Implications of new health plan for PM&R?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
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.


I think that in a pure govt run program your salary levels will be lower. I would be pretty happy with 200K if I was only working 40hrs/wk with no night call. (I make more now but work MUCH more than that;))

Finally, if you have ever worked with a bad radiologist, it can be one of the most frustrating things in the world. I personally do not want more dumb doctors of any type. There are too many of us already :laugh:

Members don't see this ad.
 
I think that in a pure govt run program your salary levels will be lower. I would be pretty happy with 200K if I was only working 40hrs/wk with no night call. (I make more now but work MUCH more than that;))

Finally, if you have ever worked with a bad radiologist, it can be one of the most frustrating things in the world. I personally do not want more dumb doctors of any type. There are too many of us already :laugh:

It might be lower, it might not be. The only thing we know is that it will be lower than current rates.

I'm sure bad radiologists suck, and that wasn't my point. My point is simply that you'd be hard pressed to find a person who wouldn't rather have a better general surgeon, internist, pulmonologist, nephrologist, hematologist/oncologist, ob/gyn, infectious disease, etc.
 
Members don't see this ad :)
It might be lower, it might not be. The only thing we know is that it will be lower than current rates.

I'm sure bad radiologists suck, and that wasn't my point. My point is simply that you'd be hard pressed to find a person who wouldn't rather have a better general surgeon, internist, pulmonologist, nephrologist, hematologist/oncologist, ob/gyn, infectious disease, etc.

But please explain to me how more govt intervention improves the quality of your surgeons, internists etc.?

In the 15 yrs I have been practicing I have found one thing. The more govt intervention, the worse care gets.
 
But please explain to me how more govt intervention improves the quality of your surgeons, internists etc.?

In the 15 yrs I have been practicing I have found one thing. The more govt intervention, the worse care gets.

Oh, it won't. I'm definitely not saying it will. I'm saying that capping salaries at the numbers I mentioned isn't going to drastically reduce quality of care.

I'm not really making a subjective statement about whether or not I think it should happen. I'm simply offering my objective assessment that in the face of the inevitable (decreased reimbursement rates), quality of care might see a slight decrease, but nothing drastic.
 
Hey!

I just wanted to let folks know that I don't think that entrepreneurial physicians should write off the future quite so quickly. The challenges are steeper than before but not as steep as it would be for a non-physician to make money off of Medicare and the Government - which many folks do quite well.

Docs should not underestimate their leverage in any future. 30-50% of all current practicing docs ( done with training) will be retiring over the next few years. Many practices won't even look at a Medicaid contract. Just today I got a call from a patient who called 25 providers supposedly in network with her husbands plan, including very well known institution, who simply won't take the plan because of payment problems with the plan ( not Medicaid). We see a limited number of folks from the plan because humanistically its the right thing to do, but the plan has minimal to no additive value from a strictly business standpoint ( I called the plan today since I get this type of phone call 2x a month - to try and let them know they have an access problem - but they don't care - they are just looking at margins)

Nurses won't be drilling burr holes or doing anything much else procedure wise and on and on. I don't see nurses practicing psychiatry either. I know who'd I want my friends to be in Medicine when dealing with various entities like insurance companies, hospitals, and governmental health care groups. If I'm in PMR I'd make myself as valuable as possible in making a wheel turn flawlessly for as many docs as possible - are we gonna make it easy for specialists, primary care docs, or both. Heck - lets think a bit - maybe getting a primary care nurse practitioner in a PMR practice to practice primary care is a GOOD thing. Be smart.

No reason for fear - just need to realize that sitting back and letting things happen won't work anymore. The government cannot force doctors to see patients at low paying fee schedules, and there rally isn't enough money to make the proposed changes work. There is just no way. Many many specialties are basically protected. I do think there are too many cardiologists in big cities though. That specialty is at risk for big cuts.

Anyway-just a few thoughts.
 
The government cannot force doctors to see patients at low paying fee schedules, and there rally isn't enough money to make the proposed changes work. There is just no way.

I agree to an extent. I just spent 30 min (luckily I had a no-show) on the phone with the Oklahoma health care authority trying to appeal a rejection on a Tier 2 med. The contracting agency they used for pharmacy management had denied my request since THEY did not have trials of the tier 1 meds in their system-Despite the fact that I sent them a fax with a detailed list of all 5 tier1 meds and their failures (all occurred prior to her being on Medicaid). The "contracting agency" did not even look at my fax.

When I got a human on the phone, her comment was "Don't you know that the entire prescription benefit may be on the chopping block?" I told her to let it happen, cut physician fee schedules again (we are currently at 90%of medicare rates) so we can all drop off Medicaid again (like it is in Texas now).

Then there will be a whole lot of people covered by Medicaid but no doctors to care for them.

The Fed mandate to the states will likely DOUBLE the Medicaid roles here in Oklahoma. We cannot afford to provide appropriate care for our patients now. What the heck is going to happen next year?

So all of you young guys know, I am not at all concerned for my personal well being. As rysa said, there are opportunties in medicne still. I am concerned for our society as a whole, for our patients, and for the new doctors.


OK rant over.:D
 
Hey!

I just wanted to let folks know that I don't think that entrepreneurial physicians should write off the future quite so quickly. The challenges are steeper than before but not as steep as it would be for a non-physician to make money off of Medicare and the Government - which many folks do quite well.

Docs should not underestimate their leverage in any future. 30-50% of all current practicing docs ( done with training) will be retiring over the next few years. Many practices won't even look at a Medicaid contract. Just today I got a call from a patient who called 25 providers supposedly in network with her husbands plan, including very well known institution, who simply won't take the plan because of payment problems with the plan ( not Medicaid). We see a limited number of folks from the plan because humanistically its the right thing to do, but the plan has minimal to no additive value from a strictly business standpoint ( I called the plan today since I get this type of phone call 2x a month - to try and let them know they have an access problem - but they don't care - they are just looking at margins)

Nurses won't be drilling burr holes or doing anything much else procedure wise and on and on. I don't see nurses practicing psychiatry either. I know who'd I want my friends to be in Medicine when dealing with various entities like insurance companies, hospitals, and governmental health care groups. If I'm in PMR I'd make myself as valuable as possible in making a wheel turn flawlessly for as many docs as possible - are we gonna make it easy for specialists, primary care docs, or both. Heck - lets think a bit - maybe getting a primary care nurse practitioner in a PMR practice to practice primary care is a GOOD thing. Be smart.

No reason for fear - just need to realize that sitting back and letting things happen won't work anymore. The government cannot force doctors to see patients at low paying fee schedules, and there rally isn't enough money to make the proposed changes work. There is just no way. Many many specialties are basically protected. I do think there are too many cardiologists in big cities though. That specialty is at risk for big cuts.

Anyway-just a few thoughts.

