Medicare plans

[whournameiz]

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http://online.wsj.com/article/SB124646885862181139.html#articleTabs=article
By JANE ZHANG

WASHINGTON -- The Obama administration said Wednesday that it plans to cut Medicare payments for imaging services and specialists, and will use the savings to increase payments to physicians providing primary care.

Under the proposal, Medicare would put specialists' payments for evaluating and managing illnesses on par with those of primary-care physicians starting in January.

That, combined with other changes, would boost payments to internists, family physicians, general practitioners and geriatric specialists by 6% to 8% next year, said the Centers for Medicare and Medicaid Services, the agency that manages Medicare, the federal insurance program for the elderly and disabled.

Payments to cardiologists would be trimmed by 11% overall, but certain procedures they perform would see steeper reductions. Alfred Bove, president of the American College of Cardiology, figured that cardiologists would receive 42% less for an echocardiogram and 24% less for a cardiac catheterization.

Radiologists would see an estimated cut of 20% for imaging services using expensive equipment such as MRI and CT scans, said Bibb Allen, chairman of the commission on economics at the American College of Radiology. That would be in addition to the cuts imposed on radiologists under a 2005 law, he said.

The proposal, open for public comment until Aug. 31 and expected to be completed by Nov. 1, comes as the Obama administration seeks to boost the number of primary-care doctors to meet the needs of an aging population and care for the newly insured if legislation to overhaul the nation's health-care system is enacted.

The administration is already spending $500 million in stimulus funds to train more primary-care physicians and repay the student loans of primary-care doctors who work in underserved areas.

Legislation being debated in the House and the Senate also includes provisions intended to increase the number of primary-care physicians.

Ted Epperly, president of the American Academy of Family Physicians, said the Medicare proposal would help reduce the income gap among doctors -- specialists make two to five times as much as primary-care physicians -- and attract more medical students to primary care. He called the change "long overdue."

Groups representing cardiologists, radiologists and other specialists said they will lobby lawmakers to stop the cuts. Dr. Bove warned that "cutting back like this certainly threatens the successes we have had over the years with reducing heart disease."

 

[Nilf]

http://online.wsj.com/article/SB124646885862181139.html#articleTabs=article
By JANE ZHANG

WASHINGTON -- The Obama administration said Wednesday that it plans to cut Medicare payments for imaging services and specialists, and will use the savings to increase payments to physicians providing primary care.

Under the proposal, Medicare would put specialists' payments for evaluating and managing illnesses on par with those of primary-care physicians starting in January.

That, combined with other changes, would boost payments to internists, family physicians, general practitioners and geriatric specialists by 6% to 8% next year, said the Centers for Medicare and Medicaid Services, the agency that manages Medicare, the federal insurance program for the elderly and disabled.

Payments to cardiologists would be trimmed by 11% overall, but certain procedures they perform would see steeper reductions. Alfred Bove, president of the American College of Cardiology, figured that cardiologists would receive 42% less for an echocardiogram and 24% less for a cardiac catheterization.

Radiologists would see an estimated cut of 20% for imaging services using expensive equipment such as MRI and CT scans, said Bibb Allen, chairman of the commission on economics at the American College of Radiology. That would be in addition to the cuts imposed on radiologists under a 2005 law, he said.

The proposal, open for public comment until Aug. 31 and expected to be completed by Nov. 1, comes as the Obama administration seeks to boost the number of primary-care doctors to meet the needs of an aging population and care for the newly insured if legislation to overhaul the nation's health-care system is enacted.

The administration is already spending $500 million in stimulus funds to train more primary-care physicians and repay the student loans of primary-care doctors who work in underserved areas.

Legislation being debated in the House and the Senate also includes provisions intended to increase the number of primary-care physicians.

Ted Epperly, president of the American Academy of Family Physicians, said the Medicare proposal would help reduce the income gap among doctors -- specialists make two to five times as much as primary-care physicians -- and attract more medical students to primary care. He called the change "long overdue."

Groups representing cardiologists, radiologists and other specialists said they will lobby lawmakers to stop the cuts. Dr. Bove warned that "cutting back like this certainly threatens the successes we have had over the years with reducing heart disease."

I was going to post this article here, but you beat me to it.

