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Targeting physician salaries: I speak for the ten-percenters
ROCKY BILHARTZ, MD | POLICY | MARCH 14, 2015
I’m a cardiologist. But if you believe the news, you will assume my entire medical specialty is shady and full of morally suspect physicians. Let me tell you why.
Recently, two articles surfaced in the lay press, one published by the New York Times and the other by U.S. News & World Report. Like the majority of medical news that I’ve seen originate from these sources over the last few years, the articles provide no meaningful contribution to advancing quality standards in medicine or improving patient care. They are written by medical outsiders and fraught with errors. But, to their defense, the authors have been tasked with the impracticable job of interpreting a data dump of poorly understood numbers released to the general public by the Centers for Medicare & Medicaid Services (CMS).
In case you haven’t been intently following this ordeal (in which case I commend you for not wasting your time), CMS started publicizing physician payments and utilization of Medicare services last year. As you know, I have absolutely no problem with transparency. But predictably, CMS has failed to provide the general public with the road map necessary to make this information meaningful.
Here’s CMS’s idea in a nutshell. Throw up a bunch of dollar signs on a billboard. Explain none of the variables. Mention nothing about physician overhead or the frequent redistribution of physician collections in certain specialties back to device manufacturers and pharmaceutical companies. Then, call this transparency, and further propagate the public perception that the person actually providing your health care is the greedy enemy. And, in the process, this will reduce your medical bills while somehow improving the quality of your care.
You want me to tell you why this makes absolutely no sense?
Physician salaries account for less than 10 percent of all health care spending in this country. Kind of makes you wonder who is making out with the other 90 percent of your medical dollars, doesn’t it? I’ll let you think some more about whether you want a rich doctor or a poor doctor doing procedures on your heart, but ultimately, that doesn’t even matter. If doctors worked for free, we’d still have a health care spending crisis.
CMS just doesn’t get it. You have problems with access to care. You have physician and nursing shortages in many areas of the country. Folks can’t get appointments quick enough. So, you decide to hassle the ten-percenters with fraud audits, siphon more money to those administering the currently absurd medical bureaucracy, and target labor costs? It’s like trying to get better gas mileage by polishing your wheels when the gas-guzzling engine should be replaced.
But, CMS has everything mixed up. They remain laser focused on the wheels, which is why you are going to continue to see more nonsense news publications like the ones above.
The first article is best summed up by its opening sentence: “At a time of increasing scrutiny of procedures to open blocked heart arteries, cardiologists are turning to — and reaping huge payments from — controversial techniques that relieve blockages in the arms and legs.” Basically, cardiologists are no longer just inappropriately putting stents in your heart. Instead, they are now doing it in the arteries of your legs! The second article suggests that high-volume operators, essentially those cardiologists performing the most cases, are “exposing heart patients to unnecessary cardiac procedures.” In fact, those words are in the actual title of the article. Unbelievable.
If all this inappropriate stuff is being done by cardiologists across the country, why don’t these same news agencies answer the following questions:
Why is cardiovascular mortality continuing to decrease in this country at a record pace?
Why are more folks living longer rather than dying earlier from heart and vascular disease?
Why are outcomes of cardiovascular procedures getting better and not worse?
Why has the rate of leg amputations, an extremely debilitating thing to have happen to you, plummeted by 45 percent in the last decade and a half, as procedures like stenting have became more readily available for restoring blow flow to the extremities?
Why does anyone think that leg artery procedures are controversial — like they are some ongoing experiment in medicine — when multiple medical societies in this country have been publishing guideline statements related to these therapies since 2005?
Why isn’t it viewed as a success story that therapies are increasing for peripheral vascular disease (the diagnosis where you have blockages in the arteries of your extremities)? More than 200 million people worldwide have this diagnosis, and this condition is associated with a five-fold increased risk of dying from stroke or heart attack.
