Medicare rates

Started by anbuitachi
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anbuitachi

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Saw the ASA email recently about their plan to fight the 28% medicare to commercial reimbursement for anesthesiologists. I've heard this mentioned a few times on this forum, about the unfair reimbursements. Trying to learn more about this since i know nothing about billing. Doesnt this happen to a lot of specialties? Private insurance often pays >2x medicare dont they? do we get paid the lowest by medicare compared to commercial? And why did this happen to us?
 
anbuitachi said:
Saw the ASA email recently about their plan to fight the 28% medicare to commercial reimbursement for anesthesiologists. I've heard this mentioned a few times on this forum, about the unfair reimbursements. Trying to learn more about this since i know nothing about billing. Doesnt this happen to a lot of specialties? Private insurance often pays >2x medicare dont they? do we get paid the lowest by medicare compared to commercial? And why did this happen to us?
Click to expand...

I wouldn’t worry too much between the balence billing legislation and inevitable single payor that will follow. You will be lucky to get Medicare rates in the future. Everyone will be equal.
 
Private insurance companies are using balance billing legislation to race to the bottom and have parity with Medicare rates. In our market private insurance rates range from $76 —$95 per unit and Medicare is $25 /unit. Medicaid is $15 per unit. Our revenue is -30% from private insurance by claim (>60% of total revenue). So, basically if the insurance companies have their way then my W2 will drop by about 45-60%.
 
Correct on all counts. Medicare rates is a possible death sentence for physician anesthesiologists likely to be replaced by nurse anesthesiologists.

Other specialties typically get paid 75-80 percent of commercial rates by Medicare.
They get a haircut while you get a scalping.

Medicare for all means lack of physician Anesthesiologist for many as early retirements occur and new graduates shun the field. Residency programs will rely on IMGs to fill the void.

The silver lining will be a great deal of job openings over a short period of time
 
BLADEMDA said:
Correct on all counts. Medicare rates is a possible death sentence for physician anesthesiologists likely to be replaced by nurse anesthesiologists.

Other specialties typically get paid 75-80 percent of commercial rates by Medicare.
They get a haircut while you get a scalping.

Medicare for all means lack of physician Anesthesiologist for many as early retirements occur and new graduates shun the field. Residency programs will rely on IMGs to fill the void.

The silver lining will be a great deal of job openings over a short period of time
Click to expand...

why hasn't the ASA targetted this garbage payment sooner? or have they and failed? it seems ridiculous we get reimbursed so little vs other fields. they sounds like a major issue that needs to be fixed..
 
anbuitachi said:
that sounds pretty messed up.
Click to expand...

About to get a whole lot worse

The NYT wrote some bizarre article about how to get doctors to work for less. It was nauseating to read. Basically trying to pull some cheap behavioral psychology.

20% isn’t a haircut that’s a knife in the back

40% that’s disembowelment
 
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RadsWFA1900 said:
About to get a whole lot worse

The NYT wrote some bizarre article about how to get doctors to work for less. It was nauseating to read. Basically trying to pull some cheap behavioral psychology.

20% isn’t a haircut that’s a knife in the back

40% that’s disembowelment
Click to expand...

The NY Times doesn’t have to write that article. Getting people to work more for less has been the subject of an enormous amount of corporate research for decades. Doctors are now just employees of those corporations.
 
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It's a great learning opportunity for Anesthesiologists to learn to manage 6-8 rooms at the same time, and see at least 20 pts or cases per day.
 
I have always said that the day my salary plummets to that of a family med doc will be the day I default on my loans and leave this country. I am sure I am not alone here in this view.
 
You’d probably have to move to Mexico or something. Those loans follow you to the grave.

The day your salary plummets is a day you should be actively planning for now.

Non clinical work
Consulting
Real estate
Back to school
Admin

Maybe add to the list if you’ve got ideas.

If you have any nice toys or homes, I’d consider selling those.
 
