Rethinking the "Battle on Reimbursment Cuts"

[McDoctor]

A copy of a letter I'll be sending to the editors of The D.O. regarding President Ajluni's recent column. (It hasn't been spellchecked or even meaningfully vetted yet). I post it here for discussion. Comment if you agree or disagree.

edit: deleted until reviewed by editors.

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[DrMidlife]

Really? You'd list medicare reimbursement as a lower priority than simpler credentialing? Medicare reimbursement affects every patient interaction! It sets the prices for BSBC, HMO etc. reimbursement. If a doctor isn't directly involved in seeing the numbers, that doesn't mean he/she isn't affected by them. Are you seriously thinking that a primary care provider making $90k in a community clinic is better served by a streamlined credentialing process than by better medicare reimbursement? Seriously?!?

On the one hand you say that most grads won't have to worry about reimbursement issues because they're not going into private practice. On the other hand you say that business understanding (so that grads can run a private practice? so that they can understand their economic role as a cog?) is more important than reimbursement. This is contradictory.

Your major complaint about the complications of credentialing isn't supported in this letter. I don't think you've debunked the importance of medicare reimbursement either. Adding in the old "MD needs an MBA" issue waters it down further. The issues you're attempting to address are orthogonal, so it doesn't work to play them against each other.

 

[McDoctor]

Really? You'd list medicare reimbursement as a lower priority than simpler credentialing? Medicare reimbursement affects every patient interaction! It sets the prices for BSBC, HMO etc. reimbursement. If a doctor isn't directly involved in seeing the numbers, that doesn't mean he/she isn't affected by them. Are you seriously thinking that a primary care provider making $90k in a community clinic is better served by a streamlined credentialing process than by better medicare reimbursement? Seriously?!?

On the one hand you say that most grads won't have to worry about reimbursement issues because they're not going into private practice. On the other hand you say that business understanding (so that grads can run a private practice? so that they can understand their economic role as a cog?) is more important than reimbursement. This is contradictory.

Your major complaint about the complications of credentialing isn't supported in this letter. I don't think you've debunked the importance of medicare reimbursement either. Adding in the old "MD needs an MBA" issue waters it down further. The issues you're attempting to address are orthogonal, so it doesn't work to play them against each other.

I pulled the letter since after further thought, perhaps it should be vetted by the editor of the D.O. before I post it here.

Thanks for the feedback.

My point is that most new grads will be strong armed into unfavorable employment positions anyway, and be salaried. There is no opportunity to compete because the typical grad will have to go through a several month long credentialing process with each insurer. This is almost impossible to navigate alone, and is more complex than it needs to be. Basically, it is a tactic to prevent insurers from having to pay you, and certainly time limits can be legislated.

This is a bigger hurdle for students and perhaps should garner more focus, as opposed to getting caught up in the group-think that all problems stem from medicare reimbursement.

I didn't say medicare reimbursement wasn't a problem, only that it receives a disproportionate amount of attention from students, and in 75% of cases since 1994, it won't have a big impact anyway.

The current system stifles competition from new grads. The lack of business training in school doesn't help. That is my only point. Students should spend more time trying to figure out ways to make it better for themselves to start a practice, fighting reimbursement is just a small part of this, especially when current credentialing processes are set up to prevent them from getting paid for several months right out of the gate.

The current fervor over reimbursment among students is alot of group-think, though I see how it is more important to established physicians.

 

[DrMidlife]

I don't know any students who are actively up in arms about reimbursement. I think there are some residents who are starting to smell the coffee, but not students. Did you see a student article about reimbursement somewhere? It's hardly representative. Look at the threads in this forum: people are flipping out about there not being an M in DO, about getting audition rotations, and about navigating the match process. Group think? What group think?

The only interest your post received was from this 41 year old, and I'm not even in med school yet.

 

[McDoctor]

I don't know any students who are actively up in arms about reimbursement. I think there are some residents who are starting to smell the coffee, but not students. Did you see a student article about reimbursement somewhere? It's hardly representative. Look at the threads in this forum: people are flipping out about there not being an M in DO, about getting audition rotations, and about navigating the match process. Group think? What group think?

The only interest your post received was from this 41 year old, and I'm not even in med school yet.

I have to agree with you on many points. Dr. Ajluni's column specifically encouraged students to "continue the fight", but it wasn't the heart of his column.

But I do encounter students who are active in the AOA's political advocacy organizations, and my feeling is they spend a disproportionate amount of time focusing on medicare's system of reimbursement, and don't quite realize that there are many barriers preventing them from competing out of school beyond this simple issue.

I don't see much interest in the issue on this website. The group think, I should rephrase, is mostly a downstream phenomenon wherein established physicians harp on the importance of the issue to students rotating with them, and those students think this is the pre-eminent issue that they will face when they complete residency. I base this on my own observations. Probably, "group-think" is too strong a word, though, at least referring to students.

I think reimbursement is important, I don't argue otherwise, just less important than knocking down other barriers to competition. The two causes are not mutually exclusive, and again, already established physicians have no incentive to lobby for changes which generate more competition.

 

[DragonWell]

I have to agree with you on many points. Dr. Ajluni's column specifically encouraged students to "continue the fight", but it wasn't the heart of his column.

But I do encounter students who are active in the AOA's political advocacy organizations, and my feeling is they spend a disproportionate amount of time focusing on medicare's system of reimbursement, and don't quite realize that there are many barriers preventing them from competing out of school beyond this simple issue.

I don't see much interest in the issue on this website. The group think, I should rephrase, is mostly a downstream phenomenon wherein established physicians harp on the importance of the issue to students rotating with them, and those students think this is the pre-eminent issue that they will face when they complete residency. I base this on my own observations. Probably, "group-think" is too strong a word, though, at least referring to students.

I think reimbursement is important, I don't argue otherwise, just less important than knocking down other barriers to competition. The two causes are not mutually exclusive, and again, already established physicians have no incentive to lobby for changes which generate more competition.

I can't say that I've been involved much with the political side of things over the last two years, but based on what I hear from students who are involved with things like OPAC , reimbursement is certainly the main issue I've heard actively discussed.

Honestly, I think for at least the first two years, most students are so focused on surviving boards, etc. that it's pretty hard to get up in arms over anything that doesn't have an impact on your daily life.