Physician's pay increased by ACA?

[Awesome Sauceome]

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Hey I was wondering what some people's thoughts were on if there will be increased pay for physicians due to the ACA?

There seem to be two sides to the coin. On the one hand, there should be less uninsured going through the system. Therefore more people will be going to the doctors who will will have insurance and thus physicians would reap the benefit of having increased amounts of money coming from insurance companies. I imagine this would be especially beneficial for EM and FM where there has been a consistent flow of uninsured patients in the past. In a lot of these situations the physician or the hospital has to pretty much "eat" the cost.

On the other side of the argument there is the claim that in order to keep cost of insurance down, insurance companies are fighting to keep reparations to physicians down, therefore benefits will decrease...

Anyone have some thoughts on this?

 

[karayaa]

Not sure that EM/FM would be affected at all.
EM is often paid by the hospital - they don't charge patients themselves - so the hospital eats the cost of uninsured rather than the doctors.
For FM, presumably, if they don't have insurance, they just self-pay. Or they avoid the FM and go to the ED. I don't know how many FMs are in a position to actually provide free charity pro bono care (ie completely private practice where they can make that decision, rather than being in a group that sets such policies), and how many choose to do so.
I would expect FM to have more patients, because now that people have insurance they might be more willing to utilize services. But we don't know how many will choose to pay the penalty rather than pay the higher cost of insurance, so we don't know how the patient numbers will change.

 

[FormerPhysicist]

I like to lurk on the EM boards. From what I've read, their consensus seems to be that the average pay will stay relatively the same, but the workload (and burnout) is set to increase quite a bit in the next few years. It's all very vague, though.

 

[Pacna]

Not sure that EM/FM would be affected at all.
EM is often paid by the hospital - they don't charge patients themselves - so the hospital eats the cost of uninsured rather than the doctors.
For FM, presumably, if they don't have insurance, they just self-pay. Or they avoid the FM and go to the ED. I don't know how many FMs are in a position to actually provide free charity pro bono care (ie completely private practice where they can make that decision, rather than being in a group that sets such policies), and how many choose to do so.
I would expect FM to have more patients, because now that people have insurance they might be more willing to utilize services. But we don't know how many will choose to pay the penalty rather than pay the higher cost of insurance, so we don't know how the patient numbers will change.

I have found this to be quite variable, actually. EM docs are usually paid by an association (I work for one) that is separate from the hospital and contracts docs out to many local hospitals. This actually is a bad thing for EM docs because doctors' associations are typically for profit and thus do not qualify for loan forgiveness.

@OP: I was under the impression that FM docs were getting a slight boost from the ACA and specialist docs were taking somewhat of a hit. I had not heard anyone else being affected. I am willing to wager that I am misinformed about this, however, considering the scope of the law.

 

[Playdoh4lyfe]

More cash-flow into the insurance system means more cash-flow into the healthcare system, especially with a lot of people not using the healthcare they will be required to get. Then again, people with pre-existing conditions will also be utilizing their newfound health insurance so specialties like Onco or HIV/ID may see an influx in pts. if not pay as well. Ultimately, however, pay will remain relatively the same with a select few specialties going up. Likely EM, PC, Onco, HIV/ID etc.

If cash-flow from all the people buying policies doesn't go into the healthcare system, going into insurance, actuarial science or health management would be a very lucrative career path.

This is just a simplified view, as there are many, many more factors that play a role in reimbursement.

 

[karayaa]

More cash-flow into the insurance system means more cash-flow into the healthcare system, especially with a lot of people not using the healthcare they will be required to get. Then again, people with pre-existing conditions will also be utilizing their newfound health insurance so specialties like Onco or HIV/ID may see an influx in pts. if not pay as well. Ultimately, however, pay will remain relatively the same with a select few specialties going up. Likely EM, PC, Onco, HIV/ID etc.

If cash-flow from all the people buying policies doesn't go into the healthcare system, going into insurance, actuarial science or health management would be a very lucrative career path.

This is just a simplified view, as there are many, many more factors that play a role in reimbursement.

