Final senate bill to lower compensation by 40% - all hands on deck - please call your Senators/Reps

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Both CMG’s and insurance companies claiming victimhood.:rofl:



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Senate Health Bill Includes Pay Cap

Sen Alexander introduced legislation to curb balance billing, out-of-network billing, or frequently reported in the news media as "surprise billing." Let me be clear: there is no surprise about it. Many insurance companies purposefully don't contract with physicians because it is a way to...
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This likely will be challenged in court if OON rates are tied to Medicare or regional median IN rates. The American Hospital Association is against the Alexander bill.

OON bills shouldn't happen frequently, and if so, insurers should be required to pay the rate listed in the FAIR Health Database. This uses aggregate claims data. The proposals in Congress right now use what insurers report as what they typically pay. Who can trust them? Who can trust Alexander with all of his insurance money he receives?

The bottom line is this: insurance companies are for-profit entities just like physician staffing groups. They have shifted their contractual requirements to pay for care that their paying members should receive onto the members. They purposefully low-ball contract negotiations so they can maximize profits. By low-balling an offer, they force the providers to not sign a contract and be IN. Insurance companies love for providers to be OON. That way, they don't have to pay anything or pay significantly less for their OON bills. This in turn allows them to report profits to their shareholders and to justify their CEO salaries.

2017 insurance CEO total compensation:
Michael NeidorffCentene$24.9 million (396 times median employee pay at Centene)
Bruce BroussardHumana$34.2 million
Joseph ZubretskyMolina$19.7 million
Mark BertoliniAetna$58.75 million
Joseph SwedishAnthem$26.4 million
Stephen HemsleyUnitedHealth Group$27.2 million
David CordaniCigna$43.9 million
David WichmanUnitedHealth Group$83.2 million
Kenneth BurdickWellcare$11.3 million
Gail BoudreauxAnthem (took over as CEO)2017: $2.2 million, 2018: $14.2 million

As you can see, the administrators of health insurance companies have no shame in taking large amounts of money from their members.

By comparison, Chris Holden (CEO of Envision) was paid $7.3 million in 2017. TeamHealth's Leif Murphy signed for $1 million salary plus a $2.8 million signing bonus. Hardly the salaries seen by the CEO's of insurance companies. I fail to see the provider groups being the problem here.
 
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So tomorrow (July 17), the House Energy & Commerce Committee will debate the House version. We need them to pass Rep. Ruiz's version of the bill (who is an EM MD) or we will all get a 15-20% pay-cut. Now's the time to contact your US Representative. Welcome to the beginning of screwing doctors to cute healthcare costs--get involved or we're for dinner, guys.

https://www.healthaffairs.org/do/10.1377/hblog20190708.627390/full/
 
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sum dude said:
So tomorrow (July 17), the House Energy & Commerce Committee will debate the House version. We need them to pass Rep. Ruiz's version of the bill (who is an EM MD) or we will all get a 15-20% pay-cut. Now's the time to contact your US Representative. Welcome to the beginning of screwing doctors to cute healthcare costs--get involved or we're for dinner, guys.

https://www.healthaffairs.org/do/10.1377/hblog20190708.627390/full/
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So out of curiosity how much of a hit would the Ruiz plan be? I mean that’s great we have a doc in the senate but just wanna know
 
It is July 17... what's the status on this bill at the House Energy Commitee (or whatever it is called)?
I called my rep yesterday to voice my displeasure. Took 30 seconds. More should do it.
 
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GeneralVeers said:
You're right. How about a 70% tax on all income over 100K to cover "free abortions for trans-people". You my friend should sign up to run for the Democratic nomination with gems like that.
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you do realize the 70% proposition wouldn't affect any doctor, right?
 
I'm surprised so many people on this forum would vote for trump's administration for the possibility or maybe even the perception of saving money. Willing to put aside all the sexual abuse, child kidnapping and child abuse at the border, racism, throwing our historic allies under the bus, siding with our political enemies, dodging the draft, over the top litigation, blatant corruption, lies and deceit. It is astounding and disappointing to me how many of us are willing to look the other way in the name or our own greed. And of course this topic is sparked on this forum from a republican bill, misinterpreted here as if this is some sort of progressively left legislation. I just don't get it.
 
