Senate Threatens to Cut PEAR (Path/EM/Anesthesia/Radiology) reimbursement 20%

[sum dude]

Cross-posting from EM/Anesthesia forums--right now there's a bill out in senate which will cut all PEAR (Path/EM/Anesthesia/Radiology) reimbursement 20%. If senate bill passes with Benchmarking standard, CBO estimates 20% pay cuts to hospital-based physicians. It will basically force everyone to accept InNetwork rates from Insurances. Something is going to pass Congress--it's important we get Independent Dispute Resolution (IDR) currently favored by the House (HR3060) passed instead, which won't have such draconian effects.

Please contact your local reps/Senators--Benchmarking in the Senate bill is a Trojan Horse attempt at instituting a Fee Schedule for all physicians (the first of which will be us).

CAP Applauds New State Law to Stop Surprise Medical Bills

WASHINGTON, May 21, 2019 /PRNewswire/ -- The College of American Pathologists (CAP) commended officials in the state of Washington for enacting law to protect...

www.prnewswire.com

https://www.highyieldscript.com/what-i-believe-about-surprise-billing-reform/
This is about so much more than "surprise bills"

---

Members don't see this ad.

 

[LADoc00]

Cross-posting from EM/Anesthesia forums--right now there's a bill out in senate which will cut all PEAR (Path/EM/Anesthesia/Radiology) reimbursement 20%. If senate bill passes with Benchmarking standard, CBO estimates 20% pay cuts to hospital-based physicians. It will basically force everyone to accept InNetwork rates from Insurances. Something is going to pass Congress--it's important we get Independent Dispute Resolution (IDR) currently favored by the House (HR3060) passed instead, which won't have such draconian effects.

Please contact your local reps/Senators--Benchmarking in the Senate bill is a Trojan Horse attempt at instituting a Fee Schedule for all physicians (the first of which will be us).

CAP Applauds New State Law to Stop Surprise Medical Bills

WASHINGTON, May 21, 2019 /PRNewswire/ -- The College of American Pathologists (CAP) commended officials in the state of Washington for enacting law to protect...

www.prnewswire.com

This is about so much more than "surprise bills"
This is about so much more than "surprise bills"

Pathology has a very unique way to profit off this change but I definitely agree that Rads and Gas would be completely wrecked. I think this is all part of very careful strategy to destroy private practice, fee for service and physician compensation so that instead of having to fight with doctors for a single payer system, you will eventually have doctors begging for it.

This is the exact playbook Nikita Khrushchev used in Cold War.

Physicians are the single easiest professional group to bully, even accountants would be engaging in guerrilla war planting explosives and taking up AKs if they faced a similar career destruction. But physicians are supposed to have only done medicine to help unwashed masses of humanity and to this end politicians think we should be lucky to drink clean water and sleep in bed let alone get paid.

 

[Spikebd]

Pathology has a very unique way to profit off this change but I definitely agree that Rads and Gas would be completely wrecked. I think this is all part of very careful strategy to destroy private practice, fee for service and physician compensation so that instead of having to fight with doctors for a single payer system, you will eventually have doctors begging for it.

This is the exact playbook Nikita Khrushchev used in Cold War.

Physicians are the single easiest professional group to bully, even accountants would be engaging in guerrilla war planting explosives and taking up AKs if they faced a similar career destruction. But physicians are supposed to have only done medicine to help unwashed masses of humanity and to this end politicians think we should be lucky to drink clean water and sleep in bed let alone get paid.

How would we profit? By getting $25 for an 88305 versus a $12.50 from Quest?

 

[jupiterianvibe]

Pathology has a very unique way to profit off this change but I definitely agree that Rads and Gas would be completely wrecked. I think this is all part of very careful strategy to destroy private practice, fee for service and physician compensation so that instead of having to fight with doctors for a single payer system, you will eventually have doctors begging for it.

This is the exact playbook Nikita Khrushchev used in Cold War.

Physicians are the single easiest professional group to bully, even accountants would be engaging in guerrilla war planting explosives and taking up AKs if they faced a similar career destruction. But physicians are supposed to have only done medicine to help unwashed masses of humanity and to this end politicians think we should be lucky to drink clean water and sleep in bed let alone get paid.

