CMS proposed physician payment rule 2023

[DrMDAware]

but, you have to RF cluneal nerves and PRP everything with a pulse

We’re putting PRP in the radial artery now?

Nice.

Oh wait you said “with” a pulse not “in” it.

My bad.

---

Members don't see this ad.

 

[Pain Applicant1]

so HOPD doctors are not allowed to make money, only PP docs.

thanks for the clarification.

☝️ is correct. We finally found something that you and I agree on.

Good job ducttape! 👍

 

[Doctodd]

☝️ is correct. We finally found something that you and I agree on.

Good job ducttape! 👍

only if he is a true idealogue......did he forget he works for the greater good? not for money?

 

[geauxg8rs]

We’re putting PRP in the radial artery now?

Nice.

Oh wait you said “with” a pulse not “in” it.

My bad.

Prp in radial artery possibly for long Covid symptoms? Or possibly if you haven’t regained smell or taste? Could work

 

[SSdoc33]

Prp in radial artery possibly for long Covid symptoms? Or possibly if you haven’t regained smell or taste? Could work

makes as much sense as ivermectin and plaquenil

 

[Ferrismonk]

We’re putting PRP in the radial artery now?

Nice.

Oh wait you said “with” a pulse not “in” it.

My bad.

You laugh, but I've seen patients who have had IV PRP from other "providers".

Yes, they take blood (with anticoagulation), spin it down, then inject the PRP back IV. Total scam.

 

[bedrock]

You laugh, but I've seen patients who have had IV PRP from other "providers".

Yes, they take blood (with anticoagulation), spin it down, then inject the PRP back IV. Total scam.

Total scam. How do they explain it to patients I wonder ???

 

[Doctodd]

You laugh, but I've seen patients who have had IV PRP from other "providers".

Yes, they take blood (with anticoagulation), spin it down, then inject the PRP back IV. Total scam.

yup.....ive answered multiple questions on facebook from patients asking about this

 

[MitchLevi]

IV stem cells very common too.

"They just...Know where to go."

 

[Iamnew2]

My current vibe...

View attachment 357137

Hahaha! You win!

 

[DrMDAware]

Prp in radial artery possibly for long Covid symptoms? Or possibly if you haven’t regained smell or taste? Could work

You are a true KOL

 

[geauxg8rs]

You are a true KOL

Not until i get my pointy shoes

 

[sloh]

Total scam. How do they explain it to patients I wonder ???

You don’t need to explain anything. When patients hear “stem cells” or “PRP” their eyes light up.

 

[drusso]

so HOPD doctors are not allowed to make money, only PP docs.

thanks for the clarification.



fyi if it makes you feel better, i can guarantee you that my salary is significantly under 50% MGMA.

Look: They let it slip out. This prime example is "Saying the quiet part out loud..." Over the years, I've taken a lot of flack for pointing to the naked Emporer. Admin will never see the HOPD-MD as anything more than an RVU-monkey. None of this is by accident. Instead, it's by design. It was a feature of Obama's ACA, and D's tried to pretend it wasn't @SSdoc33

Major Physician Reimbursement Gap for Independent Versus Hospital Docs

A new study suggests that higher Medicare physician reimbursement for hospital-employed versus independent doctors is pushing more hospital-physician integration.

revcycleintelligence.com

“These payment rules create an arbitrage opportunity. Hospital‐based billing increases total payments, and the additional payments can be allocated, explicitly or implicitly, between hospitals and physicians. As a result, there is an incentive for hospitals to buy, and physicians to sell physician practices,” the healthcare economist explained.”

 

[powermd]

Look: They let it slip out. This prime example is "Saying the quiet part out loud..." Over the years, I've taken a lot of flack for pointing to the naked Emporer. Admin will never see the HOPD-MD as anything more than an RVU-monkey. None of this is by accident. Instead, it's by design. It was a feature of Obama's ACA, and D's tried to pretend it wasn't @SSdoc33

Major Physician Reimbursement Gap for Independent Versus Hospital Docs

A new study suggests that higher Medicare physician reimbursement for hospital-employed versus independent doctors is pushing more hospital-physician integration.

revcycleintelligence.com

“These payment rules create an arbitrage opportunity. Hospital‐based billing increases total payments, and the additional payments can be allocated, explicitly or implicitly, between hospitals and physicians. As a result, there is an incentive for hospitals to buy, and physicians to sell physician practices,” the healthcare economist explained.”

I would share your enthusiasm if the person letting this slip was an administrator at CMS, not some Harvard economist.

"CMS has continued to push for greater site-neutral payment rates to bend the healthcare cost curve."