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A lot of “sky is falling” in this thread. IF Medicare for all ever becomes a reality and IF insurance companies just shrug and say “well we had a good run” and IF Medicare rates stay the same for anesthesia then the hospitals will have to find a way to supplement anesthesia income. Even cheap, solo CRNAs won’t be dumb enough to take call on nights, weekends, and holidays for $100k a year. If the hospitals want the ORs to run, they will have to pay for it...someone will have to pay for it. There’s a lot of “IFs” there, though.

Otherwise pay off debts and stop buying boats.
 
anbuitachi said:
why hasn't the ASA targetted this garbage payment sooner? or have they and failed? it seems ridiculous we get reimbursed so little vs other fields. they sounds like a major issue that needs to be fixed..
Click to expand...

I’m still a relatively new attending, but personally, I don’t see much that the ASA has done to benefit the field. Everything is reactive in nature.
 
PainDrain said:
I have always said that the day my salary plummets to that of a family med doc will be the day I default on my loans and leave this country. I am sure I am not alone here in this view.
Click to expand...
Lol leave this country? Unless you’re a Swiss citizen, idk where you’re gonna go to find a more lucrative job in a politically stable country.
 
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GravelRider said:
A lot of “sky is falling” in this thread. IF Medicare for all ever becomes a reality and IF insurance companies just shrug and say “well we had a good run” and IF Medicare rates stay the same for anesthesia then the hospitals will have to find a way to supplement anesthesia income. Even cheap, solo CRNAs won’t be dumb enough to take call on nights, weekends, and holidays for $100k a year. If the hospitals want the ORs to run, they will have to pay for it...someone will have to pay for it. There’s a lot of “IFs” there, though.

Otherwise pay off debts and stop buying boats.
Click to expand...

I do NOT see Medicare for all anytime soon. Warren would be lucky just to get a public option limited to those 55 and older added to the exchange. The support for Medicare for all just isn’t there among many Democrats.

So, there is no immediate need to panic or make plans for Mexico. I do think Medicare for all is possible down the road in 10-15 years but highly unlikely with the next administration
 
bronx43 said:
Lol leave this country? Unless you’re a Swiss citizen, idk where you’re gonna go to find a more lucrative job in a politically stable country.
Click to expand...
Now you've done it

Someone will be along shortly to talk about some great $$$ opportunities in the United Arab Emirates or perhaps North Korea
 
BLADEMDA said:
I do NOT see Medicare for all anytime soon. Warren would be lucky just to get a public option limited to those 55 and older added to the exchange. The support for Medicare for all just isn’t there among many Democrats.

So, there is no immediate need to panic or make plans for Mexico. I do think Medicare for all is possible down the road in 10-15 years but highly unlikely with the next administration
Click to expand...

i dont even think our system will be fixable. either they ration care or they tank salaries. i dont see why people will become doctors if salary goes down anymore. Its simply not worth it at all. Then if they do that they will have to make medicine/residency less rigorous, then care suffers. i guess only solution is to replace MD w NP/PA.
 
pgg said:
Now you've done it

Someone will be along shortly to talk about some great $$$ opportunities in the United Arab Emirates or perhaps North Korea
Click to expand...

Or as an O-5 in Kanazawa or Okinawa.

Military retention for physicians is going to get a huge boost if Medicare for all becomes a reality.
 
bronx43 said:
Lol leave this country? Unless you’re a Swiss citizen, idk where you’re gonna go to find a more lucrative job in a politically stable country.
Click to expand...

I have heard of some pretty good jobs in NZ and Australia. Also, for all the talking points about Canada being a
terrible place I have spoken to two docs (one EM and one anesthesia/pain) and they do very well and it’s easy to game their system.
 
PainDrain said:
I have heard of some pretty good jobs in NZ and Australia. Also, for all the talking points about Canada being a
terrible place I have spoken to two docs (one EM and one anesthesia/pain) and they do very well and it’s easy to game their system.
Click to expand...
Those are far smaller countries that cant accommodate large influx. If it’s actually easy to transition there and prosper, you can bet that hordes of American physicians would. They would then saturate the market there or those countries would change the rules so foreigners can’t encroach on their market.

