Specialist Doctors Head for Exit as U.S. Shifts Payments

[drusso]

http://www.bloomberg.com/news/artic...-doctors-head-for-exit-as-u-s-shifts-payments

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[Ligament]

I'm so tired of this crap. I've been an attending since 2008. Every year, medicine gets worse. Our subspecialty declines more. We are paid less, yet incur more overhead and regulation.

Is it too much to ask for something GOOD once in a while? I mean even once in a year frequency? ie. Hey you are getting paid MORE for some service. Or hey we've removed some useless burdensome regulation from your head...something...

 

[hyperalgesia]

If Medicare gets out of the fee-for-service business, it might open the market for cash providers.

 

[emd123]

Don't worry. There will be ways around it or to adapt

 

[Birdstrike]

If Medicare gets out of the fee-for-service business, it might open the market for cash providers.

Or, if medicare pays a lump sum, per patient per year, pretty soon you'll see docs sitting on them, doing NOTHING for them at all and doing the minimal follow ups necessary per year and nothing to help them other than the bare minimum to get their yearly lump sum. With human nature being what it is, that's exactly what will happen.

 

[drpainfree]

it's what happens in a communist society.

 

[clubdeac]

Funny, cause we have a communist in the white house.

 

[drpainfree]

look at how fast china has been growing economically while going from communism to capitalism.

then look at us and europa

 

[Louisville04]

look at how fast china has been growing economically while going from communism to capitalism.

then look at us and europa

I still wouldn't move there

 

[space3223]

Or, if medicare pays a lump sum, per patient per year, pretty soon you'll see docs sitting on them, doing NOTHING for them at all and doing the minimal follow ups necessary per year and nothing to help them other than the bare minimum to get their yearly lump sum. With human nature being what it is, that's exactly what will happen.

Perhaps I am wrong, but I thought providers in these situations had to meet certain clinical milestones, diabetics with HbA1C under 7.5% (or whatever), etc. That's what I'm hearing at least some PCPs saying. Have you heard otherwise?

 

[Ducttape]

you have heard right. there are several (33?) clinical metrics that can be/are monitored.

of course there is always a way to gain the system, but thats no different than the current fee for service system.

 

[hyperalgesia]

If my mom were a sick pt, I would like all burdens, charge restrictions, reporting requirements, ehr mandates, etc removed from the doctor so he can do his job.

 

[yankeeh8r]

you have heard right. there are several (33?) clinical metrics that can be/are monitored.

of course there is always a way to gain the system, but thats no different than the current fee for service system.

Quickest fix is you dump the non-compliant patients. Thats what my buds who are internists and FMs are doing. They no longer can afford to keep non-compliant patients on their panels. Most of them are actually quite happy to be rid of them. Of course, then they become the Emergency MDs problems.

 

[emd123]

Quickest fix is you dump the non-compliant patients. Thats what my buds who are internists and FMs are doing. They no longer can afford to keep non-compliant patients on their panels. Most of them are actually quite happy to be rid of them. Of course, then they become the Emergency MDs problems.

That's right. The government thinks we're stupid. It creates motivation to dump the sick people. And that's exactly what "pay for performance" will cause: Massive system-gaming at the patients' expense.

They're foolish enough to equate medicine with an exact science where all populations, all variables are equal, like a race run on a track against the clock.

Wait till they pay us based on patients pain scores. That will creat incentive to open the opiate flood gates. But they'll do it. Mark my words.

 

[Ducttape]

my understanding is that as a member of an ACO, you cant be just dumped by a doctor, because you are still part of the ACO, and ultimately will get reassigned to another doctor in that ACO.


unfortunately, the fee for service system is going to change. too many providers (used term ON PURPOSE) are gaming that system right now, and it is way too easy to game it. the government doesnt think we are stupid - they think we are greedy, and they are doing a good job convincing the general populace that we are...

 

[emd123]

my understanding is that as a member of an ACO, you cant be just dumped by a doctor, because you are still part of the ACO, and ultimately will get reassigned to another doctor in that ACO.


unfortunately, the fee for service system is going to change. too many providers (used term ON PURPOSE) are gaming that system right now, and it is way too easy to game it. the government doesnt think we are stupid - they think we are greedy, and they are doing a good job convincing the general populace that we are...

Do you really think the same crew that continues to run up an ever increasing $17,000,000,000,000 national debt has somehow, magically found a way to suddenly "reduce costs" in anything, healthcare included, with their simple ACO-capitation trick?

 

[drusso]

my understanding is that as a member of an ACO, you cant be just dumped by a doctor, because you are still part of the ACO, and ultimately will get reassigned to another doctor in that ACO.

That's not what I'm seeing. I'm seeing the closed-shops cherry pick what kind of care they provide and "tier out" the rest. They're more than happy to see Mrs. Smith and practice "point and click" medicine on the EMR for her diabetes, HTN, and preventive medicine services; but God forbid she wants something done for her back: She gets 3 acupuncture visits, a 90 minute pain education class taught by a PT, a hand-out on stretching....

 

[Stim4me]

Medicare will follow capitation payments, European style...They will pay the "doctor fix" costs through the practices not participating in their bogus Pqrs measures... Let it happen. Let specialist bail from the system. It's not like PA's and NP's can fill the gap.

Let Medicare for "all"happen.... based on the two tier system in Europe, the middle class employed workers and the rich will opt for higher end supplementary healthcare plans via Aeta and other insurers that want the high end business..

There will be winners and losers. Will be interesting to see what transpires, especially since Brown vs. ACA ruling is pending in a few months...

 

[emd123]

Medicare will follow capitation payments, European style...They will pay the "doctor fix" costs through the practices not participating in their bogus Pqrs measures... Let it happen. Let specialist bail from the system. It's not like PA's and NP's can fill the gap.

Let Medicare for "all"happen.... based on the two tier system in Europe, the middle class employed workers and the rich will opt for higher end supplementary healthcare plans via Aeta and other insurers that want the high end business..

There will be winners and losers. Will be interesting to see what transpires, especially since Brown vs. ACA ruling is pending in a few months...

Exactly. There will be ways to rise to the top. Will adapt.

 

[101N]

Sometimes adaptation means migration.

 

[clubdeac]

It's called go back to the Va spa... booooya baby

 

[Ducttape]

we are almost at a 2 tiered system. the crux is where the working class falls in this. i suspect it will go the same way the current income gap is heading - towards greater stratification and inequality.

 

[Stim4me]

The health middle class will stay on Medicare for all... The sicker middle class will opt for better Cadillac plans.... The upper middle class with good jobs will have Cadillac plans... The rich will have Cadillac plans... The question is what should the politicians have??? I believe Medicare or ACA plans only...they deserve it