Well, do it already.

The quiet part I'd like to hear from CMS is "we intentionally discourage physicians from owning their own labor by deliberately paying their employers more for the same services."

 

[Ducttape]

from your article:

CMS has continued to push for greater site-neutral payment rates to bend the healthcare cost curve. But the fee-for-service (FFS) system may be to blame, Chernew stated.

“Many of the payment problems reflect the FFS system, with the need for hundreds (if not thousands) of prices. Yet, other payment models are not immune to these problems and in fact many are built on a FFS chassis. However, the broader incentives in episode or population‐based payment can ameliorate the problems because high spending associated with billing under the OPPS will reduce shared saving (or possibly generate shared losses),” Chernew explained.

i would agree with this.

more eloquently:

 

[pmrmd]

Of course you would.

Obviously it’s fee for service when it’s at the most expensive site of service.

Fee for service is fine considering all the inherent limits placed on services.

This isn’t even up for debate anymore. Big Medicine is expensive, slow, and without improvement of outcomes.

 

[Doctodd]

from your article:



i would agree with this.

more eloquently:

funny how he left out so many important details about healthcare in Europe....is that you Bernie Sanders? Now do Cuba.

 

[Ducttape]

why would you automatically assume if the US were to do a non-fee for service healthcare system it would be comparable to that of a non First World countries? if the US established a managed care system, shouldnt it be more like a European model?


why compare it to Cubas? unless you have such a low opinion of the current US healthcare system that you think that a new US system would be only as good as Cuba....

 

[pmrmd]

I would like to see the US healthcare system provide equal payment regardless of SOS before any more changes are made.

Americans don't behave like Europeans. Stupid idea to take on the European model.

 

[Pain Applicant1]

from your article:



i would agree with this.

more eloquently:

That guy's funny, creative, and intelligent.

I'm curious how our life expectancy rating would change if it was broken down into different demographics. I wonder if the demographics, whatever they may be (poverty?), that skew our life expectancy rating higher, are the same demographics that receive Medicaid or medicare/medicaid. If that's the case then his argument wouldn't hold much water since all of their healthcare is free.

Hopkins is located in an impoverished area of Baltimore where I lived and trained. Most of the local folks there have free access to arguably the best healthcare in the world. Life expectancy is not very high there for various reasons and is way under the US average.

 

[drrosenrosen]

That guy's funny, creative, and intelligent.

I'm curious how our life expectancy rating would change if it was broken down into different demographics. I wonder if the demographics, whatever they may be (poverty?), that skew our life expectancy rating higher, are the same demographics that receive Medicaid or medicare/medicaid. If that's the case then his argument wouldn't hold much water since all of their healthcare is free.

Hopkins is located in an impoverished area of Baltimore where I lived and trained. Most of the local folks there have free access to arguably the best healthcare in the world. Life expectancy is not very high there for various reasons and is way under the US average.

I agree, this guy is very funny. I love his videos.

I know we have a higher infant mortality than many (most?) OECD countries. That will definitely drag the average down. We also have a higher incidence of obesity than most other countries, though UK is trying to catch us. Those two factors alone probably account for having such a low life expectancy rating.

 

[Ducttape]

there are clearly documented racial differences in life expectancy.

black life expectancy is much lower by 3-4 years.

however... hispanics have the highest life expectancy of the 3 main groups (black, white, hispanic).

and hispanics and blacks are equally likely to be enrolled in medicaid - 30% for hispanics, 34% for blacks, vs 15% for whites.

so the discrepancy is hard to relate strictly to medicaid enrollment.



i would ponder the alternative - if medicaid did not exist, i highly doubt we would have improvement in the life expectancy for these minority groups.

 

[Pain Applicant1]

there are clearly documented racial differences in life expectancy.

black life expectancy is much lower by 3-4 years.

however... hispanics have the highest life expectancy of the 3 main groups (black, white, hispanic).

and hispanics and blacks are equally likely to be enrolled in medicaid - 30% for hispanics, 34% for blacks, vs 15% for whites.

so the discrepancy is hard to relate strictly to medicaid enrollment.



i would ponder the alternative - if medicaid did not exist, i highly doubt we would have improvement in the life expectancy for these minority groups.

That's my point. It's not necessarily about access to healthcare and the US vs European model of healthcare delivery. That's what that guy is implying as are you by linking the video.

It comes down to more variables than that. Personal responsibility, genetics, etc.

Plus, it's not like they have free healthcare. They just pay for it beforehand as it comes out of their taxes.