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BAM! said:
I'm surprised so many people on this forum would vote for trump's administration for the possibility or maybe even the perception of saving money. Willing to put aside all the sexual abuse, child kidnapping and child abuse at the border, racism, throwing our historic allies under the bus, siding with our political enemies, dodging the draft, over the top litigation, blatant corruption, lies and deceit. It is astounding and disappointing to me how many of us are willing to look the other way in the name or our own greed. And of course this topic is sparked on this forum from a republican bill, misinterpreted here as if this is some sort of progressively left legislation. I just don't get it.
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Yeah...doctors don’t have allies in either party.
 
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Baggend said:
It is July 17... what's the status on this bill at the House Energy Commitee (or whatever it is called)?
I called my rep yesterday to voice my displeasure. Took 30 seconds. More should do it.
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HR 3630 passed. Different than the ones listed earlier, so I'm not really sure what this means
 
BAM! said:
you do realize the 70% proposition wouldn't affect any doctor, right?
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It actually wouldn't affect anyone, as those with that amount of income would be smart enough to dodge the taxes. With no revenue, and the need to fund massive healthcare promises, they will extend the 70% down to us as well. It's guaranteed.
 
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But I just finished residency :( can't this happen 10-20 years from now :(
 
UPDATE -


We had a win in that they added Ruiz's amendment for Independent Dispute Resolution (IDR). This allows for arbitration. If the "benchmark" version passes (which is what is now proposed by Senate), it would cut EM reimbursement by 15-20%! Basically, everyone here making 30-100,000 less per year, and everyone will make less than we were making 3-4 years ago.

Like most things w/ Congress, the win was a mixed-bag b/ they are proposing a threshold of 1250 for arbitration. So you have to have a dispute over 1250 for arbitration, which pretty much makes is worthless for EM, but at very least they can't insert a fee schedule.

It's important everyone gets involved on this and call your Senators and Congressmen and tell them to use Ruiz's version with IDR and not the benchmarking method, or we're all screwed. For all you who rip ACEP and the AMA on this, they're calling the shots and have been all over this for several years, so you can thank them for now for not having a paycut. There's still time for individuals to call and make an impact.

--Edited link--
For more info, check out https://www.acep.org/federal-advocacy/federal-advocacy-overview/acep4u-out-of-network/
 
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Out-of-network billing should be tied to the FAIR Health Database. There are no other options.

The 15-20% paycut that you propose (I haven't seen data on actual numbers) would not occur instantly unless an employer/CMG/SDG decides to stiff its IC's and employees. Current in-network rates would remain as negotiated, and it will take many years to drive down the numbers based on median out-of-network payments. This is not something where the bill passes in 2019, gets signed in 2019, and all of a sudden 2020 has a 20% pay cut.

Remember, the vast majority of emergency care by most providers is provided at the in-network rate. It's better for groups to negotiate with insurers to facilitate easier submission of charges and quicker reimbursement.
 
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BoardingDoc said:
Copying and pasting the link above works, but you've set it so that clicking on it just links back to the first page of this SDN post.
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Fixed

southerndoc said:
Out-of-network billing should be tied to the FAIR Health Database. There are no other options.

The 15-20% paycut that you propose (I haven't seen data on actual numbers) would not occur instantly unless an employer/CMG/SDG decides to stiff its IC's and employees. Current in-network rates would remain as negotiated, and it will take many years to drive down the numbers based on median out-of-network payments. This is not something where the bill passes in 2019, gets signed in 2019, and all of a sudden 2020 has a 20% pay cut.

Remember, the vast majority of emergency care by most providers is provided at the in-network rate. It's better for groups to negotiate with insurers to facilitate easier submission of charges and quicker reimbursement.
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Here's link and here explaining proposed cuts Senate currently support (need Senator Cassidy amendment).
 
MechEDoc said:
I did 23 and me, like Elizabeth Warren, I'm a FAUXCAHONTAS too (<=1%)! Otherwise northern European mutt, when means that I was distant emigrant from Africa, and makes me a >99% African-> Euro-> American + 1% african->siberian (Bering Sea land bridge)->Canadian->American. I just identify as a white guy for census reasons.
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I did it too and did find !% Indian when uploaded to GED. I also uploaded to Promethease to find all my dangerous SNPs.
 
How will this affect other hospital based specialities as well? I don’t really see a lot of talk on it from anesthesiologists, Hospitalists, radiologists or critical care docs. I’m assuming because most of those are typically in network whereas we are out of network?
 