Question to my radiology brethren: how are you going to react to this offensive of politicians? In the long run, you will win against pols who are trying to rob you, because you have sharp ammo--your hard-earned, and much needed skillz. Pols' got ephemeral, temporary herd-like mentality of sheeps who elected them. However... in the meantime, how will you fight and weather the crisis?

 

[Donvb]

I was going to post this article here, but you beat me to it.

Question to my radiology brethren: how are you going to react to this offensive of politicians? In the long run, you will win against pols who are trying to rob you, because you have sharp ammo--your hard-earned, and much needed skillz. Pols' got ephemeral, temporary herd-like mentality of sheeps who elected them. However... in the meantime, how will you fight and weather the crisis?

What's wrong with someone who goes to 5+ years of residency/fellowship and takes 3 board exams making MUCH more than someone who goes to 3 years of residency and takes one board exam??? It's capitalism, and Obama Hussein is definately bringing "change."

 

[radslooking]

What's wrong with someone who goes to 5+ years of residency/fellowship and takes 3 board exams making MUCH more than someone who goes to 3 years of residency and takes one board exam??? It's capitalism, and Obama Hussein is definately bringing "change."

if primary care folks had the option of doing 5+ years of residency and getting paid 3x what they do, im pretty sure most would have done it. That's a relatively small factor.

 

[abcxyz0123]

What's wrong with someone who goes to 5+ years of residency/fellowship and takes 3 board exams making MUCH more than someone who goes to 3 years of residency and takes one board exam??? It's capitalism, and Obama Hussein is definately bringing "change."

dumbest post ever

 

[asmallchild]

What's wrong with someone who goes to 5+ years of residency/fellowship and takes 3 board exams making MUCH more than someone who goes to 3 years of residency and takes one board exam??? It's capitalism, and Obama Hussein is definately bringing "change."

I suspect we'll see fewer people pursuing lengthier training if the salaries do equalize.

Especially in the surgical fields. Who in their right mind would pursue a 7 year neurosurgery residency when the endgame in terms of salary is similar to that of PCPs?

 

[psychforme]

I suspect we'll see fewer people pursuing lengthier training if the salaries do equalize.

Especially in the surgical fields. Who in their right mind would pursue a 7 year neurosurgery residency when the endgame in terms of salary is similar to that of PCPs?

Some of us have other things than money in our brains.

But I guess it is a difficult concept for some people to grasp. I consider it a good thing if this dreck is weeded out though.

 

[asmallchild]

Some of us have other things than money in our brains.

But I guess it is a difficult concept for some people to grasp. I consider it a good thing if this dreck is weeded out though.

A very select minority.

 

[Amxcvbcv]

I've said this before, and I feel that I should say it again.

You can't deny that reimbursement factors into peoples' choices for residency, otherwise there wouldn't be all this talk of reducing the income gap to help encourage more people to choose primary care.

For me, though, I would choose radiology again if it were the lowest paid specialty.

Unless you're completely selfless and/or a clueless boob, you're going to make a comfortable, secure living as a physician.

 

[p53]

That's because you are ALREADY in radiology.

What if you were a 3rd year medical student? Would you do three years of ER or 5 (likely 6 years due to fellowship) for radiology for the same amount of money?

Before you answer. 3 years of delaying financial gratification is tough with or without compound interest.

Plus, radiology residency is much tougher today than it was 5 years ago because of the huge image volume due to defensive medicine by the ER physicians.

I've said this before, and I feel that I should say it again.

You can't deny that reimbursement factors into peoples' choices for residency, otherwise there wouldn't be all this talk of reducing the income gap to help encourage more people to choose primary care.

For me, though, I would choose radiology again if it were the lowest paid specialty.

Unless you're completely selfless and/or a clueless boob, you're going to make a comfortable, secure living as a physician.

 

[Amxcvbcv]

That's because you are ALREADY in radiology.

What if you were a 3rd year medical student? Would you do three years of ER or 5 (likely 6 years due to fellowship) for radiology for the same amount of money?

Before you answer. 3 years of delaying financial gratification is tough with or without compound interest.

Plus, radiology residency is much tougher today than it was 5 years ago because of the huge image volume due to defensive medicine by the ER physicians.

Aside from a brief diversion in college when I was an aerospace engineering major, I have wanted to be a radiologist since I was about 14 years old.

