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These excerpts are all from the Journal of Medical Economics for a class I'm taking on the state of the healthcare profession. Can things really be this bad?
"I'm frustrated and disillusioned,I do not know one single M.D. who is happy right now, and many are actively looking for a way out. The system is all very broken. But the health plans, the insurance companies, are all more solvent than ever."
-Dr. Patrick Lyden, UCSD Department of Neurology
"I love being a physician, but practicing medicine is extremely frustrating when I never know how much my charges will translate into actual dollars. Medicine used to be about helping people. Our system of fragmented care is broken. It's time for the big overhaul."
-Patricia M. Martin, MD
"I'm a practicing board-certified internist, and over the past 25 years I've seen catastrophic changes to the practice of medicine in the state of Pennsylvania. Even the busiest physicians have found it impossible to keep up with their monthly costs. Overhead continues to rise at exponential rates and our reimbursement continues to fall. This explains why so many physicians have fled the state. Nevertheless, at 50 years of age with an established practice, and a family devoted to remaining in this area, I struggle to enhance the finances of my practice, while finding it more and more difficult to succeed."
-Ronald M. Block, MD
Medical Economics, Sept 2, 2005 v82 i17 p8(1)
Is this any way to run a business? (MEMO FROM THE EDITOR)(Editorial) Marianne Dekker Mattera.
Next issue we'll reveal, the results of our latest survey on physician income, and the picture isn't pretty. Primary care physicians total compensation is flat for the third year in a row and now specialists are struggling to keep up with the cost of living; some are losing the fight.
The big question is not why it's happening now, but why it didn't happen sooner. No other business in the country is forced to operate under the economic constraints that physicians in private practice have had to endure for nearly two decades. No other business in the country has its ability to price services and deal with customers curtailed by both big business and big government. No other business in the country is expected to operate successfully without knowing how much it will be paid for its services.
Yet that's just what doctors must endure. Health plans won't reveal what they pay or how they calculate payment. It's possible to be paid different amounts for the same service under the same contract by the same payer. Medicare's reimbursement formula is consistent, but it's based on mind-numbing calculations that factor in a variety of parameters including changes in the GDP over a decade.
Of late, those calculations have determined you deserve less money than you got the year before. The cut is 4.3 percent for 2006. Year after year, physicians live on edge, until Congress steps in at the last minute to offer a reprieve. What business can run that way?
And now the pay-for-performance concept is sweeping both private insurers and Medicare. On the Medicare front, the Feds face an interesting conflict in logic: theoretically, pay-for-performance will increase utilization as doctors are more diligent about getting patients in for follow-up and ordering tests and treatments according to guidelines. Yet the reimbursement formula penalizes physicians for increases in healthcare expenditures. Still, the Senate wants to pass P4P legislation without fixing the formula. The mind boggles. What's the physician-businessman to do?
Organized medicine is making itself heard on both the private health plan front and on Medicare, but the various groups don't always speak with one voice. You can join your individual voices by writing your legislative representatives.
The chair of the House Ways and Means health subcommittee has introduced a bill that throws out the current Medicare reimbursement system and includes voluntary participation in pay-for-performance, but the overall price tag for reform of the system may be too much for legislators approaching a 2006 re-election campaign to swallow. Again, you can write your representatives.
But, in the end, there may be nothing the doctor-businessman can do but leave the business. Maybe then big business and big government will take notice and give physicians the same leeway to run their business enjoyed by every mom-and-pop flower shop and deft in America.
Marianne Dekker Mattera
[email protected]
"I'm frustrated and disillusioned,I do not know one single M.D. who is happy right now, and many are actively looking for a way out. The system is all very broken. But the health plans, the insurance companies, are all more solvent than ever."
-Dr. Patrick Lyden, UCSD Department of Neurology
"I love being a physician, but practicing medicine is extremely frustrating when I never know how much my charges will translate into actual dollars. Medicine used to be about helping people. Our system of fragmented care is broken. It's time for the big overhaul."
-Patricia M. Martin, MD
"I'm a practicing board-certified internist, and over the past 25 years I've seen catastrophic changes to the practice of medicine in the state of Pennsylvania. Even the busiest physicians have found it impossible to keep up with their monthly costs. Overhead continues to rise at exponential rates and our reimbursement continues to fall. This explains why so many physicians have fled the state. Nevertheless, at 50 years of age with an established practice, and a family devoted to remaining in this area, I struggle to enhance the finances of my practice, while finding it more and more difficult to succeed."
-Ronald M. Block, MD
Medical Economics, Sept 2, 2005 v82 i17 p8(1)
Is this any way to run a business? (MEMO FROM THE EDITOR)(Editorial) Marianne Dekker Mattera.
Next issue we'll reveal, the results of our latest survey on physician income, and the picture isn't pretty. Primary care physicians total compensation is flat for the third year in a row and now specialists are struggling to keep up with the cost of living; some are losing the fight.
The big question is not why it's happening now, but why it didn't happen sooner. No other business in the country is forced to operate under the economic constraints that physicians in private practice have had to endure for nearly two decades. No other business in the country has its ability to price services and deal with customers curtailed by both big business and big government. No other business in the country is expected to operate successfully without knowing how much it will be paid for its services.
Yet that's just what doctors must endure. Health plans won't reveal what they pay or how they calculate payment. It's possible to be paid different amounts for the same service under the same contract by the same payer. Medicare's reimbursement formula is consistent, but it's based on mind-numbing calculations that factor in a variety of parameters including changes in the GDP over a decade.
Of late, those calculations have determined you deserve less money than you got the year before. The cut is 4.3 percent for 2006. Year after year, physicians live on edge, until Congress steps in at the last minute to offer a reprieve. What business can run that way?
And now the pay-for-performance concept is sweeping both private insurers and Medicare. On the Medicare front, the Feds face an interesting conflict in logic: theoretically, pay-for-performance will increase utilization as doctors are more diligent about getting patients in for follow-up and ordering tests and treatments according to guidelines. Yet the reimbursement formula penalizes physicians for increases in healthcare expenditures. Still, the Senate wants to pass P4P legislation without fixing the formula. The mind boggles. What's the physician-businessman to do?
Organized medicine is making itself heard on both the private health plan front and on Medicare, but the various groups don't always speak with one voice. You can join your individual voices by writing your legislative representatives.
The chair of the House Ways and Means health subcommittee has introduced a bill that throws out the current Medicare reimbursement system and includes voluntary participation in pay-for-performance, but the overall price tag for reform of the system may be too much for legislators approaching a 2006 re-election campaign to swallow. Again, you can write your representatives.
But, in the end, there may be nothing the doctor-businessman can do but leave the business. Maybe then big business and big government will take notice and give physicians the same leeway to run their business enjoyed by every mom-and-pop flower shop and deft in America.
Marianne Dekker Mattera
[email protected]