Why/how would cash going into the insurance system mean cash going into the healthcare system?
I understand the influx of patients, but why would anyone see an increase in pay, especially Onco/ID? I thought specialty visits/reimbursements were being cut. Especially oncology. They already recently were restricted from marking up their drugs, right? And isn't ID one of the lower paying sub-specialties? Are there a ton of cancer and HIV patients currently not receiving care bc of insurance, or are their reimbursements going to be increased by Medicaid?
(I'm curious, not confrontational)

 

[Awesome Sauceome]

sort of a side thought/whine. It baffles me that specialty pay is going to decrease. Yes I understand that there can sometimes be flaws with the system of procedural payment vs being payed on quality etc. But irregardless, specialists have to put in more time and training. Seems silly to hinder the people with high training... Seems VERY counterintuitive on the long run. Though I think it is great that FM is getting a boost since the need for people who practice in that field is increasing.

I have heard that a lot of EM departments are going onto the outsourced system for hiring docs and PAs.

 

[circulus vitios]

I want to start a massive FM practice where I outsource all of my work to PAs and NPs, supervise them, and get filthy rich.

 

[Skeeks]

From what I have heard of the ACA there is going to be more regulation on what can be charged for services. Its my opinion that all types of care are going to be cut. Yeah we might see more people coming through the system so maybe we will break even but we are going to be doing more work for the same amount of money. The only field of medicine I see this being a positive thing for (in terms of making the field more enticing) is for the PCPs. As mentioned earlier their services will be better utilized and they will see an increase in their revenue. I dont think that when all is said and done that any specialty field is going to see the ACA as a good thing for their specialty.

 

[Pacna]

I want to start a massive FM practice where I outsource all of my work to PAs and NPs, supervise them, and get filthy rich.

o m g.

Stolen fo sho.

 

[Playdoh4lyfe]

Why/how would cash going into the insurance system mean cash going into the healthcare system?
I understand the influx of patients, but why would anyone see an increase in pay, especially Onco/ID? I thought specialty visits/reimbursements were being cut. Especially oncology. They already recently were restricted from marking up their drugs, right? And isn't ID one of the lower paying sub-specialties? Are there a ton of cancer and HIV patients currently not receiving care bc of insurance, or are their reimbursements going to be increased by Medicaid?
(I'm curious, not confrontational)

The way it's perceived is that the ACA will benefit those who cannot afford, have been denied and need insurance. However, everyone, regardless of need, will be required to purchase it. That means everyone who doesn't use healthcare, or has no reason to, will still have to pay into the system. All the payments that go into the system are spread out throughout the healthcare system. And, like I said, if the $$$ is not going into healthcare, then it's probably a good idea to go into the insurance field.

Therefore, the patients with pre-existing conditions (many Oncology patients, among others), who have been bombarded with extremely high premiums or have been outright denied insurance, will now have access to care. Thus, physicians who would likely see patients who have been denied insurance will see an influx in business. Granted, it will be more work for the physician, but reimbursements will not fall so dramatically to the point that they will be making less than before the ACA. Because they will be providing more care, for more patients, at the same (or nearly the same) cost, they will likely see an increase in income.

The reason I speculate that ID will likely see a strong boost is for a two reasons. First, because their demographic is (generally) among the lower socioeconomic levels. With affordable healthcare now available for them, I assume they will seek out treatment options for their conditions. This is a massive market and it is very possible the influx of patients for ID will double. Many are not eligible for Medicaid which is why the ACA will give them a reason to seek out care. Second, ID being one of the lower paying sub-specialties is exactly the reason why it will see an increase in pay. I'm not saying it will increase 200% or even double, but if the ACA is all about concern for public health I'd assume they would look into funding and reimbursing ID specialists in an effort to decrease the spread of infectious diseases.

I want to start a massive FM practice where I outsource all of my work to PAs and NPs, supervise them, and get filthy rich.

Guy in Manhattan did this. Was making an absurd amount of money and only coming in bi-weekly to collect paychecks. I can only imagine how he would have done with the ACA.

 

[Beargryllz]

Would more coverage mean more people seek healthcare? Would this translate into more services rendered and more compensation?

