Today, Medicine got 21% less worth it.

[DrBowtie]

Medicare reimbursement cuts go into effect today. Lets give a big round of applause to our awful government on both sides of the aisle.

I'd like to see them take that cut.

Makes studying for this exam that much harder.

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[penguin24]

Too bad there isn't a corresponding 21% cut in med school tuition

 

[cpants]

What will be really funny is when private insurance cuts reimbursement rates to stay in line with Medicare, and simultaneously tries to pursuade congress that they need to increase fees to stay afloat.

 

[Prime2000]

While we're busy with our noses in the books, the landscape sure is changing fast. Really disturbing.

I have friends who have other decent opportunities outside of medical school contemplating whether they even want to pursue down this road anymore. I don't know if that is extreme, but this all doesn't look good.

 

[vicinihil]

I feel like this would push more towards subspecialties no? I mean NOW who wants to do FP and IM

 

[alphaholic06]

http://bunning.senate.gov/public/ Here's the guy you can blame for allowing the cuts to go forward.

 

[DrBowtie]

http://bunning.senate.gov/public/ Here's the guy you can blame for allowing the cuts to go forward.

I don't think the medicare patch was included in the Jobs bill that he voted against?

 

[dienekes88]

I thought CMS delayed the cut by 10 days or something.

 

[deleted77919]

…

 

[deleted77919]

…

 

[DrBowtie]

It was.

My Mistake.

 

[MOHS_01]

y'all need to brush up on your math... a 21% cut would translate into a much larger cut in pay, the degree to which depends upon individual practice parameters.

Overly simplified:

Practice gross $500k
250k in expenses
250k to doc

enter 21% cut.

500k revenue becomes 395k revenue for like work
250k in expenses still
145k to doc

It only gets worse as costs increase. It's not looking good for the good guys.

 

[deleted87716]

250k in expenses still

No. You will reduce expenses. You'll have to.

You'll fire some staff, cut benefits, etc. You may even conclude that you can't afford health insurance for your employees.

You'll also restrict access to new Medicare patients. You certainly won't want to take new Medicaid patients, which pay even less.

So...who loses? Everyone.

 

[DoctwoB]

Well the good news is that they'll probably repeal these cuts retroactively in the next week, and medicare is holding off on processing payments until then.

The bad news is that SGR is still a horrible, horrible system that needs to be killed with fire instead of patched with yearly fixes that means we'll be in the same situation next year.

 

[bronx43]

No. You will reduce expenses. You'll have to.

You'll fire some staff, cut benefits, etc. You may even conclude that you can't afford health insurance for your employees.

You'll also restrict access to new Medicare patients. You certainly won't want to take new Medicaid patients, which pay even less.

So...who loses? Everyone.

Well, by "you'll have to," you mean "you'll have to in order to maintain your own compensation." Unless your practice becomes unsustainable, you'll have to tell whoever you lay off that you're laying him/her off so you can still make 200k... which is what I would do, of course.

 

[deleted87716]

you'll have to tell whoever you lay off that you're laying him/her off so you can still make 200k

You don't have to tell them anything.

 

[RGMSU]

Don't lay anybody off. Just opt out of Medicare. There are still plenty of patients to be seen.

 

[RGMSU]

I feel like this would push more towards subspecialties no? I mean NOW who wants to do FP and IM

Some subspecialties are more dependent on Medicare reimbursement than many FP docs. FP docs have just about the most latitude in terms of who they will see as any physician.

 

[MOHS_01]

You don't have to tell them anything.

Looking at the income statement as I type....

-rent is fixed with signed lease.

-Staffing is marginal given the volume now -- and any cut would hurt practice capacity to a greater extent than cut costs.

-supply costs are a small line item.

-the same goes for most line items, relatively small from a percentage and total cost standpoint.

