Medicare bill fails in Senate

[Nilf]

A bill to block a 10.6% reduction in Medicare reimbursements stalled in the Senate yesterday. The cuts will take effect on July 1 — and a weeklong congressional recess starts tomorrow.

http://blogs.wsj.com/health/2008/06...ay-cuts-to-docs-stalls-in-senate/?mod=WSJBlog

Why should you care?

For a starter, you may be asked to comment on this issue during your interviews.

MORE IMPORTANTLY, you should realize that when you enter medicine, you'll become indentured servants with very limited leverage. The society considers you overpaid, and the Congress can at whim slash your reimbursements by 10%, or more, depending on specialty.

No other professionals have to put up with this sort of farce. No other profession is so removed from the laws of free market. Who knows, maybe they'll push through some legislation in next 24 hours to avert this, and then the scenario will replay in next 6 months.

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[DrChristianTroy]

A bill to block a 10.6% reduction in Medicare reimbursements stalled in the Senate yesterday. The cuts will take effect on July 1 — and a weeklong congressional recess starts tomorrow.

http://blogs.wsj.com/health/2008/06...ay-cuts-to-docs-stalls-in-senate/?mod=WSJBlog

Why should you care?

For a starter, you may be asked to comment on this issue during your interviews.

MORE IMPORTANTLY, you should realize that when you enter medicine, you'll become indentured servants with very limited leverage. The society considers you overpaid, and the Congress can at whim slash your reimbursements by 10%, or more, depending on specialty.

No other professionals have to put up with this sort of farce. No other profession is so removed from the laws of free market. Who knows, maybe they'll push through some legislation in next 24 hours to avert this, and then the scenario will replay in next 6 months.

I agree with you completely and understand the importance of all of this. However I just wanted to clarify one thing. Congress did not "at a whim" slash the compensation rate. Actually when this Medicare payment scale was originally proposed and accepted a few years ago, this 10% decline was detailed in the plans. Even with the knowledge of a 10% decrease in the near future, the bill was accepted and doctors received moderate compensation from Medicare patients.

I just wanted to explain that they did not overnight pass a bill to limit a doctor's salary, but it was something that has been imminent for over 5 years.

And as I said before, I agree with you completely. And I think that if the continue to give the government more and more control over medicine and healthcare, this is just the tip of the iceberg.

 

[DrChristianTroy]

P.S. I know a lot of private practice doctors that do not accept Medicare patients because of these issues.

 

[bcat85]

P.S. I know a lot of private practice doctors that do not accept Medicare patients because of these issues.

This is sad, but imagine the s***storm the government will create if pretty much all private practice docs stop accepting medicare patients.

 

[Nilf]

I agree with you completely and understand the importance of all of this. However I just wanted to clarify one thing. Congress did not "at a whim" slash the compensation rate. Actually when this Medicare payment scale was originally proposed and accepted a few years ago, this 10% decline was detailed in the plans. Even with the knowledge of a 10% decrease in the near future, the bill was accepted and doctors received moderate compensation from Medicare patients.

I just wanted to explain that they did not overnight pass a bill to limit a doctor's salary, but it was something that has been imminent for over 5 years.

And as I said before, I agree with you completely. And I think that if the continue to give the government more and more control over medicine and healthcare, this is just the tip of the iceberg.

Thanks for the clarification, what you said was true. Keep in mind, however, that Congress can 'at whim', change reimbursement schemes to any specialty. Actually, I don't even think Congress has to get involved; it may be be done at a lower legislative level. It has happened several years ago to hematopathology, when the medicare reimbursement for flow cytometry was changed in such way that the EFFECTIVE medicare payments decreased by 50%. And they can do it with 30 days notice...

I stand by my original point: Congress can, and has before, slash reimbursements 'at whim'. Think long and hard before you enter medicine.