I'm sorry, but the government can easily force doctors to see patients at low paying fee schedules. A simple mandate that requires acceptance of Medicare/Medicaid for a license easily solves that problem. In fact, this bill has already been passed in Massachusetts. My thought is that the more doctors that forsake Medicare, the more likely it is that this will become a federal mandate.
The reason why this can occur is the exact opposite of what you said. Doctors have no leverage at all amidst these changes, nor do they seem to seek a voice, either (bizarre but true). There is minimal lobbying, and our special interest groups seem to be divided at best. Oh, and I don't know what you mean by 30-50% of practicing physicians will be retiring in the next few years... that's impossible, unless you mean "next few decades." But, in that case, there will be even more new grads to fill their place.
The truth of the matter is that costs have to be cut one way or another. The wise thing to do is to remove the de-coupling of the consumer and the payor. However, this will obviously never happen, as everyone wants every treatment every time. Even merely uttering it would set off a cascade that would have people clamoring over "death panels," or whatever lovely euphemisms they can come up with. Therefore, the only other option for the government is to forcefully bend the cost curve down by cutting reimbursement rates. And once this happens, many private practices won't be able to remain financially sustainable. Hospitals will start to post losses, in which case the state will likely provide funding directly in exchange for control.

Maybe I'm wrong about this, but I honestly see this as an inevitable. Time is the only variable.
 
I'm sorry, but the government can easily force doctors to see patients at low paying fee schedules. A simple mandate that requires acceptance of Medicare/Medicaid for a license easily solves that problem. In fact, this bill has already been passed in Massachusetts. My thought is that the more doctors that forsake Medicare, the more likely it is that this will become a federal mandate.
The reason why this can occur is the exact opposite of what you said. Doctors have no leverage at all amidst these changes, nor do they seem to seek a voice, either (bizarre but true). There is minimal lobbying, and our special interest groups seem to be divided at best. Oh, and I don't know what you mean by 30-50% of practicing physicians will be retiring in the next few years... that's impossible, unless you mean "next few decades." But, in that case, there will be even more new grads to fill their place.
The truth of the matter is that costs have to be cut one way or another. The wise thing to do is to remove the de-coupling of the consumer and the payor. However, this will obviously never happen, as everyone wants every treatment every time. Even merely uttering it would set off a cascade that would have people clamoring over "death panels," or whatever lovely euphemisms they can come up with. Therefore, the only other option for the government is to forcefully bend the cost curve down by cutting reimbursement rates. And once this happens, many private practices won't be able to remain financially sustainable. Hospitals will start to post losses, in which case the state will likely provide funding directly in exchange for control.

Maybe I'm wrong about this, but I honestly see this as an inevitable. Time is the only variable.

I assume you live in NY. That kind of law could pass in Mass or even in NY/NJ. But not in Texas, OK, Nebraska, etc. Here in the "red" states, personal freedom is valued. If our state legislature tried that kind of noise, you would see a real revolt-and not just by physicians. Since there is no federal licensing of physicians there will not be an issue here.
 
I assume you live in NY. That kind of law could pass in Mass or even in NY/NJ. But not in Texas, OK, Nebraska, etc. Here in the "red" states, personal freedom is valued. If our state legislature tried that kind of noise, you would see a real revolt-and not just by physicians. Since there is no federal licensing of physicians there will not be an issue here.

Oh come on. Medicare is a federal program. Unless those states are running enough of a budget surplus to give physicians a stipend for seeing Medicare patients, they would have no choice to mandate service.
If physicians in the "red" states are turning down Medicare patients en masse, no one is going to oppose legislation to prevent it.
 
I'm sorry, but the government can easily force doctors to see patients at low paying fee schedules. A simple mandate that requires acceptance of Medicare/Medicaid for a license easily solves that problem. In fact, this bill has already been passed in Massachusetts. My thought is that the more doctors that forsake Medicare, the more likely it is that this will become a federal mandate.
The reason why this can occur is the exact opposite of what you said. Doctors have no leverage at all amidst these changes, nor do they seem to seek a voice, either (bizarre but true). There is minimal lobbying, and our special interest groups seem to be divided at best. Oh, and I don't know what you mean by 30-50% of practicing physicians will be retiring in the next few years... that's impossible, unless you mean "next few decades." But, in that case, there will be even more new grads to fill their place.
The truth of the matter is that costs have to be cut one way or another. The wise thing to do is to remove the de-coupling of the consumer and the payor. However, this will obviously never happen, as everyone wants every treatment every time. Even merely uttering it would set off a cascade that would have people clamoring over "death panels," or whatever lovely euphemisms they can come up with. Therefore, the only other option for the government is to forcefully bend the cost curve down by cutting reimbursement rates. And once this happens, many private practices won't be able to remain financially sustainable. Hospitals will start to post losses, in which case the state will likely provide funding directly in exchange for control.

Maybe I'm wrong about this, but I honestly see this as an inevitable. Time is the only variable.

Well I read your post, but I really don't think it is correct. Firstly, I use leverage on behalf of my group to our fiscal benefit with payors and vendors all of the time, and politically at times when I feel necessary to do so. In fact, your post is a good demonstration of what I am trying to say - that many believe exactly as you do; we as a group are not effective in influencing change-essentially a resignation of sorts. What I am saying is that is not true - its just a matter of approach. But we agree that there is room for greater efforts.

Federal Mandate on Payors to see certain class of patients - it in no way is as simple as you are stating - many doctors have a choice to stay in or out of Medicare- and many opt out completely and in growing numbers. Over time, more practice monies are coming from private payors, and less from Medicare. Our office doesn't see Medicaid primaries. Just in the hospital. The mandate itself cannot occur until society doesn't need private practice physicians anymore..that will be a long long time - if ever.

The requirements on seeing a patient on a plan if you are in network is not - "you just see everyone who calls" - just a limited number. Practices routinely create graphs and when a practice reaches a point of excess demand over excess capacity--the plans with the smaller fee schedules are dropped or patients limited from that plan. The Mayo CLinic does this now for instance. That's just how it is outside of academic medical centers mostly. More people buying insurance is only going to increase this dynamic.

I agree with you that our President would love to see a government that can call all the shots in health care and all of that - but just wait and see what happens over the next few years - it won't happen. Almost everyone I know with a job and an education is pretty angry about Health Care reform and will vote along the lines of this single issue, which to me is pretty amazing. Younger folks are split evenly, becuase its not a big issue for them yet.

The De-coupling in health care that you speak about is really a movement towards a two-tier system - you know it, I know it- we all do. That's whats happening in my opinion. Folks with decent jobs and some money will have access to better healthcare - and the rest will have access to a basic plan of benefits. I believe the middle class will be losers and will be slowly pushed downward.

Finally on physician supply and demand - a lot of specialties have beeen very smart - and tightly controlled suppply. There are going to be doc shortages in many fields. BTW- anyone see the recent BCBS mailing on their new 2 ribbon system and the 14 targeted specialties? Certainly good for discussion. Ok- off the soapbox ( for now)
 
Oh come on. Medicare is a federal program. Unless those states are running enough of a budget surplus to give physicians a stipend for seeing Medicare patients, they would have no choice to mandate service.
If physicians in the "red" states are turning down Medicare patients en masse, no one is going to oppose legislation to prevent it.