The two largest line items are collections (outsourced) and staffing. I don't see significant potential for savings in either.... so any gains will have to be on the revenue side.... oh, wait... price controls. Damn. Can play with payer mix, start selling products out of the office and ***** myself out like others do, I suppose. Crock o' **** is what it is.

 

[deleted87716]

^ Relocate. Or, start doing botox and facial peels.

 

[RGMSU]

The administration is doing a lovely job saving medical jobs. Is this all part of the new focus on jobs they were talking about recently? I predict this is all much ado about nothing. With the rough election year Dems face already, the last thing they are going to do is let Medicare cuts stick, at least not this type of Medicare cut. Don't everybody start quitting med school or firing people just yet.

 

[bronx43]

Is this newest cut across all fields, or are they going to pick and choose again like last year?

 

[TheMan21]

Is it true that private insurances set their reinbursements as a multiple of Medicare's reinbursements?

 

[MOHS_01]

Is this newest cut across all fields, or are they going to pick and choose again like last year?

All fields. Everyone to the woodshed this time.

Is it true that private insurances set their reinbursements as a multiple of Medicare's reinbursements?

Yes, many do.

 

[RGMSU]

My point is that physicians have much more bargaining power than they realize. If physicians start moving toward opting out of any plan, government or private, the executives who oversee the plan (Congress or businessmen) will be given pause. It's all a big game of chicken. The only question is who will flinch first. Private insurance companies are not going to reduce their reimbursement rates. If they do, they lose doctors. When they lose doctors, they lose patients. When they lose patients, they lose money. In the end it costs them more than they get. Same thing with Medicare. No politician is going to face an election year with Medicare cuts on their watch.

 

[MOHS_01]

My point is that physicians have much more bargaining power than they realize. If physicians start moving toward opting out of any plan, government or private, the executives who oversee the plan (Congress or businessmen) will be given pause. It's all a big game of chicken. The only question is who will flinch first. Private insurance companies are not going to reduce their reimbursement rates. If they do, they lose doctors. When they lose doctors, they lose patients. When they lose patients, they lose money. In the end it costs them more than they get. Same thing with Medicare. No politician is going to face an election year with Medicare cuts on their watch.

Discontinuing your participation with MC is not like terming with a private carrier -- MC kicks your *** into non-par status for two years (I believe). For certain specialties this simply is not an option any more than a radical penectomy is a suitable treatment for jock itch....

So, here's what happens in the real world: docs maintain their par- status and try to manage their payer mix via manipulation of the scheduling. The fedtards say "look, there's no problem -- docs still take MC" but in reality the access to care is restricted. These changes have the same effect as going non-par as far as patient access is concerned, but the physician does not burn bridges and the policy maker saves face.

 

[DoctwoB]

My point is that physicians have much more bargaining power than they realize. If physicians start moving toward opting out of any plan, government or private, the executives who oversee the plan (Congress or businessmen) will be given pause. It's all a big game of chicken. The only question is who will flinch first. Private insurance companies are not going to reduce their reimbursement rates. If they do, they lose doctors. When they lose doctors, they lose patients. When they lose patients, they lose money. In the end it costs them more than they get. Same thing with Medicare. No politician is going to face an election year with Medicare cuts on their watch.

The problem come down to organization, or lack therof, on the physician side. Medicare (or other insurance agencies) represent a huge patient population, giving them a lot of negotiating leverage. A doc who stops seeing medicare patients may stand to loose a lot of money just due to lowered patient volume, while Medicare is basically unaffected by losing one doc.

Now if all the docs acted in unison and demanded higher reimbursements or they'd stop taking medicare, then politicians would have to listen or face dire political consequences as their elderly constituents kick them out of office. This requires massive organization, however, as its better for physicians as a whole to take a stand, but generally worse for any doctor that tries to do it on his own. This organization, however, currently doesn't exist, as the AMA lacks the will, the power, and the cahones to do what I described.

As it is, there may be a slight backlash from some doctors (who have the option of filling a practice with privately insured folks or starting a conceirge business), but not enough.