 

[Awesome Sauceome]

Has anyone talked much with docs and how they feel about increased regulation on their profession.... I can see some great benefits from the ACA, particularly on patients you described. But is that what physicians need? Some government system telling them how to practice medicine...? Think there is going to be any uproar about this?

 

[TheWeeIceMan]

Has anyone talked much with docs and how they feel about increased regulation on their profession.... I can see some great benefits from the ACA, particularly on patients you described. But is that what physicians need? Some government system telling them how to practice medicine...? Think there is going to be any uproar about this?

Yep, doctors have been begging for more government regulation.😀

Seriously though, you should check out some of the specialty forums, or really anything outside of pre-allo. This stuff has been discussed since the ACA was passed years ago. I know very few doctors who are pro-ACA and I'd think that most agree that they will be taking a bit of a haircut in the years to come (maybe not FM). We can argue all day about the merits of the ACA, whether the pros outweight the cons, but physician income has no where to go but down. With that said, doctors will still make very solid money.

 

[rain4venus]

It seems like if they wanted to cut doctor pay, they ought to have added something into the bill (it was long enough that no one would have noticed anyway) to reduce the cost of med schools. At least bring back the no interest on federal loans while in med school thing.
With their payouts frozen, I don't even see PCPs making much more money, if any. It's rare that I hear about primary care providers that can't find enough patients to fill their schedules, so I doubt the greater number of patients needing to be seen will help them much at all.

 

[Anathema]

What's the dealio with the push for insurance companies, hospitals and physicians being graded for quality of care? If more patients are flowing in under the same time constraints there will be smaller appointment windows which would most likely lead to lower care per patient right?

 

[TooMuchResearch]

I like to lurk on the EM boards. From what I've read, their consensus seems to be that the average pay will stay relatively the same, but the workload (and burnout) is set to increase quite a bit in the next few years. It's all very vague, though.

Agree. The thought is per pt reimbursement will drop, total number of pts will increase, gross total reimbursement unchanged. My opinion: Likely will need doc efficiency improvements to handle increased pt volume (i.e. scribes or computerized dictation, more PAs, more techs for non-doc tasks, etc.).

 

[Law2Doc]

I want to start a massive FM practice where I outsource all of my work to PAs and NPs, supervise them, and get filthy rich.

This can be done on a small scale, but unless you are big corporation who makes money off your patients in other ways, liability risk can grow faster than profits if you try to supervise too many. Plus if all your patients get to see is NPs, I am not sure how you compete with the CVS and Walmarts of the world, where you'd also see an NP. the CVS/Walmart model is particularly smart, because the NP prescribes something and you pick it up from the pharmacy right there, and probably make some impulse buys as well. In truth, they can often lose money on the NP and still make it up on the ancillary sales.

As for the original question, under the new laws, volume will go up, but reimbursement will continue to go down, so you will be seeing more patients for less money per pop. The only ones who will make more money are those not already at full capacity (probably no one). And some might save $ on marketing because customers will be more plentiful, so that's a short term gain. Everyone else will be doing more work for less $.

 

[yehhhboiii]

What's the dealio with the push for insurance companies, hospitals and physicians being graded for quality of care? If more patients are flowing in under the same time constraints there will be smaller appointment windows which would most likely lead to lower care per patient right?

that's what happens when you have mbas and jds without any healthcare experience running the show

 

[inycepoo]

inb4 flame war by uninformed premeds with no real knowledge of health policy issues

Oh, wait......

This thread. I can't.

 

[inycepoo]

that's what happens when you have mbas and jds without any healthcare experience running the show

Also what happens when they're working with health care professionals without any policymaking/analysis experience wanting to run the show.

 

[Silent Cool]

I want to start a massive FM practice where I outsource all of my work to PAs and NPs, supervise them, and get filthy rich.

thumbup.

 

[armybound]

It seems like if they wanted to cut doctor pay, they ought to have added something into the bill (it was long enough that no one would have noticed anyway) to reduce the cost of med schools. At least bring back the no interest on federal loans while in med school thing.
With their payouts frozen, I don't even see PCPs making much more money, if any. It's rare that I hear about primary care providers that can't find enough patients to fill their schedules, so I doubt the greater number of patients needing to be seen will help them much at all.

