And there it is, Medicare's pay cuts....

[physasst]

Ruh Roh.

Pay cuts for specialists. Increases to primary care. Wealth re-allocation. Remember, you heard it here first.

http://online.wsj.com/article/SB124646885862181139.html#articleTabs=comments

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[MOHS_01]

Ruh Roh.

Pay cuts for specialists. Increases to primary care. Wealth re-allocation. Remember, you heard it here first.

http://online.wsj.com/article/SB124646885862181139.html#articleTabs=comments

I read that before work this morning. I feel like Saturday is going to be a wake more than a birthday.

 

[radslooking]

Ruh Roh.

Pay cuts for specialists. Increases to primary care. Wealth re-allocation. Remember, you heard it here first.

http://online.wsj.com/article/SB124646885862181139.html#articleTabs=comments

Umm, wealth reallocation? That's what's been happening for years in the other direction. I don't like to see anyone's pay getting cut, but the disparity is far greater than anything they will correct. Come back when you know what you are talking about.

 

[physasst]

Umm, wealth reallocation? That's what's been happening for years in the other direction. I don't like to see anyone's pay getting cut, but the disparity is far greater than anything they will correct. Come back when you know what you are talking about.

Excuse me?

If you are talking about the wide disparity between the incomes of interventionalists, or proceduralists, and primary care physicians, then of course this isn't going to completely correct it. The income disparity between these groups is pretty large. But this might be, depending on which side of the aisle you sit on, a step in the right direction. It's also a brilliant political move. Considering, that about 80% of my time is occupied with health policy, I think I have a fairly good grasp of what is going on.

 

[radslooking]

Excuse me?

If you are talking about the wide disparity between the incomes of interventionalists, or proceduralists, and primary care physicians, then of course this isn't going to completely correct it. The income disparity between these groups is pretty large. But this might be, depending on which side of the aisle you sit on, a step in the right direction. It's also a brilliant political move. Considering, that about 80% of my time is occupied with health policy, I think I have a fairly good grasp of what is going on.

Ok, then why are you arguing against it if you agree there is a huge disparity between specialists and generalists.......because you'd rather see generalists get paid more and leave specialists alone i assume?

 

[physasst]

Ok, then why are you arguing against it if you agree there is a huge disparity between specialists and generalists.......because you'd rather see generalists get paid more and leave specialists alone i assume?

Who said I was arguing against it? I think it is one of the better decisions to be made recently by CMS, and if you look at my posting history, you will see that I have actually spoken up in support of this here before. I posted this in an effort to see the responses generated. I think the Pay Disparity should be narrowed significantly, even more than this bill does. However, many on here, particularly those working in specialties, may not see things that way.

 

[tibor75]

great news! Maybe now cardiologists will be more likely to talk to patients instead of sticking their groins.

 

[radslooking]

Who said I was arguing against it? I think it is one of the better decisions to be made recently by CMS, and if you look at my posting history, you will see that I have actually spoken up in support of this here before. I posted this in an effort to see the responses generated. I think the Pay Disparity should be narrowed significantly, even more than this bill does. However, many on here, particularly those working in specialties, may not see things that way.

i guess we are arguing about nothing then. carry on good sir.

 

[chessknt]

great news! Maybe now cardiologists will be more likely to talk to patients instead of sticking their groins.

Yep this is it, decreasing their salaries is going to make them feel more inclined to do a good job.

 

[radslooking]

Yep this is it, decreasing their salaries is going to make them feel more inclined to do a good job.

that's not what he meant. he meant there'll be less incentive to doing procedures instead of other measures that are cheaper and oftentimes, just as effective. (or less dangerous)

 

[JacobSilge]

that's not what he meant. he meant there'll be less incentive to doing procedures instead of other measures that are cheaper and oftentimes, just as effective. (or less dangerous)

But the article says:

"Under the proposal, Medicare would put specialists' payments for evaluating and managing illnesses on par with those of primary-care physicians starting in January."

Therefore CMS is actually going to cut Specialist E&M codes as well as their procedures. The end result will be a pay cut, not an alteration to the incentives to promote more cost effective care. In fact, since these are only professional fee changes and technical fees aren't changing, it will actually increase the incentive to increase the volume of procedures to continue to make the same amount of money.

 

[radslooking]

But the article says:

"Under the proposal, Medicare would put specialists' payments for evaluating and managing illnesses on par with those of primary-care physicians starting in January."

