nyt article on healthcare reform

[2121115]

Recent NYT's article on physician reimbursement. Apparently people still think all of the excess money spent on healthcare goes into the doctors' back pocket. No one cares to explain how this can be true, however, since medicare pays all doctors less money every year yet healthcare costs continue to go up every year. If physician reimbursement decreases every year how can it be responsible for an increase in costs every year?

http://www.nytimes.com/2009/11/08/business/economy/08view.html

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[pathstudent]

Recent NYT's article on physician reimbursement. Apparently people still think all of the excess money spent on healthcare goes into the doctors' back pocket. No one cares to explain how this can be true, however, since medicare pays all doctors less money every year yet healthcare costs continue to go up every year. If physician reimbursement decreases every year how can it be responsible for an increase in costs every year?

http://www.nytimes.com/2009/11/08/business/economy/08view.html

We will all be salaried employees in the next few years, but on the bright side we work as little as we want and still make the same amount of money. Instead of medical care being awesome for most of the population and cluster **** for a minority of the population it will become mediocre for everyone.

What the gov't should do is increase medicare reimbursement and insure the uninsured at medicare rates while demilitarizing the country and using that money to pay for healthcare.

While medicine has been most lucrative in BFE the last few years it will now become most lucrative in places like Manhattan and Westside LA where people are unbelievably wealthy and doctors will still be able to charge fee for service.

Because the lords of wall street and the producers of network TV are not going to be on the gov't insurance.

 

[yaah]

Left unsaid there of course is that Mayo pays its physicians quite well, including large pensions after they retire.

 

[MOHS_01]

Left unsaid there of course is that Mayo pays its physicians quite well, including large pensions after they retire.

Yaah, buddy, come on now.... that is not true across the board. I declined an interview at Mayo after learning of the terms, one of my colleagues jumped at the chance. He could not find an exit fast enough after hearing the "cap" on pay -- regardless of production. Now it is entirely possible that our experiences are unique, that the pay structure for my specialty is somehow different than any other specialty... but their cap figure was significantly less than median for specialty; in fact, it was hardly above the 25%tile for specialty at that time) I am ignorant of their pension, but it is a virtual mathematical impossibility that it would be sufficient to offset decades of severely underpaid work.

Perspective, friend.... straight salaries or hourly wages would be horrible for medicine across the board. They may work great for chronic disease management, I don't know -- but they create a perverse incentive structure for the plumbers and widget makers amongst us.

 

[HbyHA]

Recent NYT's article on physician reimbursement. Apparently people still think all of the excess money spent on healthcare goes into the doctors' back pocket. No one cares to explain how this can be true, however, since medicare pays all doctors less money every year yet healthcare costs continue to go up every year. If physician reimbursement decreases every year how can it be responsible for an increase in costs every year?

http://www.nytimes.com/2009/11/08/business/economy/08view.html

did the author of that article SERIOUSLY just hold up lawyers as an example of selfless compassion for the greater good?

ha.

 

[yaah]

Yaah, buddy, come on now.... that is not true across the board. I declined an interview at Mayo after learning of the terms, one of my colleagues jumped at the chance. He could not find an exit fast enough after hearing the "cap" on pay -- regardless of production.

Hmm, doesn't jive with what I heard. I believe the "cap" though. You get paid not based on production, that is part of their whole deal. For some people that's attractive, for others it is not.

From what I have heard about Mayo salaries, they survey across the country about physician pay, and they pay their physicians a certain percentile of whatever the range for that specialty is, and the percentile is high enough to be competitive at attracting the best. The pension thing kicks in if you work there for a certain number of years, you continue to get paid at some percentage of your salary (?80%?) after you retire.

 

[MOHS_01]

Perhaps my specialty is / was an outlier, but their capped salary was well below median MGMA and fell closer to the 25% MGMA figure. That was enough to prevent me from expanding my carbon footprint with a needless flight out to the desert.

I suppose a system not being production based would be attractive to the lazy, those lower on the income ladder, and those wanting to get all they can without actually working for it (or those in a profession that is suffering from a glut of providers, resulting in a situation where there is not enough work to keep everyone as busy as they would like)... but I fear that the products of this system will suffer as a result. The unavoidable fact of the matter is that our very job is one of piecemeal work, and should be paid for as such. Two biopsies on different patients, two units of service rendered, two people paying for the service they benefited from. Any system other than this either unfairly allocates work or reward, and often both.

