Another negative thread

[Bernoull]

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^^

To add to my above post, one solution to the cost inflation of medicare maybe to expand (in a different way) it some more. By this I mean include younger people. Right now, medicare has easily the worst risk pool possible - seniors > 65yrs with bazillion chronic conditions AND increasing longevity (thanks to contemporary medicine).

Only the gov't can insure such a population with such generous benefit bcos is economically not-viable. Now if we add younger people who are healthy, they pay in but use it much less, the risk pool markedly improves, medicare will be more fiscally viable/sustainable and its cost inflation will be ameliorated - more revenue, less expenditure per capita.

Politically, this may not be feasible due to the health insurers' lobby machine. Best solution I can think of right now.

 

[Charles_Carmichael]

I agree the cost of practicing medicine is significant. However, we need to consider the context, medicare's growth rate is simply UNSUSTAINABLE, it's outstrips the GDP and inflation by a big margin. The current cost inflation rate of the entitlements (medi care/caid + SS) will, in time, consume the entire federal budget if it continues unchecked. Simply unsustainable.

As a nation, we've overpromised benefits to seniors relative to our tax base. Everyone loves more benefits and tax cuts, therefore politicians keep expanding benefits and cutting taxes. This schizophrenia/paradox is unreal and fiscally unsustainable. At some point we'll have to cut a mix of reimbursements/benefits and/or raise taxes..

Now the challenge is that everyone involved hospitals/doctors/beneficiaries think they're "underpaid" and deserve more bcos everyone's simply looking out for their interest/paycheck. Realistically, we'll all have to give a little benefits/pay and/or pay more taxes, as unpopular as it as. There's no magic wand here, and everyone won't be happy but there's no choice. The cost inflation of medicare, medicaid, SS (but especially medicare) is UNSUSTAINABLE.

We need to have a more nuanced and broader discussion on this issue bcos it's tough, entrenched and there's few, if any, good/palatable options.

Physician reimbursement has been steadily decreasing for a long time. How much more do they need to give up? It's going to get to a point where smart people will realize that the opportunity cost of training outweighs any benefits. We might've even reached this point already.

If I remember correctly, physician income only makes up about 7% of the healthcare costs, so slashing them by even 50% is unlikely to make much of an impact. So, why keep attacking reimbursements? I feel like the main reason this keeps happening is that physicians are easy targets.

 

[Charles_Carmichael]

^^

To add to my above post, one solution to the cost inflation of medicare maybe to expand (in a different way) it some more. By this I mean include younger people. Right now, medicare has easily the worst risk pool possible - seniors > 65yrs with bazillion chronic conditions AND increasing longevity (thanks to contemporary medicine).

Only the gov't can insure such a population with such generous benefit bcos is economically not-viable. Now if we add younger people who are healthy, they pay in but use it much less, the risk pool markedly improves, medicare will be more fiscally viable/sustainable and its cost inflation will be ameliorated - more revenue, less expenditure per capita.

Politically, this may not be feasible due to the health insurers' lobby machine. Best solution I can think of right now.

I don't know if physicians would like this either. Medicare reimbursement is already pretty low and adding more people to Medicare might hurt physicians even more since a greater proportion of patients will result in them being reimbursed at the Medicare rates.

 

[Drrrrrr. Celty]

I don't know if physicians would like this either. Medicare reimbursement is already pretty low and adding more people to Medicare might hurt physicians even more since a greater proportion of patients will result in them being reimbursed at the Medicare rates.

I wish they'd just make up their mind already haha.

 

[Bernoull]

Physician reimbursement has been steadily decreasing for a long time. How much more do they need to give up? It's going to get to a point where smart people will realize that the opportunity cost of training outweighs any benefits. We might've even reached this point already.

If I remember correctly, physician income only makes up about 7% of the healthcare costs, so slashing them by even 50% is unlikely to make much of an impact. So, why keep attacking reimbursements? I feel like the main reason this keeps happening is that physicians are easy targets.

As a future physician and son of one, I share ur frustration about reimbursement. However, I simply want to broaden this discussion beyond "stop doctor cuts/pay us more end of story". What ideas to you guys have for how medicare can pay physicians better AND be fiscally sustainable.

We all agree on the problem but we need to offer solutions to the problem.