The government doesn't care about your income or your debt. They jut got rid of subsidized loans for medical students.

But I agree completely with your point about physicians having full schedules. If you see a large influx of patients with Medicare/Medicaid, which traditionally reimburses lower than other insurers, you're going to see your income diluted. This is why some physicians refuse to take these patients.

I can see 100 patients/week whose insurance pays me 100%, so why would I switch that to 80 patients who pay me 100% and 20 patients who pay me 60%?

 

[Silent Cool]

The government doesn't care about your income or your debt. They jut got rid of subsidized loans for medical students.

But I agree completely with your point about physicians having full schedules. If you see a large influx of patients with Medicare/Medicaid, which traditionally reimburses lower than other insurers, you're going to see your income diluted. This is why some physicians refuse to take these patients.

I can see 100 patients/week whose insurance pays me 100%, so why would I switch that to 80 patients who pay me 100% and 20 patients who pay me 60%?

Armybound,
Do you think that state governments will eventually make acceptance of medicare/medicaid a condition of licensure?

thanx

 

[armybound]

Armybound,
Do you think that state governments will eventually make acceptance of medicare/medicaid a condition of licensure?

thanx

I don't think so. The feds would probably have to do it. If one state did it, they'd probably see a huge efflux of physicians out of the state. That would obviously be very stupid for them to do.

 

[TooMuchResearch]

Armybound,
Do you think that state governments will eventually make acceptance of medicare/medicaid a condition of licensure?

thanx

Massachusetts already tried it. Expect others to try again.

http://www.kevinmd.com/blog/2010/05/doctors-forced-accept-medicare-rates-stay-licensed.html

 

[Silent Cool]

I don't think so. The feds would probably have to do it. If one state did it, they'd probably see a huge efflux of physicians out of the state. That would obviously be very stupid for them to do.

Army,

I agree with you but the problem is this: fundamentally, the same argument could be (and has been) applied to the ACA. As it stands now, forcing docs to take medicaid/medicare at the federal level would be unconstitutional--but that was also the same argument against the ACA. Yet here it stands--as a law, as a 'tax.' So I ask if states, rather than the fed gov't, will enforce it. I think the more likely scenario is that states will first attempt to enforce it (as did Mass.), and then other states will follow. It won't be the same sort of hot-button issue as the ACA, so I don't think it will get federal attention. In the long-term, however (esp. if Hillary gets to the W.House), I see this happening.

Needless to say....I'm not a fan of gov't intervention into *any* market.

thanx
-sc

 

[notbobtrustme]

The fact is that America is entering a new economic cycle where the old rules aren't going to apply. Sure, doctor salaries may be taking a haircut. You know what else is? Every single other profession. Very few professions are seeing an rise in real wages.

 

[inycepoo]

Needless to say....I'm not a fan of gov't intervention into *any* market.

I take it you are not familiar with Arrow's classic essay on the uniqueness of the health care market.

It is a virtually impossible thesis to argue against. Health care is not just "*any*" market. That is the exact reason the field of health policy exists. Elementary economics arguments have no place in such a discussion.

 

[inycepoo]

I don't think so. The feds would probably have to do it. If one state did it, they'd probably see a huge efflux of physicians out of the state. That would obviously be very stupid for them to do.

No, just no. Medical licensure is explicitly under the discretion of the states. It is a privilege of federalism that states have fought long and hard for in past decades. The states with Dem governor/legislatures will go yay, while the GOP ones will go nay. Exactly like the issue with setting up state exchanges.

 

[Pacna]

I have an idea. Let's give a select group of people the legal right to initiate violence against the rest of the population. Then let's put that group in charge of health insurance.

It would be laughable if i wasn't so sad.

 

[deleted480308]

I have an idea. Let's give a select group of people the legal right to initiate violence against the rest of the population. Then let's put that group in charge of health insurance.

It would be laughable if i wasn't so sad.

Anarchocapitalist or voluntaryist? I'm pretty much with you either way 😉

 

[Pacna]

Anarchocapitalist or voluntaryist? I'm pretty much with you either way 😉

I think of the two terms as synonymous. 😉

 

[deleted480308]

I think of the two terms as synonymous. 😉

Yeah, i just tried to describe the difference to myself and couldn't haha

 

[rain4venus]

The government doesn't care about your income or your debt.

