Implications of new health plan for PM&R?

[topwise]

Someone else posed this question yesterday and it got moved, but since I think it is an important question, maybe it's better to post it in a more neutral way:

I am curious what everyone, especially those already out in practice, thinks that the implications of the new health care reform will be for PM&R, if it eventually passes. Personally, I can see possible ways it might hurt us and also how it might be beneficial. But really, I'm not sure.

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[RUOkie]

I honestly don't know. I fear for a single payer system since then we are stuck. IMO, this current bill will not impact me at all (except for possibly covering more people, so less charity care) in the short term. I am very concerned for the long term. Unless the 21% medicare cut is fixed (permanently), I will stop seeing medicare and medicaid in my office (likely I will see pts on one occasion/EMGs and send back to PCP). I run a bare bones solo practice, and will lose money on Care/Caid follow ups if we are cut that drastically. The govt will not allow docs to stop seeing these pts.

If the cuts are not made, then our country is screwed since we can't pay for this. I am not concerned for me, but I am for the next generation.

If young adults are do not have a chance at making a good living, Med Schools will not attract the best and brightest anymore.

Regarding PM&R, I think that ultimately, the inpt docs will all be hospital employees (and paid as part of the DRG) or contractors. I would then never set foot in a hospital again.

 

[GoldieLox]

Well, ladies and gentleman, history has been made, and the health care reform bill is now the law of the land!

 

[rysa4]

Well, ladies and gentleman, history has been made, and the health care reform bill is now the law of the land!

Well here's whats in the health bill:

1. Doctors are no longer allowed to own or expand any health care facilities after August 10th, 2010.
2. Money is moved from Medicare to non-Medicare subsidies, thus decreasing benefits to Medicare recipients who have paid Medicare taxes their entire working lives.
3. A medical advisory panel will set medicare rates. 2 weeks ago a plastic surgeon who does Breast reconstruction, including re-vascularization, was told her procedure would be set to $400 ( some of these go for 6-9 hours).
4. Doctors medicare tax rates just went up.



So yay right? Since everyone is becoming dependent on a federal government with no financial future and a declining currency, who is going to bail the government out?

 

[GoldieLox]

I have accumulated debt and I worry about paying it off as well. I guess Obama said it well yesterday when he talked about why people chose to be a Democrat. I think the reasons why I am a Democrat have a lot to do with why I chose to be a doctor. That there is a strong desire for me to do what benefits society and what benefits those less fortunate than me. I really did not go into medicine for money. Not an ounce of me did. Really. I want to feed my family and I want to have a roof over my family's head. I completely understand how many doctors would feel differently and would expect and feel entitled to more. A huge part of my feelings have to do with the fact that I have had people very close to me who have fallen through the cracks. My aunt is 50 and has never had a mammogram. She's not dirt poor but she owns a small family business and I can tell you she cannot afford the nearly $1000 a month premiums to insure her family, her husband with a preexisting condition, and her 3 children. Yes in this case, her mortgage and her car payment which she uses to work and take her kids to school takes priority. And people call that irresponsible. She doesnt qualify for Medicaid, but she cant afford the insurance. I've had people very close to me with emergent hospitalizations. Sadly, they probably never would have been hospitalized if they had access to affordable health insurance so they could have managed their hypertension and diabetes at home, and instead of the low cost preventive care, they are stuck with thousands of dollars of hospital bills. And when you dont have insurance, the hospitals dont give them a penny's break. They charge you MORE than if you did have insurance and they hire bad a** collectors to call your home and stalk you at your home, and if you dont pay up, expect a law suit and a lien on every asset that you have. The thing is, this bill hits really close to home. I know what its like to fall between the cracks and have people call you irresponsible for not having health insurance.

I have had to read my personal statement to myself many times during my medical training because at that point, young, and in college, I know I was not yet tainted by "real" medicine. I've watched attendings give patients the boot (without the typical 24 hour discharge notice to families) because the insurance just called and said it ran out. Ive seen Medicare reimburse providers $300 for a CT scan, and Ive seen that same provider charge someone $3000 knowing very well they could never afford it because they are paying out of pocket. Is this fair? I am not an economist and I'm not a politician. I dont know all the 2000 plus pages of details of this bill. But I do know why I chose to be a doctor and I know that I will never starve as one. I just want to make sure what I do is as equally accessible to everyone.

We chose this profession because it is indeed a service profession. We are in the same line of work as teachers, firefighters, police officers. People often compare what we do to lawyers, or dentists, or MBAs, and say why do lawyers and MBAs get to make this much money straight of school, or get to charge this much per hour and we dont, but to me, what we do, it's different. I do agree that we work really hard, give up a lot of years of our youth to help people and sacrifice to take care of people, and our pay should be reflective of this. I understand to some, it may not be, and this bill may compromise that even further. But to me, I will always be doing something that I love, that I aspired all my life to do and be, but I do not want anyone to be neglected of care. My heart aches for all the women out there who have not had mammograms because they dont have health insurance. It aches for all the folks who have lost their jobs and their health insurance for their entire family. I pay 10% of my income to charity. I do not mind paying more taxes to help those less fortunate than myself and I do not mind my taxes being spent for social programs and that is what makes me a Democrat. Perhaps I am not the right person to ask about this because it hits too close to home.

I have the best job in the world and I always will. Whenever I get dismayed, I reread my personal statement to remind myself why I went into medicine. It has helped me keep perspective. I know I will never starve and I know I will always have a respectable home for me and my family and what I make will continue to be in the top 10% of Americans. I cant ask for more than that when I get to do what I love to do on top of that! I look forward to the day I can afford to do what I do for free for some people. I am excited about how wonderful that would make me feel.

As an American, as a Christian, as a Democrat, as a woman, as a doctor, I am proud and hopeful that this bill will serve our country well.

 

[MSKalltheway]

I've watched attendings give patients the boot (without the typical 24 hour discharge notice to families) because the insurance just called and said it ran out. Ive seen Medicare reimburse providers $300 for a CT scan, and Ive seen that same provider charge someone $3000 knowing very well they could never afford it because they are paying out of pocket. Is this fair?

I've seen these things too (I think we all have) but you should know why they happen. Maybe you do know this; pressure on physicians from hospitals can be a great motivating factor, and although that attending could have said I'm just gonna man up and keep the patient in the hospital, it's a bit different when you think that you could lose your job as a result and then YOUR family is the one without health insurance.

About the $3000 CT scan? It's in the law that what you charge for one person must be charged to everyone. You see insurance reimburse $300 for the CT scan, but that means that provider charged $3000 to the insurnance company too! To avoid getting into trouble for being discriminatory, that provider still has to charge $3000, insurance or not (someone may jump in to correct me if I'm wrong, this is my understanding of the laws).

I think the real problem is insurance companies. Why are the CEOs making millions and millions, and managers making 300-400K, while primary care struggles to make 150K??? The argument that physicians in other countries make less is poor. They don't have to pay for their education and it's not as long, simply put. If these companies were not for profit, you'd have tons of money to pay physicians appropriately and insure everyone. The President has very good intentions in trying to get everyone health care, but this is probably not the right way. The problem is they listened to insurance on how to do things...

Things may be better if insurance was not for-profit, of there was significant tort reform, and if people would look in the mirror and stop smoking, would eat properly and in moderation, and exercise. Then there would be tons of money to make everyone happy.