According to Kaiser Family Foundation, in 2009, the 4 greatest medicare expenditures were:
1. Part A (Hospitals, hospice etc) = 31%
2. Medicare Advantage = 23%
3. Physicians/Other Suppliers = 19%
4. Part D (scripts) = 10%

So physicians are the third most important slice, where should the savings come from?

 

[Bernoull]

I don't know if physicians would like this either. Medicare reimbursement is already pretty low and adding more people to Medicare might hurt physicians even more since a greater proportion of patients will result in them being reimbursed at the Medicare rates.

Good point, however reimbursements can be increased if the overall medicare cost growth can be reduced. In other words, if the cost inflation problem is resolved there's no longer pressure to cut reimbursements and reimbursement can be increased without jeopardizing the viability of the whole plan.

 

[Charles_Carmichael]

As a future physician and son of one, I share ur frustrations about reimbursements. However, I simply want to broaden this discussion beyond "stop doctor cuts/pay us more end of story". What ideas to you guys have for how medicare can pay physicians better AND be fiscally sustainable.

We all agree on the problem but we need to offer solutions to the problem.

According to Kaiser Family Foundation, in 2009, the 4 greatest medicare expenditures were:
1. Part A (Hospitals, hospice etc) = 31%
2. Medicare Advantage = 23%
3. Physicians/Other Suppliers = 19%
4. Part D (scripts) = 10%

Some physicians are the third most important slice. So where should the savings come from?

I'm a strong believer in tort reform. Limit how much the trial lawyers can be compensated (instead of the ridiculous percentages they get now) and there will be a reduction in frivolous suits. Having a jury who don't have any/much medical knowledge decide on malpractice lawsuits means that if the lawyers can act well, they can woo the jury onto their side. It would be better if there was a board of medically trained professionals looking at lawsuits before the reach any court to throw out ones where there's no physician error, etc.

These would help reduce the costs of defensive medicine. It's still going to take a while for the CYA mentality to go down though, even if tort reform is enacted. I think much more money could be saved by doing this instead of attacking physician reimbursements.

 

[Bernoull]

I'm a strong believer in tort reform. Limit how much the trial lawyers can be compensated (instead of the ridiculous percentages they get now) and there will be a reduction in frivolous suits. Having a jury who don't have any/much medical knowledge decide on malpractice lawsuits means that if the lawyers can act well, they can woo the jury onto their side. It would be better if there was a board of medically trained professionals looking at lawsuits before the reach any court to throw out ones where there's no physician error, etc.

These would help reduce the costs of defensive medicine. It's still going to take a while for the CYA mentality to go down though, even if tort reform is enacted. I think much more money could be saved by doing this instead of attacking physician reimbursements.

Fair enough, "tort reform". Do you have any figures of savings from tort reform, how much of a dent can it make?

I agree that physicians should not practice medicine worrying about lawsuits. They should have the peace of mind to do what's medically best for the patient.

The reimbursement issue has to do with cost control so how much would tort reform save?

PS: I really don't want this to turn political, let's objectively and rationally try to figure out how to address reimbursement within the context of unsustainable medicare cost inflation.. Good discussion thus far...

 

[Charles_Carmichael]

Fair enough, "tort reform". Do you have any figures of savings from tort reform, how much of a dent can it make?

I agree that physicians should not practice medicine worrying about lawsuits. They should have the peace of mind to do what's medically best for the patient.

The reimbursement issue has to do with cost control so how much would tort reform save?

I got this from a different thread (originally posted by ChiDO): http://thomsonreuters.com/content/press_room/tsh/waste_US_healthcare_system

According to that article:

"Unnecessary Care (40% of healthcare waste): Unwarranted treatment, such as the over-use of antibiotics and the use of diagnostic lab tests to protect against malpractice exposure, accounts for $250 billion to $325 billion in annual healthcare spending."

That's a lot of money we can save by reducing the CYA mentality (ie. enact tort reform).

 

[cliffhuxtableDO]

What are the chances that if doc's get shafted to an irreparable extent in terms of debt etc, that a lot of them move to cash/check only?

 

[TheFlashMD]

^^

To add to my above post, one solution to the cost inflation of medicare maybe to expand (in a different way) it some more. By this I mean include younger people. Right now, medicare has easily the worst risk pool possible - seniors > 65yrs with bazillion chronic conditions AND increasing longevity (thanks to contemporary medicine).