 

[nvrsumr]

"The bipartisan Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (H.R. 3259/S. 586) has garnered an impressive 47 co-sponsors in the Senate and over 100 co-sponsors in the House. If enacted, the legislation will ensure that both opioid-based and non-opioid-based treatments are reimbursed by Medicare at the same rates in the ambulatory surgical centers and hospital outpatient department settings."

Saw this today. ASCs would get a major windfall if passed. Of course the office based docs dont have a big $ lobby so get left out.

 

[vit8bsm]

"The bipartisan Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (H.R. 3259/S. 586) has garnered an impressive 47 co-sponsors in the Senate and over 100 co-sponsors in the House. If enacted, the legislation will ensure that both opioid-based and non-opioid-based treatments are reimbursed by Medicare at the same rates in the ambulatory surgical centers and hospital outpatient department settings."

Saw this today. ASCs would get a major windfall if passed. Of course the office based docs dont have a big $ lobby so get left out.

does this mean asc prices go up to hopd or hopd comes down to asc? excuse my lack of noticing if it's obvious lol, my guess is it's the latter.

 

[Ferrismonk]

My 2 cents:

Regarding fee for service, I used to think getting rid of this and paying for "quality" was a good idea. Then I was tangentially associated with an ACO structured on this model. People did not get MRIs, they got CT scans and MSK ultrasounds. They did not get name brand or new drugs. I got angry frowns whenever I did an injection or chose to see opioid patients every month instead of every 3. In my experience, paying for "quality" doesn't work either.

 

[Ducttape]

"The bipartisan Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (H.R. 3259/S. 586) has garnered an impressive 47 co-sponsors in the Senate and over 100 co-sponsors in the House. If enacted, the legislation will ensure that both opioid-based and non-opioid-based treatments are reimbursed by Medicare at the same rates in the ambulatory surgical centers and hospital outpatient department settings."

Saw this today. ASCs would get a major windfall if passed. Of course the office based docs dont have a big $ lobby so get left out.

wont pass. only 47 cosponsors.

That's my point. It's not necessarily about access to healthcare and the US vs European model of healthcare delivery. That's what that guy is implying as are you by linking the video.

It comes down to more variables than that. Personal responsibility, genetics, etc.

Plus, it's not like they have free healthcare. They just pay for it beforehand as it comes out of their taxes.

except....

life expectancy of white americans is 78.7.

life expectancy of Europe - making mostly white - include Spain 82; UK 80.9, Norway 83; France 82.

so there seems to be something beyond just race.

 

[pmrmd]

How many white men have to live to 100 to offset the white kid that ODs on fentanyl at 20 to keep that average at 80?

 

[Pain Applicant1]

wont pass. only 47 cosponsors.


except....

life expectancy of white americans is 78.7.

life expectancy of Europe - making mostly white - include Spain 82; UK 80.9, Norway 83; France 82.

so there seems to be something beyond just race.

Right, that would be the personal responsibility part. Tob, ETOH, drugs all the fun stuff that ends up being not so fun in the end...and most importantly the biggest killer of all --> processed food ... and also lack of exercise.

This is so boring and annoying to say but in all honestly, how much could we reduce healthcare costs/morbidity/mortality if people ate healthily (and organically??), exercised, spent a decent amount of time outside in nature and the sun, stayed away from the bad stuff above, had positive relationships with other humans/pets, had a strong sense of community, etc. I bet by at least 90%. Doesn't matter of course because it'll never happen although I personally strive for those things. It seems in general society moves in the opposite direction.

 

[drusso]

"The bipartisan Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (H.R. 3259/S. 586) has garnered an impressive 47 co-sponsors in the Senate and over 100 co-sponsors in the House. If enacted, the legislation will ensure that both opioid-based and non-opioid-based treatments are reimbursed by Medicare at the same rates in the ambulatory surgical centers and hospital outpatient department settings."

Saw this today. ASCs would get a major windfall if passed. Of course the office based docs dont have a big $ lobby so get left out.

I've lobbied for the inclusion of office-based physicians and worked with the co-sponsors and our state's Senator to get language included. We'll see.

Doctors should not be penalized for prescribing opioid alternatives

The opioid addiction crises has impacted every community in Oregon. Congress has a way to help stop the surge in overdoses.

pamplinmedia.com

 

[RoloTomassi]

does this mean asc prices go up to hopd or hopd comes down to asc? excuse my lack of noticing if it's obvious lol, my guess is it's the latter.

Good question. Another question is what procedures would be affected.

