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

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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.

Physicans really should pay more attention to it. But instead they put there head in the sand and basically lament about how “they just wanna practice medicine” little do they understand that when they do that they are opening themselves up to exploitation from everyone else and guess what? At somepoint they’ll be telling you how to practice now.

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Insurance companies have already started a take it or leave it approach. They are already starting to cancel contracts before balance billing legislation passes. This will drive down the median in-network rate signifciantly.

On another note, the House opened an investigation into the private equity firms behind some of the big CMG's. Should get interesting. It seems the insurance companies are pushing it more and more for ways to make physicians look like the bad guys. It's the insurance companies who drive down in-network rates and force physicians out of contracts so they can maintain their huge profits.
 
Cigna knows how to get the journalists to make them look good and the “independent doctors” of Apollo MD look bad. Hard to imagine it’s only 400 docs in the whole state though. Southern doc is that right? 400 docs?
 
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Cigna knows how to get the journalists to make them look good and the “independent doctors” of Apollo MD look bad. Hard to imagine it’s only 400 docs in the whole state though. Southern doc is that right? 400 docs?

That's probably correct, although I can't say with certainty. People on SDN think ApolloMD is larger than it is.
 
So I emailed my senators and congressman, one of them happens to be John Cornyn of TX. Here was his response:




Thank you for contacting me regarding surprise medical bills. I appreciate having the benefit of your comments on this important matter.

Patients should not be caught in the middle of billing disputes between an insurance company and a healthcare provider. Instead of burdening a patient with a surprise medical bill, health insurance companies and healthcare providers should come to a resolution for the balanced bill. I am encouraged the Texas Legislature enacted a law removing patients from the billing conflict process by requiring insurers and medical providers to come to resolve their dispute without imposing additional burdens to the patient.

I believe Congress should take similar action to protect patients from surprise medical bills. The Lower Health Care Costs Act (S. 1895) would prohibit medical facilities and physicians from sending patients a medical bill for more than the in-network cost-sharing amount. This legislation would also protect patients from surprise bills in a medical emergency. S. 1895 passed the Senate Committee on Health, Education, Labor, and Pensions on June 26, 2019, and awaits consideration by the full Senate. I look forward to working with my colleagues to enact legislation so that patients will no longer have to worry about surprise medical bills and can focus on their health.

I appreciate the opportunity to represent Texas in the United States Senate. Thank you for taking the time to contact me.

Sincerely,

JOHN CORNYN
United States Senator


....Thoughts?
 
Still doesn't tie payments with the FAIR Health Database, which is an independent claims database.

I'm hoping this doesn't pass this year. If it does, there will be federal lawsuits that will tie up the legislation for years. Several organizations are already working on it as they believe it is illegal to mandate a payment amount while mandating EMTALA requirements.

The Doctor Patient Unity funding from the private equity firms don't help our situation any.
 
What’s the most up to date news on the balanced billing legislation?
 
CMGs aren’t going anywhere because of this. They’ll just replace docs with MLPs and cut salaries. That’s it. They have already planned for this scenario.
 
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CMGs aren’t going anywhere because of this. They’ll just replace docs with MLPs and cut salaries. That’s it. They have already planned for this scenario.
A few years back it was tough to find a decent MLP, the demand for them was sky high. Now there is a glut of them..... ready to replace EM Docs especially those who dont abide by the CMG overlords demands.
 
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A few years back it was tough to find a decent MLP, the demand for them was sky high. Now there is a glut of them..... ready to replace EM Docs especially those who dont abide by the CMG overlords demands.

they dont care about patients or employees just going out of bussiness. If they have to sell their souls and the souls of their children to Satan to make it run they will absolutely do it if the numbers work out.
 
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Just saw that on my feed. Get out there and fight it. The bottom line is payers are trying to get you to accept whatever they feel like giving you under the guise of protecting the patient. Median in network rates can be gamed by payers and they do not allow physicnas to discuss rates with other providers.

Idk about you but I’d pull out all the stops on this one.
 
I got templated emails back from mine. Might as well have been signed by the insurer's PR departments.
I called mine and they didn't care. The insurance industry donates a bajillion dollars to line congressional pockets. We lost.

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Time to start replacing my physician income. If I'm smart enough to become a physician, I'm smart enough to excel at something else.
 
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New “compromise” will lead to rate setting based on benchmarking not IDR/FAIR. This may lead to as much as a 40% cut in take home pay. Please call your elected officials.