Only the gov't can insure such a population with such generous benefit bcos is economically not-viable. Now if we add younger people who are healthy, they pay in but use it much less, the risk pool markedly improves, medicare will be more fiscally viable/sustainable and its cost inflation will be ameliorated - more revenue, less expenditure per capita.

Politically, this may not be feasible due to the health insurers' lobby machine. Best solution I can think of right now.

You've never actually gotten a paycheck before have you?

~6% of your pay is used to pay for medicare. You pay half, your employer pays half. So where exactly is this "more revenue" coming from?

 

[Bernoull]

I got this from a different thread (originally posted by ChiDO): http://thomsonreuters.com/content/press_room/tsh/waste_US_healthcare_system

According to that article:

"Unnecessary Care (40% of healthcare waste): Unwarranted treatment, such as the over-use of antibiotics and the use of diagnostic lab tests to protect against malpractice exposure, accounts for $250 billion to $325 billion in annual healthcare spending."

That's a lot of money we can save by reducing the CYA mentality (ie. enact tort reform).

Interesting article and there's significant waste without a doubt. For argument sake, I'll assume the entire $700 billion is CYA waste (true figure is less than half this).

The problem is $7.0 E9 in the context of $2.3 E12 is not even a drop in the bucket. It comes out to 0.3% of total healthcare expenditure, it's probably less than the error in the $2.3 E12 measurement, in other words, it's statistically insignificant.

Clearly tort reform doesn't do it. Any other ideas of how we can improve reimbursement and fix medicare's runaway cost?

 

[TheFlashMD]

Fair enough, "tort reform". Do you have any figures of savings from tort reform, how much of a dent can it make?

I agree that physicians should not practice medicine worrying about lawsuits. They should have the peace of mind to do what's medically best for the patient.

The reimbursement issue has to do with cost control so how much would tort reform save?

PS: I really don't want this to turn political, let's objectively and rationally try to figure out how to address reimbursement within the context of unsustainable medicare cost inflation.. Good discussion thus far...

CBO study(Oct. 2009) put savings of tort reform at $50B over 10 years. It's not a panacea, but it's not a drop in the bucket either.

 

[Iso4ane]

Sounds like he should be seeing more than just 120 patients a week.

120 patients is seeing one patient every 20mins for every eight for 5 days.

(3 people/hr)*(8 hrs/day)*(5 days/week)= 120 patients per week.

And 20 mins per a patient is a pretty reasonable pace.

 

[Bernoull]

You've never actually gotten a paycheck before have you?

~13% of your pay is used to pay for medicare. You pay half, your employer pays half. So where exactly is this "more revenue" coming from?

No need to be a smart *ss, I'm just trying to put out ideas and broaden this discussion. FYI I've been working continuosly since 2003.

Yes u're right, all workers pay FICA tax (~6.5%). I overlooked this fact so lowering medicare eligibility age would actually exascerbate the problem. OK so we're in an even deeper hole...

 

[TheFlashMD]

No need to be a smart *ss, I'm just trying to put out ideas and broaden this discussion. FYI I've been working continuosly since 2003.

Yes u're right, all workers pay FICA tax (~6.5%). I overlooked this fact so lowering medicare eligibility age would actually exascerbate the problem. OK so we're in an even deeper hole...

Didn't mean to offend.

I think what would have to happen (although, it never will in this political climate) is raise the medicare/SS eligibility age. People are living longer, and using more of these benefits, that's why it's not sustainable. If anyone actually proposed this though they'd be crucified by the media as hateful to seniors.

 

[Bernoull]

Another idea for closing the growing deficit in both SS and medicare to to eliminate the income ceiling from FICA. It's currently at ~ $107K.
So if one make $50K, the entire income is subject to 6.5% tax, whereas if one makes $500K only the first $106K is subject to FICA so that individual's effective FICA is much less (basically it's a regressive tax)...

What do u guys think?

 

[Bernoull]

Didn't mean to offend.

I think what would have to happen (although, it never will in this political climate) is raise the medicare/SS eligibility age. People are living longer, and using more of these benefits, that's why it's not sustainable. If anyone actually proposed this though they'd be crucified by the media as hateful to seniors.