Roukie is correct on this. Mass and NY are prime examples of health insurance reform failures. Increased taxes and expenses barely affordable by a very high wage structure that does not exist in most other places.Very few places in the country have the concentration of hospitals like Boston and New York do, yet another reason why stuff happening in these two rare birds cannot be replicated elsewhere, and certainly not forced. The usual single dominant hospital system or speciality group- like in Tuscson Arizona for instance ( 1 million people in the area) would just laugh and give the government the high sign. ( politely)
 
Well I read your post, but I really don't think it is correct. Firstly, I use leverage on behalf of my group to our fiscal benefit with payors and vendors all of the time, and politically at times when I feel necessary to do so. In fact, your post is a good demonstration of what I am trying to say - that many believe exactly as you do; we as a group are not effective in influencing change-essentially a resignation of sorts. What I am saying is that is not true - its just a matter of approach. But we agree that there is room for greater efforts.
That's fine. Use all the leverage you want with private insurers in your area. That's really the last bastion physicians have. Even then, historical data has shown that as Medicare reimbursement falls, so falls private insurance reimbursements.
And we're talking about different scales of change. Tell me exactly how you are going to use "leverage on behalf of your group" to influence legislation? Forget federal legislation. How about even state legislation? Just because you can fight tooth and nail with regional insurers doesn't mean you can curb the tides of change in national health care.

Federal Mandate on Payors to see certain class of patients - it in no way is as simple as you are stating - many doctors have a choice to stay in or out of Medicare- and many opt out completely and in growing numbers. Over time, more practice monies are coming from private payors, and less from Medicare. Our office doesn't see Medicaid primaries. Just in the hospital. The mandate itself cannot occur until society doesn't need private practice physicians anymore..that will be a long long time - if ever.
What? Do you know what a mandate is? In Massachusetts, due to the increased number of physicians who did just as you say, it is now state law to see Medicare/Medicaid patients. Failure to comply results in losing your medical license.
The more this (physicians refusing Medicare) happens all over the country, the more likely it is that more states are going to follow suit OR the federal government will issue a national mandate securing Medicare treatment. Efforts to cut costs, especially with the fears of credit crises in the EU, will be continuous and unrelenting.
If you think the government is going to let physicians call the shots on this one, you're deluding yourself.

The requirements on seeing a patient on a plan if you are in network is not - "you just see everyone who calls" - just a limited number. Practices routinely create graphs and when a practice reaches a point of excess demand over excess capacity--the plans with the smaller fee schedules are dropped or patients limited from that plan. The Mayo CLinic does this now for instance. That's just how it is outside of academic medical centers mostly. More people buying insurance is only going to increase this dynamic.
Again, this is private insurers. In fact, what you're describing is probably applicable to a small minority of private practices. Unless you're in a underserved area, where patient demand is greater than provider supply, you probably won't turn down any privately insured patient. In saturated metropolitan and suburban markets, private payors are fought over. I would love to hear how many physician clinics in NYC turn down private payors of any plan.
I agree with you that our President would love to see a government that can call all the shots in health care and all of that - but just wait and see what happens over the next few years - it won't happen. Almost everyone I know with a job and an education is pretty angry about Health Care reform and will vote along the lines of this single issue, which to me is pretty amazing. Younger folks are split evenly, becuase its not a big issue for them yet.
I don't know anyone who is angry about the reform, who isn't a doctor. There are enough people out there who realize that the status quo is not sustainable, financially. It doesn't really matter HOW costs are going to be cut - it only matters that they will be. Physician salaries are going down, regardless. I honestly can't think of a single physician who doesn't concur.

The De-coupling in health care that you speak about is really a movement towards a two-tier system - you know it, I know it- we all do. That's whats happening in my opinion. Folks with decent jobs and some money will have access to better healthcare - and the rest will have access to a basic plan of benefits. I believe the middle class will be losers and will be slowly pushed downward.

Finally on physician supply and demand - a lot of specialties have beeen very smart - and tightly controlled suppply. There are going to be doc shortages in many fields. BTW- anyone see the recent BCBS mailing on their new 2 ribbon system and the 14 targeted specialties? Certainly good for discussion. Ok- off the soapbox ( for now)
There will probably be a two-tier system of some sort, which may function perfectly well.
 
Members don't see this ad :)
Roukie is correct on this. Mass and NY are prime examples of health insurance reform failures. Increased taxes and expenses barely affordable by a very high wage structure that does not exist in most other places.Very few places in the country have the concentration of hospitals like Boston and New York do, yet another reason why stuff happening in these two rare birds cannot be replicated elsewhere, and certainly not forced. The usual single dominant hospital system or speciality group- like in Tuscson Arizona for instance ( 1 million people in the area) would just laugh and give the government the high sign. ( politely)

Apples and oranges. The reason why the Massachusetts reform effort wasn't as cost effective as they wanted (though they DID expand care) is due to a long list of reasons, none of which has to do with what I'm talking about - decreased reimbursement for medical services.
"Give the government the high sign?" Since when can you do that? A mandate isn't a frickin' suggestion. If it was, might as well stop paying taxes.

But, honestly, enough with this irrelevant crap. I'll break it down simply for you.

-Medicare reimbursement rates will decrease more.
-Physicians will (according to you) stop seeing Medicare patients.
-The government, then, can either back down and stop cutting costs OR it can federally mandate service to Medicare.
- The latter will occur
- Physician income will decrease, as a result
 
Apples and oranges. The reason why the Massachusetts reform effort wasn't as cost effective as they wanted (though they DID expand care) is due to a long list of reasons, none of which has to do with what I'm talking about - decreased reimbursement for medical services.
"Give the government the high sign?" Since when can you do that? A mandate isn't a frickin' suggestion. If it was, might as well stop paying taxes.

But, honestly, enough with this irrelevant crap. I'll break it down simply for you.

-Medicare reimbursement rates will decrease more.
-Physicians will (according to you) stop seeing Medicare patients.
-The government, then, can either back down and stop cutting costs OR it can federally mandate service to Medicare.
- The latter will occur
- Physician income will decrease, as a result


Hi. Sorry you seem angry. Its just a discussion. I think its interesting that Roukie and I own and manage our practices in another part of the country from where you are. So I hope you can appreciate that what you believe to be reality in New York for instance - may not be the same reality or have applicability in other parts of the country.