 

[topwise]

I have accumulated debt and I worry about paying it off as well. I guess Obama said it well yesterday when he talked about why people chose to be a Democrat. I think the reasons why I am a Democrat have a lot to do with why I chose to be a doctor. That there is a strong desire for me to do what benefits society and what benefits those less fortunate than me. I really did not go into medicine for money. Not an ounce of me did. Really. I want to feed my family and I want to have a roof over my family's head. I completely understand how many doctors would feel differently and would expect and feel entitled to more. A huge part of my feelings have to do with the fact that I have had people very close to me who have fallen through the cracks. My aunt is 50 and has never had a mammogram. She's not dirt poor but she owns a small family business and I can tell you she cannot afford the nearly $1000 a month premiums to insure her family, her husband with a preexisting condition, and her 3 children. Yes in this case, her mortgage and her car payment which she uses to work and take her kids to school takes priority. And people call that irresponsible. She doesnt qualify for Medicaid, but she cant afford the insurance. I've had people very close to me with emergent hospitalizations. Sadly, they probably never would have been hospitalized if they had access to affordable health insurance so they could have managed their hypertension and diabetes at home, and instead of the low cost preventive care, they are stuck with thousands of dollars of hospital bills. And when you dont have insurance, the hospitals dont give them a penny's break. They charge you MORE than if you did have insurance and they hire bad a** collectors to call your home and stalk you at your home, and if you dont pay up, expect a law suit and a lien on every asset that you have. The thing is, this bill hits really close to home. I know what its like to fall between the cracks and have people call you irresponsible for not having health insurance.

Agree with this.

I am totally on board sacrificing some of my paycheck so that others can have health insurance. I don't live the high life and after paying my basic expenses, I figure everything else is cake. My only worry is not having a job at all if somehow the changes result in inpatient rehab being denied. I didn't go into medicine to be unemployed.

 

[rysa4]

I have accumulated debt and I worry about paying it off as well. I guess Obama said it well yesterday when he talked about why people chose to be a Democrat. I think the reasons why I am a Democrat have a lot to do with why I chose to be a doctor. That there is a strong desire for me to do what benefits society and what benefits those less fortunate than me. I really did not go into medicine for money. Not an ounce of me did. Really. I want to feed my family and I want to have a roof over my family's head. I completely understand how many doctors would feel differently and would expect and feel entitled to more. A huge part of my feelings have to do with the fact that I have had people very close to me who have fallen through the cracks. My aunt is 50 and has never had a mammogram. She's not dirt poor but she owns a small family business and I can tell you she cannot afford the nearly $1000 a month premiums to insure her family, her husband with a preexisting condition, and her 3 children. Yes in this case, her mortgage and her car payment which she uses to work and take her kids to school takes priority. And people call that irresponsible. She doesnt qualify for Medicaid, but she cant afford the insurance. I've had people very close to me with emergent hospitalizations. Sadly, they probably never would have been hospitalized if they had access to affordable health insurance so they could have managed their hypertension and diabetes at home, and instead of the low cost preventive care, they are stuck with thousands of dollars of hospital bills. And when you dont have insurance, the hospitals dont give them a penny's break. They charge you MORE than if you did have insurance and they hire bad a** collectors to call your home and stalk you at your home, and if you dont pay up, expect a law suit and a lien on every asset that you have. The thing is, this bill hits really close to home. I know what its like to fall between the cracks and have people call you irresponsible for not having health insurance.

I have had to read my personal statement to myself many times during my medical training because at that point, young, and in college, I know I was not yet tainted by "real" medicine. I've watched attendings give patients the boot (without the typical 24 hour discharge notice to families) because the insurance just called and said it ran out. Ive seen Medicare reimburse providers $300 for a CT scan, and Ive seen that same provider charge someone $3000 knowing very well they could never afford it because they are paying out of pocket. Is this fair? I am not an economist and I'm not a politician. I dont know all the 2000 plus pages of details of this bill. But I do know why I chose to be a doctor and I know that I will never starve as one. I just want to make sure what I do is as equally accessible to everyone.

We chose this profession because it is indeed a service profession. We are in the same line of work as teachers, firefighters, police officers. People often compare what we do to lawyers, or dentists, or MBAs, and say why do lawyers and MBAs get to make this much money straight of school, or get to charge this much per hour and we dont, but to me, what we do, it's different. I do agree that we work really hard, give up a lot of years of our youth to help people and sacrifice to take care of people, and our pay should be reflective of this. I understand to some, it may not be, and this bill may compromise that even further. But to me, I will always be doing something that I love, that I aspired all my life to do and be, but I do not want anyone to be neglected of care. My heart aches for all the women out there who have not had mammograms because they dont have health insurance. It aches for all the folks who have lost their jobs and their health insurance for their entire family. I pay 10% of my income to charity. I do not mind paying more taxes to help those less fortunate than myself and I do not mind my taxes being spent for social programs and that is what makes me a Democrat. Perhaps I am not the right person to ask about this because it hits too close to home.

I have the best job in the world and I always will. Whenever I get dismayed, I reread my personal statement to remind myself why I went into medicine. It has helped me keep perspective. I know I will never starve and I know I will always have a respectable home for me and my family and what I make will continue to be in the top 10% of Americans. I cant ask for more than that when I get to do what I love to do on top of that! I look forward to the day I can afford to do what I do for free for some people. I am excited about how wonderful that would make me feel.

As an American, as a Christian, as a Democrat, as a woman, as a doctor, I am proud and hopeful that this bill will serve our country well.

All of this is just fine, except you haven't read the bill and don't understand its implications for medicine. You have written a cogent but emotional treatise, but this bill runs counter to your stated interests. Read the bill and think about the implications. A situation where families making 88,000 or less have an option of medicaid isn't helpful. We have GREAT medical care in the US, unless you don't have health insurance, in which case you can still get good care. The solution was to raise the eligibility age of Medicare by two years, and , frankly, price fix pharmaceuticals to rest of world pricing for a start. The savings would have been enormous ( probably 100 billion a year on these two alone) -- and then the government could have bought and paid for private policies as a group purchaser for 20 million people a year and still saved money. I could go on but whats the point? Forcing young healthy people to spend money in this economy doesn't make sense either. This is about transferring money from people who work to those that don't, and encourages dependence on a financially failing government. Exactly the wrong direction.

 

[rysa4]

I have had to read my personal statement to myself many times during my medical training because at that point, young, and in college, I know I was not yet tainted by "real" medicine. I've watched attendings give patients the boot (without the typical 24 hour discharge notice to families) because the insurance just called and said it ran out. Ive seen Medicare reimburse providers $300 for a CT scan, and Ive seen that same provider charge someone $3000 knowing very well they could never afford it because they are paying out of pocket. Is this fair? I am not an economist and I'm not a politician. I dont know all the 2000 plus pages of details of this bill. But I do know why I chose to be a doctor and I know that I will never starve as one. I just want to make sure what I do is as equally accessible to everyone.
.

. And why would this change with the health care reform bill? Answer; It won't. The health reform bill sets up an incredibly draconion advisory board that will discourage/eliminate certain procedures for all patients except those that pay cash. It will separate the haves from the have nots in a way that will increase tension in our society. And it will decrease drastically the number of physicians who can practice independently. Moreover, it will eliminate jobs in health care. You as a doc won't ever have to worry about your next meal, but people who would have been your employees will. Health care was safeguard of the middle class in the uS. And the middle class is all that prevents us from slipping into socialism. The health care reform bill is basically yet another attack on the middle class.

 

[RUOkie]

GoldiLox, I started out just like you. On a philisophical level, I agree with you still. The big but is that these kind of changes are going to bancrupt our states. Already,I don't know what Okahoma will do. Rep Ryan from MN had a great proposal which expanded coverage and was paid for. But the special interests would not go for it. I am increasingly disgusted with our govt. and dispair for future generations.