DEFINITION OF NON-OPIOID TREATMENT.—A ‘non-opioid treatment’ means—
“(I) a drug or biological product that is indicated to produce analgesia without acting upon the body’s opioid receptors; or
“(II) an implantable, reusable, or disposable medical device cleared or approved by the Administrator for Food and Drugs for the intended use of managing or treating pain;
that has demonstrated the ability to replace, reduce, or avoid opioid use or the quantity of opioids prescribed in a clinical trial or through data published in a peer-reviewed journal.”

 

[drusso]

Good question. Another question is what procedures would be affected.

DEFINITION OF NON-OPIOID TREATMENT.—A ‘non-opioid treatment’ means—
“(I) a drug or biological product that is indicated to produce analgesia without acting upon the body’s opioid receptors; or
“(II) an implantable, reusable, or disposable medical device cleared or approved by the Administrator for Food and Drugs for the intended use of managing or treating pain;
that has demonstrated the ability to replace, reduce, or avoid opioid use or the quantity of opioids prescribed in a clinical trial or through data published in a peer-reviewed journal.”

Many of these issues will be reconciled in Conference Committee after both houses pass the bill and at Agency rule-making.

 

[HemeOncHopeful19]

wont pass. only 47 cosponsors.


except....

life expectancy of white americans is 78.7.

life expectancy of Europe - making mostly white - include Spain 82; UK 80.9, Norway 83; France 82.

so there seems to be something beyond just race.

Impacts of Cheetos

Impacts of Cheetos

impactsofcheetos.weebly.com

 

[Ducttape]

read the text. maybe it will pass, but 47 cosponsors means they need to do a lot of work. does appear that the cosponsors are bipartisan.

fwiw, i did not see any Spine organizations such as SIS or NANS or the like supporting the bill. the ASA is.

How many white men have to live to 100 to offset the white kid that ODs on fentanyl at 20 to keep that average at 80?

good point. drugs can be a big issue. drug death rates are much lower in European nations.

you can also add the number of deaths due to guns in to the equation, as most gun deaths in the US are suicides in white males.

 

[bedrock]

wont pass. only 47 cosponsors.


except....

life expectancy of white americans is 78.7.

life expectancy of Europe - making mostly white - include Spain 82; UK 80.9, Norway 83; France 82.

so there seems to be something beyond just race.

Except…..that is skewed greatly by infant mortality rates in the US, as all early deaths are counted in the US , but not in other countries.

This gives the US an artificially low life expectancy.

 

[deleted131481]

Except…..that is skewed greatly by infant mortality rates in the US, as all early deaths are counted in the US , but not in other countries.

This gives the US an artificially low life expectancy.

Do you have a source that the US counts more early deaths unlike other countries?

At 0.6% US infant mortality even if we overcounted by half that would still be something like 0.3 years off.

 

[Ducttape]

i do not see where infant mortality is not counted in other countries. please post this, because every statistic i can find counts infant mortality in their statistics.

here is a site about life expectancy at birth: (the assumption i am making is that this statistic is taking out newborn deaths)

World Bank Open Data

Free and open access to global development data

data.worldbank.org

We rank 63rd on life expectancy at birth. tied with Sri Lanka, China, Columbia, Bahrain, Iran....

 

[Ducttape]

funny how he left out so many important details about healthcare in Europe....is that you Bernie Sanders? Now do Cuba.

Cuba's life expectancy is marginally better than the US as a whole.

Life Expectancy by Country and in the World (2024) - Worldometer

List of countries and dependencies in the world ranked by life expectancy at birth, both sexes, males and females. World Population Life Expectancy with historical chart

www.worldometers.info

a statistic i find sad to consider.

 

[wendalltwolf]

Cuba's life expectancy is marginally better than the US as a whole.

a statistic i find sad to consider.

Well their only McD’s is in Guantanamo Bay

 

[Doctodd]

Cuba's life expectancy is marginally better than the US as a whole.

Life Expectancy by Country and in the World (2024) - Worldometer

List of countries and dependencies in the world ranked by life expectancy at birth, both sexes, males and females. World Population Life Expectancy with historical chart

www.worldometers.info

View attachment 357362

a statistic i find sad to consider.

cmon bro.....you think the data from Cuba is believable?!?

 

[clubdeac]

Right, that would be the personal responsibility part. Tob, ETOH, drugs all the fun stuff that ends up being not so fun in the end...and most importantly the biggest killer of all --> processed food ... and also lack of exercise.

This is so boring and annoying to say but in all honestly, how much could we reduce healthcare costs/morbidity/mortality if people ate healthily (and organically??), exercised, spent a decent amount of time outside in nature and the sun, stayed away from the bad stuff above, had positive relationships with other humans/pets, had a strong sense of community, etc. I bet by at least 90%. Doesn't matter of course because it'll never happen although I personally strive for those things. It seems in general society moves in the opposite direction.