Therefore CMS is actually going to cut Specialist E&M codes as well as their procedures. The end result will be a pay cut, not an alteration to the incentives to promote more cost effective care. In fact, since these are only professional fee changes and technical fees aren't changing, it will actually increase the incentive to increase the volume of procedures to continue to make the same amount of money.

that's an interesting point. I think the answer is probably somewhere in between both of ours. If fees are so small that it isn't worth ordering lots of tests, that would be a disincentive. If fees are still large enough, or account for enough of your earnings that it behooves you to order still more tests, that would create an increase in tests. I think that we are already on the high end of ordering tests however, and you can't go much higher, legally. I think the floor is a lot further than the ceiling. Good point though. I think the answer will be individualized on the procedure, how much professional fees are, how much of a volume that has on a person's practice, etc. Too difficult to generalize with so many details unknown.

 

[JHopRevisit]

Ruh Roh.

Pay cuts for specialists. Increases to primary care. Wealth re-allocation. Remember, you heard it here first.

http://online.wsj.com/article/SB124646885862181139.html#articleTabs=comments

You realize that Medicare's rates will be just as arbitrary before and after any changes, right? The only wealth re-allocation is from the taxpayer to our pockets - I don't think specialists can claim any high ground just because they got a larger share of the wealth first.

 

[Pianoman32]

If you want a good laugh, read the comments people posted in regards to the article.

 

[RGMSU]

great news! Maybe now cardiologists will be more likely to talk to patients instead of sticking their groins.

I sure hope you never need a cardiologist to save your life by sticking your groin. They should boycott you if you do since you habitually believe their work isn't worth the financial compensation they receive. Oh, I know - go to a generalist and have them cath you - see how that works out for you. Maybe specialists get paid more because, in many instances, they train for twice as long, see patients twice as complex, and engage in activities twice as risky - LIKE RUNNING A CARDIO CATH THROUGH SOMEBODY! Little bit riskier there to do that than to write a script for cough syrup?

 

[radslooking]

I sure hope you never need a cardiologist to save your life by sticking your groin. They should boycott you if you do since you habitually believe their work isn't worth the financial compensation they receive. Oh, I know - go to a generalist and have them cath you - see how that works out for you. Maybe specialists get paid more because, in many instances, they train for twice as long, see patients twice as complex, and engage in activities twice as risky - LIKE RUNNING A CARDIO CATH THROUGH SOMEBODY! Little bit riskier there to do that than to write a script for cough syrup?

he is a cardiologist.

 

[ThinkTooMuch]

maybe taking complete and thorough histories will become in vogue again?

 

[RGMSU]

A cardiologist who wants to volunteer to take a pay cut? Don't get it.

 

[radslooking]

A cardiologist who wants to volunteer to take a pay cut? Don't get it.

im guessing you haven't seen how healthcare operates outside of med school yet. If you did you'd see that there is some less than ideal behavior out there. Most practioners are excellent. Some do things that are perhaps more than indicated. I think he feels there's some of that behavior in cardiology.

 

[MOHS_01]

Perhaps, but he comes across as a profession loathing contrarian who sees everyone as evil and everything as greed driven. Meanwhile, some of us are more honest and take no shame in earning (expecting) a good living based upon the provision of a necessary and needed service. Like many who lean to one side, they view every flaw as an institutional flaw; that if, only somehow, we could get the system "right" all evils would be rendered moot.... ignoring the fact that system (social) engineers have propagated the same line of **** for year with dismal results.

There has never been a system that is devoid of abuse potential. It is a much more just endeavor to attempt to outline what is right and just and then reward accordingly.

 

[RGMSU]

I am aware that there are professionals of all types who engage in various forms of fraudulent billing. However, I by no means believe that to be characteristic of a significant fraction of procedural physicians, cardiologists or otherwise. Cardiologists who abuse the system are in the minority, and the ones who don't abuse the system deserve every penny of what they're earning. I seriously doubt that he is the one loan sheep cardiologist crying in the wilderness amidst all the colleague wolves. Sounds a little deluded to me.

 

[radslooking]

I am aware that there are professionals of all types who engage in various forms of fraudulent billing. However, I by no means believe that to be characteristic of a significant fraction of procedural physicians, cardiologists or otherwise. Cardiologists who abuse the system are in the minority, and the ones who don't abuse the system deserve every penny of what they're earning. I seriously doubt that he is the one loan sheep cardiologist crying in the wilderness amidst all the colleague wolves. Sounds a little deluded to me.

probably some bit of truth to what you say too. "fraudulent" is a little strong. I would say doing more than indicated. its not like they are billing what they aren't doing. just that they're doing perhaps more than they need to sometimes. Anyway, some common sense parameters on reducing overtesting would be nice.