CMS Proposing 11% DR paycut, 9% IR paycut in 2021

[g3tb0mbed]

While midlevels are getting substantial pay increases. Thoughts?

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[Neopolymath]

I'm sure most people saw this coming, unfortunately.

 

[Cognovi]

I presume much of this has to do with the E&M coding changes, which effectively increases compensation to people who submit E&M codes and decreases compensation to those who do not, thereby favoring those who bill for office visits over those who perform procedures (including a radiologic exam as a procedure).

Although I can't explain why infectious diseases would be cut 4%.

 

[odyssey2]

Is this mostly secondary to COVID?

 

[deleted941485]

It’s nonsense. CMS logic is that E&M codes are undervalued so to pay for that they decided oh let’s just pay for it by cutting everything else not E&M related because of neutrality. Even though they are probably now undervaluing other services as a result.

Also it isn’t like rads hasn’t been hammered with reimbursement cuts the last 10 years. All of a sudden CMS “discovered” all these potential savings

Even if CMS doesn’t cut by that much in the final rule, you know they are just gonna come back and propose another round of cuts anyway.

I wouldn’t let this slide. CMS has been pulling this crap for years now.

 

[deleted746658]

this is a proposal, no? is it guaranteed to go into effect? and if so, when?

11%. yikes. hello hiring freezes and double down on fellowships

 

[Spikebd]

outpatient and primary care were the big winners. Surgical specialties got a decrease. Radiology, anesthesia, and pathology got rocked

 

[deleted746658]

will this essentially translate into an 11% salary cut ?

 

[GadRads]

It seems radiology has been getting constant cuts since the early 2000s. Is the plan to slash our pay to NP levels or have us work for free?

 

[zero0]

The good news keeps on coming. Apparently there's a bill up in California that would let midlevels order and interpret their own imaging. No pesky doctors with their fancy years of training and medical degrees needed.

With the recent proposed cuts by CMS and additional 5 years of residency I'd still have to do I think the total career income probably winds up being about the same long term if i just dropped out now and went PA...

Joke's really on us for thinking the future would still exist by the time we got there. Lesson learned.

 

[Mh0311]

Wtff Is there anything we can do to fight back against this?

 

[Kracin]

Wtff Is there anything we can do to fight back against this?

I emailed my senators

 

[risus_sardonicus]

Lmao NPs and PAs getting a 8% increase what a fking joke. Let’s go ahead and gut the most important specialty in the hospital, and give pay raises to the most underqualified idiots. Who comes up with this bs?

 

[redoitall]

I guess they do a better job at lobbying than us docs...

 

[CavsFan2016]

Do you think this should influence anyone’s decision on entering the field for residency?

 

[redoitall]

Do you think this should influence anyone’s decision on entering the field for residency?

Honestly I would not go that far. Nobody really wants to take a pay cut obviously. Radiologist still make a decent salary. Although I would say that the exposure to legal issue is quite high given that the reports and pictures are always available. In that sense I think higher salaries would be justified. I mean why would read a chest X ray for less than 10 dollars and risk my entire career if I miss something?
The thing is that no matter how you look at it, medicine in general is more and more reliant on Radiology. Decreasing reimbursement will not change that need and will not change the supply / demand.
I have read that NP/PA/Fam doc can even get money to read their own imaging studies. Well in the end that may well happen until disasters ensue.

Clearly if Rads fight this, things may not end up being as bad. This is a proposal. I doubt radiology in general will go for this and won't fight it. I still believe radiology has some good days ahead, particularly when seeing how much rad is needed in pretty much all aspects of care for ED, to Surgery to Chronic conditions...

Well we'll see.

 

[deleted379552]

Do you think this should influence anyone’s decision on entering the field for residency?

I generally will discourage anyone from going into radiology (or any specialty) for the money. Do something you enjoy.

