CMS Proposing 6% paycut for EM physicians in 2021

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
I love the focus on priorities during this pandemic. Rheumatology/Heme-Onc/ENT getting a pay increase for example.
 
would congress get to vote on this?
 
The country would shut down as we know it if we ever grew a pair and organized a walkout or something of that nature. It’s said that they have us hook, line and sinker!!
 
Brigade4Radiant said:
It’s amazing that telehealth and family practice get increases When often they say go to the ER especially during this pandemic.
Click to expand...
Not just us, its several of the non-procedural specialties. Rheum and endocrine got big bumps as well.
 
Brigade4Radiant said:
It’s amazing that telehealth and family practice get increases When often they say go to the ER especially during this pandemic.
Click to expand...
I can count on my 1 hand the number of times I’ve recommended a patient go to the ED in the past year. And same during residency. That doesn’t really seem like often to me. Is FM really telling over half their patient visits in a day to go to the ED? That doesn’t seem accurate.

Regardless I agree that it doesn’t seem like ED reimbursement should go down.

I do wonder if there would ever be any consensus that one specialties pay should come down? Is anyone getting "overpaid" by CMS?
 
The problem is the zero-sum game of CMS reimbursements pits specialties against each other. A joint effort on the part of all professional societies to push for change to the budgeting rules is in our collective self-interest. When our government can invent money out of thin air for a variety of less productive things it should be able to accommodate pay increases for certain specialties without cutting others.
 
Torsion said:
The problem is the zero-sum game of CMS reimbursements pits specialties against each other. A joint effort on the part of all professional societies to push for change to the budgeting rules is in our collective self-interest. When our government can invent money out of thin air for a variety of less productive things it should be able to accommodate pay increases for certain specialties without cutting others.
Click to expand...

Exactly. It’s total nonsense. They’ll print trillions to prop up assets and bail out banks insurance companies drum up new social programs but screw the doctors who in the middle of a pandemic are dealt yet another ****ty hand.

Honestly the only question is how to limit your dealings with CMS. Because even if the cuts don’t go into effect you bet your ass next year you’ll be revisiting the same crap.

As for the others on this board criticizing FP, your just playing the game HHS wants you to play.
 
RadsWFA1900 said:
Honestly the only question is how to limit your dealings with CMS. Because even if the cuts don’t go into effect you bet your ass next year you’ll be revisiting the same crap.
Click to expand...

Dealing with CMS is part of the job description for EM, though, considering the amount of ED patients who are either Medicare or Medicaid. Considering the amount of uncompensated indigent care that EDs in this country, I would think it would benefit our specialty if more people were covered under CMS that are currently totally uninsured.
 
AMEHigh said:
I can count on my 1 hand the number of times I’ve recommended a patient go to the ED in the past year. And same during residency. That doesn’t really seem like often to me. Is FM really telling over half their patient visits in a day to go to the ED? That doesn’t seem accurate.

Regardless I agree that it doesn’t seem like ED reimbursement should go down.

I do wonder if there would ever be any consensus that one specialties pay should come down? Is anyone getting "overpaid" by CMS?
Click to expand...

I'm absolutely fine with you guys sending a pt to the ED. I don't even care anymore. In fact, I'm appreciative for the business. My eyes have been completely opened to the crazy shenanigans you guys deal with in clinic every day. My SO works as a PCP in a clinic nearby and has a new story every day. Here's a great example. She was trying to send a patient to the hospital and bypass the ED other day for a direct admit. The hospitalist refused the transfer and said they were full and only accepting admits from the ED or transfers from another hospital. She goes "So, let me get this straight...you want me to send my pt to the ED for a massive ER bill and a guaranteed admission...because he just happens to be physically located in your ER instead of just accepting him as a direct transfer from my clinic?" He goes "Yep, that's pretty much it. Hey, I don't make the rules." Sometimes, she will argue with insurance companies for half an hour who keep refusing a STAT CTA for a PE rule out of all things and ends up having to send them to the ED because the insurance will cover it as an ER visit. The list goes on.

You're really only sending less than 5 patients to the ER in a given year alone? That seems really low. They've probably sent 5 in the past month or two. All legit.
 