 

[DrChristianTroy]

Thanks for the clarification, what you said was true. Keep in mind, however, that Congress can 'at whim', change reimbursement schemes to any specialty. Actually, I don't even think Congress has to get involved; it may be be done at a lower legislative level. It has happened several years ago to hematopathology, when the medicare reimbursement for flow cytometry was changed in such way that the EFFECTIVE medicare payments decreased by 50%. And they can do it with 30 days notice...

I stand by my original point: Congress can, and has before, slash reimbursements 'at whim'. Think long and hard before you enter medicine.

Good point. I was only referring to this bill, but you are absolutely correct.

I also think that it is not a decision to avoid medicine all together, it is just a decision to keep the government as far away from it as possible. There is a very heavy correlation between doctor's reduced salaries and government control of the health care system.

 

[CardiacCathRat]

Good point. I was only referring to this bill, but you are absolutely correct.

I also think that it is not a decision to avoid medicine all together, it is just a decision to keep the government as far away from it as possible. There is a very heavy correlation between doctor's reduced salaries and government control of the health care system.

did you read the relevant articles????

the cuts are happening precisely BECAUSE BUSH WANTS TO GIVE MORE MONEY TO PRIVATE PLANS. Democrats voted to block the pay cuts. It's not as simple as giving the govt more or less power.

Moreover, even for doctors who do not accept Medicare, it is important to realize that private insurance plans track Medicare's decision. That is, if Medicare reduces payment for procedure X by 10%, UnitedHealth and BlueCross will follow suit.

http://www.nytimes.com/2008/01/31/washington/31budget.html

 

[CardiacCathRat]

Good point. I was only referring to this bill, but you are absolutely correct.

I also think that it is not a decision to avoid medicine all together, it is just a decision to keep the government as far away from it as possible. There is a very heavy correlation between doctor's reduced salaries and government control of the health care system.

did you read the relevant articles????

the cuts are happening precisely BECAUSE BUSH WANTS TO GIVE MORE MONEY TO PRIVATE PLANS. Democrats voted to block the pay cuts. It's not as simple as giving the govt more or less power.

Moreover, even for doctors who do not accept Medicare, it is important to realize that private insurance plans track Medicare's decisions. That is, if Medicare reduces payment for procedure X by 10%, UnitedHealth and BlueCross will follow suit.

http://www.nytimes.com/2008/01/31/washington/31budget.html


Then, there are some doctors who accept only cash (no insurance). However, this strategy only works for doctors practicing in certain fields. Nobody is going to pay for a heart transplant out of pocket, especially when the best places to get one are university centers that accept insurance.

 

[Nilf]

Moreover, even for doctors who do not accept Medicare, it is important to realize that private insurance plans track Medicare's decision. That is, if Medicare reduces payment for procedure X by 10%, UnitedHealth and BlueCross will follow suit.

http://www.nytimes.com/2008/01/31/washington/31budget.html

Precisely. Medicare exerts disproportionate influence on the private sector because of it's sheer volume of coverage. Therefore, the decisions made on the federal levels drive the market.

For those economically challenged: if uncle Sam decides to pay doctors 90 cents instead of 1 dollar, then private insurers will do the same, just because they can.

 

[DrChristianTroy]

Precisely. Medicare exerts disproportionate influence on the private sector because of it's sheer volume of coverage. Therefore, the decisions made on the federal levels drive the market.

For those economically challenged: if uncle Sam decides to pay doctors 90 cents instead of 1 dollar, then private insurers will do the same, just because they can.

This is exactly why I stand by my point. Medicare came along and started demanding $.90 to the dollar and then $.80 to the dollar and so on. Then all other insurance companies followed suit to some degree. How can you bargain with the government? It is either, we will give you these patients at these lowball rates or you will get nothing. As Medicare continues to grow, their bargaining power only grows.

 

[DrChristianTroy]

Then, there are some doctors who accept only cash (no insurance). However, this strategy only works for doctors practicing in certain fields. Nobody is going to pay for a heart transplant out of pocket, especially when the best places to get one are university centers that accept insurance.