Beef squashed 😀😀, I really want this discussion to be civil, respectful and less dogmatic.. Let's try to resolve the medicare fiscal crisis, improve reimbursement and send this SDN thread to Congress for passage...🙄🙄

Raising the retirement age is one option, but given that seniors are the most electorally active demographic, they'll certainly come out with pitchforks..

The demographic issue is important bcos in 1965, when medicare passed, avg life expectancy was 70.2 (so 5yr benefit period) AND the ratio of workers/retirees was about 16:1. Today life expectancy is at 78 (13yrs of benefits) and worker:retiree is about 3.3:1. Furthermore as a nation, we are aging for these metrics will only get worse.

The problem is definitely structural/demographic...

 

[mfrizzo3]

^^^
On top of the lowering reimbursements you propose we tax physicians even more?

 

[Bernoull]

^^^
On top of the lowering reimbursements you propose we tax physicians even more?

 

[mfrizzo3]

Another idea for closing the growing deficit in both SS and medicare to to eliminate the income ceiling from FICA. It's currently at ~ $107K.
So if one make $50K, the entire income is subject to 6.5% tax, whereas if one makes $500K only the first $106K is subject to FICA so that individual's effective FICA is much less (basically it's a regressive tax)...

What do u guys think?

Am I missing something here?

Beef squashed 😀😀, I really want this discussion to be civil, respectful and less dogmatic.. Let's try to resolve the medicare fiscal crisis, improve reimbursement and send this SDN thread to Congress for passage...🙄🙄

QUOTE]

JACK*****

 

[TheFlashMD]

Beef squashed 😀😀, I really want this discussion to be civil, respectful and less dogmatic.. Let's try to resolve the medicare fiscal crisis, improve reimbursement and send this SDN thread to Congress for passage...🙄🙄

Raising the retirement age is one option, but given that seniors are the most electorally active demographic, they'll certainly come out with pitchforks..

The demographic issue is important bcos in 1965, when medicare passed, avg life expectancy was 70.2 (so 5yr benefit period) AND the ratio of workers/retirees was about 16:1. Today life expectancy is at 78 (13yrs of benefits) and worker:retiree is about 3.3:1. Furthermore as a nation, we are aging for these metrics will only get worse.

The problem is definitely structural/demographic...

The problem is most definitely demographics. That's why we're having problems with both SS and medicare. The problem in DC is that politicians don't want to do whats right. They want to do whatever keeps them in office.

Thus, we need congressional reform first and foremost. Term limits and severely decreased exposure to corporate lobbyists would go along way. I'm not a big fan of these career politicians who'd kill their own mother if it got them voted into office. With term limits, you'd have more people inclined to do the right thing than the popular thing.

As far as Medicare, raising the cap to a larger number might help some, but it's probably not a sustainable fix. It's like giving a teenager 20 more bucks in allowance, its not going to be spent any wiser. And she'll keep asking for more.

 

[TheFlashMD]

Am I missing something here?

Beef squashed 😀😀, I really want this discussion to be civil, respectful and less dogmatic.. Let's try to resolve the medicare fiscal crisis, improve reimbursement and send this SDN thread to Congress for passage...🙄🙄

QUOTE]

JACK*****

He's got a point, Bernoull.

Mfrizzo: I think Bernoull's frustration is that in order to come up with a viable solution, one has to look past "what is this going to do for me, right now" attitude.

 

[mfrizzo3]

Am I missing something here?



He's got a point, Bernoull.

Mfrizzo: I think Bernoull's frustration is that in order to come up with a viable solution, one has to look past "what is this going to do for me, right now" attitude.

Oh.....I didn't read the entire thread. Then it is a viable solution.

 

[Bernoull]

^^^
On top of the lowering reimbursements you propose we tax physicians even more?

Am I missing something here?

Beef squashed 😀😀, I really want this discussion to be civil, respectful and less dogmatic.. Let's try to resolve the medicare fiscal crisis, improve reimbursement and send this SDN thread to Congress for passage...🙄🙄

QUOTE]

JACK*****

The premise of my several posts is how can we address the reimbursement problem in the context of medicare's fiscal crisis. I'm going for a wholistic rather than reductionist view. I'm throwing out different ideas of how medicare's deficit can be reduced, which I believe is a precondition for improving physician reimbursement. Ideas to close the deficit include eliminating the income ceiling, higher retirement age, reduced benefits, reduced payments, higher taxes etc. It's easy to just say stop the cuts, pay us more but how does that address the un-sustainability of medicare's cost inflation???