 

[bronx43]

As it is, there may be a slight backlash from some doctors (who have the option of filling a practice with privately insured folks or starting a conceirge business), but not enough.

Edit: nvm

 

[RGMSU]

The real questions for people in my phase of a career are - how will this figure into my specialty decision? Will I ever begin my career accepting Medicare? There are longer term trends to consider here. If young docs eschew certain specialties to avoid geriatric patients and never opt in to Medicare in the first place, that poses some problems that can't merely be swept under the rug.

 

[DoctwoB]

What kind of backlash are you talking about for a concierge doctor? Since they take cash only, wouldn't they have absolutely no need for insurers of any kind, Medicare or otherwise?

I mean people who formerly saw medicare patients closing up and starting a conceirge or private insurance only business, thus reducing physician availability to Medicare enrolees.

 

[RGMSU]

I agree that there is absolutely a problem with physicians being politically savvy enough and well-organized. And, no, the AMA is not cutting it.

 

[southerndoc]

21% cut in reimbursement, a 50% reduction in physicians accepting Medicare in only 2 years.

 

[RGMSU]

21% cut in reimbursement, a 50% reduction in physicians accepting Medicare in only 2 years.

Exactly. Which is why this is all a big parlor game.

 

[MOHS_01]

The real questions for people in my phase of a career are - how will this figure into my specialty decision? Will I ever begin my career accepting Medicare? There are longer term trends to consider here. If young docs eschew certain specialties to avoid geriatric patients and never opt in to Medicare in the first place, that poses some problems that can't merely be swept under the rug.

The only problem is, aside from plastic surgery, basically everyone is ******. There are only so many paying patients to go around. If everyone is competing for those few the marginal returns on their business will drop as well.... and don't forget there's always Uncle State who sees what you're doing and changes the rules to **** you some more, while screaming:

"you greedy little ****, how dare you alter your behavior in response to the involuntary *** raping that I gave you"...

 

[RGMSU]

Hah, well, in my neck of the woods there are plenty of patients to go around. There is a doc shortage, not a patient shortage. As far as the rest of your post, I'm afraid to use that many stars (*) or I may get another infraction or something. I will say, as a general observation, that docs don't have the ba**s to play hard ball. That's why lawyers, politicians, and businessmen get away with roughing docs up. Docs are very quick to come up with excuses as to why they "can't" defend their profession, which is a big part of the reason we've had the downward slide we've had in the past 20 years.

 

[bronx43]

The only problem is, aside from plastic surgery, basically everyone is ******. There are only so many paying patients to go around. If everyone is competing for those few the marginal returns on their business will drop as well.... and don't forget there's always Uncle State who sees what you're doing and changes the rules to **** you some more, while screaming:

"you greedy little ****, how dare you alter your behavior in response to the involuntary *** raping that I gave you"...

Even though plastic surgery's got cash only customers, that market is terribly saturated - and will only get moreso, as more MDs are trekking into the cosmetic realm. In most states, any MD can practice cosmetic surgery. You don't even need to be a trained PRS.

 

[MOHS_01]

Hah, well, in my neck of the woods there are plenty of patients to go around. There is a doc shortage, not a patient shortage. As far as the rest of your post, I'm afraid to use that many stars (*) or I may get another infraction or something. I will say, as a general observation, that docs don't have the ba**s to play hard ball. That's why lawyers, politicians, and businessmen get away with roughing docs up. Docs are very quick to come up with excuses as to why they "can't" defend their profession, which is a big part of the reason we've had the downward slide we've had in the past 20 years.

That's why you just type the *********'s and let the imagination do the rest. It's easy enough to play the game with the private insurers. MC is another matter altogether. If every doc were to begin excluding MC, MA, and the dominant private insurer in any area, there would not be enough business to go around. MC ties up a great deal of our resources; when this changes, so too will the perceived "shortage".