As you know many states have filed suit regarding the health care reform bill based on a lack of constitutionality. Win lose or draw, we should all realize that the constitution does separate state and federal powers quite clearly. That is why a federal mandate to "force" doctors to do anything isn't really feasible. The Federal Government has no basis for that type of ruling. The licensing and requirements to practice medicine are state based -And after the coming elections, I really don't think we will have a Congress so willing to move towards the socialistsic tendencies we are now seeing. But who knows, maybe I am wrong. It just won't matter. As you know, a great number of states opted out of the federal risk pool option. A lot of us already have it and realize that attaching a state already making it to a government program that is ging to go over budget doesn't make sense. States in financial trouble such as New York, California, and Mass are on one side of a fence and states that arent are on another. Texas has no desire to have its monies redistributed at the federal level to other less well managed states. That dynamic in itself will create real barriers to draconian fed takes all change.

The point here is that the states aren't going to support any federal mandates concerning health care and despite the barely passed healthcare reform bill states still are going another direction and seeking minimum involvement from the fed. In the end, the health care reform bill may cause a smaller number of changes than people expect. Physicians will be key. I hope many will choose to join private practices or build their own, in an effort to maintain more independent decision making.

Fee schedules have been dropping for a long time. And docs accept fewer and fewer medicare patients. That hasn't caused anything to happen. Not one thing. Nothing new there. You and I both know that the more a system tries to make rules the more effort is expended in adapting to them. The catch is the time spent dealing with them takes away from patient care and knowledge acquisition.

I don't think the future of health care can really be "broken down" by anyone into simple line items by the way. Its a work in progress. I hope you will join the party! :)
 
Apples and oranges. The reason why the Massachusetts reform effort wasn't as cost effective as they wanted (though they DID expand care) is due to a long list of reasons, none of which has to do with what I'm talking about - decreased reimbursement for medical services.
"Give the government the high sign?" Since when can you do that? A mandate isn't a frickin' suggestion. If it was, might as well stop paying taxes.

But, honestly, enough with this irrelevant crap. I'll break it down simply for you.

-Medicare reimbursement rates will decrease more.
-Physicians will (according to you) stop seeing Medicare patients.
-The government, then, can either back down and stop cutting costs OR it can federally mandate service to Medicare.
- The latter will occur
- Physician income will decrease, as a result

Oh by the way - The Mass reform, which no one wants to acknowledge credit for, expanded coverage, not access. And it is a huge problem. I was just in Boston this weekend talking with some folks. evryone is under more financial strain for sure--no one has more access to care- coverage has expanded, doctors won't see the patients, and no one in Mass is forcing docs to see anyone. Prime example of no doc mandate despite a much easier scenario to control.
 
That's fine. Use all the leverage you want with private insurers in your area. That's really the last bastion physicians have. Even then, historical data has shown that as Medicare reimbursement falls, so falls private insurance reimbursements.
And we're talking about different scales of change. Tell me exactly how you are going to use "leverage on behalf of your group" to influence legislation? Forget federal legislation. How about even state legislation? Just because you can fight tooth and nail with regional insurers doesn't mean you can curb the tides of change in national health care.


What? Do you know what a mandate is? In Massachusetts, due to the increased number of physicians who did just as you say, it is now state law to see Medicare/Medicaid patients. Failure to comply results in losing your medical license.
The more this (physicians refusing Medicare) happens all over the country, the more likely it is that more states are going to follow suit OR the federal government will issue a national mandate securing Medicare treatment. Efforts to cut costs, especially with the fears of credit crises in the EU, will be continuous and unrelenting.
If you think the government is going to let physicians call the shots on this one, you're deluding yourself.


Again, this is private insurers. In fact, what you're describing is probably applicable to a small minority of private practices. Unless you're in a underserved area, where patient demand is greater than provider supply, you probably won't turn down any privately insured patient. In saturated metropolitan and suburban markets, private payors are fought over. I would love to hear how many physician clinics in NYC turn down private payors of any plan.

I don't know anyone who is angry about the reform, who isn't a doctor. There are enough people out there who realize that the status quo is not sustainable, financially. It doesn't really matter HOW costs are going to be cut - it only matters that they will be. Physician salaries are going down, regardless. I honestly can't think of a single physician who doesn't concur.


There will probably be a two-tier system of some sort, which may function perfectly well.

I appreciate the time you spent writing this but you are not correct in most areas. call your Medicare carrier. You can limit the number of patients you see from any plan you want and still stay in Medicare. I have made that call myself. There is NO requirement in any state, including Massachusetts, to take a certain number of Medicare or Medicaid patients. You can see just a handful and remain in network. All comments I have made apply to Medicare Part B and Part C. I deal with this every day.

yes doctor incomes are decreasing. but that has nothing to do with your out of left field certainty that docs will be mandated to see all comers or have their network membership revoked.

Also, the comment you made about states following suit is really funny. You mean the same states that are suing the federal Government on grounds of lack of constitutionality of the Health Care Reform bill? The bill that barely passed despite having a socialist type President bullying things via his influence behind the scenes on some sort of personal vendetta? What do you think will happen, whether it be in 3 years or seven, when a new President takes office?
 
Again, this is private insurers. In fact, what you're describing is probably applicable to a small minority of private practices. Unless you're in a underserved area, where patient demand is greater than provider supply, you probably won't turn down any privately insured patient. In saturated metropolitan and suburban markets, private payors are fought over. I would love to hear how many physician clinics in NYC turn down private payors of any plan.


There will probably be a two-tier system of some sort, which may function perfectly well.


if you think the VA, Canada, and the open ward you cant access brand name drugs that dont fit the annual budget system in England functions perfectly well. The only place on the planet that has pulled off a dual system successfully is Hong Kong.

Anyway, your statement about only being in rural areas is false. I am in Houston. There is a lot of competition. When memorial hermann negotiates a contract with an ins co - they call the shots. I wont bore you with it but that's what happens. I know this first hand from the insurer side, having been a passive bystander through multiple occurrences, but with direct connect at the ins co level. The ins have no choice. I also don't consider Tucson rural. You have an East Coast mentality on this in my view. The world is not New York! If you understand why NYC only has three main big insurers remaining you know full well that a regulatory debacle resulted in BCBS- Empire basically driving the competition out. I feel sorry for you all in new York - but you all screwed yourselves big time. New York is a very unique situation and exact example of what a state shouldn't do. The state government in Texas knows this and the TDI is all on insurers here maintaining competition thus far.
 
"Oh, and I don't know what you mean by 30-50% of practicing physicians will be retiring in the next few years... that's impossible, unless you mean "next few decades." But, in that case, there will be even more new grads to fill their place."

This was from a 2009 article, the entirety of which was quite fascinating:

•Four of nine doctors, or 45%, said they "would consider leaving their practice or taking an early retirement" if Congress passes the plan the Democratic majority and White House have in mind.
More than 800,000 doctors were practicing in 2006, the government says. Projecting the poll's finding onto that population, 360,000 doctors would consider quitting.


And that's just based on the passage of an earlier version of health care reform bill that had a public option in it.


A lot of residency slots go unfilled every year and many specialties that cannot be replaced by non-docs have tightly controlled slot numbers. There are some real limits at play here if docs wanted to use them. Its up to us.
 