Will there be a pay cap for the 500k a year nurses in California? Probably not, even though someone else will be happy to do the job for 20% of that.
 
kimbosliced said:
How will this affect other hospital based specialities as well? I don’t really see a lot of talk on it from anesthesiologists, Hospitalists, radiologists or critical care docs. I’m assuming because most of those are typically in network whereas we are out of network?
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Probably the only docs immune from this type of thing are those that don't take commercial insurance.
 
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southerndoc said:
Of course not. They think physician costs are way too high and they want to reduce them significantly. They have been very vocal about that. They think it should be near the Medicare reimbursement rate.
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Because they think the solution to the current physician shortage.... is to pay us less? Brilliant.
 
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BoardingDoc said:
Because they think the solution to the current physician shortage.... is to pay us less? Brilliant.
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That doesn’t matter to them. They just want to control what they make while simultaneously bemoaning a fictitious shortage. It’s only a shortage because you don’t want to pay for it.

Why are they so fixated on Medicare rates? I mean they literally are some of the lowest rates out there and they don’t increase with inflation. So over time wouldn’t that also mean that it becomes an increasing multiple of Medicare?

Is it possible Medicare has been pulling rates out of its ass just as much as they claim providers have been doing?

A compromise between the senate bill and the house bill will likely leave both sides unsatisfied. If it passes, EM, gas, and inpatient rads will be in the toilet.
 
RadsWFA1900 said:
That doesn’t matter to them. They just want to control what they make while simultaneously bemoaning a fictitious shortage. It’s only a shortage because you don’t want to pay for it.

Why are they so fixated on Medicare rates? I mean they literally are some of the lowest rates out there and they don’t increase with inflation. So over time wouldn’t that also mean that it becomes an increasing multiple of Medicare?

Is it possible Medicare has been pulling rates out of its ass just as much as they claim providers have been doing?

A compromise between the senate bill and the house bill will likely leave both sides unsatisfied. If it passes, EM, gas, and inpatient rads will be in the toilet.
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That's the beauty of government control. They can pay us all Medicare rates, or even Medicare x 1.25 and they will come out ahead. The reason is that all they have to do to cut costs is not increase this rate with inflation. That means every year a 2% decrease in physicians wages if the rates are held stagnant. After 10 years, they will have effectively cut physician costs by 20% while essentially doing nothing to rates.

I still can't figure out why any physician is on-board with Medicare-for-all. Completely mystifies me, unless their altruism overrides any financial concerns.
 
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GeneralVeers said:
That's the beauty of government control. They can pay us all Medicare rates, or even Medicare x 1.25 and they will come out ahead. The reason is that all they have to do to cut costs is not increase this rate with inflation. That means every year a 2% decrease in physicians wages if the rates are held stagnant. After 10 years, they will have effectively cut physician costs by 20% while essentially doing nothing to rates.

I still can't figure out why any physician is on-board with Medicare-for-all. Completely mystifies me, unless their altruism overrides any financial concerns.
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One of three possibilities:

1) They are independently wealthy or have some other amazing source of income

2) They are a pediatrician and get paid s*** anyway

3) They are stupid
 
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BoardingDoc said:
Because they think the solution to the current physician shortage.... is to pay us less? Brilliant.
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No, they think one of the solutions to healthcare spending is to decrease physician reimbursement. Their solution to the physician shortage is to increase utilization of PA's and NP's.
 
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The sad thing is everyone has focused on balance billing and has completely ignored the true problem: insurance companies tightening their in-network facilities and providers so much that they get out of paying because people are forced to choose out-of-network providers or travel a long distance to see an in-network provider or be treated at an in-network hospital.

This was their plan for a while. Reduce the number of in-network payments, shift costs to the patients for out-of-network billing, and increase their profits for their shareholders.

The real solution is to pass legislation to require insurance companies to have a certain percentage of their local market as in-network.
 
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If it says brookings or even RAND, it’s likely meant to screw you.
 
FYI, neither House nor Senate will vote on this before their August recess:

Senate stalls vote on hospital contract reforms, balance billing

So y'all still have time to call your congresscritters if you have nothing better to do.

I plan to call them. It's my first time doing anything political like this, but now I'm curious about how the whole process works. And it does seem like enough of a short-term threat to our compensation to be worth doing.
 