Torsion said:
The problem is the zero-sum game of CMS reimbursements pits specialties against each other. A joint effort on the part of all professional societies to push for change to the budgeting rules is in our collective self-interest. When our government can invent money out of thin air for a variety of less productive things it should be able to accommodate pay increases for certain specialties without cutting others.
Click to expand...
Exactly while NPs get lumped into one group and can float from derm to inpt cards, EM, doing gi scopes, and now possibly radiology reading films.

Its outrageous
 
HoosierdaddyO said:
The country would shut down as we know it if we ever grew a pair and organized a walkout or something of that nature. It’s said that they have us hook, line and sinker!!
Click to expand...

This is so untrue. If all EM docs quit tomorrow, all nonemergent stuff gets told to go home or to a clinic. Maybe 20% needs to be in the Er.

They will mobilize hospitalist/PCP, increase APCS and EM as a field will be nonexistent.
 
AMEHigh said:
I can count on my 1 hand the number of times I’ve recommended a patient go to the ED in the past year. And same during residency. That doesn’t really seem like often to me. Is FM really telling over half their patient visits in a day to go to the ED? That doesn’t seem accurate.

Regardless I agree that it doesn’t seem like ED reimbursement should go down.

I do wonder if there would ever be any consensus that one specialties pay should come down? Is anyone getting "overpaid" by CMS?
Click to expand...

FM, OB pretty much every single specialty at my hospital just tells people to go to the ER.

The last one was a young 19 yo, works at an urgent Care with corona viruses testing. Called pcp due to corona exposure and feeling chills. Told to go to ER to get tested.

Literally she could have waited 8 hours to get tested from her own work place
 
RadsWFA1900 said:
Exactly. It’s total nonsense. They’ll print trillions to prop up assets and bail out banks insurance companies drum up new social programs but screw the doctors who in the middle of a pandemic are dealt yet another ****ty hand.

Honestly the only question is how to limit your dealings with CMS. Because even if the cuts don’t go into effect you bet your ass next year you’ll be revisiting the same crap.

As for the others on this board criticizing FP, your just playing the game HHS wants you to play.
Click to expand...

Drum up social programs? Yeah right. I agree with your first example, but the gov does the furthest thing from Using that money for social programs. Replace social programs with military next time.
 
Groove said:
I'm absolutely fine with you guys sending a pt to the ED. I don't even care anymore. In fact, I'm appreciative for the business. My eyes have been completely opened to the crazy shenanigans you guys deal with in clinic every day. My SO works as a PCP in a clinic nearby and has a new story every day. Here's a great example. She was trying to send a patient to the hospital and bypass the ED other day for a direct admit. The hospitalist refused the transfer and said they were full and only accepting admits from the ED or transfers from another hospital. She goes "So, let me get this straight...you want me to send my pt to the ED for a massive ER bill and a guaranteed admission...because he just happens to be physically located in your ER instead of just accepting him as a direct transfer from my clinic?" He goes "Yep, that's pretty much it. Hey, I don't make the rules." Sometimes, she will argue with insurance companies for half an hour who keep refusing a STAT CTA for a PE rule out of all things and ends up having to send them to the ED because the insurance will cover it as an ER visit. The list goes on.

You're really only sending less than 5 patients to the ER in a given year alone? That seems really low. They've probably sent 5 in the past month or two. All legit.
Click to expand...
Isn’t your SO a np? If so, she can’t be a primary care physician (PCP)
 
AMEHigh said:
I can count on my 1 hand the number of times I’ve recommended a patient go to the ED in the past year. And same during residency. That doesn’t really seem like often to me. Is FM really telling over half their patient visits in a day to go to the ED? That doesn’t seem accurate.

Regardless I agree that it doesn’t seem like ED reimbursement should go down.

I do wonder if there would ever be any consensus that one specialties pay should come down? Is anyone getting "overpaid" by CMS?
Click to expand...

I think that procedures have been overvalued and cognitive, non-procedural work has been undervalued. It's a lot harder for me to figure out dizziness in a 65 year old than to cast a distal radius Fx in a 20 year old, but I get paid more for the latter.
 