"That's fine. Use all the leverage you want with private insurers in your area. That's really the last bastion physicians have. Even then, historical data has shown that as Medicare reimbursement falls, so falls private insurance reimbursements.
And we're talking about different scales of change. Tell me exactly how you are going to use "leverage on behalf of your group" to influence legislation? Forget federal legislation. How about even state legislation? Just because you can fight tooth and nail with regional insurers doesn't mean you can curb the tides of change in national health care."

I think you misread my meaning of leverage. I don't mean to suggest a bnullying or pressure to get money. I mean more in terms of positioning, relationship building, and aligning goals for mutual outcomes that benefit everyone. Its just like PMR - a small field has to build relationships and alliances if you will- to achieve a mutually beneficial result -- there are some instances where the other type of leverage is used- but even then - its key to "leave some meat on the bone." What comes around goes around.
 
Here's a Massachusetts Physician written article from Health Care News about Health Care reform in Massachusetts:

Lowering Quality of Care A sudden glut of newly insured does contribute to problems, Stergios acknowledged. “Increased waiting times may actually dissuade patients from seeing their doctors, which in some cases could lead to lower quality care,” he said, “and there may also be a bidding up of overall costs.”
“Massachusetts is demonstrating what would happen if a national health care system were ever to become law in the United States,” said Twila Brase, president of the Citizens’ Council on Health Care. “Entitlement and so-called ‘universal coverage’ led to a surge in utilization which resulted in physician shortages” in the Bay State, she noted.

Strains on Doctors
The problem of patient overload of the system is being compounded by doctors leaving the state to work elsewhere, said Stergios.
“The strains on doctors who already have higher tort claim costs and face numerous requirements from the state government and insurers may lead even more of our doctors to practice medicine in states that are less restrictive,” Stergios noted.
“Doctors are moving to areas outside of Massachusetts because of fewer restrictions on how they practice medicine, lower costs of practicing medicine, and lower cost of living,” Stergios said.


This is just a small snipit of a much worse overall article; Physician's leaving equates to quitting on a national scale. But I personally have no concerns. Most of the rest of the country doesn't have any interest in trying anything like what Mass has done...and Romney has distanced himself from responsibility..which really is quite significant when you think about it.
 
"What? Do you know what a mandate is? In Massachusetts, due to the increased number of physicians who did just as you say, it is now state law to see Medicare/Medicaid patients. Failure to comply results in losing your medical license.
The more this (physicians refusing Medicare) happens all over the country, the more likely it is that more states are going to follow suit OR the federal government will issue a national mandate securing Medicare treatment. Efforts to cut costs, especially with the fears of credit crises in the EU, will be continuous and unrelenting.
If you think the government is going to let physicians call the shots on this one, you're deluding yourself."

I looked at this. Last week it was a bill that hadn't passed but has been proposed. I can't find its passage ANYWHERE. The feeling is it will make problems worse on several levels and is a violation of the 13th amendment. Can you quote me a link or article that shows its passage? I can't find any. In addition, the bill doesn't quite say what you have posted. It doesn't say every doctor in the state has to take every patient that calls who is on Medicaid, medicare, and Mass Whatever public plan - it says if you participate in these plans ( and ties them actually) - you have to take anyone who seeks care. Big difference. Also the language does not say " You will lose your license." The bill is online. I can't find that language in it. Show me.

BTW - I read the bill myself. But again - I haven't seen evidence of passage yet. The reason its an issue is that the system is loosing huge money so its an issue of control and being able to ratchet down rates. ( no surprise here of course)
 
You can make me accept Medicare or Medicaid with a National or state law. But I don't believe you can specify how I book them. If my next available Medcaid slot is not until 7 weeks from next Tuesday, I'm not going to be seeing much Medicaid.

Many doctors "accept" Medicare and Medicaid but have closed their practices to new patients with these payers (not insurers, these are not insurance, they are entitlements).
 
You can make me accept Medicare or Medicaid with a National or state law. But I don't believe you can specify how I book them. If my next available Medcaid slot is not until 7 weeks from next Tuesday, I'm not going to be seeing much Medicaid.

Many doctors "accept" Medicare and Medicaid but have closed their practices to new patients with these payers (not insurers, these are not insurance, they are entitlements).


Yep.
 
One would hope that if the current regime tries to federally mandate acceptance of Medicare/Medicaid as a pre-requisite for licensure, that the AMA would stop it's sycophantic fawning, get off it's gluteus, and actually advocate for physicians with a big, fat, restraint-of-trade lawsuit.

Probably won't happen though.
 
One would hope that if the current regime tries to federally mandate acceptance of Medicare/Medicaid as a pre-requisite for licensure, that the AMA would stop it's sycophantic fawning, get off it's gluteus, and actually advocate for physicians with a big, fat, restraint-of-trade lawsuit.

Probably won't happen though.

How many docs do you know that are members of the AMA? I know 3.
2 years ago the Oklahoma Med Association separated from the AMA and since then 75% of OSMA members have quit the AMA. Don't hold your breath for them to do anything except sell books and coding techniques that make your life more difficult.
 
One would hope that if the current regime tries to federally mandate acceptance of Medicare/Medicaid as a pre-requisite for licensure, that the AMA would stop it's sycophantic fawning, get off it's gluteus, and actually advocate for physicians with a big, fat, restraint-of-trade lawsuit.

Probably won't happen though.


The AMA does one thing: what its member physicians (and medical students) tell it to do. (For better or worse), It is the only organization out there that has the ability to represent the interests of all physicians out there, whether they decide to have a seat at the table or not. I always find it perplexing how many physicians refuse to be a part of the process, and then get angry when they feel their voices aren't heard.

Regarding potential implications (positive or negative) of the new health care legislation on PM&R, I'd much rather be on the side actively shaping the policy, rather than sitting passively waiting for it all to happen to me.
 
Regarding potential implications (positive or negative) of the new health care legislation on PM&R, I'd much rather be on the side actively shaping the policy, rather than sitting passively waiting for it all to happen to me.

Wouldn't really say kissing Obama's ass is shaping policy. For all the undying oaths of fealty AMA made to the press, they couldn't even get their member's #1 and #2 concerns, MedMal and SGR reform, addressed.

I cheerfully have called legislators, expressing my disgust at the healthcare 'reform'. Also, have cheerfully advocated that our practice drop Medicare if the SGR cuts are implemented.
 
The AMA does one thing: what its member physicians (and medical students) tell it to do. (For better or worse), It is the only organization out there that has the ability to represent the interests of all physicians out there, whether they decide to have a seat at the table or not. I always find it perplexing how many physicians refuse to be a part of the process, and then get angry when they feel their voices aren't heard.

Regarding potential implications (positive or negative) of the new health care legislation on PM&R, I'd much rather be on the side actively shaping the policy, rather than sitting passively waiting for it all to happen to me.

