30% Paycut By 2011

[Coastie]

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Across the board.

23.6% when SGR kicks in after Nov.
6.1% in 2011.

BUT WAIT...

Midwives, PAs, NPs, and Clinical Nurse Specialists will all get a raise!

And PAs/Midwives get expanded scope of practice/billing privileges!

http://www.ama-assn.org/amednews/2010/07/19/gvsd0723.htm

 

[Gern Blansten]

Across the board.

23.6% when SGR kicks in after Nov.
6.1% in 2011.

BUT WAIT...

Midwives, PAs, NPs, and Clinical Nurse Specialists will all get a raise!

And PAs/Midwives get expanded scope of practice/billing privileges!

http://www.ama-assn.org/amednews/2010/07/19/gvsd0723.htm

Shuh Cho Mouf!

 

[bronx43]

Across the board.

23.6% when SGR kicks in after Nov.
6.1% in 2011.

BUT WAIT...

Midwives, PAs, NPs, and Clinical Nurse Specialists will all get a raise!

And PAs/Midwives get expanded scope of practice/billing privileges!

http://www.ama-assn.org/amednews/2010/07/19/gvsd0723.htm

There's little to no chance the SGR will actually be enacted. The Senate will vote last second and "save" Medicare patients from health care abyss. But, the internal fee schedule payments will probably be altered heavily in the coming years to cut many high paying procedural reimbursements. Diagnostic imaging will probably be targeted first.

 

[PL32]

I know nothing on this subject so I figured I'd ask what is probably a stupid question: since oftentimes hospitals subsidize/supplement the anesthesia group's billing revenues, why can't we build an argument for higher subsidies once our billing revenues are decreased by these policies? Can we "soften the blow" at all or have we no leverage?

 

[kazuma]

I know nothing on this subject so I figured I'd ask what is probably a stupid question: since oftentimes hospitals subsidize/supplement the anesthesia group's billing revenues, why can't we build an argument for higher subsidies once our billing revenues are decreased by these policies? Can we "soften the blow" at all or have we no leverage?

From what I understand, Anesthesiologists generally don't bring business to the hospital, surgeons do. Although surgery isn't possible without seamless, efficient, and safe anesthesia, my guess is that increasing anesthesia group subsidies is a low priority for most hospitals.

 

[badasshairday]

😴

 

[pgg]

I know nothing on this subject so I figured I'd ask what is probably a stupid question: since oftentimes hospitals subsidize/supplement the anesthesia group's billing revenues, why can't we build an argument for higher subsidies once our billing revenues are decreased by these policies? Can we "soften the blow" at all or have we no leverage?

I think geography will continue to matter a lot when it comes to the subsidy question.

So long as the operating room remains every hospital's cash cow, the bean counters will be motivated to keep anesthesia coverage available. But to have leverage, there has to be a credible threat that the anesthesiologists will really, actually, truly LEAVE if their pay drops below a certain threshold. And I'm skeptical of that - it's clear from the people I know in real life, and from reading this board, that there are a LOT of anesthesiologists TODAY willing to earn $200K/year LESS for the privilege of living in the big city.

Out here in the sticks, where anesthesia coverage always seems to be squeaking by just to keep the ORs open, the hospitals pay large subsidies to the anesthesia groups and the pay is great. (Cost of living is low, too.) Those hospitals know if they don't cough up the money, the locums anesthesia guys will quit coming, and the ORs will shut down. They have paid and will keep paying the subsidies.

Honestly, I bet if the average tied-to-a-city anesthesiologist watched his salary go from $300K to $250K or $200K, he'd bitch & moan and go commiserate with the pediatricians ... but he wouldn't actually quit and move to Cowtown for a better wage. I'm really quite curious to see how those urban paradise hospitals play their hand when it comes to this issue over the next 10 years. (I'll be watching from Cowtown.)

 

[deleted126335]

I think geography will continue to matter a lot when it comes to the subsidy question.