 

[GoldieLox]

Live Now on CNN.com

Doctors for America briefing with the President of all the major professional organizations, AAFP, AAP, etc supporting the health care reform bill. May I ask, where is AAPMR President (was he there)?

"When you stand in strength, you allow others to find you. All of you represent the hope of a better system. Allow yourselves to be an inspiration to your colleagues... This is a turning point for our profession.."

The bill is not perfect. But it is a start. Why do I compare myself to teachers and police officers? Because our children have a human right to quality education, a human right to protection from harm, and a human right to health care. Heck even when your life and capital punishment is on the line, this country gives you a free public defender. Health care is no different.

When you know someone that Dr. Lori Heim, President of AAFP talks about, that is in the ICU, and didnt have to be there if she could afford a $4 hypertension medication, then the bill takes on personal value.

 

[GoldieLox]

Read the bill and think about the implications. A situation where families making 88,000 or less have an option of medicaid isn't helpful.

Au contraire. I can count on two hands the families I personally know that will be helped by this target population of the bill. Please explain why this isn't helpful.

We have GREAT medical care in the US, unless you don't have health insurance, in which case you can still get good care.

Have you ever been hospitalized without health insurance. Of course, we do not turn away people who do not have health insurance. But have you gone home from a hospital stay with hundreds of thousands of dollars to pay in bills waiting for you that you cannot afford? And don't worry, you can only ignore them for so long before they come after you for every penny you own and worked your entire life to build.

 

[axm397]

I agree with the concept of covering everyone. I also think people should have catastrophic coverage for exactly what goldielox describes (bankrupsy from hospitalization bills). I have been uninsured in the past and so have my family members and friends so I do know the pain of medical debt and the repurcussions of poor health. I have also lived in other countries with national healthcare and have seen the pros and cons of that type of system.

However, unique to the U.S. is the issue of frivolous law suits. Without tort reform true healthcare reform cannot happen. Goldielox is too young in her training to have been sued or have had the experience of trying to help an uninsured patient only to be bitten in the butt by those same patients. When i was in med school during my 6 wk ob-gyn rotation, there was at least one lawsuit per week. One was an uninsured woman who came in through the ER and ultimately gave birth to a premature baby then sued the hospital for the prematurity of the baby and the resultant disability. Another woman smoked marijuana and cocaine and barely got prenatal care then sued when her infant had respiratory issues.

I also see patients who claim they can't afford their blood pressure meds somehow able to afford their pain medication and to get their hair and nail done professionally every week. Those are the same ppl who have flat screen TVs, designer bags, and nice cars.

When I do see a truly grateful and motivated self-pay patient, I do my best to keep their cost down and even do some things pro-bono. These are the most gratifying patients to treat and it reminds me of why I am a physician. Unfortunately, those patients are rare.

It's easy to judge people when u have not experienced being an attending physician, getting sued, or having to support not just your family but your employees' families. I do agree that true healthcare reform is necessary but I do not agree with the way this is being done through this bill full of "political favors", no tort reform, no solution for SGR, no solution for decreasing cost, and no increase in individual responsibiltiy. I do think that there needs to be more self-policing and aggressive prosecution of fraud in medicine and that physicians and hospitals need to do their part in reforming healthcare. However, as long as patients do not take individual responsibility, attourneys file frivilous law suits, and insurance companies deny coverage and make clinical decisions instead of physicians, we won't be able to have true reform.

 

[RUOkie]

I agree with the concept of covering everyone. I also think people should have catastrophic coverage for exactly what goldielox describes (bankrupsy from hospitalization bills). I have been uninsured in the past and so have my family members and friends so I do know the pain of medical debt and the repurcussions of poor health. I have also lived in other countries with national healthcare and have seen the pros and cons of that type of system.

However, unique to the U.S. is the issue of frivolous law suits. Without tort reform true healthcare reform cannot happen. Goldielox is too young in her training to have been sued or have had the experience of trying to help an uninsured patient only to be bitten in the butt by those same patients. When i was in med school during my 6 wk ob-gyn rotation, there was at least one lawsuit per week. One was an uninsured woman who came in through the ER and ultimately gave birth to a premature baby then sued the hospital for the prematurity of the baby and the resultant disability. Another woman smoked marijuana and cocaine and barely got prenatal care then sued when her infant had respiratory issues.

I also see patients who claim they can't afford their blood pressure meds somehow able to afford their pain medication and to get their hair and nail done professionally every week. Those are the same ppl who have flat screen TVs, designer bags, and nice cars.

When I do see a truly grateful and motivated self-pay patient, I do my best to keep their cost down and even do some things pro-bono. These are the most gratifying patients to treat and it reminds me of why I am a physician. Unfortunately, those patients are rare.

It's easy to judge people when u have not experienced being an attending physician, getting sued, or having to support not just your family but your employees' families. I do agree that true healthcare reform is necessary but I do not agree with the way this is being done through this bill full of "political favors", no tort reform, no solution for SGR, no solution for decreasing cost, and no increase in individual responsibiltiy. I do think that there needs to be more self-policing and aggressive prosecution of fraud in medicine and that physicians and hospitals need to do their part in reforming healthcare. However, as long as patients do not take individual responsibility, attourneys file frivilous law suits, and insurance companies deny coverage and make clinical decisions instead of physicians, we won't be able to have true reform.

WELL SAID!

 

[Sig123]

I agree with the concept of covering everyone. I also think people should have catastrophic coverage for exactly what goldielox describes (bankrupsy from hospitalization bills). I have been uninsured in the past and so have my family members and friends so I do know the pain of medical debt and the repurcussions of poor health. I have also lived in other countries with national healthcare and have seen the pros and cons of that type of system.

However, unique to the U.S. is the issue of frivolous law suits. Without tort reform true healthcare reform cannot happen. Goldielox is too young in her training to have been sued or have had the experience of trying to help an uninsured patient only to be bitten in the butt by those same patients. When i was in med school during my 6 wk ob-gyn rotation, there was at least one lawsuit per week. One was an uninsured woman who came in through the ER and ultimately gave birth to a premature baby then sued the hospital for the prematurity of the baby and the resultant disability. Another woman smoked marijuana and cocaine and barely got prenatal care then sued when her infant had respiratory issues.

I also see patients who claim they can't afford their blood pressure meds somehow able to afford their pain medication and to get their hair and nail done professionally every week. Those are the same ppl who have flat screen TVs, designer bags, and nice cars.

When I do see a truly grateful and motivated self-pay patient, I do my best to keep their cost down and even do some things pro-bono. These are the most gratifying patients to treat and it reminds me of why I am a physician. Unfortunately, those patients are rare.

It's easy to judge people when u have not experienced being an attending physician, getting sued, or having to support not just your family but your employees' families. I do agree that true healthcare reform is necessary but I do not agree with the way this is being done through this bill full of "political favors", no tort reform, no solution for SGR, no solution for decreasing cost, and no increase in individual responsibiltiy. I do think that there needs to be more self-policing and aggressive prosecution of fraud in medicine and that physicians and hospitals need to do their part in reforming healthcare. However, as long as patients do not take individual responsibility, attourneys file frivilous law suits, and insurance companies deny coverage and make clinical decisions instead of physicians, we won't be able to have true reform.

Agree with all of your points. Tort reform is certainly an ESSENTIAL component towards reducing health care costs.

I personally know several physicians who were against this bill purely because it did not address tort reform.

However, why can't tort reform follow this major first step is providing mass health care coverage?