The problem is no-one wants to give up anything and everyone wants more.

What do you propose?

PS: I thought the facepalm was just a universal expression of frustration..lol... which shouldn't contradict - "I really want this discussion to be civil, respectful and less dogmatic"

 

[randombetch]

So...

He makes $100,000 in profit, of which 33% comes from Medicare reimbursements.

If Medicare is cut by 21%, then he'll miss out $7000 of his salary.

I know that other insurance providers for his patients are also pegged to Medicare rates, but come on, $93,000 is hardly considered "minimum wage."

Am I missing something? 😕

Your calculations are simply wrong.

He makes $800k in revenue, $100k of that goes in his pocket.

If 21% of 33% of 800k is lost, then his revenue will go from 800k to 745k. Assuming all of his other costs are the same, he'll income will go from $100k to $45k.

 

[TheFlashMD]

Your calculations are simply wrong.

He makes $800k in revenue, $100k of that goes in his pocket.

If 21% of 33% of 800k is lost, then his revenue will go from 800k to 745k. Assuming all of his other costs are the same, he'll income will go from $100k to $45k.

Not even taking into account the way pvt insurance's reimbursement rates are tied to medicare.

 

[mfrizzo3]

1. The only logical answer to a stupid question or statement.
2. To hit one's own forehead with your hand/palm, and drag it down one's face. Most often done in frustration or agitation.
   Sometimes forcefully done to others for humour purposes.
4. When someone is so stupid that it makes you speechless, and the only thing you can do is shake your head or facepalm
5. The new "epic fail"
6. Because words are not suitable to describe how dumb that was.
7. The action of the palm of your hand hitting your face in an "are you kidding me" sort of manor. Normally done when you ask your friend a question and they reply with something stupid or completely not of matter.

Now we're both informed. Also, I am switching back and forth between SDN and the doctor hating dribble on CNN, and I misinterpreted your post within the context of the entire thread.

 

[Bernoull]

1. The only logical answer to a stupid question or statement.
2. To hit one's own forehead with your hand/palm, and drag it down one's face. Most often done in frustration or agitation.
   Sometimes forcefully done to others for humour purposes.
3. When someone is so stupid that it makes you speechless, and the only thing you can do is shake your head or facepalm
4. The new "epic fail"
5. Because words are not suitable to describe how dumb that was.
6. The action of the palm of your hand hitting your face in an "are you kidding me" sort of manor. Normally done when you ask your friend a question and they reply with something stupid or completely not of matter.

Now we're both informed. Also, I am switching back and forth between SDN and the doctor hating dribble on CNN, and I misinterpreted your post within the context of the entire thread.

No offense intended, it was just frustration on my part.. my bad.

 

[45408]

As a future physician and son of one, I share ur frustration about reimbursement. However, I simply want to broaden this discussion beyond "stop doctor cuts/pay us more end of story". What ideas to you guys have for how medicare can pay physicians better AND be fiscally sustainable.

We all agree on the problem but we need to offer solutions to the problem.

According to Kaiser Family Foundation, in 2009, the 4 greatest medicare expenditures were:
1. Part A (Hospitals, hospice etc) = 31%
2. Medicare Advantage = 23%
3. Physicians/Other Suppliers = 19%
4. Part D (scripts) = 10%

So physicians are the third most important slice, where should the savings come from?

1. Cut back on FUTILE care. Some people might call them death panels, I'd call it "Stop the torture" panels. Great blog post by Doctor Grumpy a few days ago on the topic - http://drgrumpyinthehouse.blogspot.com/2010/03/checkout-time.html

2. Not sure

3. No change

4. Slash it. We have many, many medications that are CHEAP and EFFECTIVE. Right now, too many physicians prescribe expensive drugs that have a marginal benefit over a $4 wal-mart drug, and if the patients were a little more closely tied to the drug cost, they would ask "Is there a cheaper alternative?" The answer is often yes. Switch from Lipitor to simvastatin.


Lastly, raise the age of eligibility. When Social Security started, the average life expectancy was 68, and you qualified for SS at 65. When Medicare started, the life expectancy was a little higher, but not a whole lot. We're paying into the system for the same number of years, but now we want to cash in on benefits for a longer duration. Doesn't work.

