CMS Proposing 6% paycut for EM physicians in 2021

[g3tb0mbed]

NPs and PAs would get a 8% increase. Crazy that EM and ID are getting paycuts after being at the forefront of this epidemic.

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[NYEMMED]

Yea EM physicians saved countless during a pandemic, yea cut their pay...

 

[Porfirio]

I love the focus on priorities during this pandemic. Rheumatology/Heme-Onc/ENT getting a pay increase for example.

 

[bravotwozero]

would congress get to vote on this?

 

[cyanide12345678]

Another reason for cmgs to keep cutting salaries

 

[Frazier]

Ugh, terrible.

 

[southerndoc]

Hate it that NP's are getting an increase.

 

[deleted859535]

****ing insulting.

 

[Brigade4Radiant]

Nurse practioners have a powerful lobbying group. A lot of ED docs were working for free and volunteering so as the saying goes no good deed goes unpunished

 

[HoosierdaddyO]

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]

It’s amazing that telehealth and family practice get increases When often they say go to the ER especially during this pandemic.

 

[thegenius]

Yea but I’m OK with FP getting more money. They need more so more docs go into it.

 

[VA Hopeful Dr]

It’s amazing that telehealth and family practice get increases When often they say go to the ER especially during this pandemic.

Not just us, its several of the non-procedural specialties. Rheum and endocrine got big bumps as well.

 

[bravotwozero]

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.

They get monkey butlers to throw darts at a board...

 

[AMEHigh]

It’s amazing that telehealth and family practice get increases When often they say go to the ER especially during this pandemic.

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?

 

[Torsion]

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.

 

[deleted941485]

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.

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.

 

[Torsion]

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.

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.

 

[Groove]

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?

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.

 

[Modanq]

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.

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

 

[emergentmd]

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!!

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.

 

[cyanide12345678]

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?

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

 

[NicksMD]

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.

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.

 

[MLNS]

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.

Isn’t your SO a np? If so, she can’t be a primary care physician (PCP)

 

[Groove]

Isn’t your SO a np? If so, she can’t be a primary care physician (PCP)

Yeah, she's an NP. I define PCP as primary care provider.

 

[WilcoWorld]

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?

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.

 

[AMEHigh]

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.

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.

 

[Lawpy]

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!!

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?

 

[WilcoWorld]

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.

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.

 

[goodoldalky]

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?

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.)

 

[WilcoWorld]

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...

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!

 

[rokshana]

Hate it that NP's are getting an increase.

Are all NPs getting an increase or outpt ones ? Are your EM NPs getting that increase?

 

[rokshana]

I love the focus on priorities during this pandemic. Rheumatology/Heme-Onc/ENT getting a pay increase for example.

You do realize that these decisions were in the works long before the pandemic...

 

[rokshana]

Not just us, its several of the non-procedural specialties. Rheum and endocrine got big bumps as well.

As endocrinologist, we are one of the lowest/reimbursement in pay so it is long overdue ...maybe this will make us the third lowest in pay instead of the second lowest...

 

[rokshana]

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?

Because someone finally realized that there is value in counseling and discussions with patients?

 

[rokshana]

Isn’t your SO a np? If so, she can’t be a primary care physician (PCP)

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.

 

[VA Hopeful Dr]

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.

I sent 2 in so far today.

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

 

[Vandalia]

Not just us, its several of the non-procedural specialties. Rheum and endocrine got big bumps as well.

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.

 

[WilcoWorld]

I sent 2 in so far today.

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

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".

 

[Apollyon]

I sent 2 in so far today.

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

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.

 

[VA Hopeful Dr]

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".

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.

 

[VA Hopeful Dr]

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.

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.

 

[Apollyon]

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.

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.

 

[WilcoWorld]

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.

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.

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.

 

[VA Hopeful Dr]

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.

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.

 

[VA Hopeful Dr]

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.

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.

 

[MLNS]

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.

It’s primary care PHYSICIAN. Genius. Good lord, as a physician you should know what basic acronyms actually mean.

 

[RustedFox]

It’s primary care PHYSICIAN. Genius. Good lord, as a physician you should know what basic acronyms actually mean.

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.

 

[Rekt]

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.

You can autofellate yourself all you want, but an NP is a mid-level, regardles of how many fake sequences of letters they put after their name.

 

[rokshana]

It’s primary care PHYSICIAN. Genius. Good lord, as a physician you should know what basic acronyms actually mean.

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?