Even though plastic surgery's got cash only customers, that market is terribly saturated - and will only get moreso, as more MDs are trekking into the cosmetic realm. In most states, any MD can practice cosmetic surgery. You don't even need to be a trained PRS.

Very true, but most are not narcissistic (or frankly stupid) enough to do the bigger surgeries. That is why I did not include derm -- every Tom, Dick, and Harry believes they can do the typical derm cosmetic procedures.

 

[JaggerPlate]

10 days to fix it ... (for now) fingers crossed. Wish they would fix the SGR.


Any other pre-meds out there thinking twice right now? I'm supposed to start in August, and struggle to convince myself day after day with everything happening lately.

 

[RGMSU]

It's easy enough to play the game with the private insurers. MC is another matter altogether. If every doc were to begin excluding MC, MA, and the dominant private insurer in any area, there would not be enough business to go around. MC ties up a great deal of our resources; when this changes, so too will the perceived "shortage".

What you describe is the disaster scenario. One that would never happen. Third party payers are no more unified in their actions than doctors are. The key is that threatening that it could happen and having people believe that docs might actually do it can safeguard the profession considerably. Docs are not easily replaceable. Old people vote. They vote a lot. They also go to the doctor a lot. Any politician who is seen as keeping them from doing so won't last long. Politicians know that. Any future Medicare cuts, ie, those in the Dems' healthcare bill, will be targeted. They will not be across the board cuts. This must be viewed within the larger context of the fact that the Dems are about to try to push through healthcare reform hell or high water.

 

[RGMSU]

Political side note - might this all be a trick by Congress to try to spook the crap out of doctors and make them think something has to be done now, ie, healthcare reform? Ehh - probably. That's the way these politicians think. And, I would have to say based on the frantic emails I have gotten from the AMA, TMA, etc, today that it appears to be working. The biggest piece of artillery docs have is to empower the patient. Every time you have to alter what you do with a patient because of Medicare, and the patient asks why am I seeing you once every 6 mos instead of once every 3 mos, for example, tell them precisely why. Then they will know who to be pi**ed at when elections roll around. Then the politicians start getting scared of the docs and patients instead of the other way around.

 

[bronx43]

Political side note - might this all be a trick by Congress to try to spook the crap out of doctors and make them think something has to be done now, ie, healthcare reform? Ehh - probably. That's the way these politicians think. And, I would have to say based on the frantic emails I have gotten from the AMA, TMA, etc, today that it appears to be working. The biggest piece of artillery docs have is to empower the patient. Every time you have to alter what you do with a patient because of Medicare, and the patient asks why am I seeing you once every 6 mos instead of once every 3 mos, for example, tell them precisely why. Then they will know who to be pi**ed at when elections roll around.

But, the same doctors that are taking the hit are the ones that are opposing Obamacare. It's a classic case of picking your poison.

 

[RGMSU]

But, the same doctors that are taking the hit are the ones that are opposing Obamacare. It's a classic case of picking your poison.

That's precisely what I mean. This could be an attempt to spook docs into accepting healthcare reform. It could be an attempt to show "this is what you'll get if you don't go along." There's some motive for trying to throw the medical community into a panic. I'm not sure healthcare reform is necessarily bad for docs. Obviously, that's debatable. Faced with choosing that compared to across the board cuts, though, could very well make some folks rethink their positions. Again, though, I don't think these cuts will last long. Whatever the reasoning was in allowing this to happen, Congress is too unpopular right now to pile unpopularity on top of unpopularity. At some point docs are going to have to pony up and accept healthcare reform. The system we have is unsustainable long term. Nobody disputes that. The question is what the terms will be. The sooner we get proactive in defining the terms rather than just being conservatively reactive, the better things will turn out for us. I'm sure that was the philosophy of the AMA in attempting to deal with Congress. It's much easier to shape the system as it's being reformed than it is to try to go on strike against it after it's already in place.