The reality is that the government here knows they have us cornered.
 
Epilepsy365 said:
It's a great learning opportunity for Anesthesiologists to learn to manage 6-8 rooms at the same time, and see at least 20 pts or cases per day.
Click to expand...

This is a ridiculous mindset. A response of someone who is ready and willing to be a meek sheep. The mindset of someone who lives to work as opposed to works to live.

Why stop at 6-8 rooms? 10-12 is even more. Why not see 30-40 patients? Why work 60+ hours when you can work 80+ or even 100+ hours? Who needs to see their families, friends, or pursue outside hobbies?

Those of us who supervise are essentially there to oversee inferior practitioners perform the job we love to do. We're there to pray that nothing goes awry or to put out fires as they arise. As it stands I can barely execute a slightly higher level plan on a more challenging patient while covering 3-4 rooms. 6-8 rooms and i'm there just to sign the chart and push the propofol + sux while hoping the CRNA doesn't extubate in stage 2 and calls me to save their ass.
 
bronx43 said:
Those are far smaller countries that cant accommodate large influx. If it’s actually easy to transition there and prosper, you can bet that hordes of American physicians would. They would then saturate the market there or those countries would change the rules so foreigners can’t encroach on their market.

The reality is that the government here knows they have us cornered.
Click to expand...

strike strike strike!
 
anbuitachi said:
strike strike strike!
Click to expand...
That's actually not a bad idea.

If the government decides to make me a government servant, then I'm joining the government physician union.

I want daily minimum of $3000 per 8 hour shift, no mandatory call, no production incentives, full pension after 15 years, no legal liability, 16 weeks vacation.


If we don't get our demands, we're shutting down all the operating rooms.
 
Mikkel said:
That's actually not a bad idea.

If the government decides to make me a government servant, then I'm joining the government physician union.

I want daily minimum of $3000 per 8 hour shift, no mandatory call, no production incentives, full pension after 15 years, no legal liability, 16 weeks vacation.


If we don't get our demands, we're shutting down all the operating rooms.
Click to expand...

There will be plenty of CRNAs who will work for $1,500 per 12h shift, no pension, and 4 weeks of vacation.

The OR will remain open with or without anesthesiologists.
 
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Mikkel said:
That's actually not a bad idea.

If the government decides to make me a government servant, then I'm joining the government physician union.
Click to expand...

Physicians being able to unionize might actually be a (very faint) silver lining to everyone becoming an employee. But don't get too carried away with what you imagine that will actually mean.


Mikkel said:
I want daily minimum of $3000 per 8 hour shift, no mandatory call, no production incentives, full pension after 15 years, no legal liability, 16 weeks vacation.

If we don't get our demands, we're shutting down all the operating rooms.
Click to expand...

This is a naive fantasy.

Do you remember what True Republican Hero President Reagan did when air traffic controllers tried to strike?

Also, remember that there wasn't an army of "midlevel" air traffic controllers waiting in the wings, desperate for a chance to fill those positions, to prove that they were just as good as real air traffic controllers.

The public was overwhelmingly supportive of Reagan when he absolutely crushed the striking air traffic controllers. Cancelled flights were just a vacation inconvenience to most Americans. You think the public won't get behind the government hammer when it's their healthcare in question?

Incidentally, Reagan didn't just stop at firing them, he also banned them for life for ever working for the federal government again. That was upheld in court, by the way, and wasn't reversed until the Clinton years. We've already seen states (e.g. Massachusetts) make attempts to tie physician licensing to acceptance of state medicaid, even if those payments are below the cost of providing the service.

Careful what you wish for.
 
PainDrain said:
I have heard of some pretty good jobs in NZ and Australia. Also, for all the talking points about Canada being a
terrible place I have spoken to two docs (one EM and one anesthesia/pain) and they do very well and it’s easy to game their system.
Click to expand...
Seriously? “Game their system?” Is that something you flaunt and are proud of?
And there are plenty of family docs making 250k. That will make you leave the country?
 