 

[Slack3r]

I really think that if MD/DO's start making less nurses and PA's will make less too. In the end I think that this is a tribulation period. However freshman and sophomores are lucky we still have time to avoid a drowning ship if it takes a turn for the worse. However the guys in medical school or applying for medical school are screwed because they are left just hoping that everything will turn for the best.

Or they said "f*** it" and decided to try dentistry instead.

 

[rama kandra]

if I had a chance to re-do all of this, I would have gone to dental school. All private practices, my friends who are my age are already getting job offers in swank dental clinic groups. I'll be in med school till im 27 and likely out of residency after 30. Welcome to the new normal.

 

[Bernoull]

1. Cut back on FUTILE care. Some people might call them death panels, I'd call it "Stop the torture" panels. Great blog post by Doctor Grumpy a few days ago on the topic - http://drgrumpyinthehouse.blogspot.com/2010/03/checkout-time.html

First off, great post!

I totally agree with end of life care, about 30% of medicare dollars are spent on the last year of life. As a society we need to accept the inevitability of death, at some point. Does a 90yr old need endless, intensive acute care, especially if it isn't their expressed wish? Can this money be better spent on say keeping people healthy (incentivizing healthier lifestyles, helping the pts better mange chronic conditions) thus keeping them out of the hospital in the first place.

Addressing the vast regional disparities in utilization that doesn't improve pt outcomes is another avenue for savings.. (see dartmouth study)

http://neurologicalcorrelates.com/w...-end-of-life-care-what-should-we-do-about-it/
http://www.dartmouthatlas.org/atlases/w6513.pdf

2. Not sure

Part A I'll slash too, it essentially pays private insurers to cover medicare beneficiaries. One insurer pays another insurer to cover the former's clients. Makes no sense to me, cut it out, give the seniors the extra perks they currently enjoy from private insurers, pay docs more and still save $ on redundant overhead.

3. No change

From all these savings, I think docs can be paid more competitively, while preserving medicare into the future.

4. Slash it. We have many, many medications that are CHEAP and EFFECTIVE. Right now, too many physicians prescribe expensive drugs that have a marginal benefit over a $4 wal-mart drug, and if the patients were a little more closely tied to the drug cost, they would ask "Is there a cheaper alternative?" The answer is often yes. Switch from Lipitor to simvastatin.

Also, medicare should be empowered to negotiate prices, for god's sake it's a humongous program with an economy of scale that private companies will kill for!! By all means negotiate for lower prices. If medicare can "negotiate"/cut physician reimbursements, then the same standard should apply to Pharma. Huge savings here too.

Lastly, raise the age of eligibility. When Social Security started, the average life expectancy was 68, and you qualified for SS at 65. When Medicare started, the life expectancy was a little higher, but not a whole lot. We're paying into the system for the same number of years, but now we want to cash in on benefits for a longer duration. Doesn't work.

Increasing eligibility age is definitely one route; however, absent other guarantee-issue affordable plan, I'm concerned about seniors who may fall in the cracks, i.e. laid off/disabled but are below the new/increased eligibility age. These seniors will definitely be un-insurable in the private market (they've got A-Z health issues).

I'll remove the income limit on FICA. With all these saving and new revenue, docs can be reimbursed higher - competitive with private ins. rates and they do financially better, more FICA notwithstanding.

 

[rama kandra]

spoken like a true capitalist bernoull, i like where your head's at.

 

[Morsetlis]

A note about antibiotic wastes:

It is a waste to give antibiotics for a random outpatient cold, yes, but nosocomial infections in the hospital tend to be pretty serious (->bacteremia, etc) that pretty much every old person with multiple comorbidities are on a steady IV drip of antibiotics. Compared to the additional cost incurred for ANOTHER day at the hospital, the cost of antibiotics overuse in hospital is justified.

 

[randombetch]

Not even taking into account the way pvt insurance's reimbursement rates are tied to medicare.

Yup, I was going to mention that but I didn't.

 

[Morsetlis]

Have fun trying to get into a Canadian med school ;p

 

[Bernoull]

Everyone knows that in order to protect their salaries, physicians will simply stop accepting medicare patients.