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southerndoc said:
The sad thing is everyone has focused on balance billing and has completely ignored the true problem: insurance companies tightening their in-network facilities and providers so much that they get out of paying because people are forced to choose out-of-network providers or travel a long distance to see an in-network provider or be treated at an in-network hospital.

This was their plan for a while. Reduce the number of in-network payments, shift costs to the patients for out-of-network billing, and increase their profits for their shareholders.

The real solution is to pass legislation to require insurance companies to have a certain percentage of their local market as in-network.
Click to expand...
This is the real answer. Insurance is so constricting now that you may have to travel hours for any sort of coverage.

Insurance should not be able to restrict coverage so heavily and more egregious is that multiple services may not be in network and the patient really has no recourse for this. The objective should be increasing the scope of insurance coverage.
 
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hundreddaysoff said:
FYI, neither House nor Senate will vote on this before their August recess:

Senate stalls vote on hospital contract reforms, balance billing

So y'all still have time to call your congresscritters if you have nothing better to do.

I plan to call them. It's my first time doing anything political like this, but now I'm curious about how the whole process works. And it does seem like enough of a short-term threat to our compensation to be worth doing.
Click to expand...

Is there any chance this is to let the political fervor surrounding this die down and then maybe there won't even be a vote on this? Or do people think this will immediately be on the docket when they resume?
 
aafisahar said:
This is the real answer. Insurance is so constricting now that you may have to travel hours for any sort of coverage.

Insurance should not be able to restrict coverage so heavily and more egregious is that multiple services may not be in network and the patient really has no recourse for this. The objective should be increasing the scope of insurance coverage.
Click to expand...

But then insurance costs would go up. One of the ways that insurance companies under the ACA were able to keep costs somewhat low despite being forced to provide a massive array of mandatory services was by narrowing their network. If insurance costs go up more, it gives cover to those espousing Medicare-for-all.
 
GeneralVeers said:
If insurance costs go up more, it gives cover to those espousing Medicare-for-all.
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Intriguing. I wonder if the insurance company C-suites realize this. If they do realize it, I wonder which of the two next possible steps in the logic chain they follow: (1) they shouldn't try to have it all because then the government would take it all from them, or (2) they'll just use their mad crony capital skillz to have it all anyway under Medicare-for-all.

Or is there a possibility #3? Maybe (3) take as much as possible now and then retire to a private island in a few years and make it someone else's problem?
 
hundreddaysoff said:
Intriguing. I wonder if the insurance company C-suites realize this. If they do realize it, I wonder which of the two next possible steps in the logic chain they follow: (1) they shouldn't try to have it all because then the government would take it all from them, or (2) they'll just use their mad crony capital skillz to have it all anyway under Medicare-for-all.

Or is there a possibility #3? Maybe (3) take as much as possible now and then retire to a private island in a few years and make it someone else's problem?
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#3. They only care about yearly bonus and stock options since the tenure of the average CEO is around 5 years.
 
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hundreddaysoff said:
Intriguing. I wonder if the insurance company C-suites realize this. If they do realize it, I wonder which of the two next possible steps in the logic chain they follow: (1) they shouldn't try to have it all because then the government would take it all from them, or (2) they'll just use their mad crony capital skillz to have it all anyway under Medicare-for-all.

Or is there a possibility #3? Maybe (3) take as much as possible now and then retire to a private island in a few years and make it someone else's problem?
Click to expand...

We'll never go to just Medicare for all b/c Health Insurance is over $1 Trillion dollar business in US. Congress would never make a $1Trillion business disappear. We might see some hybrid system if enough D's take over (that's essentially what Obamacare was, but we screwed the pooch so bad on it that we basically only got portions of it, many of them bad). Rest assured, doctors and hospitals will be left holding the bag.

GonnaBeADoc2222 said:
Is there any chance this is to let the political fervor surrounding this die down and then maybe there won't even be a vote on this? Or do people think this will immediately be on the docket when they resume?
Click to expand...

From what everyone is saying, there will definitely be a vote and something will pass before November. Both R's and D's want this, and even Trump has said as much.

southerndoc said:
The sad thing is everyone has focused on balance billing and has completely ignored the true problem: insurance companies tightening their in-network facilities and providers so much that they get out of paying because people are forced to choose out-of-network providers or travel a long distance to see an in-network provider or be treated at an in-network hospital.