BLADEMDA said:
I do NOT see Medicare for all anytime soon. Warren would be lucky just to get a public option limited to those 55 and older added to the exchange. The support for Medicare for all just isn’t there among many Democrats.

So, there is no immediate need to panic or make plans for Mexico. I do think Medicare for all is possible down the road in 10-15 years but highly unlikely with the next administration
Click to expand...

though I agree with you, had Hilary won I bet we would be in the early stages of a single payer right now

Obamacare was a precursor the the ultimate plan of single payer

correct me if I’m wrong, but wasn’t it pretty much a foregone conclusion were getting single payer before trump won?

one thing I bank on is this is America, there will always be a private sector because people will pay for it. (Cash hospitals etc etc) However, those jobs will be hard to come by
 
Popping over from EM

Same **** happening over here

M4A probably not a political reality anytime soon, but the immediate danger, which was already mentioned, is the balance billing legislation which seeks to set out of network reimbursement to average in network reimbursement. Which, if you see what the insurance industry is trying to do by lowering in network reimbursement, you can see how this will go.

Everyone should be contacting their representatives in Congress about this.

With regards to "supervision," I quit a place where we were being forced to see 2 patients per house on our own and then supervise another 2 pph with the midlevels. We have been sheeped by the corporations. Run.



Sent from my Pixel 3 using SDN mobile
 
chocomorsel said:
Seriously? “Game their system?” Is that something you flaunt and are proud of?
And there are plenty of family docs making 250k. That will make you leave the country?
Click to expand...

If my country has beaten it into the brains of its citizens that education and achievement are the ultimate goals, allows the rigging of the student loan industry while simultaneously cutting the salaries of its citizens not by market forces but by legislation pushed by industry; that’s not really a place I want to live and raise my family in. And not to brag but a 250K salary would be about 250k less than I currently make and I am definitely not living like I make that kinda money. A huge portion of my income goes to pay for my and my spouse’s student loans.

A little anecdote for you about student loans. When I finished training I sat down and created several spread sheets with our student loans and various scenarios to pay them off. I thought it strange that between my loans and my spouses our debt had changed hands about six times in four years. I also found it interesting that Navient kept telling my spouse to defer defer defer. I also found it interesting that when I logged on to the servicer’s website it was purposely confusing and removed several things you would obviously assume would be clearly present on a loan statement, such as the interest rate and months of repayment. I called one of my loan companies and found that I would be 71 when the loan was paid off at the terms they “automatically” enrolled me in. See, this is a game to milk people for the rest of their lives. Make it difficult to understand the loans, make it difficult to see your terms, make it difficult to repay in a timely fashion. Navient and several others are being sued for taking advantage of borrowers by forcing them into deferment. And you say I am gaming the system.
 
PainDrain said:
If my country has beaten it into the brains of its citizens that education and achievement are the ultimate goals, allows the rigging of the student loan industry while simultaneously cutting the salaries of its citizens not by market forces but by legislation pushed by industry; that’s not really a place I want to live and raise my family in. And not to brag but a 250K salary would be about 250k less than I currently make and I am definitely not living like I make that kinda money. A huge portion of my income goes to pay for my and my spouse’s student loans.

A little anecdote for you about student loans. When I finished training I sat down and created several spread sheets with our student loans and various scenarios to pay them off. I thought it strange that between my loans and my spouses our debt had changed hands about six times in four years. I also found it interesting that Navient kept telling my spouse to defer defer defer. I also found it interesting that when I logged on to the servicer’s website it was purposely confusing and removed several things you would obviously assume would be clearly present on a loan statement, such as the interest rate and months of repayment. I called one of my loan companies and found that I would be 71 when the loan was paid off at the terms they “automatically” enrolled me in. See, this is a game to milk people for the rest of their lives. Make it difficult to understand the loans, make it difficult to see your terms, make it difficult to repay in a timely fashion. Navient and several others are being sued for taking advantage of borrowers by forcing them into deferment. And you say I am gaming the system.
Click to expand...
You yourself said it honey. Not me. Don’t put words on my keyboard.