Why is their understanding of the facts so misconstrued that nearly 60 percent of the procedures mentioned in their article discussing “blockages” in the extremities, seem to not even deal with procedures that actually treat “blockages” in the extremities? Say what? Indeed, from the data presented, it appears that the greatest increase in extremity procedures over the 10-year period was in venous laser procedures, which most commonly occlude (not stent) varicose veins. For the record, I don’t even perform any of these procedures. This mistake is literally the equivalent of me writing an article about various foods purchased at McDonald’s without knowing that hamburgers and french fries are two different items on the menu.
Why am I wasting my time countering this nonsense? Because with the passing of the Affordable Care Act (ACA) in 2010, CMS has seemingly accelerated its quest to consolidate medicine. By strong-arming physicians through complex administrative policies and other regulatory means, they’ve reduced the number of unique groups and individual providers in medicine to achieve more absolute control of health care. The problem is that CMS continues to demonstrate that they understand very little about quality in medicine or how best to control waste in health care.
Unless something changes soon, we are headed toward a two-tiered medical system is this country, and its our wiser generation — those who have contributed the greatest amount of tax funds into the system — who will be most disappointed by the quality of their Medicare dollars. The solution is not more regulation, it’s less. If you give everyone a health savings account in a system with more physician-ownership and transparent medical pricing, the market will resurrect this failing industry. Sure, the ACA has managed to provided government subsidies to previously uninsured people, but the reality is that these individuals continue to have poor access to the best medical care, and their subsidies are still being used to pay the same exorbitant prices that comprise 90 cents out of every dollar in American healthcare.
You can debate the above all you want, but I speak for the ten-percenters. We represent the wheels on the gas-guzzling machine. In fact, if the wheels fall off, maybe that will actually be a good thing. The patients and I can then hitch a ride together. And, I guarantee you that I’ll be going somewhere where there is less red tape.
Rocky Bilhartz is a cardiologist and the author of Finding Truth in Transparency: Our Broken Healthcare System and How We Can Heal It. He can be reached at BilhartzMD.com.
ROCKY BILHARTZ, MD | POLICY | MARCH 14, 2015
I’m a cardiologist. But if you believe the news, you will assume my entire medical specialty is shady and full of morally suspect physicians. Let me tell you why.
Recently, two articles surfaced in the lay press, one published by the New York Times and the other by U.S. News & World Report. Like the majority of medical news that I’ve seen originate from these sources over the last few years, the articles provide no meaningful contribution to advancing quality standards in medicine or improving patient care. They are written by medical outsiders and fraught with errors. But, to their defense, the authors have been tasked with the impracticable job of interpreting a data dump of poorly understood numbers released to the general public by the Centers for Medicare & Medicaid Services (CMS).
In case you haven’t been intently following this ordeal (in which case I commend you for not wasting your time), CMS started publicizing physician payments and utilization of Medicare services last year. As you know, I have absolutely no problem with transparency. But predictably, CMS has failed to provide the general public with the road map necessary to make this information meaningful.
Here’s CMS’s idea in a nutshell. Throw up a bunch of dollar signs on a billboard. Explain none of the variables. Mention nothing about physician overhead or the frequent redistribution of physician collections in certain specialties back to device manufacturers and pharmaceutical companies. Then, call this transparency, and further propagate the public perception that the person actually providing your health care is the greedy enemy. And, in the process, this will reduce your medical bills while somehow improving the quality of your care.
You want me to tell you why this makes absolutely no sense?
Physician salaries account for less than 10 percent of all health care spending in this country. Kind of makes you wonder who is making out with the other 90 percent of your medical dollars, doesn’t it? I’ll let you think some more about whether you want a rich doctor or a poor doctor doing procedures on your heart, but ultimately, that doesn’t even matter. If doctors worked for free, we’d still have a health care spending crisis.
