Private Practice after ACA repeal?

[MedZeppelin]

Hello,
Any thoughts on whether the time is now right in 2017 to go into private practice, after the proposed repeal of Obamacare?
I understand many physicians joined,or remained hospital employees due to burdensome ACA red tape. With that monstrosity gone, will there be a desire to go back into private practice?
Thank you!
MZ

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[Aether2000]

I wouldn't count on the onerous paperwork being repealed....

 

[Ligament]

It was bad enough before Obamanocare, and got much worse after. Yes, if Obamacare is repealed and hopefully not replaced, private practice will be much more viable. It is overall very good news for private practice docs and poor news to hospital employed docs. Hospitals gained a LOT of momentum in gobbling up private practices thanks to Obamacare when the private practice docs realized they could not keep up with the red tape and decreasing payments.

Obamacare also dramatically increased private insurance deductibles, copays, and premiums, so that even privately insured patients got less care simply because they could not afford it...since they were forced to subsidize other citizens who could not afford it...so then you had two classes of patients who could not afford health care except for catastrophic issues.

 

[nvrsumr]

Maybe. I have a contrarian position that obamacare may have been good for a new doc as more new patients and disruption of established practices.

 

[MedZeppelin]

Thank you for the input! It would seem to me that the Obamacare repeal should be a revelation for all those pain docs considering private practice. The ACA, and all the beurocracy laden initiatives, such as HITECH, PQRS, RACs, etc, can finally be put to rest, and allow physicians the opportunity to get back in the business of treating patients...

 

[drusso]

Yes, post-repeal things will be better in private practice. Large physician employers (hospitals) will have to give up subsidies that caused distorted markets.

 

[hyperalgesia]

I agree there was massive red tape before Obama and it got a LOT worse over a short time with the ACA and HITECH and now MACRA. If anyone can undo some of this, it's Trump but it's still an enormous task.

 

[Ligament]

Yes, post-repeal things will be better in private practice. Large physician employers (hospitals) will have to give up subsidies that caused distorted markets.

this

 

[Ligament]

Maybe. I have a contrarian position that obamacare may have been good for a new doc as more new patients and disruption of established practices.

I think it varied regionally. In my region Obamacare plans pay very poorly and not worth taking any of them. Reading on SDN it appears some of you guys got some favorable rates.

 

[lobelsteve]

Rvu is an rvu.

 

[Stim4me]

You may want to wait until Trumpcare takes full effect AND the economy picks up. This
May take 2 years or more. Expendable cash in the economic system is key for pp.

 

[drusso]

Rvu is an rvu.

It's only the conversion factors that matter...

 

[Gauss]

Rvu is an rvu.

Until CMS changes the RVU # and reimbursement because it costs too much without considering time, work, training, experience, risk, skill, etc. needed

I'm not optimistic a repeal will have much improvement, it just slows down the inevitable march (more like sprint) to the bottom falling out in medicine. They would have to repeal EHR, meaningful use, MACRA, MIPS, along with crushing the power insurance companies have on denying care through prior auths/medical necessity/peer to peer, and getting CMS to increase RVU numbers and reimbursements.
I don't foresee the trend of practices changing to concierge slowing down because of this repeal. medicine remains in a deep recession

 

[drusso]

I don't foresee the trend of practices changing to concierge slowing down because of this repeal. medicine remains in a deep recession

Recession or Renaissance?

 

[Pain Applicant1]

Thank you for the input! It would seem to me that the Obamacare repeal should be a revelation for all those pain docs considering private practice. The ACA, and all the beurocracy laden initiatives, such as HITECH, PQRS, RACs, etc, can finally be put to rest, and allow physicians the opportunity to get back in the business of treating patients...

MU and PQRS did not get put to rest. They, along with some other govt reqs, just got combined into MACRA. This is a bipartisan experiment and separate from the ACA. Unfortunately, I don't think it's going anywhere.

 

[Stim4me]

MU and PQRS did not get put to rest. They, along with some other govt reqs, just got combined into MACRA. This is a bipartisan experiment and separate from the ACA. Unfortunately, I don't think it's going anywhere.