Groove said:
I'm absolutely fine with you guys sending a pt to the ED. I don't even care anymore. In fact, I'm appreciative for the business. My eyes have been completely opened to the crazy shenanigans you guys deal with in clinic every day. My SO works as a PCP in a clinic nearby and has a new story every day. Here's a great example. She was trying to send a patient to the hospital and bypass the ED other day for a direct admit. The hospitalist refused the transfer and said they were full and only accepting admits from the ED or transfers from another hospital. She goes "So, let me get this straight...you want me to send my pt to the ED for a massive ER bill and a guaranteed admission...because he just happens to be physically located in your ER instead of just accepting him as a direct transfer from my clinic?" He goes "Yep, that's pretty much it. Hey, I don't make the rules." Sometimes, she will argue with insurance companies for half an hour who keep refusing a STAT CTA for a PE rule out of all things and ends up having to send them to the ED because the insurance will cover it as an ER visit. The list goes on.

You're really only sending less than 5 patients to the ER in a given year alone? That seems really low. They've probably sent 5 in the past month or two. All legit.
Click to expand...
Yeah it is a huge mess.
And yes I’m pretty sure I only sent 5 last year. But it’s helpful where I work in an underserved area.
We do a lot of prenatal care, and I’m trained in ultrasounds and manage stable ectopics, so never send for that.
We have an urgent care area as well, so can take care of that stuff. Have a radiology place next door.
Also we do have some point of care stuff like hgb so never have to send away for that if think someone is anemic for example.

I know some pcp’s obviously send more, but the person who said often seems like a huge exaggeration because I consider often to be more than half the time. There’s no way most PCPs are sending half their patients to the ED that often.

It’s not a competition to poop on each other’s specialties. We should all be paid fairly.
 
HoosierdaddyO said:
The country would shut down as we know it if we ever grew a pair and organized a walkout or something of that nature. It’s said that they have us hook, line and sinker!!
Click to expand...

We need to better represent ourselves and aggressively lobby the government to advance our interests. Why do nurses and midlevels get to have strong unions and lobbying groups and not us?
 
AMEHigh said:
Yeah it is a huge mess.
And yes I’m pretty sure I only sent 5 last year. But it’s helpful where I work in an underserved area.
We do a lot of prenatal care, and I’m trained in ultrasounds and manage stable ectopics, so never send for that.
We have an urgent care area as well, so can take care of that stuff. Have a radiology place next door.
Also we do have some point of care stuff like hgb so never have to send away for that if think someone is anemic for example.

I know some pcp’s obviously send more, but the person who said often seems like a huge exaggeration because I consider often to be more than half the time. There’s no way most PCPs are sending half their patients to the ED that often.

It’s not a competition to poop on each other’s specialties. We should all be paid fairly.
Click to expand...

It sounds like you have that increasingly rare thing...a highly functional clinic!

We EM docs have a spectrum bias: we don't know the docs & clinics that are high functioning, because they don't send us patients very often.
 
Lawpy said:
We need to better represent ourselves and aggressively lobby the government to advance our interests. Why do nurses and midlevels get to have strong unions and lobbying groups and not us?
Click to expand...

Most physicians to this point by and large subscribe to ideals such as ‘duty’, ‘oath’, ‘responsibility’... etc. the same reason folks came out of retirement and such to volunteer their EM expertise at ground zero of the pandemic while the line docs got pay cuts at those sites.. nurses and mid levels are not like this to the same degree (no offense intended by that)...

Secondly, most physicians are not in a position to walk away from a ****ty job. They are up to their ears in debt, have a Tesla and a million dollar house, and live basically paycheck to paycheck... give them a raw deal and they will begrudgingly take it. Give them a really raw deal and they will begrudgingly take it and maybe complain out loud.

yeah, this proposed cms cut is terrible. But without even seeing it coming, I took a 30% pay cut this year (RVU system)... so, there’s that.

The only leverage unions and such have is the willingness of the employees to walk off the job. Docs just don’t do that. (Maybe we should? Open for debate.)
 
goodoldalky said:
Secondly, most physicians are not in a position to walk away from a ****ty job. They are up to their ears in debt, have a Tesla and a million dollar house, and live basically paycheck to paycheck...
Click to expand...