 

[Labslave]

Aside from a brief diversion in college when I was an aerospace engineering major, I have wanted to be a radiologist since I was about 14 years old.

You saw the dark at an early age. 🙂

In all honesty, I think this news is something that needs to be taken seriously, however I would consider it very (VERY) unlikely that specialists' salaries would be on par with primary care docs' by January. Nothing in Washington ever moves that fast. Also remember that it's often times the case that lofty goals have to be met to even accomplish 10% of what politicians really want.

Although this is lowly medical student conjecture, I do think that in the next ten years the gap between specialist and primary care salaries will be smaller. It's driven by their assumption that we need more primary care docs in the first place, which is stupid. They certainly have their place, but with their training they should be able to delegate the BS to midlevels. NPs and PAs can diagnose a URI.

 

[Doublecortin]

Some of us have other things than money in our brains.

But I guess it is a difficult concept for some people to grasp. I consider it a good thing if this dreck is weeded out though.

I absolutely love to hear these kind of comments, especially from someone who's never had to work a real job and pay their bills and who was born with a trust fund and a silver spoon in their mouth

 

[Neuronix]

This thread makes me kind of queasy. It will bother me a bit if all my colleagues care about is following the money.

I would still be heading into Radiology if it paid half of what it does. I was born into poverty and have worked numerous real jobs.

 

[digitlnoize]

This thread makes me kind of queasy. It will bother me a bit if all my colleagues care about is following the money.

I would still be heading into Radiology if it paid half of what it does. I was born into poverty and have worked numerous real jobs.

Ditto. I think this is a very interesting conversation. If you take a look at rads applicant numbers vs. salary, you'll see that, once upon a time, rads did not pay well, and was NOT a popular specialty choice.

I, for one, wouldn't mind a drop in salary, if it meant I could actually get into my dream field...small price to pay, IMO. I mean, gasp, I might have to live on 200k/yr, instead of 350k! How will I manage?!?!? 😀

Let's face it, money is a big reason why many people have picked rads over the last 5-10 years...not everyone obviously, but enough. We'll see how many stay if salaries drop...

 

[Labslave]

Let's face it, money is a big reason why many people have picked rads over the last 5-10 years...not everyone obviously, but enough. We'll see how many stay if salaries drop...

Agreed. Money plus lifestyle. With those two elements in place, people begin to focus on the other benefits of radiology (lack of dealing with BS social issues, no need to smell feces, benign residency, etc.) and convince themselves rather quickly that rads is a good deal...often times without thinking about whether or not they actually like the radiology itself. I think the majority of the rads residents I've come across don't actually enjoy the work they do, but tell themselves that it's only for 9 hours a day (DURING RESIDENCY) and roll with it.

Personally, it's more important that I have control over my schedule than it is for me to be making bank - I don't mind working hard (after all, I want to wear many hats in academics), but I would like to know what time I'm going home. That being said, I also want to enjoy what I do.

Getting back to the point...

Nothing being mentioned in the news right now with regards to reimbursment cuts for radiologists comes as a surprise. The salaries of virtually every field are in constant flux and radiology is not immune to this. Hopefully this is a good lession that people should just choose whatever the hell it is they want to do and just frickin' do it. Everyone should take money into consideration, but because of the constant ebb and flow, it's stupid to make it one's primary concern.

 

[deleted263296]

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[mattorama]

. I think the majority of the rads residents I've come across don't actually enjoy the work they do, but tell themselves that it's only for 9 hours a day (DURING RESIDENCY) and roll with it.

Really? One of the first things I noticed about radiology was that every resident I met seemed to truly enjoy their job. The only other field where I noticed people being just as happy was pathology.

 

[radslooking]

Really? One of the first things I noticed about radiology was that every resident I met seemed to truly enjoy their job. The only other field where I noticed people being just as happy was pathology.

Agreed, almost all the rads people, residents or otherwise I've surveyed seem to very much like their jobs. The exception are those with brutal residency call schedules.

 

[Labslave]

Agreed, almost all the rads people, residents or otherwise I've surveyed seem to very much like their jobs. The exception are those with brutal residency call schedules.

Well, I should probably clarify a bit. I feel like a lot of the rads residents don't really love what they do...as in it's not one of those things like surgery where people get pumped to go in the OR. I feel like they treat radiology like a job rather than a calling (not that there's anything wrong with that).