 

[Mh0311]

No.
Example:
2020 Revenue = 600K-Overhead =200k gives Salary=400k
2021 Revenue=534K - Overhead 200K gives Salary=334K
So in this example 11% reimbursement cut leads to 16.5% pay cut

Good god that’s like a 70k hit, I highly doubt CMS would ever give rads an 11% boost but does it ever go into the positive or are cuts just to be expected now?

 

[odyssey2]

Good god that’s like a 70k hit, I highly doubt CMS would ever give rads an 11% boost but does it ever go into the positive or are cuts just to be expected now?

Isn't this assuming that your entire salary is coming from Medicare though?

 

[risus_sardonicus]

**** Medicare. I have a masters degree in finance and can’t wait till I singlehandedly overhaul these administrative crooks

 

[deleted379552]

Do something you enjoy is not always valid imo. You may like repairing typewriters but there is no future in it. There is no future for being a utility meter reader either. AI may make major inroads into radiology over time.

Here we go again.

AI as a threat at this point in time is purely theoretical and definitely not limited to diagnostic fields like radiology. In theory, a powerful enough AI oncology algorithm (like the one they're building at memorial sloan kettering) could lead to an army of "nurse oncologists" seeing and prescribing chemo and managing the side effects... and displacing MDs. Most oncology follow-ups visits at my hospital now are already with NP/PAs... add a powerful enough AI and it begs the question of why an MD is even needed. That could be said about any medical field besides maybe surgery (think nurse endocrinologist, PA rhuematologist). My point is, you can't predict the future of any field based on theoretical fears of AI.

Science is not static. AI may make inroads in radiology, but radiology (like any field in medicine) will continue to grow as science evolves. Who knows how we'll be diagnosing diseases in 30 years. With imaging getting more and more powerful, will we even need tissue to differentiate between adeno and squamous cell or grade a tumor. Who knows what the role of radiologist is in the future.

Keeping in mind that nothing in medicine stands still for very long, the best advice is still do what you like imo. Maybe all doctors will be useless "utility meter reader" in the not so distant future. Maybe they'll replace all of us with a machine like the one in Idiocracy (that movie is incredibly prescient). The theoretical existential possibilities are endless.

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[zero0]

At this point I'm counting on AI to come along and help increase volume of reads. It's our only potential savior in a sea of impending cuts.

 

[GadRads]

I was a bit worried about AI in radiology as a medical student. As I have gained more experience in radiology, those worries now seem to have been unfounded. Radiology is more difficult than it looks, and the wide spectrum of pathology, nuances of imaging, and the numerous variables one must consider in image interpretation make it difficult to meaningfully and safely automate diagnostic radiology.

As mentioned above, NP/PA + AI is a more reasonable possibility than AI rendering diagnostic radiology obsolete. The more likely future is AI + diagnostic radiologist working in tandem to speed up image interpretation and enhance accuracy.

 

[GadRads]

Sounds like the sweatshop of the future.
If today’s workload of a radiologist seems to be akin to being a gerbil running inside a wire wheel, the analogy is not so farfetched. That is what radiologists interpreting CT and MRI examinations are doing, according to a study published online July 22, 2015 in Academic Radiology. Based on 255 uninterrupted eight-hour workdays per year, radiologists are needing to review one image every three to four seconds to meet workload demands.

The radiologist’s gerbil wheel: interpreting images every 3-4 seconds eight hours a day at Mayo Clinic • APPLIED RADIOLOGY

It's already that way to a degree presently. Mental fatigue is high at the end of the workday or post-call. Our colleagues on the patient-interacting clinical side don't understand. We might look relaxed outwardly while reading images, but the mental intensity is high during image interpretation, and this intensity needs to be maintained for 8-12 hours or you miss important stuff. Current radiologists who switched from surgery and other specialties to radiology usually come to appreciate what we complain about in regard to volume, pace and complexity.

Radiology is still a good specialty, but the current wave of recalcitrant cuts is not sustainable in the long run. Per unit of time, we work harder than the vast majority of other specialties.