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I'm still premed obviously, but what's the big deal? I guess I can see this leading to having all doctors with the same fees whether in network or out of network.
 
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Will this bill translate into the reimbursement rates across all of medicine or is it confined to EM reimbursements?
 
...big deal because you are bound by EMTALA. Basically a patient shows up and your eval should be billed at $600, but Big Insurance Co. says, "nah, we're going to pay you $450". You are going to have to accept that rate. There basically will be no negotiating what you feel should be appropriate. After Big Insurance Co. says $450, then Dick Insurance Co. says, "hey, the benchmark is now $450", that is what we are going to pay. Just keep doing this scenario year after year.

This is hugely important, basically allowing insurance companies to define what we should be able to charge, instead of negotiation.

Please please please call your rep, or decide if you want to change jobs.
 
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...big deal because you are bound by EMTALA. Basically a patient shows up and your eval should be billed at $600, but Big Insurance Co. says, "nah, we're going to pay you $450". You are going to have to accept that rate. There basically will be no negotiating what you feel should be appropriate. After Big Insurance Co. says $450, then Dick Insurance Co. says, "hey, the benchmark is now $450", that is what we are going to pay. Just keep doing this scenario year after year.

This is hugely important, basically allowing insurance companies to define what we should be able to charge, instead of negotiation.

Please please please call your rep, or decide if you want to change jobs.
Ok I understand it a bit better now. Thank you
 
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Essentially it is a gift of power to insurance companies. They will no longer have incentive to negotiate contracts or play nice with ED, or other hospital based care.

Like most all laws passed, they start out with good intentions, but the ripple effect leaves waves of unintended destruction.
 
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The alternative bills are not much better, but at least they give docs more power with arbitration. I think we’ll all be taking a cut regardless, but 1-4% obviously much different than 10-40%.
 
Does it actually do anything though

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Yes. Silence on each of our parts constitutes agreement to the proposed anti-physician plan. Please click the button. Even if it may wind up being futile in the end, how many actions do you already take that are clearly medically futile in the name of patient care? Do this one (potentially) futile action in the name of physician care.
 
Of course I clicked the button. I just don't think it does anything.

I called my reps and emailed them in the summer. Got a "idc" response from one. Their pockets are lined by United and Anthem, they don't give a **** about us.
Yes. Silence on each of our parts constitutes agreement to the proposed anti-physician plan. Please click the button. Even if it may wind up being futile in the end, how many actions do you already take that are clearly medically futile in the name of patient care? Do this one (potentially) futile action in the name of physician care.

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They may give a **** when we peace out of the profession. I certainly will if there is a substantial pay cut, despite being less than 1 year out from residency. I have a list of backup plans and business ideas. Adios.
 
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They may give a **** when we peace out of the profession. I certainly will if there is a substantial pay cut, despite being less than 1 year out from residency. I have a list of backup plans and business ideas. Adios.

Sadly, this represents one of the best hopes for our field if conditions get worse. A mass exodus of well-trained EM docs, and the resulting fallout, is one of the few things that will get everybody's attention.
 
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They may give a **** when we peace out of the profession. I certainly will if there is a substantial pay cut, despite being less than 1 year out from residency. I have a list of backup plans and business ideas. Adios.

Good on you! I'm glad that some younger docs are going into this clear-eyed and clearheaded. Medicine just does not offer the stability, prestige, income, or satisfaction it once did, and there is no reason to feel wedded to the field or to stay at a lower salary.
 

This has some interesting thoughts.

Some take aways:

1) Call your representative's home district office (not just their DC one).
2) Show up to a town hall meeting.

Elsewhere I've read that in order of decreasing effectiveness:

1) In person meeting (town hall, or ask if you can schedule an appointment).
2) Phone call to home office
3) Phone call to DC office
4) Snail mail letter
5) Email (does not get read)
 
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Sadly, this represents one of the best hopes for our field if conditions get worse. A mass exodus of well-trained EM docs, and the resulting fallout, is one of the few things that will get everybody's attention.
Good on you! I'm glad that some younger docs are going into this clear-eyed and clearheaded. Medicine just does not offer the stability, prestige, income, or satisfaction it once did, and there is no reason to feel wedded to the field or to stay at a lower salary.

