No pay for consults, less pay for diagnostic tests: how bad is the result?

[WhyMD]

With zero pay for consults and deep cut in reimbursements for diagnostic tests, how are neurologists fairing since those are pretty much most of what you do?

Why would anyone take consults for free since they take up valuable time? What was the rational for making these new "policies"?

I really wonder how AMA or physicians just allowed all these ridiculous things to happen to them. All those mindless memorizing and bowing our heads to whatever comes our ways throughout the long trainings seem to have made majority of physicians into obedient machines.

If today a new rule is made that prevent lawyers from getting any pay for their phone consultations, there will be a national uproar tomorrow.

Or is it that there are good reasons behind these new no pay policies that I am not aware of?

Most importantly, I want to know how neurologists are dealing with this.

I appreciate your honest sharing.

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[WhyMD]

Is the reason for no response due to limited traffic flow to this forum, lack of experienced thoughts, or sheer desire to ignore the issue because it's really not a big deal?

From the number of clicks to this thread, it looks like people want to know.

Share your views or experience for the benefit of us all.

 

[PhakeDoc]

I think the folks most versed in responding are attending level, and they frequent not as often as the med students. I will admit I don't know enough to really make any points of value. The one thing that gets me, though, is that we as a "profession" can come up with ridiculous tests to make all students take - Step 2 CS - and control numbers in to med school, etc., but can't fight for "ourselves", i.e. the AMA and no broadside into the claims that physicians should make less, etc. I think "we" will end up being the elements of our own destruction unless people at the top wise-up.

 

[Fencer]

These issues have been discussed in prior threads...

 

[Rogue Synapse]

:troll:
He's a disgruntled med student who tried to switch to dental school.

 

[WhyMD]

:troll:
He's a disgruntled med student who tried to switch to dental school.

Hey, how does that make me a troll? True, I thought about dental but love working with patients and enjoy neurology so much that I turned down acceptances to return to medicine. It's funny how you immediately interpret legitimate questioning as "disgruntled." That kind of sheepish mindset and "as long as I'm ok, everything is ok" attitude are exactly why US medical system was allowed to be in this mess in the hands of lawyers, pharm and insurance corps.

If you truly care for a profession, you should pay attention to all aspects that are happening to your profession. So don't sidestep the question but see if you have any solution or at least an opinion.

If this topic has been already dealt with in the neurology forum, I seem to have trouble locating the threads.

 

[eyesupply]

I really wonder how AMA or physicians just allowed all these ridiculous things to happen to them. All those mindless memorizing and bowing our heads to whatever comes our ways throughout the long trainings seem to have made majority of physicians into obedient machines.

If today a new rule is made that prevent lawyers from getting any pay for their phone consultations, there will be a national uproar tomorrow.

The AMA is largely primary care physicians who are happy to have specialists do work where they get no pay. Medicare successfully got some primary care doctors fight specialists. They tried to say that consults are the same as regular office visits but they are not. For one thing, specialists have to write a consult letter. Lawyers charge a few hundred for letters but Medicare says the letters are now free, if written by specialists.

Medicare and private insurances do not pay for phone consultations.

Proponents of universal health care and one payer systems don't seem to campaign for universal legal care. There are quite a few legal problems that I ignore because of cost. So my access to legal care is limited just because I am poor and not a Donald Trump/Bill Gates. In essence, if I have a legal condition (disease), I often ignore it. If there were universal legal coverage, I'd see a lawyer more often.

 

[Raggaman]

My guess is that if there is zero pay for consults then all the specialists will clamber over each other too do admits. Less consults may be called which may save medicare money. Patient care may suffer as each specialist may be a little hesitant to call a consult on the slightest sniffle, scared of being consulted reciprocally.

Our neurology service admits all acute strokes and status patients. If a non-acute stoke patient presents with multiple co-morbidities (AFIB w RVR, uncontrolled DM etc) then we prefer medicine to admit the patient and us being consultants as they are better suited to manage medical issues. At least 30 to 40% of our service is consult based.

I will admit that I am the last to know/understand the new healthcare plan but from the little I know it doesn't make sense. In which profession does anyone expect to receive a service and not pay for it?

"Here Bob, I want you to help me with the piping of the house as you are a plumber and I am just the guy who erects the walls. Wait, you will not get paid as I built the house. What you won't do it? Don't you care about laying pipes so that people can have water in their homes? You greedy SOB! Don't you make enough already? You shouldn't have become a plumber!"


Saying all that, i am sure that a new equilibrium will be found somehow.
Good luck to us all.

 

[neurolddoc]

There is not "zero pay" for consults; they are coded as an initial evaluation and reimbursed at a somewhat lower level. The reimbursement for evaluation and follow up codes is supposed to go up a bit. No one knows precisely what will happen to testing reimbursement. Much will depend on the resolution of the Medicare payment formula issue.

It is still possible to make a good living as a neurologist. One needs to be smart and adapt to change.

 

[ariwax]

"There are quite a few legal problems that I ignore because of cost. So my access to legal care is limited just because I am poor and not a Donald Trump/Bill Gates. In essence, if I have a legal condition (disease), I often ignore it. If there were universal legal coverage, I'd see a lawyer more often."

i seem to remember being told something once about having the right to an attorney. i think i also had the right to remain silent.