Obviously, the bill isn't perfect, will require several modifications and additions as the consequences of what is in the bill become revealed. During this period of modification, addressing the issue of tort reform would take on such a larger significance as the survival of the bill as a whole would be in question.

 

[DistantMets]

Here's the scenarios I fear.

1. More people can get insurance
2. Government and insurance companies insure more people but is has to be affordable for the patient. Rates can only be so high. Technology is expensive. Cost exceeds revenue.
3. Gov't and big Ins have to cut costs so they deny more care OR... pay physicians even less.
4. Physicians drop Medicare/Medicaid because they take a loss
5. Medicare/Medicaid patients go to ED for care (oh wait, that's the problem we just fixed right?)
6. Gov't says physicians are greedy/don't care about patients...we can't drop anyone
7. Physicians can't afford to practice without working for big physician groups or gov't clinics
8. Physicians become gov't employed
9. Healthcare is socialized

 

[rysa4]

Au contraire. I can count on two hands the families I personally know that will be helped by this target population of the bill. Please explain why this isn't helpful.



Have you ever been hospitalized without health insurance. Of course, we do not turn away people who do not have health insurance. But have you gone home from a hospital stay with hundreds of thousands of dollars to pay in bills waiting for you that you cannot afford? And don't worry, you can only ignore them for so long before they come after you for every penny you own and worked your entire life to build.

Because Medicaid is co-financed by the state and the feds - the catch here is that the states do not have the money to put into Medicaid if the Medicaid enrollment substantially increases. In addition, the provider lists for Medicaid are not large. The volume cannot be handled in any way. Please see the video today by Louisiana's governor. In that state-- health care reform will increase the state Medicaid roles by 320,000. They can't do it. So we will get what happened with Tenncare - its the same thing.

I work in a private Oncology practice. We treat the uninsured. How? Because we can get free drug replacement for the patients, so their costs are minimized. We utilize public options - including MD Anderson, for other things that are too expensive otherwise, like radiation.

That being said, there is no disagreement on a lack of health insurance being a BIG problem - but tearing up 20% of our economy and further dis-incentivizing work isn't necessary. Read my post above - simply reign in costs and buy the policies. What we have is a political protection of lawyers and big pharma in the current situation.

In Texas, we have tort reform - malpractice premiums are way down as a result. And we have the Texas Health Insurance Risk Pool. Google it. Insurance that anyone can get if unemployed. The premiums are expensive ( mine would hit at $600/month) -- but here is my question - Did anyone actually ask Congress/Obama what the premium structure might look like in the future for all of this insurance?

I did the math already based on Medicare Part A, medicare Part B, and Walmarts monthly premiums as examples - guess what? Premiums are going to go way up for everyone - and everyone will be forced to fork over money in premiums and penalties. And why should everyone who works in the US since 1965 and after pay Medicare taxes only to have those benefits redistributed to non-Medicare recipients?

I like the discussion though -- keep it up! It's you all's future!

 

[rysa4]

Live Now on CNN.com

Doctors for America briefing with the President of all the major professional organizations, AAFP, AAP, etc supporting the health care reform bill. May I ask, where is AAPMR President (was he there)?

"When you stand in strength, you allow others to find you. All of you represent the hope of a better system. Allow yourselves to be an inspiration to your colleagues... This is a turning point for our profession.."

The bill is not perfect. But it is a start. Why do I compare myself to teachers and police officers? Because our children have a human right to quality education, a human right to protection from harm, and a human right to health care. Heck even when your life and capital punishment is on the line, this country gives you a free public defender. Health care is no different.

When you know someone that Dr. Lori Heim, President of AAFP talks about, that is in the ICU, and didnt have to be there if she could afford a $4 hypertension medication, then the bill takes on personal value.

This is certainly moving...but again...emotional. Also, where were ANY of the specialty organizations? That's what sets us apart in medical care in this country.

 

[axm397]

Live Now on CNN.com

Doctors for America briefing with the President of all the major professional organizations, AAFP, AAP, etc supporting the health care reform bill. May I ask, where is AAPMR President (was he there)?

First of all, the AAPM&R president is a woman. And I don't think "Doctors for America" is any more representative of all physicians in the U.S. than groups like "Physicians United for Patients". Most specialty physicians oppose the bill in its current form. Although I would argue that most physicians do see a need for change.

The AAPM&R has been advocating on specific issues that pertain to our specialty - http://aapmr.org/hpl/legislation/healthcarereform.htm#passHCRleg

http://aapmr.org/hpl/legislation/academy_advocacy.htm

 

[lifeaseyeknowit]

Everyone brings up great points (and many that I absolutely agree with) but there is still something I think is very important to be addressed. I, too, believe that reform for healthcare in some form is very important and am very highly on the side of the millions of civilians that have no health insurance.

However, I still want to know how this will affect PM&R as a specialty. PM&R is not considered an absolute basic need (though perhaps it should be) compared to basic internal medicine or pediatrics or surgery. I want to know if anyone anticipates PM&R as having significantly reduced funding from hospitals and insurance companies to make room for other basic needs for millions of people? This will likely affect those that are currently in training for PM&R.

 

[topwise]

However, I still want to know how this will affect PM&R as a specialty. PM&R is not considered an absolute basic need (though perhaps it should be) compared to basic internal medicine or pediatrics or surgery. I want to know if anyone anticipates PM&R as having significantly reduced funding from hospitals and insurance companies to make room for other basic needs for millions of people? This will likely affect those that are currently in training for PM&R.

Exactly. This is why I made the post, because I would like to know the implications for PM&R, inpatient and outpatient.

Or more generally, I'm sure there are some people here who are planning to start their own private practice. If you have a prior medical condition (especially if you are a woman!), under the current system, you might not be able to get health insurance for yourself. Has this been a problem for anyone in the past? (It happened to a physician I know and was a huge PITA.) Of course, most of us are young and healthy, but I know at least some of us must have medical conditions.

Regarding the general implications for medicine, I agree we BADLY need tort reform. It is totally ridiculous what goes on. I am *hoping* though that the bill is a small step in the right direction, because it's my understanding that people showing up to the ER uninsured and not being able to pay their bills is a huge cost to the taxpayers. It's not like buying a house, where if someone doesn't have the money, they simply can't buy the house. Unless we are willing to turn away uninsured patients with medical emergencies..... (hopefully nobody feels this way)

That said, I don't want to lose my job! (Although at least if I do, I will be able to get health insurance )

 

[rysa4]

Exactly. This is why I made the post, because I would like to know the implications for PM&R, inpatient and outpatient.

Or more generally, I'm sure there are some people here who are planning to start their own private practice. If you have a prior medical condition (especially if you are a woman!), under the current system, you might not be able to get health insurance for yourself. Has this been a problem for anyone in the past? (It happened to a physician I know and was a huge PITA.) Of course, most of us are young and healthy, but I know at least some of us must have medical conditions.

Regarding the general implications for medicine, I agree we BADLY need tort reform. It is totally ridiculous what goes on. I am *hoping* though that the bill is a small step in the right direction, because it's my understanding that people showing up to the ER uninsured and not being able to pay their bills is a huge cost to the taxpayers. It's not like buying a house, where if someone doesn't have the money, they simply can't buy the house. Unless we are willing to turn away uninsured patients with medical emergencies..... (hopefully nobody feels this way)

That said, I don't want to lose my job! (Although at least if I do, I will be able to get health insurance )

The medicare tax increases in the bill are way more expensive to the tax payer, as is the requirement for everyone to pay for insurance. No one can legally be turned away from true emergency rooms if they have an emergency under the current system. By the way, the medicare tax increases in the bill were not indexed for inflation, so this will be, basically, an AMT situation again ( alternative minimum tax). It will just gobble up the middle class over time, drive up premiums, drive an increasing number of families to Medicaid, and deplete state budgets, forcing general tax increases. Yippee.

