indigint care. This may make up some physician revenue due to lost reimbursement. This trend has helped stablilize physician net income.

Hence, to answer your question, no specialty is immune to government payor sources, cash only practices not withstanding (surprisingly enough, Psych may be one of the strongest specialites in this regard).

Originally Posted by ucladoc2b

The simple answer (from a gross perspective): 835B/2.2T. So 40-50% of US healthcare spending if from a governmental payor. This will be increasing. I have heard estimates of 80% from Medicare by 2020-2030.

With so much uncertainty in the Medicare/US Health Care system right now, how can there be any valid 10-20 year projections? Are those numbers contingent upon Obamacare's failure/success in the supreme court?