21% medicare cut

[shahalam]

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I recently read on WhiteCoat's blog that the 21% cut in Medicare is going to take affect here in a couple of weeks. Being ER docs (or future ones), you obviously cant deny medicare. How do you guys think it's going to affect the salary? Thanks for the responses guys.

 

[GeneralVeers]

I recently read on WhiteCoat's blog that the 21% cut in Medicare is going to take affect here in a couple of weeks. Being ER docs (or future ones), you obviously cant deny medicare. How do you guys think it's going to affect the salary? Thanks for the responses guys.

Negatively. Even worse is that the physicians who have a choice, like primary care and specialists may stop taking Medicare altogether. If that happens I think that the Medicare cuts will be rapidly reversed. Nothing accomplishes change like angry seniors who vote.

 

[Dwindlin]

Negatively. Even worse is that the physicians who have a choice, like primary care and specialists may stop taking Medicare altogether. If that happens I think that the Medicare cuts will be rapidly reversed. Nothing accomplishes change like angry seniors who vote.

I know you were being serious but for some reason the bolded part made me laugh...

 

[Pilot]

My partners and I stopped taking new Medicare patients 3 months ago. Saw the writing on the wall. Billed 15% more in 2009 vs 2008, and our net collections were down 10% in the same time period. Looked at biggest offenders - no surprise - was Medicare, Tricare, and Medicare secondary plans (United, Secure Horizons).

We are keeping the patients we have, but not taking new ones with these plans. No sense working harder for less money.

 

[Red Beard]

Looks like the 21% cut went through, and goes into effect today.

http://www.google.com/hostednews/ap/article/ALeqM5gC_JUxACvC2mi0yR_N2APmvp19lAD9E63FBO0

But:

Hoping the Senate will act soon to stave off the cuts, the Obama administration directed Medicare billing contractors to hold off processing claims for 10 business days. Medicare normally takes 14 days to pay doctors, so there would be no reduction in reimbursement if lawmakers move quickly

So we'll see.....

 

[Master Deep]

Yep just went into effect today. And this is bad for doctors who see mostly older patients.

 

[NinerNiner999]

EP's get the "double whammy" - 21% reduction in reimbursement for medicare patients, and higher volumes of the same patients, since their primary doctors won't be seeing them anymore. We get to see more for less...

 

[JaggerPlate]

There is a 10 day extension before it's set in stone, hopefully congress will fix it.

 

[Master Deep]

Well medicare is holding all payments until it is official after 10 days. So hopefully the senate acts quickly.

 

[strongboy2005]

Can emergency doctors opt out of Medicare and just bill straight to the patient?

 

[Master Deep]

It is slightly worrying going into a career where I still don't know what it will be like in 8-10 years when I'm out of residency. Who knows, specialists might be making only 200k and and those high end surgery specialties that take 6-8 years of residency/fellowship might be down to 250 by then. I often wonder if I will be able to provide the same type of life for my kids that my parents were able to provide for me. 🙁

All I know is that I will still love my job. But I still have that worry in the back of my head about the future. And I know I'm not alone.

 

[southerndoc]

Can emergency doctors opt out of Medicare and just bill straight to the patient?

I answered this in another thread. The government cannot force physicians to accept Medicare. Therefore, emergency physicians are not required to accept Medicare.

 

[deleted87716]

I answered this in another thread. The government cannot force physicians to accept Medicare. Therefore, emergency physicians are not required to accept Medicare.

No, but how practical would it be?

If nothing else, it would trash your Press Ganey scores. 😉

 

[GeneralVeers]

I answered this in another thread. The government cannot force physicians to accept Medicare. Therefore, emergency physicians are not required to accept Medicare.

You have the individual right to refuse, however most hospitals are going to make it a condition of employment that you accept Medicare. Unless you are in a freestanding ER owned by EPs, your chance of refusing Medicare patients is zero.

 

[willow18]

It is slightly worrying going into a career where I still don't know what it will be like in 8-10 years when I'm out of residency. Who knows, specialists might be making only 200k and and those high end surgery specialties that take 6-8 years of residency/fellowship might be down to 250 by then. I often wonder if I will be able to provide the same type of life for my kids that my parents were able to provide for me. 🙁

All I know is that I will still love my job. But I still have that worry in the back of my head about the future. And I know I'm not alone.

Yes, it's so 🙁 that your kids will have to live on just a measly $200,000.

Nothing accomplishes change like angry seniors who vote.

Right on. And if young people voted in those numbers, Republicans would've been 'defending' a national health care system for young people too. As it is, they only have to grovel to seniors (and insurance company execs).

 

[southerndoc]

You have the individual right to refuse, however most hospitals are going to make it a condition of employment that you accept Medicare. Unless you are in a freestanding ER owned by EPs, your chance of refusing Medicare patients is zero.

Independent contractors of a democratic group can choose not to accept Medicare. You're right that employees of a corporation probably won't go that route.

 

[Master Deep]

lol i meant 200 gross. (before 401k, taxes, etc.)

But anyways, it seems that the cut is going to be reversed.

 

[GeneralVeers]

lol i meant 200 gross. (before 401k, taxes, etc.)

But anyways, it seems that the cut is going to be reversed.

To some people it seems like a lot, but considering the training, stress, debt, and general crapitude of the job (on some days) 200K isn't that much.

 

[deleted87716]

lol i meant 200 gross. (before 401k, taxes, etc.)

But anyways, it seems that the cut is going to be reversed.

Update from Kevin Burke of the AAFP:

Last night, the Senate approved the House-passed bill that extends unemployment benefits, COBRA, the SGR and other payment and benefit provisions. The bill funds Medicare payments to physicians at the current rate until March 31. The President immediately signed the bill.

Meanwhile, the Senate is working on another bill that would extend these same benefits for several more months. In the case of the SGR, payments would be extended to October 1 of this year. This bill will likely pass the Senate later this week or early next and would likely be approved quickly in the House.

Most Senators who voted for the legislation cited the difficulties created for the unemployed, but they also heard from a large number of physicians and that made a significant difference in their sense of urgency.

Another Band-Aid, but better than a cut. Pun intended.

 

[Red Beard]

I suspect it will be indefinite band-aids with this issue.

Every time an opportunity for a definitive solution to this issue gets missed, the current cost of that definitive solution gets higher. This has been going on since the mid-1990s.

Nobody wants to take the issue head on because backing some kind of permanent fix (and its associated 'cost') would be political suicide.

Granting these periodic extensions hides the cost such that our politicians don't have to stake their political careers on the issue.

Its cowardice if you ask me.

 

[GeneralVeers]

I suspect it will be indefinite band-aids with this issue.

Every time an opportunity for a definitive solution to this issue gets missed, the current cost of that definitive solution gets higher. This has been going on since the mid-1990s.

Nobody wants to take the issue head on because backing some kind of permanent fix (and its associated 'cost') would be political suicide.

The permanent fix is relatively simple. Make Medicare an actual insurance benefit, not a welfare handout. Put more simply, if seniors had to pay more out of pocket for care, they would ration themselves. Medicare could exist as a catastrophic insurance plan to protect them from poverty.

This same fix needs to apply to all of healthcare, as 85% of payments are made by third parties. If something is "free" you will use more of it.