That being said, I'm sure if you took surgeons or medicine residents and made them work 50 hours a week, you'd find some pretty happy residents in those specialties, too.

 

[mattorama]

I just started radiology 3 weeks ago. Do I get pumped to go in every day? No. I don't think getting super, duper, pee-my-pants-this-is-my-calling-give-me-high-five excited about ANY job is in my DNA (unless work entailed beer, women and video games).

That said, I think I am in one of the coolest areas of medicine. I get to learn about the pathology of every specialty and (hopefully) provide insight that helps other physicians take care of their patients. We see all the coolest cases in the hospital and still get to be home in time for dinner while avoiding a lot of the crap that makes clinical medicine not so fun. Cutting out the crap is what lets us "see" lots of patients each day and hence the (current) high overall reimbursement.

If I won the lottery tomorrow I would quit in a heartbeat without giving medicine a second thought. That, however, is highly unlikely to happen. In the mean time I can't imagine a better job then being a radiologist.

 

[Labslave]

This thread makes me kind of queasy. It will bother me a bit if all my colleagues care about is following the money.

I would still be heading into Radiology if it paid half of what it does. I was born into poverty and have worked numerous real jobs.

A few months ago while still deciding between radiology and some other fields, I made a pros/cons list and listed your sentiment as a con for radiology. In particular, there are a few money hungry, gold digging classmates of mine pursuing rads that make me think, "Do I REALLY want these people to be my colleagues?" Then I realized that I'll be doing academics anyways and likely avoiding these types for good.

 

[turkeyjerky]

I thought the push was to limit the number of these services ordered. Anyways, with a 45% income tax likely, it may be better to make less than $250k.

I really wish that people would take 30 seconds to obtain a basic understanding of how income taxes work before posting ******ed comments like this.

Man, when are they gonna make a course in common sense a pre-req for med school.

 

[Doublecortin]

I thought the push was to limit the number of these services ordered. Anyways, with a 45% income tax likely, it may be better to make less than $250k.

ahhm, , it might actually be better to make 0$ so that your income tax is 0%👍

 

[sjdsn135]

I feel compelled for some reason to explain how income tax works to Virie and anyone else who is confused and curious.

Let's say you earn $450,000 a year. The first 80k is taxed at say 15%, the next 120k is taxed at 25%, and the final 250k is taxed at 38%.

This makes sure that (if the cutoff for 45% taxation will be 250k) someone grossing 249k takes home less than someone grossing 251k.

 

[BlackNDecker]

The absurdity of the declining reimbursement is that the least expensive imaging modalities are the hardest hit by Obamacare. Cardiac ultrasonography is dirt cheap compared to cardiac MRI, and with adjuncts like IV contrast enhancement, it can approximate the diagnostic yield of MRI for intracardiac masses (admittedly a narrow scope of utilization, but with significant potential). Yet, reimbursement is slated to decrease by ~40% for Echo vs. 20% for MRI. EKG is also taking a significant hit at ~20%.

Radiologists have been smart, though, by increasing the amount of clinic time and office visits. An E4 is slated for an 11% increase🙂

A few months ago while still deciding between radiology and some other fields, I made a pros/cons list and listed your sentiment as a con for radiology. In particular, there are a few money hungry, gold digging classmates of mine pursuing rads that make me think, "Do I REALLY want these people to be my colleagues?" Then I realized that I'll be doing academics anyways and likely avoiding these types for good.

Personally, it's more important that I have control over my schedule than it is for me to be making bank - I don't mind working hard (after all, I want to wear many hats in academics), but I would like to know what time I'm going home. That being said, I also want to enjoy what I do.

You do realize that this thread is not about you, right? Take your blog to facebook....

 

[Labslave]

You do realize that this thread is not about you, right? Take your blog to facebook....

You're ridiculous. I was just responding to Neuronix's post saying that he/she was concerned about potentially having a whole bunch of shallow, money hungry gold diggers for colleagues. I share the sentiment and was letting Neuronix know it.

Thanks for reminding me that docs can be dicks, though. I haven't been on surgery in a while. 🙄

 

[Neuronix]

You're ridiculous. I was just responding to Neuronix's post saying that he/she was concerned about potentially having a whole bunch of shallow, money hungry gold diggers for colleagues. I share the sentiment and was letting Neuronix know it.