This was their plan for a while. Reduce the number of in-network payments, shift costs to the patients for out-of-network billing, and increase their profits for their shareholders.

The real solution is to pass legislation to require insurance companies to have a certain percentage of their local market as in-network.
Click to expand...

If the current senate version passes with Benchmarking, they won't need to improve their InNetwork markets, b/c Out of network will no longer exist. Basically everyone will be "In Networ", b/c that's the only rates they'll have to pay. Technically it's 125% of Median Innetwork, but all they'll do is lower the average rates of In-Network until the median drops below what the old Median InNetwork rate was.

If benchmarking passes, everyone on this forum is taking a 20-40% paycut. It says as much in the CBO estimate. Everyone needs to push their representatives to pass IDP (Ruiz/Roe) or else we are screwed.
 
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Sent emails and called congresspeople - got an automated email back a couple weeks later basically like "Thanks for your opinion, I'm voting for the ******y plan, f*** you."
 
sum dude said:
We'll never go to just Medicare for all b/c Health Insurance is over $1 Trillion dollar business in US. Congress would never make a $1Trillion business disappear. We might see some hybrid system if enough D's take over (that's essentially what Obamacare was, but we screwed the pooch so bad on it that we basically only got portions of it, many of them bad). Rest assured, doctors and hospitals will be left holding the bag.



From what everyone is saying, there will definitely be a vote and something will pass before November. Both R's and D's want this, and even Trump has said as much.



If the current senate version passes with Benchmarking, they won't need to improve their InNetwork markets, b/c Out of network will no longer exist. Basically everyone will be "In Networ", b/c that's the only rates they'll have to pay. Technically it's 125% of Median Innetwork, but all they'll do is lower the average rates of In-Network until the median drops below what the old Median InNetwork rate was.

If benchmarking passes, everyone on this forum is taking a 20-40% paycut. It says as much in the CBO estimate. Everyone needs to push their representatives to pass IDP (Ruiz/Roe) or else we are screwed.
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Lol you will never need a network anymore! Literally would make insurance obsolete. Pay trillions of dollars to the to the govt and insurance companies Just so they can set a price.
 
GonnaBeADoc2222 said:
Sent emails and called congresspeople - got an automated email back a couple weeks later basically like "Thanks for your opinion, I'm voting for the ******y plan, f*** you."
Click to expand...

I think maybe these hospital based specialties might be better off coming up with can contingency plans.
 
Nice article in Modern Healthcare regarding California's balance billing law. They enacted exactly what several federal versions are trying: median in-network rate or 125% of Medicare rate, whichever is highest. As expected, insurers are now using a "take it or leave it" approach to negotiations and provider reimbursements are going down. California surprise billing law takes spotlight in federal fight

We really need to stay on top of this and voice our opinion to our legislators. FAIR Health Database is the only way to go.
 
southerndoc said:
Nice article in Modern Healthcare regarding California's balance billing law. They enacted exactly what several federal versions are trying: median in-network rate or 125% of Medicare rate, whichever is highest. As expected, insurers are now using a "take it or leave it" approach to negotiations and provider reimbursements are going down. California surprise billing law takes spotlight in federal fight

We really need to stay on top of this and voice our opinion to our legislators. FAIR Health Database is the only way to go.
Click to expand...

So currently, if one averages all of the reimbursements across all patients (with private insurance, govt insurance, and no insurance), is the average reimbursement > 125% of Medicare rate?

Edit #1: Also, can you post the content of the article above? It's for subscribers only.

Edit #2: I think I found a copy of it searching the web
 
thegenius said:
So currently, if one averages all of the reimbursements across all patients (with private insurance, govt insurance, and no insurance), is the average reimbursement > 125% of Medicare rate?
Click to expand...

The answer to that will depend largely on your payor mix.
 
Hercules said:
The answer to that will depend largely on your payor mix.
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I figured it would....and I'm aware there is no one answer to fit all providers. it all depends on what you or your CMG / SDG were able to negotiate on your behalf.

I guess the implication of this is that most private insurers pay > 125% because of all the hoopla around this.

Does Medicare / CMS pay about $38/RVU?
 
Physicians not knowing what they are being reimbursed is one of the reasons we are in this predicament. Ask any other group, except maybe the hospitalist, and they can tell you roughly how each insurer reimburses them.

We really need to be better.
 
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