Not easy to just stop taking medicare payments, it's 22% of total health expenditures. Most physicians can live with current medicare reimbursements, grudgingly or otherwise, thus they accept it. If u disproportionately see elderly pts, you really don't have a choice.

This really disturbs me.

If you look at the picture of the old man sitting in his doctor's office, he looks like he could be anyone's Dad. I would have a moral problem not accepting this category of patients. On the other hand, I would not want my altruism to end up screwing me over: isn't it so that medicare/medicaid patients are a huge liability?

Huge liability, in what sense? This would be news to me...

For instance, they have medicaid/medicare because they have no money. The medicare patients are seniors with more comorbidities than younger patients, which could mean on average that they are more difficult to manage. In a nutshell: patients who have less money, more health problems, who live in a country that has no effective tort reform and think doctors make too much money (of course physicians are rich relative to people on welfare, but that doesn't mean they are over-compensated), are huge liabilities.

Medicare and medicaid are different, the former come from all SES whereas the latter are usually poorer/diabled. Being on medicare has to do with age and not income. What liability are you referring to?

Who in their right mind wants to take that on?!

And then, I imagine the public outrage -- where people point their finger at the doctors; who are neglecting their ethics and morals in favour of securing their "already too high" income, and our parents are paying for it with sub-standard care, and *gulp*, their lives.

The media is not above such melodrama.

I am hopeful that a "medicare backlash" will stamp out ignorance about what physicians actually earn after their investments have been deducted.

But I am not so hopeful that physicians will compensated appropriately in the near future.

It's wierd how physicians don't have a stronger lobby. There docs in every nook n cranny in the US, the AMA represents about 20% of docs. I think all these specialty assoc. should coalesce, on some issues, and represent most practicing docs..

Reason? There's simply not enough physicians to look out for their interests. I'm not a lawyer but anti-trust laws may prevent physicians from boycotting medicare entirely.

<...moving back to Canada...>

antitrust has more to do with monopoly or "cornering the market, physicians are free to decide what insurers they accept. There's cash only practices, some reject medicaid insurance, some don't accept certain private insurers etc etc...

 

[Bernoull]

Everyone knows that in order to protect their salaries, physicians will simply stop accepting medicare patients.

Not easy to just stop taking medicare payments, it's 22% of total health expenditures. Most physicians can live with current medicare reimbursements, grudgingly or otherwise, thus they accept it. Also if u disproportionately see elderly pts, you really don't have a choice.

This really disturbs me.

If you look at the picture of the old man sitting in his doctor's office, he looks like he could be anyone's Dad. I would have a moral problem not accepting this category of patients. On the other hand, I would not want my altruism to end up screwing me over: isn't it so that medicare/medicaid patients are a huge liability?

Huge liability, in what sense? This would be news to me...

For instance, they have medicaid/medicare because they have no money. The medicare patients are seniors with more comorbidities than younger patients, which could mean on average that they are more difficult to manage. In a nutshell: patients who have less money, more health problems, who live in a country that has no effective tort reform and think doctors make too much money (of course physicians are rich relative to people on welfare, but that doesn't mean they are over-compensated), are huge liabilities.

Medicare and medicaid are different, the former covers pts from all SES backgrounds whereas the latter covers the poor/diabled. Being on medicare has to do with age and not income. What liability are you referring to?

Who in their right mind wants to take that on?!

And then, I imagine the public outrage -- where people point their finger at the doctors; who are neglecting their ethics and morals in favour of securing their "already too high" income, and our parents are paying for it with sub-standard care, and *gulp*, their lives.

The media is not above such melodrama.

I am hopeful that a "medicare backlash" will stamp out ignorance about what physicians actually earn after their investments have been deducted.

But I am not so hopeful that physicians will compensated appropriately in the near future.

It's wierd how physicians don't have a stronger lobby. There docs in every nook n cranny in the US, the AMA represents about 20% of docs. I think all these specialty assoc. should coalesce, on some issues, and represent most practicing docs..

Reason? There's simply not enough physicians to look out for their interests. I'm not a lawyer but anti-trust laws may prevent physicians from boycotting medicare entirely.

<...moving back to Canada...>

antitrust has more to do with monopoly or "cornering the market, physicians are free to decide what insurers they accept. There's cash only practices, some reject medicaid insurance, some don't accept certain private insurers etc etc...