This is why I am in favor of High Deductible Insurance Plans. Let the people take responsibility for their medical issues to some degree but have a net to catch them when the sh** hits the fan.

Why does everyone now believe that their insurance policy should cover everything that they do, especially when they go to the doctor for a stuffy nose?

 

[CardiacCathRat]

This is why I am in favor of High Deductible Insurance Plans. Let the people take responsibility for their medical issues to some degree but have a net to catch them when the sh** hits the fan.

Why does everyone now believe that their insurance policy should cover everything that they do, especially when they go to the doctor for a stuffy nose?

Huh? You clearly have no idea what you're talking about. I'm not even going to respond to you any further. Read-up on some issues before going on forums and looking like a complete idiot.

 

[DrChristianTroy]

Huh? You clearly have no idea what you're talking about. I'm not even going to respond to you any further. Read-up on some issues before going on forums and looking like a complete idiot.

Please explain what you think the best plan of action is for the country's healthcare crisis. Please do not call me an idiot just because my ideas do not mesh with yours.

Also, I am aware that HDHPs do not work for everyone (or really anyone). I was just using it as an extreme example of how I think that people should have some type of co-payment/ co-insurance so that they do not over-spend the system.

 

[joyrunner]

I've been really trying to sort through these medicare bills: scheduled cuts, bills to stall the scheduled cuts...and it seems really complicated. President Bush supports some sort of medicare cuts:
http://www.nytimes.com/2008/01/31/washington/31budget.html?_r=1&adxnnl=1&oref=slogin&adxnnlx=1214578746-Ol60Txe4ushCBMwGsd25PQ ,
but there seem to be so many different ways you can cut medicare payments that it seems like just a matter of stealing from Peter to pay Paul. I think that the bottom line is that the country is suffering from severe budget deficits, and this bill wasn't meant to make anyone happy. Instead it is meant to alleviate some strain on the system since the cuts take place when the medicare system goes over budget, and is decided by a formula. It sounds to me like the plan to cover these health cost was flawed from the day it was created, and now that we're on hard times economically with budget deficits out the wazoo, those flaws are causing problems for everyone.

 

[NeuroFP]

I love how when a doctor makes $500k a year, some people go in an uproar, but I never hear anyone challenging the big sports guys making tens of millions a year or the corporation giants. The people who help seem to always be the ones that get slapped in the face.

 

[joyrunner]

The government doesn't subsidize the tickets. And the sports guys are making a lot of other people rich.

 

[WellWornLad]

Don't forget, there's another 10% cut scheduled for January 2009.

The comments under the article are especially revealing. While it's scary to think that such cuts can continue, the fact is that it is no longer profitable to see Medicare patients for many doctors. Yeah, Medicare has leverage by being the largest purchaser of health care in the country, but you can't force people to lose money seeing patients.

When millions of people can no longer find a doctor that takes their Medicare, you can bet that their lawmakers will hear about it, and that their voice will be more shrill than that of private insurance companies looking for a handout to stay profitable.

Not that physicians will be fairing very well while all this is going on, mind you....

Here's another good article on the subject: http://www.bloomberg.com/apps/news?pid=20601124&sid=auBzV50JuieQ&refer=home

Insurance companies are paid on average 13 percent more under Medicare Advantage than the government pays to provide services directly. While Democrats say insurers get excess profit from the program, Republicans counter that the companies give seniors added care that would be endangered by reimbursement cuts.

I wonder how much they're going to value that "added care" when the only doctor that will take their Medicare plan is 100 miles away and has a 6 month waiting list for appointments.

The legislation would have reduced payments to Medicare Advantage by removing money linked to the extra cost of treating patients at teaching hospitals. Hospitals already receive separate payments to cover this and that wouldn't have changed, according to the measure.

So the government is preserving the right of private insurance companies to receive payment from the government for costs that they don't pay for, as hospitals already are compensated for these costs separately?

