21% cut proposed for Pathologists!

[LADoc00]

Well I just dived into the 2010 proposed Medicare cuts and it is looking like a 21% cut for 88305 interpretation for Pathologists. Which would be a straight up 21% cut in pay for those doing purely biopsy work, read: Derm, GI and GU.

OUCH.

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[psychforme]

About time.

 

[stickyshift]

You don't think this is going to be reversed?

 

[KeratinPearls]

What will be left of pathology after the hot fellowships get nailed?

 

[MOHS_01]

Well I just dived into the 2010 proposed Medicare cuts and it is looking like a 21% cut for 88305 interpretation for Pathologists. Which would be a straight up 21% cut in pay for those doing purely biopsy work, read: Derm, GI and GU.

OUCH.

It is worse than that, my friend... although I somehow believe that you know this already. A 21% cut will translate into a greater than 21% decrease in pay -- unless somehow your overhead is zero.

We (derm) knew this was coming. There has even been discussions on creating a new series of codes for dermpath services due to the volume per provider (which is also tracked by CMS).

On another note, I see that no forum is safe from the troll(s)...........

 

[KluverB]

How are they're planning on axing 305s by 21%, but they're projecting a 0% "impact"? Something don't smell right.

 

[yaah]

How are they're planning on axing 305s by 21%, but they're projecting a 0% "impact"? Something don't smell right.

Pathologists aren't real doctors.

 

[Nilf]

Well I just dived into the 2010 proposed Medicare cuts and it is looking like a 21% cut for 88305 interpretation for Pathologists. Which would be a straight up 21% cut in pay for those doing purely biopsy work, read: Derm, GI and GU.

OUCH.

Link please.

 

[KluverB]

Link please.

http://www.federalregister.gov/OFRUpload/OFRData/2009-15835_PI.pdf

Page 720...

 

[MOHS_01]

That chart assumes that the conversion factor cut due to the SGR formula is allowed to stand....

 

[Nilf]

That chart assumes that the conversion factor cut due to the SGR formula is allowed to stand....

In other words.... after factoring in overhead costs, and the fact that the changes in SGR will result in further cuts, pathologists are looking at a ballpark figure of 50% net decrease in reimbursement.

 

[stickyshift]

Another issue is how the private payers will react: since so many contracts are based on a percentage of Medicare, the effects could go far beyond Medicare reimbursement.
If this happens, dropping service to Medicare patients becomes a no-brainer.

 

[DocOfDocs]

everyone would get screwed on that!!! -19% on ED visits, -38% on ECG's, -38% on stress tests, -23& on mammograms and -25% on CXR's!!! LOL, is this going to be put into effect??? WTF is going on here???

 

[LADoc00]

LOL, is this going to be put into effect??? WTF is going on here???

LOL-ROFLcopter-LMAO: yes.

 

[v112233s]

delete

 

[radslooking]

In other words.... after factoring in overhead costs, and the fact that the changes in SGR will result in further cuts, pathologists are looking at a ballpark figure of 50% net decrease in reimbursement.

I don't think those cuts will be allowed to stand.....although you never know i guess.

cards is getting hammered in there too. ekg/stress/heart cath/stents all down 25-38%.

 

[gclax30]

If this happens, dropping service to Medicare patients becomes a no-brainer.

What about when "free" govt healthcare puts private insurance out of business and becomes the only show in town? Won't we then have to take Medicare or else find a new profession?

 

[Nilf]

What about when "free" govt healthcare puts private insurance out of business and becomes the only show in town? Won't we then have to take Medicare or else find a new profession?

Well... yes, but... they would have to legislate that doctors take government insurance. Since there is legitimate demand for our services, nothing short of a new law will prevent you from accepting payments from private sources, whether it patient, clinician, or private insurance. I hope that these market forces will prevent Medicare from becoming true monopsonist. But it will get close to being one, (I'm guessing at least 80% of the market will be government based in 10 years).

This is macro, long-term picture. However, short term things look grimmer every day, and there is no end in sight.

And of course, nothing can prevent the government from passing such draconian law--in this case, wer'e talking true monopsony, or 100% of market share.

 

[yaah]

Why do you assume that even if the government develops its own plan that private insurance plans would go away? In my mind, there will always be a substantial market for them - just like in almost every other country with government run insurance. It's not as if the supposed government run plan would be any better for healthcare (apart from cost to the patient) - it would probably be less efficient and more bureaucratic, and therefore many will flock to private plans.

Congress is still saying that everything is on the table EXCEPT a single-payor government plan.

 

[v112233s]

Why do you assume that even if the government develops its own plan that private insurance plans would go away? In my mind, there will always be a substantial market for them - just like in almost every other country with government run insurance. It's not as if the supposed government run plan would be any better for healthcare (apart from cost to the patient) - it would probably be less efficient and more bureaucratic, and therefore many will flock to private plans.

PBS aired a review on the various health care systems around the world. I did a bit more research, and apparently, in places where government developed its ow national health plans (eg Taiwan & Japan), there really is no room for private insurance. I met a Japanese visiting student during a peds elective just a few months ago, and apparently, the situation there is TERRIBLE for all specialties. Physicians are overworked, and the income level there is kept very low. I wouldn't underestimate the power of government run insurance. Once people get used to cheap healthcare, there would be very little room for private.