CMS just doesn’t get it. You have problems with access to care. You have physician and nursing shortages in many areas of the country. Folks can’t get appointments quick enough. So, you decide to hassle the ten-percenters with fraud audits, siphon more money to those administering the currently absurd medical bureaucracy, and target labor costs? It’s like trying to get better gas mileage by polishing your wheels when the gas-guzzling engine should be replaced.
But, CMS has everything mixed up. They remain laser focused on the wheels, which is why you are going to continue to see more nonsense news publications like the ones above.
The first article is best summed up by its opening sentence: “At a time of increasing scrutiny of procedures to open blocked heart arteries, cardiologists are turning to — and reaping huge payments from — controversial techniques that relieve blockages in the arms and legs.” Basically, cardiologists are no longer just inappropriately putting stents in your heart. Instead, they are now doing it in the arteries of your legs! The second article suggests that high-volume operators, essentially those cardiologists performing the most cases, are “exposing heart patients to unnecessary cardiac procedures.” In fact, those words are in the actual title of the article. Unbelievable.
If all this inappropriate stuff is being done by cardiologists across the country, why don’t these same news agencies answer the following questions:
Why is cardiovascular mortality continuing to decrease in this country at a record pace?
Why are more folks living longer rather than dying earlier from heart and vascular disease?
Why are outcomes of cardiovascular procedures getting better and not worse?
Why has the rate of leg amputations, an extremely debilitating thing to have happen to you, plummeted by 45 percent in the last decade and a half, as procedures like stenting have became more readily available for restoring blow flow to the extremities?
Why does anyone think that leg artery procedures are controversial — like they are some ongoing experiment in medicine — when multiple medical societies in this country have been publishing guideline statements related to these therapies since 2005?
Why isn’t it viewed as a success story that therapies are increasing for peripheral vascular disease (the diagnosis where you have blockages in the arteries of your extremities)? More than 200 million people worldwide have this diagnosis, and this condition is associated with a five-fold increased risk of dying from stroke or heart attack.
Why is their understanding of the facts so misconstrued that nearly 60 percent of the procedures mentioned in their article discussing “blockages” in the extremities, seem to not even deal with procedures that actually treat “blockages” in the extremities? Say what? Indeed, from the data presented, it appears that the greatest increase in extremity procedures over the 10-year period was in venous laser procedures, which most commonly occlude (not stent) varicose veins. For the record, I don’t even perform any of these procedures. This mistake is literally the equivalent of me writing an article about various foods purchased at McDonald’s without knowing that hamburgers and french fries are two different items on the menu.
Why am I wasting my time countering this nonsense? Because with the passing of the Affordable Care Act (ACA) in 2010, CMS has seemingly accelerated its quest to consolidate medicine. By strong-arming physicians through complex administrative policies and other regulatory means, they’ve reduced the number of unique groups and individual providers in medicine to achieve more absolute control of health care. The problem is that CMS continues to demonstrate that they understand very little about quality in medicine or how best to control waste in health care.
Unless something changes soon, we are headed toward a two-tiered medical system is this country, and its our wiser generation — those who have contributed the greatest amount of tax funds into the system — who will be most disappointed by the quality of their Medicare dollars. The solution is not more regulation, it’s less. If you give everyone a health savings account in a system with more physician-ownership and transparent medical pricing, the market will resurrect this failing industry. Sure, the ACA has managed to provided government subsidies to previously uninsured people, but the reality is that these individuals continue to have poor access to the best medical care, and their subsidies are still being used to pay the same exorbitant prices that comprise 90 cents out of every dollar in American healthcare.
You can debate the above all you want, but I speak for the ten-percenters. We represent the wheels on the gas-guzzling machine. In fact, if the wheels fall off, maybe that will actually be a good thing. The patients and I can then hitch a ride together. And, I guarantee you that I’ll be going somewhere where there is less red tape.
Rocky Bilhartz is a cardiologist and the author of Finding Truth in Transparency: Our Broken Healthcare System and How We Can Heal It. He can be reached at BilhartzMD.com.