My loans are easy to understand and yes they have changed hands a few times but I have never had an issue deciphering what was owed and the interest rates. I don’t relate to anything you are saying here.

If Navient screwing people over, then I am glad someone is suing them.

If you want to game the system and want to move to Canada because you can’t possibly survive off 250k, then go for it. But I bet it’s not gonna be as easy as you think.
 
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Surprise out of network medical bills were a gift to the insurance industry by greedy shortsighted medical care providers. The highly publicized stories were outrageous ($500k dialysis bill, $75k surgical assist fee, $75k neuromonitoring fee) and the insurance industry ran with it. Now we have a wave of surprise medical bill legislation which will disarm any leverage we had during in-network contract negotiations. Why would any insurance company negotiate in good faith knowing our OON charges are limited to 120% of Medicare.
 
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The real problem is the entire anesthesia payment structure. Why does private insurance pay $800-900 for 15 min colonoscopy and Medicare pays $150 if u are lucky.

vs gi docs getting $500-600 for private and $350 for Medicare.

are there any other specialists who get OVERPAID like we do for private Insurance (come on we all know the private insurance is ridiculous payments) and severely UNDERPAID (relative to private insurance payments) for medicare rates

most specialities get roughly 60%

anesthesia is less than 30% or even less if the amc $100-120/unit billing for private is accounted for.
 
aneftp said:
The real problem is the entire anesthesia payment structure. Why does private insurance pay $800-900 for 15 min colonoscopy and Medicare pays $150 if u are lucky.

vs gi docs getting $500-600 for private and $350 for Medicare.

are there any other specialists who get OVERPAID like we do for private Insurance (come on we all know the private insurance is ridiculous payments) and severely UNDERPAID (relative to private insurance payments) for medicare rates

most specialities get roughly 60%

anesthesia is less than 30% or even less if the amc $100-120/unit billing for private is accounted for.
Click to expand...

Yep I agree $600 for a 5min nerve block is not really reasonable.
 
aneftp said:
The real problem is the entire anesthesia payment structure. Why does private insurance pay $800-900 for 15 min colonoscopy and Medicare pays $150 if u are lucky.

vs gi docs getting $500-600 for private and $350 for Medicare.

are there any other specialists who get OVERPAID like we do for private Insurance (come on we all know the private insurance is ridiculous payments) and severely UNDERPAID (relative to private insurance payments) for medicare rates

most specialities get roughly 60%

anesthesia is less than 30% or even less if the amc $100-120/unit billing for private is accounted for.
Click to expand...
nimbus said:
Yep I agree $600 for a 5min nerve block is not really reasonable.
Click to expand...

Is that all inclusive? is that money going toward paying for the equipments/drugs as well? or is that separate
 
nimbus said:
Yep I agree $600 for a 5min nerve block is not really reasonable.
Click to expand...

Gotta say I disagree with this. I’d pay that out of pocket for a working nerve block that would get me through a substantial period of time pain free. It potentially saves an overnight hospital stay and let’s you feel “normal”by avoiding a bunch of opioids. I feel for patients that are limited to IV meds for pain relief honestly.

Compared to the reimbursement for an emergency airway though...that’s an issue. 2 units for a life saving measure compared w 8-10 units for a nerve block—doesn’t make any sense to me.
 
d9sccr said:
Gotta say I disagree with this. I’d pay that out of pocket for a working nerve block that would get me through a substantial period of time pain free. It potentially saves an overnight hospital stay and let’s you feel “normal”by avoiding a bunch of opioids. I feel for patients that are limited to IV meds for pain relief honestly.

Compared to the reimbursement for an emergency airway though...that’s an issue. 2 units for a life saving measure compared w 8-10 units for a nerve block—doesn’t make any sense to me.
Click to expand...

Agree if you’re talking about value to the patient. I was talking more about the effort and energy required on my part....it’s not much.
 
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