Yes, SGR created by Newt Gingrich. Quality measures implemented by AcA . All schemes meant to reduce Medicare expenditures/payments and salvage the program. Not sure trumpcare can save Medicare until wholesale changes are made( i.e. Age eligibility, higher deductibles, fraud prevention, privatization ?)...

 

[Ducttape]

Any doc thinking that repealing Obamacare is going to make PP so much better is projecting his politics and not considering the reality of healthcare.

We physicians have given up the mantle of being determinants of healthcare. Hospitals will take a hit... but any ensuing vacuum left by repealing ACA will be sucked up by Big Insurance. They will buy up practices, set fees, determine fiscal and health policies in the future, as they power to determine the marketplace.


Sent from my iPhone using SDN mobile

 

[Stim4me]

Any doc thinking that repealing Obamacare is going to make PP so much better is projecting his politics and not considering the reality of healthcare.

We physicians have given up the mantle of being determinants of healthcare. Hospitals will take a hit... but any ensuing vacuum left by repealing ACA will be sucked up by Big Insurance. They will buy up practices, set fees, determine fiscal and health policies in the future, as they power to determine the marketplace.


Sent from my iPhone using SDN mobile

This is coming from somebody that has never had a pp or employeed anybody in his life. Heed this advise with caution...

 

[Ligament]

Any doc thinking that repealing Obamacare is going to make PP so much better is projecting his politics and not considering the reality of healthcare.

We physicians have given up the mantle of being determinants of healthcare. Hospitals will take a hit... but any ensuing vacuum left by repealing ACA will be sucked up by Big Insurance. They will buy up practices, set fees, determine fiscal and health policies in the future, as they power to determine the marketplace.


Sent from my iPhone using SDN mobile

I agree physicians have given up the mantle. Also agree Big Insurance will attempt, and probably will to a degree, fill up the vampire vacuum left by the ACA. However, nothing is as evil and inefficient as big government, I'll take a battle with big insurance any day over the fed.

 

[MedZeppelin]

Thank you for the input! I agree, it's hard to work against or be competitive against the fed...

 

[hyperalgesia]

Any doc thinking that repealing Obamacare is going to make PP so much better is projecting his politics and not considering the reality of healthcare.

We physicians have given up the mantle of being determinants of healthcare. Hospitals will take a hit... but any ensuing vacuum left by repealing ACA will be sucked up by Big Insurance. They will buy up practices, set fees, determine fiscal and health policies in the future, as they power to determine the marketplace.


Sent from my iPhone using SDN mobile

The ACA favors the hospital/ACO model of care over independent practices. This allows bureaucrats to prioritize population health (what politicians want) over individualized health (what pts and docs want). Giant insurance companies with forced participation and crony capitalism work hand in hand with this mentality.

I think if the ACA is repealed and the mentality in Washington really changes, it will be a great thing for private practice and a horrible thing for the hospital/insurance complex. People like Tom Price have made is pretty clear where they stand and Trump by nominating him.

 

[Ducttape]

This is coming from somebody that has never had a pp or employeed anybody in his life. Heed this advise with caution...

and this disqualifies me how?

after all, am I not the target audience for the initial question, and not you, who has only experienced private practice?

I understand many physicians joined,or remained hospital employees due to burdensome ACA red tape. With that monstrosity gone, will there be a desire to go back into private practice?

fyi, I did "private practice" ER for 3 out of 16 years of my ER career, working for various agencies

 

[Stim4me]

"Any doc thinking that repealing Obamacare is going to make PP so much better is projecting his politics and not considering the reality of healthcare. "

Sounds like you are discrediting active private physician experiences because of political motives. This coming from a lifelong hospital employee. Of course you want trumpcare to fail, its much 'safer' for hospitalists to want the corrupt incompetent hospitals to run the healthcare system...