The doctor, plumber, electrician, cabinet maker, etc should all be paid based upon the work they do for an individual. If a doctor provides a necessary and good service for 10 people, and another provides an equally good and appropriate service for 20, the one performing more work should be reimbursed accordingly.

 

[2121115]

Perhaps my specialty is / was an outlier, but their capped salary was well below median MGMA and fell closer to the 25% MGMA figure. That was enough to prevent me from expanding my carbon footprint with a needless flight out to the desert.

I suppose a system not being production based would be attractive to the lazy, those lower on the income ladder, and those wanting to get all they can without actually working for it (or those in a profession that is suffering from a glut of providers, resulting in a situation where there is not enough work to keep everyone as busy as they would like)... but I fear that the products of this system will suffer as a result. The unavoidable fact of the matter is that our very job is one of piecemeal work, and should be paid for as such. Two biopsies on different patients, two units of service rendered, two people paying for the service they benefited from. Any system other than this either unfairly allocates work or reward, and often both.

The doctor, plumber, electrician, cabinet maker, etc should all be paid based upon the work they do for an individual. If a doctor provides a necessary and good service for 10 people, and another provides an equally good and appropriate service for 20, the one performing more work should be reimbursed accordingly.

I agree with this conceptually, but I don't think that reality is always that black and white. For instance, few would consider Mayo pathology faculty lazy and even less would say that their work is of low quality. I can't remember where I heard this but I think someone told me their path faculty make over 200 starting as an assistant prof, which is pretty good as far as academic salaries go in pathology.

 

[yaah]

The doctor, plumber, electrician, cabinet maker, etc should all be paid based upon the work they do for an individual. If a doctor provides a necessary and good service for 10 people, and another provides an equally good and appropriate service for 20, the one performing more work should be reimbursed accordingly.

But what if the person seeing the 10 people is more thorough and the patient ends up appreciating the experience more, coming back for other issues, recommending it to others? What if the more thorough person does do a better job? Which is more valuable? It's not really easy to answer that. Like, for example, plumbers often get paid by the hour, so many will linger and not be efficient. But others get paid just for the job, so they might rush through it and not be thorough. Which is better?

 

[MOHS_01]

I agree with this conceptually, but I don't think that reality is always that black and white. For instance, few would consider Mayo pathology faculty lazy and even less would say that their work is of low quality. I can't remember where I heard this but I think someone told me their path faculty make over 200 starting as an assistant prof, which is pretty good as far as academic salaries go in pathology.

It was said a little tongue in cheek, but not totally... the point is that every system has an inherent incentive structure, and not all incentive structures are created equal. There will always be tradeoffs within and between systems.

But what if the person seeing the 10 people is more thorough and the patient ends up appreciating the experience more, coming back for other issues, recommending it to others? What if the more thorough person does do a better job? Which is more valuable? It's not really easy to answer that. Like, for example, plumbers often get paid by the hour, so many will linger and not be efficient. But others get paid just for the job, so they might rush through it and not be thorough. Which is better?

A "good" job is worth what a "good" job is worth; a "poor" job is worth less. In a free market the public / provider interaction would dictate what that value is. The lack of that crucial dynamic is the problem with our current structure; price fixing treats everyone as if they were Michael Jordan when some of us are clearly more Opie Taylor...

When I speak on these matters I assume that everyone is trying to do the best job they can according to their abilities; failure to do such is a flaw in the individual. In anything resembling a free market system, those who suck would earn that reputation in short order -- forcing them to either improve, accept lower wages, or go belly up.

Your line of questioning does make for an interesting topic of debate, however. One of the biggest problems is that everyone tends to believe that they are doing a great job, whether they really are or not. Without good, fair, and appropriate quality measures no one can answer that question -- and I am of the opinion that, for much of medicine, a set of criteria that meet these principles are not possible given the often subjective nature of the subject matter.

 

[MOHS_01]

...although the short answer would have been:

I don't know, is 20 minutes of [insert form of pleasure here] really all that much better than 10? I would argue not....