I was one of the PMR reps to the AMA for 9 years ( resident section, then YPS, and finally and briefly- alternate delegate) - its an interesting organization and I learned a great deal during my tenure. The board of directors did not endorse the health care legislation, It was done by a now past president based on deal with the Obama administration in landing him a future position out side of the AMA ; what I am saying is that the AMA did not support legislation anymore than congress did - its all about behind the scenes influence of a few ignoring the needs and desires of the masses.

Currently a meager 18% of docs belong to the AMA and that percentage is declining. 18% of docs does not a consensus make.
 
The AMA does one thing: what its member physicians (and medical students) tell it to do. (For better or worse), It is the only organization out there that has the ability to represent the interests of all physicians out there, whether they decide to have a seat at the table or not. I always find it perplexing how many physicians refuse to be a part of the process, and then get angry when they feel their voices aren't heard.

Regarding potential implications (positive or negative) of the new health care legislation on PM&R, I'd much rather be on the side actively shaping the policy, rather than sitting passively waiting for it all to happen to me.

I am very politically active. I am a member (and former delegate) to OSMA (OK med association), contribute to political campaigns, call and write my legislators. My US rep knows me by name and I have spoken to him personally on the phone on many occassions. One of my senators is a physician from my town! But I am NOT and never will be a member of the AMA ever again. They do not represent my interests, nor the interests of most physicians.:thumbdown:
 
The bill in Mass is still tied up in the House, I believe. It is a disheartening sign of potential things to come. While I do not believe the Fed can one day up and mandate Medicare coverage, I also don't think every physician can just stop seeing ****ty govt/state run plans. It's going to get messy, and I don't see physicians on the winning side of the battle.
 
The bill in Mass is still tied up in the House, I believe. It is a disheartening sign of potential things to come. While I do not believe the Fed can one day up and mandate Medicare coverage, I also don't think every physician can just stop seeing ****ty govt/state run plans. It's going to get messy, and I don't see physicians on the winning side of the battle.

I agree that there is a battle in Massachusetts. The question is why? In that state, negotiations drove up costs, along with some utilization, as docs needed to be enticed to see patients. So then the whole thing became too expensive to maintain and now its a major problem.

So now the legislation, as I read it, is tying Medicare, Medicaid, and through the state insured plans together in a way by making a pre-requisite of seeing all who seek care in order to maintain an in-network status with all three plans. In a way, I hope the legislation passes but I don't think it will.

In the big picture, my only comment is that Part B monies to doctors only represents 7% of Medicare Part B total expenditures. Even if doctors went unpaid and 7% of Medicare costs were eliminated, the problem would remain, at least as far as costs.

My solution would in fact be a sort of two tiered system alongside a few major changes. But I would simply provide mammography, colonoscopy, diabetic testing and care, as well as Hyperternsion monitoring and management, for free to everyone. Early detection and good management in these areas would lower overall costs directly and also at a societal level. ( An opinion)

But I would also raise the age of medicare eligibility a few years and place a limit on drug reimbursements by government plans to a certain percentage max above global market pricing. I think the cost savings here would be close to 60 billion per year.

Of course, I'd also cut the federal government by about 25%,,,but that's another story.
 
Tort reform, while important, would reduce healthcare spending by 0.5%. Medicare cuts were taken exclusively from Medicare Advantage. Insurance companies too the brunt of that cut in order to gain 32 million new customers. Current traditional Medicare insured were in no way impacted by the Medicare cutes the Health Care Reform bill implemented.

Fixing the SGR is a problem largely because physicians could never agree on a solution. The recent 1-2% over inflation proposals are the first time organized medicine has agreed on a solution.

"Entrepreneurial physicians" is code for docs who have figured out how to rape the system. I in no way begrudge them the revenues they earned legally, but it is clear that physician owned facilities, whether they be MRIs, ASCs, or hospitals, are over-utilized in comparison to those in which physicians do not own interests. That these excesses ought to be reigned in really ought not to be a topic of discussion, and most who continue to advocate the "entrepreneurial" position are placing their own interests ahead of their patients.

No one ever said any physician was entitled to a 7-figure income, yet many of the ferals now rake those kind of numbers in each year. We as a field know who the thieves are, but have refused to call them out for years. Medical Advisory panels are mandated to make evidence-based determinations. Ferals will be the biggest losers, and those who practice evidence-based medicine have little to fear.

The Constitutional challenges to the Health Care Reform bill are non starters. The 10th Amendment argument is the same that was advocated by segregationists under the "states rights" banner. It failed to win the day then, just as it will fail now. Tea party Republicans are using this and repeal initiatives largely to bolster fund-raising campaigns.

Lastly, states that will be required to increase their funding for Medicaid programs are typically the ones with the lowest current funding for a whole host of initiatives to help the poor. We as a society owe the poorest amongst us adequate healthcare, and the states in question are typically the least friendly to minorities (ie. states with a high percentage of Hispanics, or with a "Confederate" history)
 
"Entrepreneurial physicians" is code for docs who have figured out how to rape the system. I in no way begrudge them the revenues they earned legally, but it is clear that physician owned facilities, whether they be MRIs, ASCs, or hospitals, are over-utilized in comparison to those in which physicians do not own interests. That these excesses ought to be reigned in really ought not to be a topic of discussion, and most who continue to advocate the "entrepreneurial" position are placing their own interests ahead of their patients.

What about physican owned fluoro units in their offices?

Physician owned hospitals/ASC's have more efficient care, higher patient satisfaction, and better outcomes (lower infection rates, lower morbidity/mortality).
 
Tort reform, while important, would reduce healthcare spending by 0.5%. Medicare cuts were taken exclusively from Medicare Advantage. Insurance companies too the brunt of that cut in order to gain 32 million new customers. Current traditional Medicare insured were in no way impacted by the Medicare cutes the Health Care Reform bill implemented.

Fixing the SGR is a problem largely because physicians could never agree on a solution. The recent 1-2% over inflation proposals are the first time organized medicine has agreed on a solution.

"Entrepreneurial physicians" is code for docs who have figured out how to rape the system. I in no way begrudge them the revenues they earned legally, but it is clear that physician owned facilities, whether they be MRIs, ASCs, or hospitals, are over-utilized in comparison to those in which physicians do not own interests. That these excesses ought to be reigned in really ought not to be a topic of discussion, and most who continue to advocate the "entrepreneurial" position are placing their own interests ahead of their patients.

No one ever said any physician was entitled to a 7-figure income, yet many of the ferals now rake those kind of numbers in each year. We as a field know who the thieves are, but have refused to call them out for years. Medical Advisory panels are mandated to make evidence-based determinations. Ferals will be the biggest losers, and those who practice evidence-based medicine have little to fear.

The Constitutional challenges to the Health Care Reform bill are non starters. The 10th Amendment argument is the same that was advocated by segregationists under the "states rights" banner. It failed to win the day then, just as it will fail now. Tea party Republicans are using this and repeal initiatives largely to bolster fund-raising campaigns.