 

[rysa4]

Exactly. This is why I made the post, because I would like to know the implications for PM&R, inpatient and outpatient.

Or more generally, I'm sure there are some people here who are planning to start their own private practice. If you have a prior medical condition (especially if you are a woman!), under the current system, you might not be able to get health insurance for yourself. Has this been a problem for anyone in the past? (It happened to a physician I know and was a huge PITA.) Of course, most of us are young and healthy, but I know at least some of us must have medical conditions.

Regarding the general implications for medicine, I agree we BADLY need tort reform. It is totally ridiculous what goes on. I am *hoping* though that the bill is a small step in the right direction, because it's my understanding that people showing up to the ER uninsured and not being able to pay their bills is a huge cost to the taxpayers. It's not like buying a house, where if someone doesn't have the money, they simply can't buy the house. Unless we are willing to turn away uninsured patients with medical emergencies..... (hopefully nobody feels this way)

That said, I don't want to lose my job! (Although at least if I do, I will be able to get health insurance )

Implications for PMR - Throws outpatient private practice under a bus potentially - inpatient units will be around under tight budgets.

 

[MSKalltheway]

Implications for PMR - Throws outpatient private practice under a bus potentially - inpatient units will be around under tight budgets.

How so? Do you think U/S, EMG/NCS and injections, among other things, will not be reimbursed as well? And how would inpatient be more adversely impacted than it already has been?

 

[rysa4]

How so? Do you think U/S, EMG/NCS and injections, among other things, will not be reimbursed as well? And how would inpatient be more adversely impacted than it already has been?

Its an unsubstantiated guess on my part, just to be clear. One strength of PMR as an oupt field is the ability to bill for a variety of services. That's a good thing. But an ins co could very easily exclude the co-billing of an US with an injection for instance from paying for both. Then you just bill the US perhaps. I think we will see more of this back and forth, and thus it pays to stay right on payment policies by ins co and watch your EOBs very carefully as well.

In an era of bundled payments, if things go that way, there could be some real problems for outpt PMR and many specialities. Although primary care would be the most vulnerable to this frankly.

A bundled payment still makes sense for a rehab unit however, as long as total revenue per illness is set up as a true average or better. That's where the national organizations come in and thats the type of data I might be collecting if I was a physician or administrator in rehab.

The future will prize the business oriented mind on the part of a physician moreso than it has in the past, due to declining margins.

 

[SSdoc33]

The future will prize the business oriented mind on the part of a physician moreso than it has in the past, due to declining margins.

ie: NOT ordering an MRI which might save a lawsuit. nice.

 

[rysa4]

ie: NOT ordering an MRI which might save a lawsuit. nice.

Actually the things I am talking about are in a bit of a different league. At several levels. resources once in the purview of the doctor patient relationship are aggressively being moved into other buckets/places so that there is a dwindling amount of resources left for the doctor patient relationship and services/care. This is largely due to inadequate and disorganized responses and actions on the part of physicians relative to a literal plethora of non-doctor entities that are all making a living on healthcare. We are giving it away. Even in the current environment, a doctor can most certainly be quite successful financially if that is an interest, but simply training in medicine and being competent in a medical field doesn't enable or quailfy someone to have good business acumen or be able to make it or not get taken advanatage of once in a practice setting of any sort. The catch here is that the days of living off of a lot of margin are quickly disappearing, and so poor business and management skills are reaking havoc on docs. The stuff I see, hear, and get involved with are pretty incredible.

 

[RUOkie]

Even in the current environment, a doctor can most certainly be quite successful financially if that is an interest, but simply training in medicine and being competent in a medical field doesn't enable or quailfy someone to have good business acumen or be able to make it or not get taken advanatage of once in a practice setting of any sort. The catch here is that the days of living off of a lot of margin are quickly disappearing, and so poor business and management skills are reaking havoc on docs..

To support rysa4, any physician going into solo or small group practice needs to take some basic accounting classes. If you don't know how to read a balance sheet, an expense report, and hopefully a pro-forma you will be screwed. If you don't know how to negotiate a contract with an insurer, you will be screwed.

As an example. I was in an academic practice where I had no control over contracting. I knew that my fee schedule for UHC was at or below Medicare, but could do nothing about it (the transplant surgeons did very well, and the Faculty practice plan threw all E&M coding-and EMG codes under the bus). Then, when I moved to solo practice, UHC offered to continue my previous contract level . I happen to have a little business training. I told them to take a hike. I was out of network for UHC for 2 years, which made my patients very mad. I was also the only physiatrist in 50miles. After 2 years, I called them to renegotiate. Now they are my best payer other than work comp. Most docs know how to be doctors, but running a practice is a lot more than that. The tighter things get with profit margin, the less wiggle room you have.

Fixed expenses (rent, office salaries, supplies, insurance (liability, work comp, malpractice)) don't change! There are only so many variable expenses in a physician office. If your reimbursement is cut, you then either have to work harder, or make less-or none at all.

Going to a single payer will take away ALL negotiating power a physician or group of physicians has. Then you get reimbursement cuts and you can do nothing.

There is a growing trend of making all physicians employees of either hospitals or practice groups. I think that takes away from the doctor patient relationship. If I am an employee, I will have no incentive to come in to take care of my own patient in the ER--let the hospitalists do it. I won't take call-go to the ER, or call your ARNP gatekeeper. I will work 9-5, 5days/wk. As a solo practitioner now, I am always available to my referral docs as well as to my patients. If we go to single payer, I know I will not survive in my current situation

I, like most physicians, became a doctor so I could help treat patients. But I also have a life outside of medicine. If the incentives change, I will just spend more time on my life outside of medicine and less time with my patients. And that would be a shame.

 

[Brooklyndo2.1]

Health care reform needed to be done, needs to be done and is need of doing.
this is all still true with this new law
I agree that the current system has soo many flaws its devastating.
Recently I was taking the RR in new york and overheard two older women having a conversation that went something like :
"the doctor only wants to see me for one thing, he doesnt care that i have a few problems, he says to make another appointment"
other other woman made some comment about doctors not caring ...
well.... let me ask, do we care? I do
But, I would love to be able to keep my clinic open (i dont have a clinic, but for arguement's sake)
So the insurance only pays me for about 10 to 15 minutes of my time to treat one or a couple of complaints .

If they are not really related and I dont have time to do a proper physical for another complaint, and I do the exam anyway and continue to do this for everyone this is what happens : Some patients get great care for a few months, then I close down and try to get a job at an article 28 clinic to put food on the table , and my patients go to see me and i say, sorry the clinic doesnt let me do this test like this, please have the front desk make an appt for you thanks

Reality is that the current proposal will put more people in jeopardy of a worse system of care, and many current physicians may find other things to do for a majority of their income.
I can say this as someone who has emmigrated from a country with that kind of system, you will get substandard care, if youre lucky to get care.

As for treating everyone well, I am not someone who is doing this for the money, but it would be nice to be able to pay my loans, drive a car that doesnt break down, and well, generally do financially better than the kid who didnt care enough about society to go to med school.
This country was based on working hard and getting rewarded for it. If we lose that, than we are no longer living in the country our forefathers bled for.