They'll probably need to start caring, since if training in medicine becomes a direct path to bankruptcy (with nondischargeable debt!), there won't be many people who opt to do it.

 

[notbobtrustme]

I have an idea. Let's give a select group of people the legal right to initiate violence against the rest of the population. Then let's put that group in charge of health insurance.

It would be laughable if i wasn't so sad.

You're free to move where a government won't "coerce" payments from you. I hear Somalia is nice this time of year.

 

[NickNaylor]

You're free to move where a government won't "coerce" payments from you. I hear Somalia is nice this time of year.

The typical Tea Party solution to this is so tired by now.

 

[Pacna]

You're free to move where a government won't "coerce" payments from you. I hear Somalia is nice this time of year.

Bahahaha! I'm dying. If I had a nickel for every time somebody said *sputtersputter*SOMALIA to me, I'd be filthy rich.

If you start demanding money from your neighbors, would it be fair to tell them that they're free to move to Somalia if they don't want to pay you? I mean sure they could move, but they shouldn't have to. They should be naturally free from your "coercion." (Not sure why you're putting that word in quotes, but I thought I'd follow your lead.)

 

[Law2Doc]

Armybound,
Do you think that state governments will eventually make acceptance of medicare/medicaid a condition of licensure?

thanx

I think you are combining some unrelated topics. You can be licensed and not even practice. You can be licensed and work for an organization which provides service to another institution with patients and have no idea about the payment status of any patient -- many ERs work this way. License ha no relation to th service or billing. There will be rules with respect to the ACA, like Midicare that you need to abide to to get the volume business, but it has nothing to do with licensure. That's a different concept and will stay different.

 

[NickNaylor]

I think you are combining some unrelated topics. You can be licensed and not even practice. You can be licensed and work for an organization which provides service to another institution with patients and have no idea about the payment status of any patient -- many ERs work this way. License ha no relation to th service or billing. There will be rules with respect to the ACA, like Midicare that you need to abide to to get the volume business, but it has nothing to do with licensure. That's a different concept and will stay different.

They're unrelated but not by necessity. It doesn't seem unreasonable for a state to force physicians licensed by that state to accept that state's public insurance programs. Massachusetts tried such a thing not that long ago. It's not all that farfetched.

 

[Silent Cool]

I think you are combining some unrelated topics. You can be licensed and not even practice. You can be licensed and work for an organization which provides service to another institution with patients and have no idea about the payment status of any patient -- many ERs work this way. License ha no relation to th service or billing. There will be rules with respect to the ACA, like Midicare that you need to abide to to get the volume business, but it has nothing to do with licensure. That's a different concept and will stay different.

L2D,

I think this article does a better job of showing what I was getting at:

http://masonconservative.typepad.co...to-accept-medicare-and-medicaid-patients.html

Virginia Democrat Calls For Forcing Doctors To Accept Medicare And Medicaid Patients

 

[sinombre]

They'll probably need to start caring, since if training in medicine becomes a direct path to bankruptcy (with nondischargeable debt!), there won't be many people who opt to do it.

We're a long way away from that happening. Vet students take on the same amount of debt and make a fraction of the salary of physicians, and there's no shortage of applicants to vet school.

 

[inycepoo]

I don't think so. The feds would probably have to do it. If one state did it, they'd probably see a huge efflux of physicians out of the state. That would obviously be very stupid for them to do.

This is still really funny every time this thread is bumped and I see the post again. Licensure was, is, and will be regulated at the state level. States are not going to give the right up.

It just goes to show how "informed" everyone ITT is on the topic. :LOL:

 

[deleted393595]

sort of a side thought/whine. It baffles me that specialty pay is going to decrease. Yes I understand that there can sometimes be flaws with the system of procedural payment vs being payed on quality etc. But irregardless, specialists have to put in more time and training. Seems silly to hinder the people with high training... Seems VERY counterintuitive on the long run. Though I think it is great that FM is getting a boost since the need for people who practice in that field is increasing.

I have heard that a lot of EM departments are going onto the outsourced system for hiring docs and PAs.