 

[badasshairday]

I may be just thinking conspiracy theory right now... but with these cuts plus the increase in new medical schools/class sizes, this could easily increase supply by a lot. I just hope that these snake politicians aren't going to use the money from these cuts to help fund more residency positions as well.

We really don't have a doctor shortage at all. It is a myth. The real issue is that we have a oversupply in cities and an undersupply in rural areas/small towns. So it is a distribution thing, not raw numbers.

 

[RGMSU]

I may be just thinking conspiracy theory right now... but with these cuts plus the increase in new medical schools/class sizes, this could easily increase supply by a lot. I just hope that these snake politicians aren't going to use the money from these cuts to help fund more residency positions as well.

We really don't have a doctor shortage at all. It is a myth. The real issue is that we have a oversupply in cities and an undersupply in rural areas/small towns. So it is a distribution thing, not raw numbers.

I don't know about all this. There are plenty of patients to be seen. Most places don't have an oversupply of physicians - at least not the places I've been. Hopefully, they will fund more residency positions. I would rather see more physicians trained to fill the shortages than see some of the alternatives that are occurring right now. Physicians are going to have to get their heads out of the sand and realize we have a generation of baby boomers about to be knocking on our doors. We have two choices - either we can step up to the plate and care for them and train enough physicians to care for them. Or, we can let someone else step in and take our jobs over.

 

[RGMSU]

Now, you're right - smaller cities and towns need docs too. This is another instance where training primary care physicians should be emphasized again. We probably don't need more primary care residency slots. We just need to entice people to fill them.

 

[Dr Oops]

I don't know about all this. There are plenty of patients to be seen. Most places don't have an oversupply of physicians - at least not the places I've been. Hopefully, they will fund more residency positions. I would rather see more physicians trained to fill the shortages than see some of the alternatives that are occurring right now. Physicians are going to have to get their heads out of the sand and realize we have a generation of baby boomers about to be knocking on our doors. We have two choices - either we can step up to the plate and care for them and train enough physicians to care for them. Or, we can let someone else step in and take our jobs over.

And what happens when these baby boomers are gone?

 

[DoctwoB]

And what happens when these baby boomers are gone?

You do have a point that if we boost med student enrollment through the roof to meet the baby boomer entering medicare phase we'll have a glut of physicians later. To be fair honest though, we'll have to boost enrollment just to keep physician levels at the same levels as they are now, due to many many baby boomer generation physicians retiring as well. With the recession, I bet more than a few put off retirement to earn back some of those investment losses, and as the economy bounces back over the next few years many will retire.

 

[RGMSU]

And what happens when these baby boomers are gone?

There will be a glut in the market by then anyway. The only question will be whether it is filled by physicians or mid-levels. If more physicians aren't created in America, there will either be more foreign physicians imported or more mid-levels created to meet the need. People in America aren't going to die on the street corners just because physicians don't want to boost medical school enrollment. They will look elsewhere for a solution. You can't predict that far in advance though. Any time the medical community has sought to predict decades in advance, they've turned out to be flat wrong. It wasn't so long ago that everyone was predicting an oversupply of physicians, including primary care physicians. Obviously, that didn't happen. Again, at some point physicians and students are going to have to get a little more positive and proactive about their profession, or just leave and enter another profession. The doom and gloom isn't getting us anywhere.

 

[deleted87716]

And what happens when these baby boomers are gone?

Today's fat kids are tomorrow's vasculopaths. Look around you. As a nation, we're sure as hell not getting any healthier.

 

[tibor75]

I just laugh at all the whining by doctors. How many of these doctors were whining when Bush was passing his mega-tax cuts for teh rich? You know, which include a lot of doctors?

NOw these same doctors are crying about the Medicare cuts...done because of out of control deficits..that are because of tax cuts...that they enjoyed. And of course, they are too greedy to notice the relationship.

"Oh now! My patients can't get a heart cath every year so that I can put a stent they don't need every year!"