 

[odyssey2]

It's already that way to a degree presently. Mental fatigue is high at the end of the workday or post-call. Our colleagues on the patient-interacting clinical side don't understand. We might look relaxed outwardly while reading images, but the mental intensity is high during image interpretation, and this intensity needs to be maintained for 8-12 hours or you miss important stuff. Current radiologists who switched from surgery and other specialties to radiology usually come to appreciate what we complain about in regard to volume, pace and complexity.

Radiology is still a good specialty, but the current wave of recalcitrant cuts is not sustainable in the long run. Per unit of time, we work harder than the vast majority of other specialties.

Do you think AI could help with the pace and mental fatigue or make it worse?

 

[qwerty89]

It's already that way to a degree presently. Mental fatigue is high at the end of the workday or post-call. Our colleagues on the patient-interacting clinical side don't understand. We might look relaxed outwardly while reading images, but the mental intensity is high during image interpretation, and this intensity needs to be maintained for 8-12 hours or you miss important stuff. Current radiologists who switched from surgery and other specialties to radiology usually come to appreciate what we complain about in regard to volume, pace and complexity.

Radiology is still a good specialty, but the current wave of recalcitrant cuts is not sustainable in the long run. Per unit of time, we work harder than the vast majority of other specialties.

This is very underappreciated. In an era where businesses of all kinds have expanded accessibility, somehow its OK for primary care to work 8-5pm M-F with no call, no weekends, and no nights. Yet they are always the poster child of doctors being underpaid. At places like Kaiser they can make 250K for 8-5 M-F with nearly the same vacation time as the radiologists.

Just funny to me how we complain that nobody sees their primary care doc but then we don't ask why there are no PCP offices open after hours or on the weekends. There is no excuse now in the era of telehealth.

 

[Clean7795]

Do you think AI could help with the pace and mental fatigue or make it worse?

Most likely better. E.g. Autodetection of pulmonary nodules with comparisons automatically brought up. Improved hanging protocols and voice recognition.

 

[sloh]

This is very underappreciated. In an era where businesses of all kinds have expanded accessibility, somehow its OK for primary care to work 8-5pm M-F with no call, no weekends, and no nights. Yet they are always the poster child of doctors being underpaid. At places like Kaiser they can make 250K for 8-5 M-F with nearly the same vacation time as the radiologists.

Just funny to me how we complain that nobody sees their primary care doc but then we don't ask why there are no PCP offices open after hours or on the weekends. There is no excuse now in the era of telehealth.

FM at Kaiser is brutal. The volume is hard to sustain and most of their physicians are finishing documentation; returning inbox messages and phone calls during lunch and off hours/at night.

 

[vm26]

While midlevels are getting substantial pay increases. Thoughts?

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[zero0]

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This is the best that any one of us can. Please pass it on.

This is m0ronic and extremely poorly thought out. Asking for more money for rich doctors in the middle of an economic crisis? Not gonna happen. Still signed though.

What we should be advocating for is to keep the CMS budget the same but not reimburse more for unskilled labor. Give the NPs and PAs a pay cut and shift that money over to primary care. Keep specialties the same otherwise no one will train long enough to do that crap. I don't think any of that will happen though. The powers that be favor pumping as much unskilled labor into the healthcare system as possible and want to encourage more PAs and NPs to go to school.

 

[scoopdaboop]

Any thoughts on the AUC/CDS mandate, which has the potential to deny reimbursement for improperly ordered procedures?

Medicare Proposed Major Cut in Radiology Reimbursement for 2021

The Centers for Medicare and Medicaid Services (CMS) has released their annual proposal for changes to the Medicare payment system for the coming year.

info.hapusa.com

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This website does a good job talking about all major cuts.

 

[YeOleBoneWiz]

hopefully people will take into account this notion when they opt for more government control over things non healthcare. NPs are nothing but scut monkeys in knowledge and ability, the govt giving them more pay while at the same time cutting pay of those who provide skilled services should sway the vote on other topics.