 

[PMR 4 MSK]

Health care reform needed to be done, needs to be done and is need of doing.
this is all still true with this new law
I agree that the current system has soo many flaws its devastating.
Recently I was taking the RR in new york and overheard two older women having a conversation that went something like :
"the doctor only wants to see me for one thing, he doesnt care that i have a few problems, he says to make another appointment"
other other woman made some comment about doctors not caring ...
well.... let me ask, do we care? I do
But, I would love to be able to keep my clinic open (i dont have a clinic, but for arguement's sake)
So the insurance only pays me for about 10 to 15 minutes of my time to treat one or a couple of complaints .

If they are not really related and I dont have time to do a proper physical for another complaint, and I do the exam anyway and continue to do this for everyone this is what happens : Some patients get great care for a few months, then I close down and try to get a job at an article 28 clinic to put food on the table , and my patients go to see me and i say, sorry the clinic doesnt let me do this test like this, please have the front desk make an appt for you thanks

Reality is that the current proposal will put more people in jeopardy of a worse system of care, and many current physicians may find other things to do for a majority of their income.
I can say this as someone who has emmigrated from a country with that kind of system, you will get substandard care, if youre lucky to get care.

As for treating everyone well, I am not someone who is doing this for the money, but it would be nice to be able to pay my loans, drive a car that doesnt break down, and well, generally do financially better than the kid who didnt care enough about society to go to med school.
This country was based on working hard and getting rewarded for it. If we lose that, than we are no longer living in the country our forefathers bled for.

Nobody cares if doctors make money or not. They assume we are all filthy-rich and drive Bentleys.

Nobody cares how much time you took with every other patient you saw that day, they only care how much time you spend with them.

Nobody cares why you want them to come in for an office visit, they assume it is only to make more money at their expense.

Nobody cares about doctors except other doctors and their families.

If you go looking for sympathy for your plight from you patients, you will find none. Don't look for it there.

The Average Joe now feels that a doctor is the employee of the patient and is there to to do the patient's bidding.

And no one want to pay you what you are worth - not the patient, not the insurance, not the government.

Aren't you glad you chose this field?

 

[rlop17]

I have accumulated debt and I worry about paying it off as well. I guess Obama said it well yesterday when he talked about why people chose to be a Democrat. I think the reasons why I am a Democrat have a lot to do with why I chose to be a doctor. That there is a strong desire for me to do what benefits society and what benefits those less fortunate than me. I really did not go into medicine for money. Not an ounce of me did. Really. I want to feed my family and I want to have a roof over my family's head. I completely understand how many doctors would feel differently and would expect and feel entitled to more. A huge part of my feelings have to do with the fact that I have had people very close to me who have fallen through the cracks. My aunt is 50 and has never had a mammogram. She's not dirt poor but she owns a small family business and I can tell you she cannot afford the nearly $1000 a month premiums to insure her family, her husband with a preexisting condition, and her 3 children. Yes in this case, her mortgage and her car payment which she uses to work and take her kids to school takes priority. And people call that irresponsible. She doesnt qualify for Medicaid, but she cant afford the insurance. I've had people very close to me with emergent hospitalizations. Sadly, they probably never would have been hospitalized if they had access to affordable health insurance so they could have managed their hypertension and diabetes at home, and instead of the low cost preventive care, they are stuck with thousands of dollars of hospital bills. And when you dont have insurance, the hospitals dont give them a penny's break. They charge you MORE than if you did have insurance and they hire bad a** collectors to call your home and stalk you at your home, and if you dont pay up, expect a law suit and a lien on every asset that you have. The thing is, this bill hits really close to home. I know what its like to fall between the cracks and have people call you irresponsible for not having health insurance.

I have had to read my personal statement to myself many times during my medical training because at that point, young, and in college, I know I was not yet tainted by "real" medicine. I've watched attendings give patients the boot (without the typical 24 hour discharge notice to families) because the insurance just called and said it ran out. Ive seen Medicare reimburse providers $300 for a CT scan, and Ive seen that same provider charge someone $3000 knowing very well they could never afford it because they are paying out of pocket. Is this fair? I am not an economist and I'm not a politician. I dont know all the 2000 plus pages of details of this bill. But I do know why I chose to be a doctor and I know that I will never starve as one. I just want to make sure what I do is as equally accessible to everyone.

We chose this profession because it is indeed a service profession. We are in the same line of work as teachers, firefighters, police officers. People often compare what we do to lawyers, or dentists, or MBAs, and say why do lawyers and MBAs get to make this much money straight of school, or get to charge this much per hour and we dont, but to me, what we do, it's different. I do agree that we work really hard, give up a lot of years of our youth to help people and sacrifice to take care of people, and our pay should be reflective of this. I understand to some, it may not be, and this bill may compromise that even further. But to me, I will always be doing something that I love, that I aspired all my life to do and be, but I do not want anyone to be neglected of care. My heart aches for all the women out there who have not had mammograms because they dont have health insurance. It aches for all the folks who have lost their jobs and their health insurance for their entire family. I pay 10% of my income to charity. I do not mind paying more taxes to help those less fortunate than myself and I do not mind my taxes being spent for social programs and that is what makes me a Democrat. Perhaps I am not the right person to ask about this because it hits too close to home.

I have the best job in the world and I always will. Whenever I get dismayed, I reread my personal statement to remind myself why I went into medicine. It has helped me keep perspective. I know I will never starve and I know I will always have a respectable home for me and my family and what I make will continue to be in the top 10% of Americans. I cant ask for more than that when I get to do what I love to do on top of that! I look forward to the day I can afford to do what I do for free for some people. I am excited about how wonderful that would make me feel.

As an American, as a Christian, as a Democrat, as a woman, as a doctor, I am proud and hopeful that this bill will serve our country well.

Not to get political here, but since you made the above statement yourself...It must be said that you cannot be Democrat and Christian, if you are being intellectually honest. As a Christian you cannot support the immorality Obama is promoting (abortion, gay rights etc) I know this will deter this thread to places it does not need to go, and I am sorry if some find this offensive, but I am sick and tired of people not fully understanding what it means to associate yourself with a particular group. We are all physicians because we have the intelligence required and the desire to help others.
So in short- you are not intellectually honest with yourself or with anyone else. I suggest you go study apologetics with all this time you will have when this health bill drives you out of business.

 

[topwise]

I started this thread to discuss the implications of the health care bill on PM&R.

I think it is inappropriate, irrelevant and offensive to make a comment saying that abortion and gay rights are immoral. I think the moderator should intervene before this conversation goes somewhere we don't want it to go.

 

[surftheiop]

[/COLOR]


Not to get political here, but since you made the above statement yourself...It must be said that you cannot be Democrat and Christian, if you are being intellectually honest. As a Christian you cannot support the immorality Obama is promoting (abortion, gay rights etc) I know this will deter this thread to places it does not need to go, and I am sorry if some find this offensive, but I am sick and tired of people not fully understanding what it means to associate yourself with a particular group. We are all physicians because we have the intelligence required and the desire to help others.
So in short- you are not intellectually honest with yourself or with anyone else. I suggest you go study apologetics with all this time you will have when this health bill drives you out of business.

 

[GoldieLox]

[/COLOR]


Not to get political here, but since you made the above statement yourself...It must be said that you cannot be Democrat and Christian, if you are being intellectually honest. As a Christian you cannot support the immorality Obama is promoting (abortion, gay rights etc) I know this will deter this thread to places it does not need to go, and I am sorry if some find this offensive, but I am sick and tired of people not fully understanding what it means to associate yourself with a particular group. We are all physicians because we have the intelligence required and the desire to help others.
So in short- you are not intellectually honest with yourself or with anyone else. I suggest you go study apologetics with all this time you will have when this health bill drives you out of business.