 

[Charles_Carmichael]

Huge liability, in what sense? This would be news to me...

I'm not sure where I heard this from, so I'm not entirely sure of its accuracy, but apparently, Medicare patients tend to be some of the sicker, complex, multiply comorbid patients. Maybe the poster meant huge liability in the sense that more complex = higher risk of error/bad outcome = higher risk of lawsuit?

 

[Morsetlis]

Medicare patients are poor/old. That naturally leads to higher health risks.

Correct me if I'm wrong.

 

[Drrrrrr. Celty]

if I had a chance to re-do all of this, I would have gone to dental school. All private practices, my friends who are my age are already getting job offers in swank dental clinic groups. I'll be in med school till im 27 and likely out of residency after 30. Welcome to the new normal.

I'm reluctant to go into dent... Unless I was guaranteed a spot in orthodontics. Not to mention dental practices are hard to start and dental school cost even more then medical school....
But yah I'm slightly not happy with the whole lets work 80 hours a week and survive residency.

 

[Mandiblespeaks]

*&ck Medicare then,

VIP Medicine. For only 1,500 a year patients get MUCH better quality care from doctors by paying for it. Why should we?

http://www.mdvip.com/newcorpwebsite/aboutus/track_onthemoney_cnbc_july2407_index.aspx

http://www.mdvip.com/newcorpwebsite/index.aspx

Also known as Boutique Medicine. Its a changing healthcare system out there, but there are always options to get paid. After all that work if they want to pay me only 44k a year, then they should pick up the tab on my loans. And I am not talking about HPSP either.

 

[FlowRate]

I agree the cost of practicing medicine is significant. However, we need to consider the context, medicare's growth rate is simply UNSUSTAINABLE, it's outstrips the GDP and inflation by a big margin. The current cost inflation rate of the entitlements (medi care/caid + SS) will, in time, consume the entire federal budget if it continues unchecked. Simply unsustainable.

As a nation, we've overpromised benefits to seniors relative to our tax base. Everyone loves more benefits and tax cuts, therefore politicians keep expanding benefits and cutting taxes. This schizophrenia/paradox is unreal and fiscally unsustainable. At some point we'll have to cut a mix of reimbursements/benefits and/or raise taxes..

Now the challenge is that everyone involved hospitals/doctors/beneficiaries think they're "underpaid" and deserve more bcos everyone's simply looking out for their interest/paycheck. Realistically, we'll all have to give a little benefits/pay and/or pay more taxes, as unpopular as it as. There's no magic wand here, and everyone won't be happy but there's no choice. The cost inflation of medicare, medicaid, SS (but especially medicare) is UNSUSTAINABLE.

We need to have a more nuanced and broader discussion on this issue bcos it's tough, entrenched and there's few, if any, good/palatable options.

Totally agree with this. I believe the problem stems from years of people not saving for their own retirement. If you buy everything on credit while you're working and grow up feeling entitled to the credit of others when you're old, there's no reason to save. The US culture needs to see a shift in attitude sometime soon, lest we screw ourselves up way hard.

 

[Bernoull]

I'm not sure where I heard this from, so I'm not entirely sure of its accuracy, but apparently, Medicare patients tend to be some of the sicker, complex, multiply comorbid patients. Maybe the poster meant huge liability in the sense that more complex = higher risk of error/bad outcome = higher risk of lawsuit?

Medicare patients are poor/old. That naturally leads to higher health risks.

Correct me if I'm wrong.

I completely agree with you guys that medicare pts are older and tend to have more medical conditions. Clearly older pts will be sicker the younger ones.

However, if you compare medicare pts to privately insured ones AND control for age, gender, race, SES etc, I don't think medicare patients will be any sicker..

At any rate, as doctors, we should not shy away from complex pts, everyone should be cared for. I can understand docs' anxiety about lawsuits from complex cases and I support reform that gives docs the peace to do what's medically right in such cases. However, I don't support barring pts who have been harmed from seeking legal redress. A balance has to be struck where both patients' & doctors' right are protected.

Finally I just find it a little awkward that as a society, we have enough confidence in our legal system to adjudicate guilt/innocence in death penalty cases, but somehow the same legal system cannot discern frivolous suits from those with merit..🙄🙄🙄