 

[stickyshift]

But in places where government develops its ow national health plan (eg Taiwan & Japan), there really is no room for private insurance plans to exist. These are two places that exemplify overworked physicians (to compensate for severe cut in salary) and significant drop in physician income. Also, I wouldn't underestimate the power of government run insurance. Once people get used to cheap healthcare, there would be very little room for private.

I have heard that doctors working in both the government system and the private sector drag their feet in the government clinics and then bust their butts when they work in their private clinics. Makes sense.
As government insurance takes over and doctors try to cost shift to the private payers, private insurance will become more and more expensive. Ironically, I think it's conceivable that doctors could eventually find private coverage for their own families cost prohibitive.

 

[stickyshift]

Congress is still talking about the public option, the Trojan horse for single-payer.
Senate is pushing a surtax on the wealthy ($200,000+) to pay for health care. Taxation of health care benefits appears to be too unpopular, because it would actually require that 95% of the population to pay up. Easier to assure the citizenry that only the top 5% will be required to pay for their healthcare.

 

[yaah]

Congress is still talking about the public option, the Trojan horse for single-payer.
Senate is pushing a surtax on the wealthy ($200,000+) to pay for health care. Taxation of health care benefits appears to be too unpopular, because it would actually require that 95% of the population to pay up. Easier to assure the citizenry that only the top 5% will be required to pay for their healthcare.

If they want to fund healthcare they are going to have to raise taxes somehow. I just wish they would acknowledge that and get on with it. If people aren't willing to pay higher taxes for quality public health care, then they don't want quality public healthcare. They have to frame the debate that way and quit pandering.

I heard congressmen say yesterday, "Everything is on the table except for single-payor healthcare." Perhaps you heard different.

 

[radslooking]

If they want to fund healthcare they are going to have to raise taxes somehow. I just wish they would acknowledge that and get on with it. If people aren't willing to pay higher taxes for quality public health care, then they don't want quality public healthcare. They have to frame the debate that way and quit pandering.

I heard congressmen say yesterday, "Everything is on the table except for single-payor healthcare." Perhaps you heard different.

he meant that public option is a ruse. once it is in place its collective bargaining will lower costs/premiums so low that people will flee their private insurance or have it dropped because it can't compete. Thus, de facto single payer.

 

[igottaquestion]

single payer = saving money by not giving health care dollars to ceos, lawyers, actuaries, medical billers, and others who contribute zero/zip/nada value to actual health care.

 

[TypicalTuesday]

single payer = saving money by not giving health care dollars to ceos, lawyers, actuaries, medical billers, and others who contribute zero/zip/nada value to actual health care.

But it comes with the potential of a huge trade-off. It's like comparing VA hospital care with private hospital care....kind of scary to think what might be!

 

[Parts Unknown]

But it comes with the potential of a huge trade-off. It's like comparing VA hospital care with private hospital care....kind of scary to think what might be!

No, it's not like that at all. Physicians in the VA are salaried employees, and their hospitals operate on fixed budgets. Physicians in a single payer system operate privately in a fee-for-service model.

 

[TypicalTuesday]

No, it's not like that at all. Physicians in the VA are salaried employees, and their hospitals operate on fixed budgets. Physicians in a single payer system operate privately in a fee-for-service model.

I was not referring to a physicians stance, but talking about care from the patient's viewpoint and the potential hit that it could take in terms of quality!

 

[pathologic]

Those job posting in Dubai are looking better everyday.

 

[Parts Unknown]

[FONT=arial, helvetica]Jha et al. .[FONT=Arial, Helvetica, sans-serif]Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care. NEJM .348:2218-2227, 2003.
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[FONT=arial, helvetica] Background In the mid-1990s, the Department of Veterans Affairs(VA) health care system initiated a systemwide reengineeringto, among other things, improve its quality of care. We soughtto determine the subsequent change in the quality of healthcare and to compare the quality with that of the Medicare fee-for-serviceprogram..

[FONT=arial, helvetica]Methods Using data from an ongoing performance-evaluation programin the VA, we evaluated the quality of preventive, acute, andchronic care. We assessed the change in quality-of-care indicatorsfrom 1994 (before reengineering) through 2000 and compared thequality of care with that afforded by the Medicare fee-for-servicesystem, using the same indicators of quality..

[FONT=arial, helvetica]Results In fiscal year 2000, throughout the VA system, the percentageof patients receiving appropriate care was 90 percent or greaterfor 9 of 17 quality-of-care indicators and exceeded 70 percentfor 13 of 17 indicators. There were statistically significantimprovements in quality from 1994–1995 through 2000 forall nine indicators that were collected in all years. As comparedwith the Medicare fee-for-service program, the VA performedsignificantly better on all 11 similar quality indicators forthe period from 1997 through 1999. In 2000, the VA outperformedMedicare on 12 of 13 indicators..
[FONT=arial, helvetica]
Conclusions The quality of care in the VA health care systemsubstantially improved after the implementation of a systemwidereengineering and, during the period from 1997 through 2000,was significantly better than that in the Medicare fee-for-serviceprogram. These data suggest that the quality-improvement initiativesadopted by the VA in the mid-1990s were effective..

 

[Adrian Cocot]

...b-b-but SOCIALISM!