Lastly, states that will be required to increase their funding for Medicaid programs are typically the ones with the lowest current funding for a whole host of initiatives to help the poor. We as a society owe the poorest amongst us adequate healthcare, and the states in question are typically the least friendly to minorities (ie. states with a high percentage of Hispanics, or with a "Confederate" history)

I am still looking for the punch line. I could write a small novel refuting just about everything in this post, which is so far removed from reality that its difficult to believe we actually live in the same country. Does anyone else here believe any of the content of this post and if so perhaps that would be a good point for discussion. Wow.
 
I am still looking for the punch line. I could write a small novel refuting just about everything in this post, which is so far removed from reality that its difficult to believe we actually live in the same country. Does anyone else here believe any of the content of this post and if so perhaps that would be a good point for discussion. Wow.
I have watched you rail, rant, and attack others on this thread. Feed free to attempt an intelligent discussion - so long you can back up your positions with documentable facts, rather than repeating tired old Republican talking points, I am all ears. Your small novel, btw, would be in line with your prior posts, as novels are, by definition, works of fiction.
 
"Entrepreneurial physicians" is code for docs who have figured out how to rape the system. )

I consider myself somewhat entrepreneurial, but do not "Rape the system", nor do I do anything unethical nor illegal. I practice good medicine. I do market my practice and run my business like a business. I am willing to travel to get patients. I was offended by your characterization.

Lastly, states that will be required to increase their funding for Medicaid programs are typically the ones with the lowest current funding for a whole host of initiatives to help the poor. We as a society owe the poorest amongst us adequate healthcare, and the states in question are typically the least friendly to minorities (ie. states with a high percentage of Hispanics, or with a "Confederate" history)

Oklahoma has fairly good benes for the Medicaid population. We are also one of the poorest, least educated states, with very high rates of chronic diseases. We do not have the money to fund the doubling of the Medicaid roles. The Oklahoma Health care authority is seriously considering the ELIMINATION of all DME and Rx drug coverage for ALL adults! What should we do?
 
I have watched you rail, rant, and attack others on this thread. Feed free to attempt an intelligent discussion - so long you can back up your positions with documentable facts, rather than repeating tired old Republican talking points, I am all ears. Your small novel, btw, would be in line with your prior posts, as novels are, by definition, works of fiction.

I voted for Obama in the last election and lean towards the democrats in most elections. I am not interested in mud wrestling, just facts and quality of care for patients. I am interested in seeing if anyone else backs you on anything you have said. Nothing so far to talk about with regards to your post. Maybe something will come up. Have a good one. BTW - I think that evidence based medicine overall is a good thing - but that would definitely have a negative impact on PMR.
 
I invited you to engage in an intelligent discussion, and you instead insist upon a popularity contest.

It's a shame you are apparently incapable of rational discourse when someone challenges your positions.
 
I consider myself somewhat entrepreneurial, but do not "Rape the system", nor do I do anything unethical nor illegal. I practice good medicine. I do market my practice and run my business like a business. I am willing to travel to get patients. I was offended by your characterization.



Oklahoma has fairly good benes for the Medicaid population. We are also one of the poorest, least educated states, with very high rates of chronic diseases. We do not have the money to fund the doubling of the Medicaid roles. The Oklahoma Health care authority is seriously considering the ELIMINATION of all DME and Rx drug coverage for ALL adults! What should we do?


The Louisiana governor is saying the same thing - a doubling of Medicaid roles to about 320,000 would bankrupt the state. The Feds have proposed changing the balance of fed vs state monies towards the feds, but even with the change, it's still a no way situation for many states. We did the math in Texas; the argument is not about whether or not its an increase in state expense with money we don't have; it's a disagreement on how many billions more health care reform will cost us and who does the math. Unfortunately, public education loses either way, and, amazingly, some state supported health care systems, including free clinics of all things. Great.
 
I am not interested in mud wrestling, just facts
I invited you to engage in an intelligent discussion, and you instead insist upon a popularity contest.

It's a shame you are apparently incapable of rational discourse when someone challenges your positions.

You disparaged my earlier post, but as of yet have not presented one "fact" to challenge my assertions.
 
You disparaged my earlier post, but as of yet have not presented one "fact" to challenge my assertions.

(I know you are picking your fight with Rysa, and not me.)

And at the same time, you continue to IGNORE mine. I ask again
  1. What should we be doing about paying at a state level for a federally mandated program when we don't have the money to pay for what we are doing now?
  2. What is your opinion of the ethics of office based fluoro units and x-ray?
  3. How do you explain the improved quality of care and lower morbidity and mortality at physician owned/joint venture hospitals?
 
(I know you are picking your fight with Rysa, and not me.)

And at the same time, you continue to IGNORE mine. I ask again
  1. What should we be doing about paying at a state level for a federally mandated program when we don't have the money to pay for what we are doing now?
  2. What is your opinion of the ethics of office based fluoro units and x-ray?
  3. How do you explain the improved quality of care and lower morbidity and mortality at physician owned/joint venture hospitals?

No additional patients will enrolled in Medicaid as a result of Healthcare reform until 2014. Revenue to fund this additional insured starts being collected this year. You can disagree all you like, but OMB found this program to be revenue neutral for the first decade of the program.

As you know, office based fluoro is not a separate cost center - we are reimbursed on a global basis. So there is no way of being in network as the physician, while being out of network for the facility fee. Out of network facility fees are where physicians set their charges at exorbitant rates.

Physician owned facilities over-utilize services compared with community owned facilities providing the same services.. Physician owned facilities are an inherent conflict of interest. If you have a vested interest, you will be more likely to order borderline procedures than if you send them out. We all insist we are good guys who don't do that, but the numbers say otherwise.

You can hypothesize improved quality of care and lower M&M rates, but there is no national data to back up such a claim
 
I consider myself somewhat entrepreneurial, but do not "Rape the system", nor do I do anything unethical nor illegal.
The average epidural done in the office generates CHARGES of about $1200-1500. A similar procedure done in a physician owned hospital generates between $8 and 30,000 in charges. I am sorry if characterizing that as raping the system offends your delicate sensibilities, but a 2500% differential is unconscionable
 
Tort reform, while important, would reduce healthcare spending by 0.5%. Medicare cuts were taken exclusively from Medicare Advantage. Insurance companies too the brunt of that cut in order to gain 32 million new customers. Current traditional Medicare insured were in no way impacted by the Medicare cutes the Health Care Reform bill implemented.

Fixing the SGR is a problem largely because physicians could never agree on a solution. The recent 1-2% over inflation proposals are the first time organized medicine has agreed on a solution.

"Entrepreneurial physicians" is code for docs who have figured out how to rape the system. I in no way begrudge them the revenues they earned legally, but it is clear that physician owned facilities, whether they be MRIs, ASCs, or hospitals, are over-utilized in comparison to those in which physicians do not own interests. That these excesses ought to be reigned in really ought not to be a topic of discussion, and most who continue to advocate the "entrepreneurial" position are placing their own interests ahead of their patients.