 

[Ducttape]

please stop using strawman arguments as to what you think my qualifications are, and making false assumptions about what I think of private practice experiences.

my point is that healthcare is so far gone that I doubt those who essentially own healthcare - ie big insurance - will acquiesce to giving up their piece of the pie, regardless of what the government does.



and as I mentioned - even as you practice your "motivated reasoning" - I did the "private practice" model for ER back in my day.

 

[Stim4me]

please stop using strawman arguments as to what you think my qualifications are, and making false assumptions about what I think of private practice experiences.

my point is that healthcare is so far gone that I doubt those who essentially own healthcare - ie big insurance - will acquiesce to giving up their piece of the pie, regardless of what the government does.



and as I mentioned - even as you practice your "motivated reasoning" - I did the "private practice" model for ER back in my day.

Private practice ER???
Urgent care center???huh

Unless you have negotiated contracts and dealt with insurances directly as a owner/director , you have no clue what you lack in knowledge and experience.

As ligament implied, I would deal with big insurance ALL day over the governement or hospital-run healthcare organizations. Big insurances are negotiable, you just need to know how to do it (consortiums, physician groups, or out right leaving the networks).

 

[hyperalgesia]

my point is that healthcare is so far gone that I doubt those who essentially own healthcare - ie big insurance - will acquiesce to giving up their piece of the pie, regardless of what the government does.

The govt can create a business friendly environment, with rock bottom taxes and minimal regulation that ENCOURAGES new market participants in healthcare insurance. Instead of demonizing insurance companies and then striking deals with them to screw the people.

 

[Ducttape]

Unless you have negotiated contracts and dealt with insurances directly as a owner/director , you have no clue what you lack in knowledge and experience.

funny you mention that....

 

[SeniorWrangler]

Maybe wait to see what actually happens with Repeal and what, if anything, happens with Replace.
Don't forget that the Republican House passed MACRA.
And no matter what anybody in the legislature wants, health care expenditure is still at 20% of GDP.

 

[jacobsjj12]

[QUOTE="Stim4me, post: 18515868, member: 682023" Trumpcare.[/QUOTE]

You use this term multiple times. I'm curious what you mean by this as "Trumpcare" literally doesn't exist. There is no actual plan for what happens after the ACA repeal.

 

[Stim4me]

[QUOTE="Stim4me, post: 18515868, member: 682023" Trumpcare.

You use this term multiple times. I'm curious what you mean by this as "Trumpcare" literally doesn't exist. There is no actual plan for what happens after the ACA repeal.[/QUOTE]
Yes there is. Patient care act.

Aca was a construct of the Nixon administration . Healthcare mandate was a republican concept. There are several plans being contemplated all outlined in the past 6 years in the patient care act. Read up.... sounds like more state control, medicaid block grants, interstate competition, and coverage for all. Obviously more complex than I can summarize

 

[drusso]

[QUOTE="Stim4me, post: 18515868, member: 682023" Trumpcare.

You use this term multiple times. I'm curious what you mean by this as "Trumpcare" literally doesn't exist. There is no actual plan for what happens after the ACA repeal.[/QUOTE]

https://newsatjama.jama.com/2016/10...-flaws-alternatives-for-health-system-reform/

 

[hyperalgesia]

The replacement might take the form of high cost in the short term (for the govt) in exchange for more control in the long term. Some kind of voucher system that covers more people than ACA.

 

[Stim4me]

Maybe wait to see what actually happens with Repeal and what, if anything, happens with Replace.
Don't forget that the Republican House passed MACRA.
And no matter what anybody in the legislature wants, health care expenditure is still at 20% of GDP.

The bipartisan congress passed the SGF. Partisan congress passed Aca/Medicare tax/advisory board. CMS director elected by Obama enacted and implemented MACRA , not republicans. The new CMS director hopefully will modify MACRA/pqrs, and other Medicare mandates ...