Gut check time. People on here love to anonymously hem and haw and scream and say how they'll quit and this and that if the worst outcome secondary to this legislation comes true. I don't believe any of it. You'll keep working for 130/hr because you have no alternative. We are not trained for anything else. Sure the peri-retired folks or even the FIRE folks that figured they were 10 years away from retirement might jump ship. The 1% of docs that are truly creative and savvy will be able to reinvent themselves. Maybe another 1% will go off and do a fellowship (this is a small possibility for me).

The rest of us (residency graduation within past 10 yrs) will be ****ed.

And even if there is some magical mass exodus, take a look at the med student and pre med sub forums. There's just tons of ***** sheep lining up for the slaughter.
 
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Gut check time. People on here love to anonymously hem and haw and scream and say how they'll quit and this and that if the worst outcome secondary to this legislation comes true. I don't believe any of it. You'll keep working for 130/hr because you have no alternative. We are not trained for anything else. Sure the peri-retired folks or even the FIRE folks that figured they were 10 years away from retirement might jump ship. The 1% of docs that are truly creative and savvy will be able to reinvent themselves. Maybe another 1% will go off and do a fellowship (this is a small possibility for me).

The rest of us (residency graduation within past 10 yrs) will be ****ed.

And even if there is some magical mass exodus, take a look at the med student and pre med sub forums. There's just tons of ***** sheep lining up for the slaughter.

Do not be falsely led to believe that your training only allows you to work in an ED. A residency-trained EM doc has MANY other options.

I work 1/2 time outside of the ED. And I'm hardly unique in that regard.

You DO have the knowledge/skills/ability to do things other than RunACodeTurkeySandwichWorkNote. Gut check time.
 
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What do you do?
Do not be falsely led to believe that your training only allows you to work in an ED. A residency-trained EM doc has MANY other options.

I work 1/2 time outside of the ED. And I'm hardly unique in that regard.

You DO have the knowledge/skills/ability to do things other than RunACodeTurkeySandwichWorkNote. Gut check time.

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Do not be falsely led to believe that your training only allows you to work in an ED. A residency-trained EM doc has MANY other options.

I work 1/2 time outside of the ED. And I'm hardly unique in that regard.

You DO have the knowledge/skills/ability to do things other than RunACodeTurkeySandwichWorkNote. Gut check time.
What do you do outside the ED?
 
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What do you do?

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What do you do outside the ED?

I have to maintain some anonymity. But it's 9-5, no nights, no weekends, no holidays. I have time off to eat lunch, am never rushed to complete a task, almost always get out on time, and never take work home with me.

There are too many possibilities to list, but you'll find many options discussed if you search on this forum and on the EM docs and Physician Nonclinical Career (and other similar groups) on Facebook.
 
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This legislation is the real deal (i.e. bad).
Bad enough that our SDG is sending out the call to action to everyone in the group to hammer call our senators and reps and working with our major local competitor to make sure they're doing the same. Let's just say they don't usually work with us in a collegial fashion (aside from politics).
 
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The CMGs are going nuts too.

This is balls to the wall time folks.

I already sent the emails. I called in the Summer and I'll be calling again this week.

Time to save the Alliance from the Empire.
This legislation is the real deal (i.e. bad).
Bad enough that our SDG is sending out the call to action to everyone in the group to hammer call our senators and reps and working with our major local competitor to make sure they're doing the same. Let's just say they don't usually work with us in a collegial fashion (aside from politics).

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I'm still premed obviously, but what's the big deal? I guess I can see this leading to having all doctors with the same fees whether in network or out of network.

Here's the breakdown (simplified numbers, but pretty close to average numbers):
25% your patients pay nothing
25% pay Medicaid, which for a level 5 reimbursement is like $80
25% pay Medicare, which for a level 5 is $170
25% are commercial payers.

Where do you guys think we get paid those wonderful numbers people like to boast on this very forum? In the US, EMTALA is funded by commercial payors. Insurances decided they've had enough, now want to remove that. They want to pay us at Median In-Network rates, which basically means you'll have to take whatever the rate falls to after 10 years. Congress CBO predicts that to save $20-25 Billion.

So to recap, 75% of patients you see reimburse less than your hourly, and Congress wants to cut your pay (and all PEAR--path, em, anesthesia, radiology) by $20-25Billion next 10 years.

This is a pretty big F&$ing deal.
Doctors need to learn about how they make their wages and learn to defend them or their going to be taken to the cleaners over the next 10 years.
 
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