Basis for pay cuts of physicians?

[herewego]

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Forgive me, I'm not very political savy, nor do I have an extensive knowledge of the US healthcare system (so I'm reading up and asking questions).

So could someone explain the basis for this fear of physician salaries getting cut and what it has to do with medicare/and or Obama's plan?

I've been reading and listening to his plan and haven't heard much mention of it.

Any help would be appreciated. Thanks!

 

[TopSecret]

Forgive me, I'm not very political savy, nor do I have an extensive knowledge of the US healthcare system (so I'm reading up and asking questions).

So could someone explain the basis for this fear of physician salaries getting cut and what it has to do with medicare/and or Obama's plan?

I've been reading and listening to his plan and haven't heard much mention of it.

Any help would be appreciated. Thanks!

Physician reimbursements will probably be cut. This is bad news since about 40-50% of what a physician is reimbursed goes into paying the expenses for the medical practice. This includes employees' salaries and benefits. What remains is the physician's income, which by the way is not the same thing as a salary.

 

[RogueUnicorn]

Physician reimbursements will probably be cut. This is bad news since about 40-50% of what a physician is reimbursed goes into paying the expenses for the medical practice. This includes employees' salaries and benefits. What remains is the physician's income, which by the way is not the same thing as a salary.

can you point to a general part of the bill outlining this? just wondering if anyone knew this for sure or not

 

[TopSecret]

can you point to a general part of the bill outlining this? just wondering if anyone knew this for sure or not

It's almost guaranteed in whatever form the bill arrives. The Republicans were for a 10% pay cut last year and the Democrats resisted. Now it looks like both Democrats and Republicans want to start slashing away at payments.

http://www.ama-assn.org/amednews/2008/07/28/gvl10728.htm

 

[herewego]

so anyone have any solid confirmed info about it though? i dont' want to go into an interview talking about stuff that isn't quite in stone.

 

[TopSecret]

so anyone have any solid confirmed info about it though? i dont' want to go into an interview talking about stuff that isn't quite in stone.

Medicare will be insolvent in 8 years and this includes factoring in a 21% cut in physician reimbursement. The writing is on the wall and it's not an election year....

http://online.wsj.com/article/SB124212734686110365.html

 

[OHMAN0125]

so anyone have any solid confirmed info about it though? i dont' want to go into an interview talking about stuff that isn't quite in stone.

I believe this article explains pretty well the basis of the public option and trying to create competition.

I love the following quote:
"Right now, there's no incentive for insurers or big hospital groups to negotiate with each other, because they can pass higher payments on through premiums," said economist Linda Blumberg, co-author of the report. "A public plan would have the leverage to set lower payment rates and get providers to participate at those rates."

"The private plans would come back to the providers and say, 'If you don't negotiate with me, you're going to be left with only the public plan.'" Blumberg continued. "Suddenly, you have a very strong economic incentive for them to negotiate."

Yeah let's screw the providers from the private and public end!!

http://news.yahoo.com/s/ap/20090822/ap_on_bi_ge/us_health_care_insurance_competition

 

[TopSecret]

I believe this article explains pretty well the basis of the public option and trying to create competition.

I love the following quote:
"Right now, there's no incentive for insurers or big hospital groups to negotiate with each other, because they can pass higher payments on through premiums," said economist Linda Blumberg, co-author of the report. "A public plan would have the leverage to set lower payment rates and get providers to participate at those rates."

"The private plans would come back to the providers and say, 'If you don't negotiate with me, you're going to be left with only the public plan.'" Blumberg continued. "Suddenly, you have a very strong economic incentive for them to negotiate."

Yeah let's screw the providers from the private and public end!!

http://news.yahoo.com/s/ap/20090822/ap_on_bi_ge/us_health_care_insurance_competition

Cash will always be accepted, I think.

 

[TopSecret]

I'm guessing physician reimbursement will be slashed by Medicare in the range of 30-40% over the next decade (3-5% decrease each year). Surgeons and specialists will be hit pretty hard. Primary care physicians may face a 10-20% decline in their income as well.

In the end internists will probably make $100-$125k. Surgeons will probably make $150-180k in 10 years. Will the income be proper reimbursement for 60 hour weeks and 7+ years of education and training? It will be about $27 per hour on the low end for internists and about $40-50 per hour for surgeons.

After health care is reformed and the economy picks up steam, I am assuming that a lot of pre-meds will migrate to pre-law. Lawyers usually charge more than $150 per hour and they don't have to be on call. They also don't have to worry about facing simultaneous emergencies and being sued out of their homes.