You make a lot of good points, but this is the one I'd like to highlight to the med students and residents.

Living below your means is the best protection against burnout, because if your job is burning you out - you can get a different one!
 
Prehealth1011 said:
Sorry if it sounds stupid but how do they determine who gets a bump? I thought Rheum/Endo would continue dropping in $ since they aren't procedural.

Also, how often do CMS proposals actually take effect?
Click to expand...
Because someone finally realized that there is value in counseling and discussions with patients?
 
WilcoWorld said:
It sounds like you have that increasingly rare thing...a highly functional clinic!

We EM docs have a spectrum bias: we don't know the docs & clinics that are high functioning, because they don't send us patients very often.
Click to expand...
I sent 2 in so far today.

O2 sat of 80% (that I really hope is CHF) and a dislocated shoulder.
 
VA Hopeful Dr said:
Not just us, its several of the non-procedural specialties. Rheum and endocrine got big bumps as well.
Click to expand...

True. This is basically another step in the process of moving money away from procedural to non-procedural specialties that has been going on for years.
 
VA Hopeful Dr said:
I sent 2 in so far today.

O2 sat of 80% (that I really hope is CHF) and a dislocated shoulder.
Click to expand...

Is this meant to be a counterexample to my post? I certainly wasn't trying to suggest that ever sending patients to the ED indicates a clinic is dysfunctional. My point is that Emergency Physicians who gripe that all PCPs are lousy probably are failing to appreciate that they don't see many non-emergent transfers from good PCPs. Furthermore, when a good PCP sends in a patient in respiratory distress (I'll bet you sent your patient in via ambulance), they think of that case as an "ER patient" rather than a "clinic transfer".
 
Last edited:
VA Hopeful Dr said:
I sent 2 in so far today.

O2 sat of 80% (that I really hope is CHF) and a dislocated shoulder.
Click to expand...
Were you trained in dislocation reduction, for fingers, elbows, shoulders, or patellas, for example? If so, do you 1. give it a try or 2. splint in place? And, if you do reduce, do you still send them? Not hammering on you, just never thought of it.
 
WilcoWorld said:
Is this meant to be a counterexample to my post? I certainly wasn't trying to suggest that ever sending patients to the ED indicates a clinic is dysfunctional. My point is that Emergency Physicians who gripe that all PCPs are lousy probably are failing to appreciate that they don't see many non-emergent transfers from good PCPs. Furthermore, when a good PCP sends in a patient in respiratory distress (I'll bet you sent your patient in via ambulance), they think of that case as an "ER patient" rather than a "clinic transfer".
Click to expand...
Not at all, this was just a super abnormal day for me (I probably average 1 patient sent to the ED every 1-2 weeks) and your post was one of the more recent on the subject so I used it.

I didn't use an ambulance because I'm pretty far out of town, the patient's sister can drive him 2/3rds of the way to the hospital in about the same time it would take the ambulance to get here in the first place.
 
Apollyon said:
Were you trained in dislocation reduction, for fingers, elbows, shoulders, or patellas, for example? If so, do you 1. give it a try or 2. splint in place? And, if you do reduce, do you still send them? Not hammering on you, just never thought of it.
Click to expand...
Not even a little. If I were desperate I could probably YouTube my way through it, but my area has both good ED physicians and pretty good ortho if it comes to that.

Plus, this guy fell and did this 12+ hours ago and I seem to recall reading that the longer its out the harder it is to get back in.
 
VA Hopeful Dr said:
Not even a little. If I were desperate I could probably YouTube my way through it, but my area has both good ED physicians and pretty good ortho if it comes to that.

Plus, this guy fell and did this 12+ hours ago and I seem to recall reading that the longer its out the harder it is to get back in.
Click to expand...
Yes, you are correct. If this is the first dislocation, and he waited 12 hours, he's possibly booked himself for an OR. If it's recurrent, ortho might try to still do it closed. I'll tell you - as a dumb ER doc, I'm not finagling with that! Fresh, straightforward, simple, no fracture - sure. Not that, I'm making a call.