I fully understand everything that I say and believe in. I chose to be a Democrat because I believe in the social programs that benefit those less fortunate than me, just as Christianity teaches me to do the same.
Christianity teaches kindness, love, charity, tolerance, forgiveness, and also teaches us not to judge others. I am a sinner, and last I checked, you were not designated as my judge. If you want to ask me about intellectual honesty and Christianity, please read the Bible first.

If you dont have that kind of time on your hands, please dont judge other peoples' faiths or beliefs with your ignorance.

Finally, I chose to be a doctor to help people. I wont ever be driven out of business as long as that is my goal. And with that, let's get back to the topic at hand... healthcare reform

 

[rlop17]

I fully understand everything that I say and believe in. I chose to be a Democrat because I believe in the social programs that benefit those less fortunate than me, just as Christianity teaches me to do the same.
Christianity teaches kindness, love, charity, tolerance, forgiveness, and also teaches us not to judge others. I am a sinner, and last I checked, you were not designated as my judge. If you want to ask me about intellectual honesty and Christianity, please read the Bible first. (ever read solo scriptura? it seems as if not)

If you dont have that kind of time on your hands, please dont judge other peoples' faiths or beliefs with your ignorance.

Finally, I chose to be a doctor to help people. I wont ever be driven out of business as long as that is my goal. And with that, let's get back to the topic at hand... healthcare reform

I apologize if you feel judged. I feel a duty in my faith to defend my values and the values that should be represented by my faith. I should not be taken out of forums for disagreeing on topics or saying I cannot agree because of my faith, I should not have to be passive- and I will not be. I am simply trying to live my faith as a physician and this requires me to be against certain things like abortion, birth control etc. If a health care plan will make me pay to provide these things to people, you'd have to understand how I feel outraged I am asked to be an accessory to another's sins.

Maybe I should have said it in a more constructive way. But it is only fair that I am allowed to say why I am against Obamacare. It is not that he will tax the crap out of me, it is that he is causing me to fund mortal sins- and that I simply will not be quiet about.

The big picture is WAY worse that what is being done to medicare- so we all will earn less, work more- is that the worst? If we really think about what is going on- we have bigger things to be concerned about.

 

[topwise]

I am simply trying to live my faith as a physician and this requires me to be against certain things like abortion, birth control etc. If a health care plan will make me pay to provide these things to people, you'd have to understand how I feel outraged I am asked to be an accessory to another's sins.

The health care bill, as I understand it, doesn't ask the taxpayer to fund abortion. Although even if it did, all the abortions in the country cost a teensy tiny fraction of the war that we're all paying for, which much of the country doesn't believe in.

If you think birth control is a mortal sin though, there's no point in even discussing this further. GoldieLox and I shouldn't even be here then, in your opinion, because we'd be too busy being pregnant 100% of the time and caring for our 10 children each.

Ugh, this is why I wanted to stick to the topic of PM&R specifically.

 

[rlop17]

The health care bill, as I understand it, doesn't ask the taxpayer to fund abortion. Although even if it did, all the abortions in the country cost a teensy tiny fraction of the war that we're all paying for, which much of the country doesn't believe in.

If you think birth control is a mortal sin though, there's no point in even discussing this further. GoldieLox and I shouldn't even be here then, in your opinion, because we'd be too busy being pregnant 100% of the time and caring for our 10 children each.

Ugh, this is why I wanted to stick to the topic of PM&R specifically.

Shows your ignorance, I am female and I am not pregnant 100% of the time. There are other options that are just as effective without the consequences.
Simply put: The bill pays for abortion= tax payer money supports the bill

 

[topwise]

Shows your ignorance, I am female and I am not pregnant 100% of the time. There are other options that are just as effective without the consequences.
Simply put: The bill pays for abortion= tax payer money supports the bill

We could argue about this all day. You won't change my mind, I won't change yours. THIS HAS NOTHING TO DO WITH PM&R.

And honestly, I don't appreciate the name-calling.

 

[axm397]

let's keep the conversation civil and stick to the original topic which is the effect of this healthcare reform on the field of PM&R. Abortion, christianity, etc. can be discussed in the lounge. Let's keep this PM&R relevant.

 

[Cp22kjer]

[/COLOR]


Not to get political here, but since you made the above statement yourself...It must be said that you cannot be Democrat and Christian, if you are being intellectually honest. As a Christian you cannot support the immorality Obama is promoting (abortion, gay rights etc)

This is one of the most absurd posts I've read. Everyone interprets their religion differently (typically it's manipulated to support the way they choose to live life). There's parity in Christianity like all religions and what makes your interpretation the "right" one to make such a blanket statement?

This post makes me think you're blinded by your own religious goggles to such an extent that you can't even begin to see anything else...talk about being intellectually honest...come back to earth and think outside of your box for a minute.

 

[Cp22kjer]

let's keep the conversation civil and stick to the original topic which is the effect of this healthcare reform on the field of PM&R. Abortion, christianity, etc. can be discussed in the lounge. Let's keep this PM&R relevant.

Sorry axm, I just didn't get to your post until after I replied.

Questions about PMR:

Where is therapy component of healthcare heading with this new bill? I'll admit I can't fully comprehend all of the implications after reading the outline of the bill.

I always hear discussion about the necessity of tort reform yet it's gone no where. Whats the outlook on this?

Some of you implied PMR being reduced to nothing. My limited knowledge says it's a growing field, and an essential one. For example: Who would take over the inpatient scenarios where currently you only see PMR physicians.

I've spent some time trying to predict what's to come, as a medical student it's pertinent. What I've come to realize though, is that it's impossible to accurately assume anything. Who's to say when Obama's term is up that conservatives don't come in and change everything? I won't be practicing for another ~6-8 years, sometimes I think so much will change by then that it's pointless to try to understand and plan for the future (such as deciding of a "favorable" specialty).

One good thing is that PMR doctors won't be battling with mid-levels for jobs. I realize things can change, but I don't see how anyone but a physician could be in such a position. There are many other fields where encroachment is a problem due to over-utilization of mid-levels (which they've embraced in this current reform).

 

[GoldieLox]

Some of you implied PMR being reduced to nothing. My limited knowledge says it's a growing field, and an essential one. For example: Who would take over the inpatient scenarios where currently you only see PMR physicians.

As an attending physician at a major academic center, with a private practice as well, I have no doubt that rehab will continue to be essential, and in need. I am more worried about the people discharged without health insurance, when they need close follow-up care. It is about time that some of the trillion dollars spent on defending the "greatest nation in the world" is used to insure its great citizens. How come we don't criticize our government for being responsible for spending a trillion dollars on defense and war, but we criticize our government when its steps in to defend its citizens' health. It's about time our tax dollars go to something more humanitarian than building bombs.

 

[rysa4]

let's keep the conversation civil and stick to the original topic which is the effect of this healthcare reform on the field of PM&R. Abortion, christianity, etc. can be discussed in the lounge. Let's keep this PM&R relevant.

There are really two health care reform bills that passed, for a total of 3000 pages. I have been attending a number of meetings, webinars etc on them and their implications. As far as I can tell, there are good bad and ugly components for physicians in private practice that could affect PMR, both dealing with reimbursement.

1. The Independent Medical Advisory Board - this group of Senate appointed folks have only one assignment: cut costs. Nothing else. SO they will cut reimbursement to doctors.

2. Hospitals escape this panel until 2019, based on their lobbying efforts. But the panel goes to work in 2015. This means that cuts in Medicare between 2015 and 2019 will come solely from physician fee schedules. Pharma struck their deal and remains protected.