So long as the operating room remains every hospital's cash cow, the bean counters will be motivated to keep anesthesia coverage available. But to have leverage, there has to be a credible threat that the anesthesiologists will really, actually, truly LEAVE if their pay drops below a certain threshold. And I'm skeptical of that - it's clear from the people I know in real life, and from reading this board, that there are a LOT of anesthesiologists TODAY willing to earn $200K/year LESS for the privilege of living in the big city.

Out here in the sticks, where anesthesia coverage always seems to be squeaking by just to keep the ORs open, the hospitals pay large subsidies to the anesthesia groups and the pay is great. (Cost of living is low, too.) Those hospitals know if they don't cough up the money, the locums anesthesia guys will quit coming, and the ORs will shut down. They have paid and will keep paying the subsidies.

Honestly, I bet if the average tied-to-a-city anesthesiologist watched his salary go from $300K to $250K or $200K, he'd bitch & moan and go commiserate with the pediatricians ... but he wouldn't actually quit and move to Cowtown for a better wage. I'm really quite curious to see how those urban paradise hospitals play their hand when it comes to this issue over the next 10 years. (I'll be watching from Cowtown.)

👍 I am a refugee from urban paradise. Moved to inner Cowtown. Not as lucrative as outer Cowtown but really good by urban paradise standards. (Furthest that I could get the wife to move). The higher that subsidies go, the more the hospitals will seek to employ you. The key to making it work in Cowtown is don't buy the big house and don't get too emotionally attached. Even small hospitals have vice presidents and accountants that lie awake at night thinking how to cut their costs, i.e. the price for your services.

 

[Gern Blansten]

It seems to me that:
The higher the subsidy-->the lower the group's leverage
I think that the more they have to subsidize, the more interested they will be in looking for other options to lower their bottom line.

 

[SleepIsGood]

So having gone to capital hill to lobby for thsi stuff in June, fromwhat we gather the senate/congress will always renew the SGR bill. Apparently,they dnt do it 'longterm' because they want to 1) be able to go back to their constiuents and saythey 'saved money' 2) they all want to proclaim that they saved the doctors,etc.

It's totally BS.. They really should do a permanent doc fix. Most republicans are on board with this. However, since the Dems have the majority often times and more power currently...it's tough to do.

 

[bronx43]

So having gone to capital hill to lobby for thsi stuff in June, fromwhat we gather the senate/congress will always renew the SGR bill. Apparently,they dnt do it 'longterm' because they want to 1) be able to go back to their constiuents and saythey 'saved money' 2) they all want to proclaim that they saved the doctors,etc.

It's totally BS.. They really should do a permanent doc fix. Most republicans are on board with this. However, since the Dems have the majority often times and more power currently...it's tough to do.

Seems like 1 and 2 are entirely anti-thetical. The GOP will naturally be on board with this, until, of course, one of them gets into the Oval Office, and their spending habits are put under the microscope. The SGR might be revoked one day, but that will only soften the blow that will come eventually.

 

[urge]

It seems to me that:
The higher the subsidy-->the lower the group's leverage
I think that the more they have to subsidize, the more interested they will be in looking for other options to lower their bottom line.

That makes for unstable contracts. Kind of what happened in Virginia not long ago. We all know where this is headed.

 

[kmurp]

From talking to people and from what I have read, the "subsidy wave" of the last decade has peaked and is retrenching. Ii will be interesting to see this years MGMA data on this subject with the caveat that their survey of anesthesia practices has very low participation and may not be representative.
If I were in a group with a subsidy, I would be very nervous when the next contract came up and be thinking proactively for ways to reduce or eliminate it.

 

[PL32]

There's always creative ways to "sweeten the pot" in any negotiation with a hospital, and I should hope that a highly educated and motivated professional such as a physician would make better negotiations than a less rigorously educated nurse (although if you looked at what the AANA has accomplished to date, you'd think otherwise).

I would argue that we should not relinquish subsidies, because that's the wrong message to send to hospital administrators. The correct message is that higher quality costs more money. Our status as hospital employees leaves us in a perilous position, and makes it more difficult for us to completely name our terms in any given hospital. We've lost a lot of ground to midlevel providers, and may be seen as interchangeable. However, we can reclaim some of that bargaining power by being just as vociferous as those "militant" CRNAs.