 

[cardinal2010]

I'm guessing physician reimbursement will be slashed by Medicare in the range of 30-40% over the next decade (3-5% decrease each year). Surgeons and specialists will be hit pretty hard. Primary care physicians may face a 10-20% decline in their income as well.

In the end internists will probably make $100-$125k. Surgeons will probably make $150-180k in 10 years. Will the income be proper reimbursement for 60 hour weeks and 7+ years of education and training? It will be about $27 per hour on the low end for internists and about $40-50 per hour for surgeons.

After health care is reformed and the economy picks up steam, I am assuming that a lot of pre-meds will migrate to pre-law. Lawyers usually charge more than $150 per hour and they don't have to be on call. They also don't have to worry about facing simultaneous emergencies and being sued out of their homes.

I know you're an attending, and may be better informed than I am, but where are you getting these numbers from. The way I see it is that the market won't allow salaries to go so low, becuase it removes the incentives for more work. In the short run, what economists call the income effect will predominate, and doctors will work more do make up the loss in funds per procedure. In the long run, however, new doctors will come in with lower expectations, and work less hours bc they're getting less out of their work. Supply of health care will go down, waiting times will increase and explode, and a lot of doctors will switch to conceirge or cash based care (substitution effect), lowering supply further. Combined with a increase in insurance coverage, that = massive shortage and waiting times.

In the long run, physician salaries will have to stay high, mabye not quite as high as now, but pretty high to keep supply of physicians relatively close to demand. The only thing I'm worried about is that it'll take a period of physician under-supply to teach the politicians whats up.

 

[donkeykong1]

I'm guessing physician reimbursement will be slashed by Medicare in the range of 30-40% over the next decade (3-5% decrease each year). Surgeons and specialists will be hit pretty hard. Primary care physicians may face a 10-20% decline in their income as well.

In the end internists will probably make $100-$125k. Surgeons will probably make $150-180k in 10 years. Will the income be proper reimbursement for 60 hour weeks and 7+ years of education and training? It will be about $27 per hour on the low end for internists and about $40-50 per hour for surgeons.

After health care is reformed and the economy picks up steam, I am assuming that a lot of pre-meds will migrate to pre-law. Lawyers usually charge more than $150 per hour and they don't have to be on call. They also don't have to worry about facing simultaneous emergencies and being sued out of their homes.

are you estimating this from the top of your head? obviously this is all very alarming. i don't have the facts yet to argue your salary guesses. but if you can please list your sources.

 

[donkeykong1]

are you estimating this from the top of your head? obviously this is all very alarming. i don't have the facts yet to argue your salary guesses. but if you can please list your sources.

c2010 you beat me to it

 

[Winged Scapula]

The way I see it is that the market won't allow salaries to go so low, becuase it removes the incentives for more work. In the short run, what economists call the income effect will predominate, and doctors will work more do make up the loss in funds per procedure.

But what you're neglecting, for procedural fields, is:

- finite number of patients and operations (you can only take out 1 gallbladder per patient)

- and even if I wanted to, hospitals will not allow me to continue adding on cases late into the afternoon, evening and weekends, so there is a finite amount of work that can be done. I can't run a "late night OR" like some practices do with late night appointments.

If my block time is already filled with cases, I cannot add on more unless the hospitals start building more operating rooms and/or speeding up their ridiculously slow turn-over times.

Surgeons will become even more unwilling to do multiple procedures under the new reimbursement plans. As it stands you end up making 50% or less for multiple procedures for the 2nd and so on procedures as you do for the first. My patients may find that I am no longer willing to do bilateral procedures or use frozen section and will just have to come back for a second time. That is if I can even find an anesthesiologist to do my cases...at Medicare rates, they are basically doing pro bono work.

 

[TopSecret]

are you estimating this from the top of your head? obviously this is all very alarming. i don't have the facts yet to argue your salary guesses. but if you can please list your sources.

Physician income has been stagnant when adjusted for inflation.

Congress would've slashed Medicare physician reimbursement 10% last year had it not been for an election year. Now both Democrats and Republicans are in favor of slashing Medicare spending. This will likely be done incrementally over a decade or so to keep the government from going bankrupt.

http://www.hschange.org/CONTENT/851/
http://www.managedcaremag.com/archives/0607/0607.compmon.html

A lot of health care dollars are being spent on things other than physicians (drugs, medical supplies, laboratories, imaging centers, etc). But physicians are a very visible target and so they're abused more.