No one ever said any physician was entitled to a 7-figure income, yet many of the ferals now rake those kind of numbers in each year. We as a field know who the thieves are, but have refused to call them out for years. Medical Advisory panels are mandated to make evidence-based determinations. Ferals will be the biggest losers, and those who practice evidence-based medicine have little to fear.

The Constitutional challenges to the Health Care Reform bill are non starters. The 10th Amendment argument is the same that was advocated by segregationists under the "states rights" banner. It failed to win the day then, just as it will fail now. Tea party Republicans are using this and repeal initiatives largely to bolster fund-raising campaigns.

Lastly, states that will be required to increase their funding for Medicaid programs are typically the ones with the lowest current funding for a whole host of initiatives to help the poor. We as a society owe the poorest amongst us adequate healthcare, and the states in question are typically the least friendly to minorities (ie. states with a high percentage of Hispanics, or with a "Confederate" history)

i dont disagree with everything ampa says. i think the way he says it is what gets under people's skin.


0.5% -- dont know how anyone can reasonably estimate that

SGR is obviously a problem.

we, as physicians, do a horrible job of policing ourselves. how many A-hole injectionists out there do you know of? not all "entrepreneurial physicians" rape the system. but way too many do.

poorer states will have more trouble keeping up. historically, these are the old "conferderate" states
 
0.5% -- dont know how anyone can reasonably estimate that
Annual jury awards and legal settlements involving doctors amounts to "a drop in the bucket" in a country that spends $2.3 trillion annually on health care, Amitabh Chandra, a Harvard University economist, recently told Bloomberg News. Chandra estimated the cost of jury awards at about $12 per person in the U.S., or about $3.6 billion. Insurer WellPoint Inc. has also said that liability awards are not what's driving premiums.

And a 2004 report by the Congressional Budget Office said medical malpractice makes up only 2 percent of U.S. health spending. Even "significant reductions" would do little to curb health-care expenses, it concluded.

A study by Bloomberg also found that the proportion of medical malpractice verdicts among the top jury awards in the U.S. declined over the last 20 years. "Of the top 25 awards so far this year, only one was a malpractice case." Moreover, at least 30 states now cap damages in medical lawsuits.

The experience of Texas in capping damage awards is a good example. A recent analysis by Atul Gawande in the New Yorker found that while Texas tort reforms led to a cap on pain-and-suffering awards at two hundred and fifty thousand dollars, which led to a dramatic decline in lawsuits, McAllen, Texas is one of the most expensive health care markets in the country. In 2006, "Medicare spent fifteen thousand dollars per person enrolled in McAllen, he finds, which is almost twice the national average — although the average town resident earns only $12,000 a year. "Medicare spends three thousand dollars more per person here than the average person earns."
 
The average epidural done in the office generates CHARGES of about $1200-1500. A similar procedure done in a physician owned hospital generates between $8 and 30,000 in charges. I am sorry if characterizing that as raping the system offends your delicate sensibilities, but a 2500% differential is unconscionable

So the fact that you get paid the global fee in the office as opposed to the professional component does not impact you?

You are being a hypocrit. You work in a facility that has its own MRI/CT and fluoro equiptment. But YOU don't do anything unethical.

You are talking about CHARGES in physician owned hosp. as being different from other types of hospitals (not for profit/for profit private). They are not. Everyone tries to maximize their reimbursement.

The physician owned hospital in my town has the SAME charges as the other hospital in town. Both are for profit. The readmission rate at the physician owned hospital are lower. Oh, and the Patient/nurse ratio is LOWER at the physician owned hospital! (HIGHER COSTS!!)
 
Annual jury awards and legal settlements involving doctors amounts to “a drop in the bucket” in a country that spends $2.3 trillion annually on health care, Amitabh Chandra, a Harvard University economist, recently told Bloomberg News. Chandra estimated the cost of jury awards at about $12 per person in the U.S., or about $3.6 billion. Insurer WellPoint Inc. has also said that liability awards are not what’s driving premiums.

And a 2004 report by the Congressional Budget Office said medical malpractice makes up only 2 percent of U.S. health spending. Even “significant reductions” would do little to curb health-care expenses, it concluded.

A study by Bloomberg also found that the proportion of medical malpractice verdicts among the top jury awards in the U.S. declined over the last 20 years. “Of the top 25 awards so far this year, only one was a malpractice case.” Moreover, at least 30 states now cap damages in medical lawsuits.

The experience of Texas in capping damage awards is a good example. A recent analysis by Atul Gawande in the New Yorker found that while Texas tort reforms led to a cap on pain-and-suffering awards at two hundred and fifty thousand dollars, which led to a dramatic decline in lawsuits, McAllen, Texas is one of the most expensive health care markets in the country. In 2006, “Medicare spent fifteen thousand dollars per person enrolled in McAllen, he finds, which is almost twice the national average — although the average town resident earns only $12,000 a year. “Medicare spends three thousand dollars more per person here than the average person earns.”

uggh. again, spoked like a true lawyer.

neither an economist or the CBO has even the slightest idea how the threat of a lawsuit (regardless of how many dollars get paid out in a settlement) can change practice management. this is why the estimates are ludicrous. lawyers, quite honestly, do not improve the quality of health care delivery, yet they do increase costs and spending. the fact that this was not addressed in the reform legislation in directly related to the trial lawyer lobby. THAT is what is unconscionable
 
0.5% -- dont know how anyone can reasonably estimate that
Annual jury awards and legal settlements involving doctors amounts to “a drop in the bucket” in a country that spends $2.3 trillion annually on health care, Amitabh Chandra, another Harvard University economist, recently told Bloomberg News. Chandra estimated the cost of jury awards at about $12 per person in the U.S., or about $3.6 billion. Insurer WellPoint Inc. has also said that liability awards are not what’s driving premiums.

And a 2004 report by the Congressional Budget Office said medical malpractice makes up only 2 percent of U.S. health spending. Even “significant reductions” would do little to curb health-care expenses, it concluded.

A study by Bloomberg also found that the proportion of medical malpractice verdicts among the top jury awards in the U.S. declined over the last 20 years. “Of the top 25 awards so far this year, only one was a malpractice case.” Moreover, at least 30 states now cap damages in medical lawsuits.

The experience of Texas in capping damage awards is a good example. Contrary to Perry’s claims, a recent analysis by Atul Gawande in the New Yorker found that while Texas tort reforms led to a cap on pain-and-suffering awards at two hundred and fifty thousand dollars, which led to a dramatic decline in lawsuits, McAllen, Texas is one of the most expensive health care markets in the country. In 2006, “Medicare spent fifteen thousand dollars per person enrolled in McAllen, he finds, which is almost twice the national average — although the average town resident earns only $12,000 a year. “Medicare spends three thousand dollars more per person here than the average person earns.”
 
Top