I suspect one explanation for our loss of market share is most of us think we're too "civilized" to fight back just as fiercely. We think we should take the high road. That's not getting us very far.

 

[deleted126335]

There's always creative ways to "sweeten the pot" in any negotiation with a hospital, and I should hope that a highly educated and motivated professional such as a physician would make better negotiations than a less rigorously educated nurse (although if you looked at what the AANA has accomplished to date, you'd think otherwise).

I would argue that we should not relinquish subsidies, because that's the wrong message to send to hospital administrators. The correct message is that higher quality costs more money. Our status as hospital employees leaves us in a perilous position, and makes it more difficult for us to completely name our terms in any given hospital. We've lost a lot of ground to midlevel providers, and may be seen as interchangeable. However, we can reclaim some of that bargaining power by being just as vociferous as those "militant" CRNAs.

I suspect one explanation for our loss of market share is most of us think we're too "civilized" to fight back just as fiercely. We think we should take the high road. That's not getting us very far.

This sentence oozes inexperience and overconfidence bordering arrogance. Negotiating ability is both an inborn talent and an acquired skill. Native intelligence, education, and mastery of your specialty have little correlation to negotiating ability. In fact I believe that there is a slight negative correlation.

 

[PL32]

This sentence oozes inexperience and overconfidence bordering arrogance. Negotiating ability is both an inborn talent and an acquired skill. Native intelligence, education, and mastery of your specialty have little correlation to negotiating ability. In fact I believe that there is a slight negative correlation.

I disagree. There is plenty that can be learned from BOOKS and EXPERIENCE when it comes to the science and art of negotiating and to argue against that is ludicrous, and MORE importantly disempowering and disencouraging, IMHO. My point was that the same dedication and perseverance it takes to excel in medicine can be translated to other ventures.

 

[bronx43]

I disagree. There is plenty that can be learned from BOOKS and EXPERIENCE when it comes to the science and art of negotiating and to argue against that is ludicrous, and MORE importantly disempowering and disencouraging, IMHO. My point was that the same dedication and perseverance it takes to excel in medicine can be translated to other ventures.

Wait, so you're going to read a book to gain experience on how to negotiate?

I'll have to agree with dr doze here. Not everything is as simple as "we're better at academics, therefore we are better at everything." In fact, looking around at my medical colleagues, I have to say that many are deficient in(or at least not very proficient in) the soft skills that are necessary for success outside of medicine. As for the negotiations, I would say far more comes from innate strength of personality and social awareness than some cognitive ability to acquire third-hand experience.

Just on a side note, most of the people who echo the sentiment that if you're a doctor, you can do anything as well as anyone didn't have work experience outside of medicine. If you spend a year in any corporate environment, it becomes sharply clear that academic intelligence is only a small part of one's ability to succeed.

 

[PL32]

I see your point that there are many different kinds of intelligence, and some are better suited than others for any given activity. But I think it helps us to be optimistic. I also think it's been detrimental to our profession for every other physician to echo the almost dogmatic "doctors are terrible in business."

 

[deleted126335]

I see your point that there are many different kinds of intelligence, and some are better suited than others for any given activity. But I think it helps us to be optimistic. I also think it's been detrimental to our profession for every other physician to echo the almost dogmatic "doctors are terrible in business."

There is a reason for that stereotype. In my experience, most docs are terrible investors and business men. The reason IMO is that docs fail to treat business and investing as an academic discipline worthy of serious study, Also docs having usually gotten well above average grades all though high school and college tend to be of the opinion that this will automatically translate to above average results outside their area of expertise, disregarding the fact that most have little formal education or experience in business. Overconfidence in areas outside of medicine is simply an occupational hazard. Those docs that give business and investing the study and time that it deserves frequently excel.

Old joke: the A students in med school become the best researchers, the B students become the best clinicians, the C students make the most money.

 

[2win]

It seems to me that:
The higher the subsidy-->the lower the group's leverage
I think that the more they have to subsidize, the more interested they will be in looking for other options to lower their bottom line.

👍👍👍

Subsidize - no thank you!
Thanks GOD that I have money.
I don't need a freaking murse with a MBA to look over my shoulder.
2win