You know, SDN has its own blog feature now. I keep mine here and not Facebook anyways.

 

[Taurus]

The new CMS rules are official.

Radiology and cardiology got hit hard. Rad onc got spared.

U.S. to Cut Payments to Doctors Using Expensive Medical-Imaging

WASHINGTON -- U.S. federal health regulators on Friday announced new rules that will result in trimmed payments for doctors who use expensive medical-imaging machines to screen patients for diseases such as cancer and heart problems.

The rules will cut by up to 38% the amount doctors will get when they use disease-screening equipment for procedures such as MRIs and CT scans. The rule applies to the roughly one million doctors who are paid under the Medicare Physician Fee Schedule, a program run by the Center for Medicare and Medicaid Services, or CMS.

Analysts and observers had expected the move. Large manufacturers of such equipment, including General Electric Co. and Eastman Kodak Co., will likely be affected by the change.

CMS had proposed making changes that would result in lowered payments to physicians for using radiation oncology procedures, but decided against that. Congressman, patient groups and doctors had argued against cutting payments for radiology procedures, saying the radiology equipment is necessary to treat patients who already are shown to have cancer.

The new rules would increase, over four years, the assumed rate at which diagnostic machines are used, to 90% from 50%. A higher assumed rate results in lower payments.

 

[Green Grass]

I'm a noob to these payment plans, can you explain the changes?

 

[digitlnoize]

The new CMS rules are official.

Radiology and cardiology got hit hard. Rad onc got spared.

U.S. to Cut Payments to Doctors Using Expensive Medical-Imaging

WASHINGTON -- U.S. federal health regulators on Friday announced new rules that will result in trimmed payments for doctors who use expensive medical-imaging machines to screen patients for diseases such as cancer and heart problems.

The rules will cut by up to 38% the amount doctors will get when they use disease-screening equipment for procedures such as MRIs and CT scans. The rule applies to the roughly one million doctors who are paid under the Medicare Physician Fee Schedule, a program run by the Center for Medicare and Medicaid Services, or CMS.

Analysts and observers had expected the move. Large manufacturers of such equipment, including General Electric Co. and Eastman Kodak Co., will likely be affected by the change.

CMS had proposed making changes that would result in lowered payments to physicians for using radiation oncology procedures, but decided against that. Congressman, patient groups and doctors had argued against cutting payments for radiology procedures, saying the radiology equipment is necessary to treat patients who already are shown to have cancer.

The new rules would increase, over four years, the assumed rate at which diagnostic machines are used, to 90% from 50%. A higher assumed rate results in lower payments.

How will this affect your take home pay? Certainly a 38% drop in CT payment wouldn't result in a 38% drop in take home. I'm also a bit confused about the usage rate increase...isn't that a good thing?

 

[Taurus]

Follow the discussion by radiologists on auntminnie.com. They can give us the most insight.

http://www.auntminnie.com/forum/tm.aspx?m=223897&mpage=1&#223957

Personally, I try to look at the silver lining in this. If this will dissuade non-radiologists like cards, ortho, GI from buying their own machines and doing self-referrals, this is a huge positive for radiologists. Unfortunately, in the govt's attempt to crack down on self-referrals and the explosive growth of imaging costs, radiologists were collateral damage. Keep in mind that cardiology got hit hard too.

Bottom line, pick a field you like, not because what it looks like today. I would still radiology even if my salary was cut by 50%. Internship just reinforces what I hate about clinical medicine.

 

[Amxcvbcv]

Internship just reinforces what I hate about clinical medicine.

👍

 

[Taurus]

How will this affect your take home pay? Certainly a 38% drop in CT payment wouldn't result in a 38% drop in take home. I'm also a bit confused about the usage rate increase...isn't that a good thing?

CMS calculated that the cuts for radiology and cardiology will result in net salary cuts of 11%. Some procedures will get hit harder than others. For example, CMS proposed cutting stress tests by 42% and cath by 24%.

