Medicare Plans to Cut Specialists' Payments

[MOHS_01]

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Exactly -- this will be a generalization of the Cincinnati case against the insurers from a few years ago. The complaint was that specialists were being reimbursed higher than PCP's for E&M. It was true, the medical society won the case, and while the ignorant PCP's involved were jumping up and down like a bunch of gleeful school girls, the insurance company execs were shaking hands and smiling over their savings for the out years. You see, the only thing that the PCP's accomplished was a lowering of specialist fees; they were brought down to the lowest common denominator. Idiots.

That is the way these things work -- everything falls to the lowest common denominator. If you are one of two neurologists in a community, the basic law of economics governing such a scarcity would dictate that you would be reimbursed higher than your peer group average. Unfortunately, the insurance companies pit one vs the other until the fees are brought down to what they see fit, negating much of the advantaged status of being one of two providers. The only protection is to be the sole provider of a service within an area, and then you run into ethical (and potentially legal) headwinds for fee negotiations.

Over a barrel is where we have been since the inception of the RBRVU system...

 

[Taurus]

To say that 200k is not a good salary is kind of haughty. That salary would put you in the top 1-2% of wage earners. You will not get a lot of sympathy from most people when 200k is nonsense.

Note in my original quote I said complaint not issue. You are right. You do not have to address every issue a patient has such as chronic medical problems at every visit. But in general you should address every complaint a patient has. This is how you avoid lawsuits. Patients are not happy when you do not address all of their complaints. They say, "Well I told my doctor but he did nothing about it." One of these days, it is the complaint that you dismiss that will have an adverse event occur. Then prepare for a lawyer unleashing righteous indignation at your dereliction of duty. Fortunately most adverse events do not meet all required elements to win a lawsuit and you luck out. You learn to take every complaint seriously from experience. It's a nice feeling to dodge a bullet, but you learn not to put yourself in that situation again if at all possible.

Sure surgeons have office hours, but it does not compare to PCP's who have busy clinics all day every day.

He has my vote for biggest douchebag of the year.

 

[DOCTORSAIB]

Guys, can someone please post the link again to the CMS document.

The link on page 1 of this thread is no longer active. Thanks.

 

[Charles_Carmichael]

I don't normally post here and am still a premed, so please forgive me if this sounds stupid, but why can't doctors stop being doctors for a week or even a few days? I mean, take care of the critically ill but refuse new patients, etc. Wouldn't something like this force the government to reconsider cuts in reimbursements? I can see one problem with this being that the public view of doctors would deteriorate even further, but it would be a pretty powerful message I'd think, especially considering how Obama, in his speech today, basically said that all doctors are on board with his plan, etc.

PS. Just to clarify, I'm not advocating completely abandoning patients who need immediate attention or something like that.

 

[Impromptu]

Doctor's aren't legally allowed to unionize, and the kind of actions you are suggesting are union type actions.

 

[heech]

I don't normally post here and am still a premed, so please forgive me if this sounds stupid, but why can't doctors stop being doctors for a week or even a few days? I mean, take care of the critically ill but refuse new patients, etc. Wouldn't something like this force the government to reconsider cuts in reimbursements? I can see one problem with this being that the public view of doctors would deteriorate even further, but it would be a pretty powerful message I'd think, especially considering how Obama, in his speech today, basically said that all doctors are on board with his plan, etc.

PS. Just to clarify, I'm not advocating completely abandoning patients who need immediate attention or something like that.

I'm reasonably sure doctors *can* unionize. And of course, the nurses unions have gained quite a bit of power by advocating exactly the kind of action you're suggesting.

The key difference, IMO, is that you have to be aware who you're targeting with any sort of labor action. Doctors in private practice would be inconveniencing (and angering) their direct customer base with any sort of action. This is very different from nurses, "sanitation workers", or auto workers... in those cases, workers aren't especially concerned if the people they directly service are inconvenienced. Angry customers can't directly impact their paychecks.

 

[michaelrack]

In most cases doctors can't unionize. The exception is that doctors employed by the same organization can. So if a hospital directly employs doctors, those doctors could form a union. There can't be a union consisting of doctors from different practices or of doctors working at different hospitals.