Seriously?

 

[Nilf]

Don't forget, there's another 10% cut scheduled for January 2009.


Seriously?

Where are all those optimistic defenders of career in medicine... Prowler, Jouliesouth, nevercold to name a few. Care to comment? I know you're reading this.

 

[EpiPEN]

Where are all those optimistic defenders of career in medicine... Prowler, Jouliesouth, nevercold to name a few. Care to comment? I know you're reading this.

Perhaps their silence speaks louder than words

 

[hermit]

It's on you if your practice chooses to accept medicare. If you are your own boss, YOU decide how much to bill for your services. YOUR office can set up payment plans, interest rates, prepayment requirements and whatever else you choose with YOUR patients. There will always be hippie tree-hugging do-gooders that can worry about declining gov't reimbursement. If you want to make a buck and help people at the same time, you will always be able to do that in medicine.

 

[DrChristianTroy]

It's on you if your practice chooses to accept medicare. If you are your own boss, YOU decide how much to bill for your services. YOUR office can set up payment plans, interest rates, prepayment requirements and whatever else you choose with YOUR patients. There will always be hippie tree-hugging do-gooders that can worry about declining gov't reimbursement. If you want to make a buck and help people at the same time, you will always be able to do that in medicine.

I agree that with smart business practices you can definitely make a buck in medicine.

However it is Medicare that is directing the "allowed" amounts that doctors can charge/ other insurance companies will pay.

Not matter how high you set your charges, the patients are not paying you, the insurance companies are. The only people that are ever "expected" to pay the full charge are the uninsured. In private practice you cannot base your commission on what you charge but instead on what you can get paid. For example even if you charge $150 for an X-Ray, BCBS might only allow you to charge $100. From that $100, the patient might pay $50 and the insurance company might pay $50. The reason that payment plans and interest rates exist in the doctor's office is so physicians can insure that they receive as much money as they can from the patients especially when the patient's share becomes $2,00 instead of $50.

Don't get me wrong, you can still make a buck in medicine; I jsut do not like that a government system like Medicare is able to choke the market.

 

[hermit]

I agree that with smart business practices you can definitely make a buck in medicine.

However it is Medicare that is directing the "allowed" amounts that doctors can charge/ other insurance companies will pay.

Not matter how high you set your charges, the patients are not paying you, the insurance companies are. The only people that are ever "expected" to pay the full charge are the uninsured. In private practice you cannot base your commission on what you charge but instead on what you can get paid. For example even if you charge $150 for an X-Ray, BCBS might only allow you to charge $100. From that $100, the patient might pay $50 and the insurance company might pay $50. The reason that payment plans and interest rates exist in the doctor's office is so physicians can insure that they receive as much money as they can from the patients especially when the patient's share becomes $2,00 instead of $50.

Don't get me wrong, you can still make a buck in medicine; I jsut do not like that a government system like Medicare is able to choke the market.

What you say is true.

I would add to my original statement, however, that you neither have to accept medicare NOR insurance. Depending on the branch of medicine you choose and the demographic you serve, the patients will willingly pay fees that you alone set.

 

[WellWornLad]

It's on you if your practice chooses to accept medicare. If you are your own boss, YOU decide how much to bill for your services. YOUR office can set up payment plans, interest rates, prepayment requirements and whatever else you choose with YOUR patients. There will always be hippie tree-hugging do-gooders that can worry about declining gov't reimbursement. If you want to make a buck and help people at the same time, you will always be able to do that in medicine.

Well, that works for less expensive services like routine visits and check-ups, but something like, say, heart surgery is well beyond the means of 95% of the population. Maybe payment plans would help with that, but I wouldn't want to stretch out the payment period on patients who are over 65 and not in the best of health.

I'm also pretty sure that it's illegal to bill on top of medicare payments (e.g., take the medicare payment and make the patient pay the difference on the sticker price). You either take it or you don't.

 

[chad5871]

What you say is true.