 

[drusso]

I think that if the R's have the fortitude to spend within our means, then there will be plenty of money for universal access to insurance.

http://thf-reports.s3.amazonaws.com/2016/BlueprintforBalance.pdf

 

[SSdoc33]

I think that if the R's have the fortitude to spend within our means, then there will be plenty of money for universal access to insurance.

http://thf-reports.s3.amazonaws.com/2016/BlueprintforBalance.pdf

access. thats the buzzword. universal access, not universal coverage.

that is a sleazy way to say that there will be 20 million people not covered. access for person A may not be the same as access for person B. person A may be able to afford the 100 bucks for an urgent care visit, but person B may not. devil is in the details

 

[Stim4me]

access. thats the buzzword. universal access, not universal coverage.

that is a sleazy way to say that there will be 20 million people not covered. access for person A may not be the same as access for person B. person A may be able to afford the 100 bucks for an urgent care visit, but person B may not. devil is in the details

aca provides "universal coverage" but limited "access" for the middle class. It has failed its mission ...

 

[drusso]

access. thats the buzzword. universal access, not universal coverage.

that is a sleazy way to say that there will be 20 million people not covered. access for person A may not be the same as access for person B. person A may be able to afford the 100 bucks for an urgent care visit, but person B may not. devil is in the details

No one wants to see the Federal government deliver cash transfers to insurance companies and large physician employers (hospitals).

 

[lonelobo]

Comment was made about his on Vice News about how Insurance coverage used to be anything the Insurance Companies deemed it to be.
After the ACA at least some standards had to be met to be called a health insurance product...rolling that back has been mentioned in replacement plans

 

[SSdoc33]

aca provides "universal coverage" but limited "access" for the middle class. It has failed its mission ...

you told me what ACA didnt do. you didnt tell me why universal "access" was a problem. what good is access if you arent covered? what good is coverage if you have no access?

btw, i am not a fan of much of the ACA, but rather than deflect, can you offer anything constructive?

 

[Stim4me]

you told me what ACA didnt do. you didnt tell me why universal "access" was a problem. what good is access if you arent covered? what good is coverage if you have no access?

btw, i am not a fan of much of the ACA, but rather than deflect, can you offer anything constructive?

More insurance plans in each state (Vermont has one), more access to insterstae

you told me what ACA didnt do. you didnt tell me why universal "access" was a problem. what good is access if you arent covered? what good is coverage if you have no access?

btw, i am not a fan of much of the ACA, but rather than deflect, can you offer anything constructive?

intregrate the Aca with the aspects of the patient care act.... can be done with reasonable minds.

Hopefully trump will be the one to finally cover everybody via a capitalistic system. One thing we all learned from the Aca experience is that insurance CAN be told what to do...

 

[lonelobo]

More insurance plans in each state (Vermont has one), more access to insterstae

intregrate the Aca with the aspects of the patient care act.... can be done with reasonable minds.

Hopefully trump will be the one to finally cover everybody via a capitalistic system. One thing we all learned from the Aca experience is that insurance CAN be told what to do...

That really wouldn't be capitalism, now would it?

 

[SSdoc33]

More insurance plans in each state (Vermont has one), more access to insterstae

intregrate the Aca with the aspects of the patient care act.... can be done with reasonable minds.

Hopefully trump will be the one to finally cover everybody via a capitalistic system. One thing we all learned from the Aca experience is that insurance CAN be told what to do...

there are too many interests trying to get a piece of the pie. everybody wants their money (and rightly so). capitalism and healthcare do not mix. you end up with drugs that cost 1000 bucks a pill and fusions for everybody.

basic, crappy care for everybody as a governement entitlement. cadillac plans if you can afford it. everybody is covered, but the gvt provides a not-for-profit plan. insurance industry still makes money by covering those who choose to buy it. done.

 

[hyperalgesia]

That really wouldn't be capitalism, now would it?

It still can be capitalism without a free-for-all.

A voucher could be used to purchase Medicaid (financed through Fed and State), or to buy Medicare or add additional money to buy a private plan.

As far as regulating insurance, I would focus on SIMPLICITY, TRANSPARENCY, and CONSISTENCY of the plans. They should be required to PUBLISH things like preauthorization requirements. Do they contract 3rd parties, etc... They should not be allowed to change their policies whenever they want. Maybe they should even publish the average rates they pay doctors. It's not really a free market if consumers are lied to and cheated on.