But, something to maybe consider - see if ortho will give you a 20 minute (or less) in-service on nursemaid's elbow and finger dislocation. I would say the EM guys, but they need those procedures for the residents.
 
VA Hopeful Dr said:
Not even a little. If I were desperate I could probably YouTube my way through it, but my area has both good ED physicians and pretty good ortho if it comes to that.

Plus, this guy fell and did this 12+ hours ago and I seem to recall reading that the longer its out the harder it is to get back in.
Click to expand...
Apollyon said:
Yes, you are correct. If this is the first dislocation, and he waited 12 hours, he's possibly booked himself for an OR. If it's recurrent, ortho might try to still do it closed. I'll tell you - as a dumb ER doc, I'm not finagling with that! Fresh, straightforward, simple, no fracture - sure. Not that, I'm making a call.

But, something to maybe consider - see if ortho will give you a 20 minute (or less) in-service on nursemaid's elbow and finger dislocation. I would say the EM guys, but they need those procedures for the residents.
Click to expand...

One of my greatest moments as a doc was when I reduced my neighbor's shoulder at my kitchen table using the Cunningham method.

But his shoulder had been out for all of 10 minutes.
 
Apollyon said:
Yes, you are correct. If this is the first dislocation, and he waited 12 hours, he's possibly booked himself for an OR. If it's recurrent, ortho might try to still do it closed. I'll tell you - as a dumb ER doc, I'm not finagling with that! Fresh, straightforward, simple, no fracture - sure. Not that, I'm making a call.

But, something to maybe consider - see if ortho will give you a 20 minute (or less) in-service on nursemaid's elbow and finger dislocation. I would say the EM guys, but they need those procedures for the residents.
Click to expand...
Had a number of nursemaid's elbows in residency, the XR tech reduced all of them when doing the x-rays. 29 year old Va Hopeful was pissed.
 
WilcoWorld said:
One of my greatest moments as a doc was when I reduced my neighbor's shoulder at my kitchen table using the Cunningham method.

But his shoulder had been out for all of 10 minutes.
Click to expand...
One of my fraternity brothers did the same during intramural basketball our Senior Year. That shoulder was out all of 30 seconds. The fact that I can clearly remember it 15 years later tells you how cool I thought that was.
 
rokshana said:
Primary
Care
PROVIDER...
In many places where the midlevels are LIPs , they are the PCP off record since there are no physicians in the area.
Click to expand...
It’s primary care PHYSICIAN. Genius. Good lord, as a physician you should know what basic acronyms actually mean.
 
MLNS said:
It’s primary care PHYSICIAN. Genius. Good lord, as a physician you should know what basic acronyms actually mean.
Click to expand...

I never want to hear the word "provider" used in such a context again.
You're a physician, or you're not.
There are great PA and NP folks out there.
They're not physicians. The buck stops with us.
 
MLNS said:
It’s primary care PHYSICIAN. Genius. Good lord, as a physician you should know what basic acronyms actually mean.
Click to expand...
Yes, I know that...however in states they have licensed independent practitioners (LIPs) mid levels can be and are PCP...meaning they are the primary care for people...we may not like it...and ultimately we as physicians have allowed this to happen...so there are places where a patient’s PCP is a midlevel who is the sole person responsible for that persons care.

And funny you lash out at me and roll your eyes, yet in a few posts above me groove(#27) said exactly the same thing...where is your admonishment for HIM?
 
You must log in or register to reply here.

Similar threads

BigRhinoGuy
ACGME proposing changes to EM residency requirements
2 3 4
Replies
170
Views
15K
Old_Mil
Old_Mil
E
EM Physician stabbed in the chest while on shift
Replies
20
Views
3K
xaelia
xaelia
EctopicFetus
Elite Emergency Physicians - Indiana - VITUITY
Replies
4
Views
2K
EctopicFetus
EctopicFetus
J
AI in EM
2
Replies
53
Views
4K
Major
Major
J
Advice for EM rotation
Replies
31
Views
4K
Franzd'Epinay
F
Top