I would add to my original statement, however, that you neither have to accept medicare NOR insurance. Depending on the branch of medicine you choose and the demographic you serve, the patients will willingly pay fees that you alone set.

Read: Cosmetic Plastic Surgery

 

[DrChristianTroy]

Well, that works for less expensive services like routine visits and check-ups, but something like, say, heart surgery is well beyond the means of 95% of the population. Maybe payment plans would help with that, but I wouldn't want to stretch out the payment period on patients who are over 65 and not in the best of health.

I'm also pretty sure that it's illegal to bill on top of medicare payments (e.g., take the medicare payment and make the patient pay the difference on the sticker price). You either take it or you don't.

I read a story once of a plastic surgeon that stopped accepting insurance and now makes well over a million dollars a year. However since a lot of plastic surgeries are elective (therefore not usually covered by insurance), it makes sense that people would be willing to pay him out-of-pocket.

 

[NeuroFP]

The government doesn't subsidize the tickets. And the sports guys are making a lot of other people rich.

Anyone can make another person rich.
And doctors don't just get paid by the government.

 

[Jolie South]

This is not really a pre-med issue. Moving to Topics in Healthcare.

 

[WellWornLad]

However since a lot of plastic surgeries are elective (therefore not usually covered by insurance), it makes sense that people would be willing to pay him out-of-pocket.

Plenty of people are willing to pay for cosmetic surgery, but only those able to pay end up on the table.

 

[Dr.Millisevert]

Don't forget, there's another 10% cut scheduled for January 2009.

In Australia and New Zealand within the past 5 years... up to 30% of our FMGs are UK trained doctors and we also have an ever increasing % of FMGs coming here from the US to do residency and to work. No wonder with what's going on over there.

 

[kypdurron5]

In all the articles I've read on this, the one point I think missing is this- with EVERY other job in America from McDonalds minimum wage to the CEO of Microsoft- every single laborer expects to receive SOME amount of raise every year. From a few cents to a few million dollars, getting a raise is normal, and expected. So why exactly is it that ANYONE thinks the most valued, high educated members of the American workforce should take pay cuts? It's just insane, and will only deepen the primary care crisis. We'll see where we are 4 years from now, but I can tell you...there is no way on earth I'm going into primary care under current (and ever-worsening) conditions.

Wouldn't it just be fantastic if we adopted medicare on an all-inclusive nation-wide scale? (i.e. socialized medicine). It's working so well for Canada and Great Britain, right?

 

[southerndoc]

This is sad, but imagine the s***storm the government will create if pretty much all private practice docs stop accepting medicare patients.

You may be surprised to find that some hospital physician groups will also stop taking Medicare payments and will instead just bill patients as if they were uninsured.

Honestly, I think all physicians and hospitals nationwide should refuse to participate in Medicare. I'm sure that would create an uproar.

 

[southerndoc]

"U.S. Congressman Phil Gingrey, MD (R-GA) is pleased to announce that despite the Senate's failure to pass House-approved legislation to prevent a 10.6% cut to physicians' Medicare reimbursement, the Centers for Medicare and Medicaid Services (CMS) will effectively delay the scheduled cuts until at least July 15th - giving Congress time to address these cuts after the July 4th recess."

http://www.medicalnewstoday.com/articles/113190.php

 

[psy]

It seems that during the first vote they were short 2 votes to reach the needed 60 votes, one of missing people was McCain. Was there a reason why he didn't vote?

 

[southerndoc]

It seems that during the first vote they were short 2 votes to reach the needed 60 votes, one of missing people was McCain. Was there a reason why he didn't vote?

Not sure. I'm too irritated at my two senators to even care about McCain's absence of voting. Both my senators voted against cloture.

 

[Dirt]

It seems that during the first vote they were short 2 votes to reach the needed 60 votes, one of missing people was McCain. Was there a reason why he didn't vote?

Senators on the campaign trail are notoriously absent from their senatorial duties.