One must only look to China to see the sorry state of communist medicine.

 

[deleted314957]

Pathology has a very unique way to profit off this change but I definitely agree that Rads and Gas would be completely wrecked. I think this is all part of very careful strategy to destroy private practice, fee for service and physician compensation so that instead of having to fight with doctors for a single payer system, you will eventually have doctors begging for it.

This is the exact playbook Nikita Khrushchev used in Cold War.

Physicians are the single easiest professional group to bully, even accountants would be engaging in guerrilla war planting explosives and taking up AKs if they faced a similar career destruction. But physicians are supposed to have only done medicine to help unwashed masses of humanity and to this end politicians think we should be lucky to drink clean water and sleep in bed let alone get paid.

Just one more step in the inexorable move to “socialized”
medicine. It has been slowly coming since MC. It is their EXACT purpose to, basically, have y’all salaried. You will essentially be a gov’t employee. Much like the military but you won’t have benefit of rank or time in service. A senior officer/physician (O-5, O-6) has a pretty good/damn good life, ok pay, tons of experience and a very generous inflation indexed retirement with medical care if you do 20.
It is really too late for you folks in the dumpster fire now. But, all you kids looking to go into medicine- you are warned. If you use uncle sam properly, in a number of ways, it will be like having seniority in a system that is being/will be shoved down everyone else’s gullets. This is happening/will happen to ALL of medicine.
Don’t sit back and let others determine your lot in life. I did not even stay for retirement and had a great deal. Zero debt, great training including AFIP, better money than civvy residency and some great sea stories (from being the medical officer for a ballistic missile submarine squadron at the height of the cold war)

 

[CDX-2]

One must only look to China to see the sorry state of communist medicine.

I can't comment on the private sector, but I heard that the average public doctor in mainland China earns ~$US 15K / YEAR, with some public surgeons (?plastics, ?neurosurgery) earning up to a whopping $US 40K / YEAR...

Granted, they have minimal university debt, and the cost of living is lower than in a western country, but the pay seems pretty crap considering their working hours, patient / caseload and responsibilities.

It's no surprise that within their public sector, there's a significant portion that accept bribes in the form of "red packets" to expedite treatment / investigations. Ironically this "discriminates" against the patients who can't afford these "red packets", which undermines the intended egalitarian nature of their healthcare system.

Over there, it's apparently easier to get accepted into medical school than it is to study finance or engineering, which doesn't surprise me...

As the saying goes, "You pay peanuts, you get monkeys"...

 

[jupiterianvibe]

I can't comment on the private sector, but I heard that the average public doctor in mainland China earns ~$US 15K / YEAR, with some public surgeons (?plastics, ?neurosurgery) earning up to a whopping $US 40K / YEAR...

Granted, they have minimal university debt, and the cost of living is lower than in a western country, but the pay seems pretty crap considering their working hours, patient / caseload and responsibilities.

It's no surprise that within their public sector, there's a significant portion that accept bribes in the form of "red packets" to expedite treatment / investigations. Ironically this "discriminates" against the patients who can't afford these "red packets", which undermines the intended egalitarian nature of their healthcare system.

Over there, it's apparently easier to get accepted into medical school than it is to study finance or engineering, which doesn't surprise me...

As the saying goes, "You pay peanuts, you get monkeys"...

A doctors worth is a reflection of how much a society values the individual versus the collective

 

[LADoc00]

Im thinking that at some point in the past physicians were very much blue collar type folks, like mason or plumber. They werent the smartest or most ambitious but had a solid attention to detail like an auto mechanic. Then post WW2 it went from a tradesman type thing to an academic endeavor and went off the rails into higher income white collar profession only since the 1950s?

Dont know, but I dont think physicians generally ever made a ton of $$, maybe this all cyclical and in a few years you will do surgery in the morning shift and put in a p.m. shift at Taco Bell.

Article: The millennial doctor – A blue collar worker?

The millennial doctor – A blue collar worker?