This was the one thing that jumped out at me that I thought was really bad and could affect PMR.

 

[yobynaes]

Glad to see this thread to be brought back on track. I thought it was lost.

Thanks for your input rysa. It sounds like what you said applies to all medical fields across the board (not just PMR). You mentioned that there is good, bad and ugly components. I think I see the bad and ugly. what's the good?

There are really two health care reform bills that passed, for a total of 3000 pages. I have been attending a number of meetings, webinars etc on them and their implications. As far as I can tell, there are good bad and ugly components for physicians in private practice that could affect PMR, both dealing with reimbursement.

1. The Independent Medical Advisory Board - this group of Senate appointed folks have only one assignment: cut costs. Nothing else. SO they will cut reimbursement to doctors.

2. Hospitals escape this panel until 2019, based on their lobbying efforts. But the panel goes to work in 2015. This means that cuts in Medicare between 2015 and 2019 will come solely from physician fee schedules. Pharma struck their deal and remains protected.

This was the one thing that jumped out at me that I thought was really bad and could affect PMR.

 

[rysa4]

Glad to see this thread to be brought back on track. I thought it was lost.

Thanks for your input rysa. It sounds like what you said applies to all medical fields across the board (not just PMR). You mentioned that there is good, bad and ugly components. I think I see the bad and ugly. what's the good?

Fair question. keep in mind I am just starting to get a handle on all of this. There are some insurance regulations that many might interpret as good,regarding pre-existing medical conditions and access to a health care exchange for instance. I do have some concern that this allows folks to simply wait until an insurance need arises and then get insurance.

Some other interesting parts of the bill - " The Sunshine provision" -- so beginning at a certain point in time ( I dont have the exact date) - a drug rep who brings a lunch to an office will report the expense - and the drug manufacturer will report this to a database, visible on the internet, associating the amount spent with the physicians name as a gift. Docs may not like this very much. Also, there is some language about doctor investments in free standing facilities and some serious limitations.

There is also a tending towards a single VBA payment - or visit based accountability- which starts to move away from doctors/hospitals and MRI centers for instance -all getting paid separately for the same illness.

Amazingly--get this one -- CMS is now under the executive branch of government and not Congress- Yup - hard to believe--but true. Also key - any discovered "overpayments" by your Medicare carrier are now ( and I mean now as in yesterday) considered false claims. Which means that could recoup monies and state fraud of all things for entire claims based on minor overpayment s. Consolidated billing is a probelm area that comes to mind.

Anyway- just a few tidbits. I am very concerned about the financial burden on the states an expanded Medicaid enrollment will cause. I think this is really dangerous if you live in a fiscally viable state that can actually balance a budget. ( you Californians have nothing to worry about on that one). I don't think the federal government should take down the rest of the country with it.

 

[PMR 4 MSK]

Fair question. keep in mind I am just starting to get a handle on all of this. There are some insurance regulations that many might interpret as good,regarding pre-existing medical conditions and access to a health care exchange for instance. I do have some concern that this allows folks to simply wait until an insurance need arises and then get insurance.

Some other interesting parts of the bill - " The Sunshine provision" -- so beginning at a certain point in time ( I dont have the exact date) - a drug rep who brings a lunch to an office will report the expense - and the drug manufacturer will report this to a database, visible on the internet, associating the amount spent with the physicians name as a gift. Docs may not like this very much. Also, there is some language about doctor investments in free standing facilities and some serious limitations.

There is also a tending towards a single VBA payment - or visit based accountability- which starts to move away from doctors/hospitals and MRI centers for instance -all getting paid separately for the same illness.

Amazingly--get this one -- CMS is now under the executive branch of government and not Congress- Yup - hard to believe--but true. Also key - any discovered "overpayments" by your Medicare carrier are now ( and I mean now as in yesterday) considered false claims. Which means that could recoup monies and state fraud of all things for entire claims based on minor overpayment s. Consolidated billing is a probelm area that comes to mind.

Anyway- just a few tidbits. I am very concerned about the financial burden on the states an expanded Medicaid enrollment will cause. I think this is really dangerous if you live in a fiscally viable state that can actually balance a budget. ( you Californians have nothing to worry about on that one). I don't think the federal government should take down the rest of the country with it.

Essentially, this government is not going to stop until all entrepreneurial physicians are driven out of the market and what are left are a bunch of altruistic "I just want to help people" drones who don't mind working for what little the government and public feel they are worth - which is next to nothing.

 

[bronx43]

Essentially, this government is not going to stop until all entrepreneurial physicians are driven out of the market and what are left are a bunch of altruistic "I just want to help people" drones who don't mind working for what little the government and public feel they are worth - which is next to nothing.

By the time the government is done, doctors will be asking for socialized health care.

Well, the medical profession had a good run. It was bound to end some time. 20th century American physicians are the only ones in the history of man where doctors made this much money compared to the rest of society. And the thing is, there won't be a shortage of students trying to get into medicine even if socialized health care is implemented (given the education process is changed along with it).

 

[PMR 4 MSK]

By the time the government is done, doctors will be asking for socialized health care.

Well, the medical profession had a good run. It was bound to end some time. 20th century American physicians are the only ones in the history of man where doctors made this much money compared to the rest of society. And the thing is, there won't be a shortage of students trying to get into medicine even if socialized health care is implemented (given the education process is changed along with it).

Maybe the next generation will be happier with a more (or completely) socialized system. We older docs are too disgruntled at the constant interference in our treatment plans, the amount of paperwork and the inability to get paid for what you did. Maybe salaried docs who have nothing else to worry about except the patient in front of theem would be better.

 

[RUOkie]

By the time the government is done, doctors will be asking for socialized health care.

Well, the medical profession had a good run. It was bound to end some time. 20th century American physicians are the only ones in the history of man where doctors made this much money compared to the rest of society. And the thing is, there won't be a shortage of students trying to get into medicine even if socialized health care is implemented (given the education process is changed along with it).

There is the rub. There is no inertia to change the education process. The govt. is currently very happy to have mid level providers (NP/PA) provide a majority of the care. In addition I do NOT think there will be the QUALITY of students interested in medicine if there is no possibility of reward in the future. Many top students will go into other fields instead.

 

[bronx43]

There is the rub. There is no inertia to change the education process. The govt. is currently very happy to have mid level providers (NP/PA) provide a majority of the care. In addition I do NOT think there will be the QUALITY of students interested in medicine if there is no possibility of reward in the future. Many top students will go into other fields instead.

You're right in that there may be no change in the education process, whatsoever. It'll depend on the whims of the incumbent and his party.

Here's the thing with the decrease in talent. Let's say surgeons are under salary at $250k, IM specialists at $200k, and primary care at $150k, it's still enough to generate adequate human capital, where the quality of care won't suffer tremendously. A stable $150-250k in the medical field would still be a big enough draw for a large proportion of medical students. The only people that it will deter are the individuals who had opportunities of making far more money, such as in finance. That is a small percentage of medical students, since finance, consulting, trading jobs are only available if you attended top undergrad institutions.

For students who didn't go to a top school, medicine still offers the most bang for their buck. And even a percentage of pre-meds at top universities will prefer medicine simply due to their interest in health care. So, all in all, there may be a slight drop in the quality of students, but I think it will have a minimal (if at all) effect on health care.

Besides... look at the most competitive fields. It's dermatology, plastics, radiology. Even if you're taking away the smartest med students, you're only diluting those fields where effect on patient isn't as great as the other ones in medicine - GS, IM, etc.