 

[Taurus]

CMS follows through on bid to boost utilization rate to 90%
By Kate Madden Yee
AuntMinnie.com staff writer
November 2, 2009

The U.S. Centers for Medicare and Medicaid Services (CMS) didn't back down from its previously announced plan to increase the utilization rate for imaging equipment from 50% to 90%. It's now going to take an act of Congress -- literally -- for medical imaging to avoid what could be severe cuts in Medicare reimbursement starting January 1, 2010.

The news came October 30, when CMS announced final changes to its Medicare Physician Fee Schedule (MPFS) for 2010, which it will publish in the Federal Register November 20. The new utilization rate was one of a host of other changes in the rules.

The equipment utilization rate represents CMS' estimate of the amount of time imaging equipment is in use in outpatient settings. CMS telegraphed its intention to raise the rate when it issued proposed MPFS rules on July 1.

Increasing the utilization rate to 90% would decrease global reimbursement by 15% to 20%, according to industry experts; the effect of the change on the daily practice of the average imaging facility would depend on a number of factors, including a center's patient mix, whether it's a single-modality facility, and whether the center is urban or rural.

In the end, however, Congress will most likely save the day: Bills being considered by the U.S. House of Representatives and the Senate propose much lower utilization rates, 75% and 65%, respectively, and CMS will be hard-pressed not to follow Congress' mandate.

In the final rule, CMS also has proposed an updated conversion factor of -21.2%, or $28.4061, and a sustainable growth rate of -8.8%.

As for accreditation, CMS confirmed its plan to require suppliers of advanced imaging -- mobile units, physicians' offices, and independent diagnostic testing facilities (IDTFs) -- to be accredited by 2012.

Finally, CMS backed down on a proposal to cut radiation therapy payments by 19% on January 1, instead opting for 5% cuts phased in over the next four years. That means that radiation oncology is scheduled for a far-less-severe 1% reimbursement cut in the new year.

CMS will take comments on provisions of the final rule until December 29.

ACR responds

The American College of Radiology (ACR) of Reston, VA, was quick to express its disappointment in CMS' actions, saying in a statement that "the 90% utilization mandate and practice expense reimbursement adjustments will produce an average across the board 16% cut to imaging providers, and specifically reduce reimbursement to studies such as lung CT or MRI of the spine by 40% or more. These cuts, on top of an average 23% reduction from the Deficit Reduction Act of 2005, totaling $13.8 billion, will end the ability of many nonhospital providers to offer imaging services, particularly in rural areas where equipment is needed, but utilized less frequently."

The final rule is disastrous for patient care, said Dr. James Thrall, chair of ACR's board of chancellors.

“Medical imaging exams have been directly linked to greater life expectancy, declines in cancer mortality rates, and are generally less expensive than the invasive procedures they replace," he said in the statement. "Utilization growth is in line with or below that of other physician services. Why CMS would want to restrict access to lifesaving procedures and stifle research and development of new technologies at a time when imaging can do so much good for so many people is mind boggling. There will be a human cost such short-sighted policy decisions.”

 

[Mr. Itchy]

I really wish that people would take 30 seconds to obtain a basic understanding of how income taxes work before posting ******ed comments like this.

Man, when are they gonna make a course in common sense a pre-req for med school.

LOL i get so mad about this same thing as well. Someone told me the other day that their dad turned down a raise because it would kick him to the next tax bracket. I could barely contain my laughter

 

[penguin24]

LOL i get so mad about this same thing as well. Someone told me the other day that their dad turned down a raise because it would kick him to the next tax bracket. I could barely contain my laughter

More money, more problems

 

[psychforme]

LOL i get so mad about this same thing as well. Someone told me the other day that their dad turned down a raise because it would kick him to the next tax bracket. I could barely contain my laughter

well its not THE dumbest of all dumb things repubs have done in this world. Invading afghanistan and Iraq and ruining the world economy pales I guess 😀

 

[DrRads101]

well its not THE dumbest of all dumb things repubs have done in this world. Invading afghanistan and Iraq and ruining the world economy pales I guess 😀

Weird cuz the Repubs haven't had any power for the last three years as the Democrats have controlled pretty much everything except the signing desk where Bush's lame duck the last two just signed what they sent him... either way I know better than to blame a single party for the world economy and people's idiotic decisions to spend more money on homes than they can afford, but I'll tell you literally quintupling our deficit this year with no end in sight certainly isn't going to help us any!