I agree with you whole heartedly however there are some on here with an extremely erroneous and warped view of disease such as duct who believes the main contributor of cardiovascular disease is genetic. When he said that I was so blown away I asked several of our cardiologists down the hall what % of cardiovascular disease they thought was due to lifestyle. They said probably close to 90%. Duct of course was trying to make a point about Covid so perhaps he was speaking from a place of emotion. I at least hope that was the case

 

[Ducttape]

please post the specific comment you are throwing around.

i do not ever remember stating that genetics is the primary driver of cardiovascular disease.

it is a factor.

40-60%?

https://www.ahajournals.org/doi/10.1161/circresaha.115.306566

Coronary artery disease (CAD) has important genetic underpinnings considered equivalent to that of environmental factors. The heritability of CAD has been estimated between 40% and 60%, on the basis of family and twin studies, a method that yields high precision despite potential bias (Vinkhuyzen et al1). In the Framingham Offspring Study, the age-specific incidence of CAD increased by >2-fold after adjustment for conventional CAD risk factors in participants with a family history of premature disease.2 The Swedish Twin registry reported on close to 21 000 subjects followed up for >35 years and calculated the heritability of fatal CAD events to be 0.57 and 0.38, for men and women, respectively. Of note, heritable effects are most manifest in younger individuals.3 This accords with other data, indicating that the genetic influence is the greatest for early-onset CAD events.4

30%?

Contribution of Gene Regulatory Networks to Heritability of Coronary Artery Disease:

www.jacc.org

cmon bro.....you think the data from Cuba is believable?!?

if you dont want to use Cuba, there are what 44 other countries that have better life expectancy at birth. lots of data from those countries that should be more believable for you.

but if you are denying all forms of collected data, then dont bother looking. because you wont find the answers you want.

 

[Ducttape]

Well their only McD’s is in Guantanamo Bay

not only that, it is not accessible to Cubans - only Americans.

 

[Pain Applicant1]

Here's something else to throw in, controversial of course, just the way I like it, lol. IQ correlates with life span. In fact, IQ correlates with many societal issues and problems....and IQ is correlated mostly with genetics, not nurture. So much so, that this is something that can't even be studied because it's such a taboo right now for whatever reason (but won't be forever).

So maybe ducttape is correct in some sense if he did in fact say it since IQ has a major influence on the decisions we make and the lifestyles we live.

Who wants to shoot me with arrows?

 

[Doctodd]

not only that, it is not accessible to Cubans - only Americans.

At least you didnt say it was due to lack of guns in Cuba.

 

[Ducttape]

i am not a supporter of Cuba in any manner and do not know their gun policies, but since you posted a comment, here are some facts:

number of gun deaths skyrocketed in Cuba the last year i could find data - 2015 - to 28.

thats roughly the number of gun deaths that occur every 2 hours in the US.

eliminating base rate fallacy - Cuba has roughly 0.5 gun deaths per 100,000. the US ha 4.46 per 100,000.

 

[IAmTheOne1]

I wish for this thread to become related to its title.

 

[bedrock]

i do not see where infant mortality is not counted in other countries. please post this, because every statistic i can find counts infant mortality in their statistics.

here is a site about life expectancy at birth: (the assumption i am making is that this statistic is taking out newborn deaths)

World Bank Open Data

Free and open access to global development data

data.worldbank.org

We rank 63rd on life expectancy at birth. tied with Sri Lanka, China, Columbia, Bahrain, Iran....

Do you have a source that the US counts more early deaths unlike other countries?

At 0.6% US infant mortality even if we overcounted by half that would still be something like 0.3 years off.

Do Differences in Reporting of Live Births Affect Comparability of Infant Mortality Rates? - The Center for Community Solutions

This is just one example. My covid brain isn't up for more research today, but it is a well know fact among pediatricians and OB/GYN that America counts many infant death at a gestational ages that other countries still classify as miscarriages, so those extra deaths are not counted against those countries.

 

[sloh]

Here's something else to throw in, controversial of course, just the way I like it, lol. IQ correlates with life span. In fact, IQ correlates with many societal issues and problems....and IQ is correlated mostly with genetics, not nurture. So much so, that this is something that can't even be studied because it's such a taboo right now for whatever reason (but won't be forever).

So maybe ducttape is correct in some sense if he did in fact say it since IQ has a major influence on the decisions we make and the lifestyles we live.

Who wants to shoot me with arrows?

This.