This is what happens when you let Communists get into power and give them a free rein in running their centralized planning schemes.... Good luck finding a specialist in the future - most of the older ones will be retiring b/c of Obamacare pretty soon (I know 2 surgeons with plenty of experience who are doing so) while brighter minds will rethink going into medicine once they see see the rising opportunity costs of being a doctor here in America

 

[armybound]

This is still really funny every time this thread is bumped and I see the post again. Licensure was, is, and will be regulated at the state level. States are not going to give the right up.

It just goes to show how "informed" everyone ITT is on the topic. :LOL:

Don't be obtuse. The feds have the power to impact this process if they so choose, and they have more interest in who would accept medicare/medicaid. I don't see any state just willy-nilly deciding to do this, as it would be stupid for them to do so, which was my point. The licensing issue is secondary to the acceptance of medicare/medicaid issue.

 

[inycepoo]

Don't be obtuse. The feds have the power to impact this process if they so choose, and they have more interest in who would accept medicare/medicaid. I don't see any state just willy-nilly deciding to do this, as it would be stupid for them to do so, which was my point. The licensing issue is secondary to the acceptance of medicare/medicaid issue.

*yawn*

I refuse to argue with a med student with little, if any, knowledge of federalism and how it works in our legal system. I'm not trying to beat you down, but it's pretty obvious this isn't exactly what you know about.

ICYDK or forgot, the only part of the ACA that was struck down was the part where "the feds" required the states to do something in return for something from the government. States won't be jumping to require acceptance, and that's tough titties for the government for the time being, which was my point. That is all.

 

[armybound]

*yawn*

I refuse to argue with a med student with little, if any, knowledge of federalism and how it works in our legal system. I'm not trying to beat you down, but it's pretty obvious this isn't exactly what you know about.

ICYDK or forgot, the only part of the ACA that was struck down was the part where "the feds" required the states to do something in return for something from the government. States won't be jumping to require acceptance, and that's tough titties for the government for the time being, which was my point. That is all.

So we're in agreement that it wouldn't be the states who would push for that sort of thing.

I didn't know that the feds couldn't force states to do something in return for rewards. That was the only way I could see this happening.

 

[circulus vitios]

This is what happens when you let Communists get into power and give them a free rein in running their centralized planning schemes.... Good luck finding a specialist in the future - most of the older ones will be retiring b/c of Obamacare pretty soon (I know 2 surgeons with plenty of experience who are doing so) while brighter minds will rethink going into medicine once they see see the rising opportunity costs of being a doctor here in America

Obamacare is a steaming pile of **** but you're being ridiculous.

Brighter minds rethinking medicine, lol. Name any other career where you're nearly guaranteed $200k/year for maintaining a minimum level of competency. Memorizing biology facts at State U and taking standardized tests doesn't translate into running a successful business or landing a biglaw job. Investment banking jobs require Ivy league pedigree, ridiculous connections, and/or incredible luck.

 

[notbobtrustme]

Medicine is the worst field to go into, except all other fields.

Something like 70% of all jobs created since the recession have been for 30k or less. That's the economic reality that we live in today.

Honestly, unless you are a computer programmer/engineer (and even this is debatable), chances are you'll have a **** job.



Finally, opinion is split on what the ACA will do to physician compensation, but remember, right now, even under ideal circumstances, 5-15% of all your care will be done charity. Either because the person can't pay or because the insurance won't pay. The ACA clamps down hard on insurers refusing to pay for procedures, which translates to more pay. Secondly, with more patients coming into the system, the competition for doctors will increase and the best way to attract doctors is more compensation. Finally, the Medscape surveys, while not perfect, show that physician compensation, on the whole, has risen for the last couple years.

 

[sobored]

Obamacare is a steaming pile of **** but you're being ridiculous.

Brighter minds rethinking medicine, lol. Name any other career where you're nearly guaranteed $200k/year for maintaining a minimum level of competency. Memorizing biology facts at State U and taking standardized tests doesn't translate into running a successful business or landing a biglaw job. Investment banking jobs require Ivy league pedigree, ridiculous connections, and/or incredible luck.

Maintaining a minimum level of competency?! Are you insane?