 

[lonelobo]

It still can be capitalism without a free-for-all.

A voucher could be used to purchase Medicaid (financed through Fed and State), or to buy Medicare or add additional money to buy a private plan.

As far as regulating insurance, I would focus on SIMPLICITY, TRANSPARENCY, and CONSISTENCY of the plans. They should be required to PUBLISH things like preauthorization requirements. Do they contract 3rd parties, etc... They should not be allowed to change their policies whenever they want. Maybe they should even publish the average rates they pay doctors. It's not really a free market if consumers are lied to and cheated on.

Well that is not true Capitalism then. If those who promote Capitalism really desire that, then Free Market determines the rules not the Government. There should be no Government involvement whatsoever.

 

[Ducttape]

http://money.cnn.com/2017/01/18/news/drug-pricing-mallinckrodt-ftc-fine/index.html

an honest question - should the government be allowed to step in in this case, or EpiPen or Daraprim, for those people who believe in free market capitalism?

not trying to flame, I am curiously interested in hearing what people who are most vested in that have to say. aren't these price increases justified based on that principle, and let the market "correct" itself? is there a limit to where government should step in?

 

[VA Hopeful Dr]

http://money.cnn.com/2017/01/18/news/drug-pricing-mallinckrodt-ftc-fine/index.html

an honest question - should the government be allowed to step in in this case, or EpiPen or Daraprim, for those people who believe in free market capitalism?

not trying to flame, I am curiously interested in hearing what people who are most vested in that have to say. aren't these price increases justified based on that principle, and let the market "correct" itself? is there a limit to where government should step in?

Except patents wouldn't exist without the government protecting them either...

 

[Stim4me]

Arguing extremes is mindless...
Moderation is key.
Even socialist and communist countries rely on capitalism to support their entitlements.

Hopefully Chuck Schumer sees the light.

 

[hyperalgesia]

Well that is not true Capitalism then. If those who promote Capitalism really desire that, then Free Market determines the rules not the Government. There should be no Government involvement whatsoever.

Capitalism has nothing to do with making rules. Government always makes the rules. This is another liberal demonization of a word - as if free market capitalism is anarchy. This word was demonized to keep you in your place by the way - so you support the state and are fearful of people and businesses.

If the rules allow for free exchange of goods and services - that's free-market capitalism. If the rules say the govt distributes and controls goods and services - that's socialism.

 

[hyperalgesia]

http://money.cnn.com/2017/01/18/news/drug-pricing-mallinckrodt-ftc-fine/index.html

an honest question - should the government be allowed to step in in this case, or EpiPen or Daraprim, for those people who believe in free market capitalism?

not trying to flame, I am curiously interested in hearing what people who are most vested in that have to say. aren't these price increases justified based on that principle, and let the market "correct" itself? is there a limit to where government should step in?

When a company uses its leverage to suppress competition, you don't have a free market any more. It's like if you bribe a judge or something, you are corrupting the judicial system. The govt must protect the system.

"Survival of the fittest" in the economic sense, is understood to mean "within the rules". It seems like this company violated the law. "This is an egregious case of a monopolist doing a deal to eliminate potential competition and keep its power over pricing". So it looks like a case for law enforcement.

Hypothetically, if there were no violation of the law and the company just developed a drug in good faith and wanted to charge a billion dollars for the drug, they can do that.

 

[Ducttape]

thanks for the reasoned reply hyperalgesia.

and stim, im not arguing for extremes. I was worried that there were no limits to those extremes. I agree, moderation is key.

when I read some of arguments against liberalism posted on this board, the gestalt seems that are no perceived limits to the bounds of liberalism. I know that there are, personally, and I am not making any presumptions or arguments for those limits (ie as a liberal, I personally do not support heroin safe havens or medical marijuana or disability, for example). I am just determining if the conservative viewpoint espoused by some on this board have limitations in themselves.