The practice of medicine in the UK has changed so significantly over the last 20 years that we risk tomorrow's junior doctor transforming into a blue collar worker. This doctor will merely be a tick-box competent worker bee who clocks in and out of rigid shift patterns of work. We fear they will still be working within a system similar to what we see in 2016; one that is still ‘underfunded, underdoctored and overstretched.

Im not 100% sure...someone correct if Im wrong, but I dont think Upton Sinclair in 1930 included physicians as strictly "white collar workers" when he created the system. I think white collar was management only and physicians may have been purple..
Purple collar – Skilled workers, typically someone who is both white and blue collar
?
So a Bernie Sanders future where doctors in America make around 80K a year is not only probable, but highly likely.

Chinese annual average income is around 10K and U.S. is 80K so that 15K per year in China would actually be equivalent to 120K here so even Chinese slave wages might be too generous for where we are going.

 

[deleted941485]

Im thinking that at some point in the past physicians were very much blue collar type folks, like mason or plumber. They werent the smartest or most ambitious but had a solid attention to detail like an auto mechanic. Then post WW2 it went from a tradesman type thing to an academic endeavor and went off the rails into higher income white collar profession only since the 1950s?

Dont know, but I dont think physicians generally ever made a ton of $$, maybe this all cyclical and in a few years you will do surgery in the morning shift and put in a p.m. shift at Taco Bell.

Article: The millennial doctor – A blue collar worker?

The millennial doctor – A blue collar worker?

The practice of medicine in the UK has changed so significantly over the last 20 years that we risk tomorrow's junior doctor transforming into a blue collar worker. This doctor will merely be a tick-box competent worker bee who clocks in and out of rigid shift patterns of work. We fear they will still be working within a system similar to what we see in 2016; one that is still ‘underfunded, underdoctored and overstretched.

Im not 100% sure...someone correct if Im wrong, but I dont think Upton Sinclair in 1930 included physicians as strictly "white collar workers" when he created the system. I think white collar was management only and physicians may have been purple..
Purple collar – Skilled workers, typically someone who is both white and blue collar
?
So a Bernie Sanders future where doctors in America make around 80K a year is not only probable, but highly likely.

Chinese annual average income is around 10K and U.S. is 80K so that 15K per year in China would actually be equivalent to 120K here so even Chinese slave wages might be too generous for where we are going.

The govt doesn’t give a **** about doctors. Why should they? They own you and your profession. Their organizations aren’t just as impotent as he ones in this country. They don’t want you to take hinkle on your own the they want you to follow the ****ing protocol: you know the cheaper one.

The public is also complicit in this. Most people don’t really like doctors to be honest with you. I think deep down if something comes to a vote that makes them choose between your professional fulfillment’s and well being and them getting more out of you for less. It’s never going to be a hard choice. You will always lose.

 

[LADoc00]

You’re going to a dark place where everyone hates us. I don’t think that is true at all. I think people in general are just apathetic. If it doesn’t affect their lives, they simply don’t care. If doctors were led around in leg irons by Socialist horsemen like chain gangs, I think it will be because people simply don’t care to even look up from their phone.

 

[deleted941485]

You’re going to a dark place where everyone hates us. I don’t think that is true at all. I think people in general are just apathetic. If it doesn’t affect their lives, they simply don’t care. If doctors were led around in leg irons by Socialist horsemen like chain gangs, I think it will be because people simply don’t care to even look up from their phone.

Apathy and maybe a bit of schnedenfraude.

 

[Kilgoretrout 65]

When I am forced to take 50% of medicare reimbursement from Anthem for an 88305 I guess medicare for all will look pretty good. At least
I can dream of unemployed health insurance CEOs and lackeys.

 

[Kilgoretrout 65]

Pathology has a very unique way to profit off this change but I definitely agree that Rads and Gas would be completely wrecked. I think this is all part of very careful strategy to destroy private practice, fee for service and physician compensation so that instead of having to fight with doctors for a single payer system, you will eventually have doctors begging for it.

This is the exact playbook Nikita Khrushchev used in Cold War.

Physicians are the single easiest professional group to bully, even accountants would be engaging in guerrilla war planting explosives and taking up AKs if they faced a similar career destruction. But physicians are supposed to have only done medicine to help unwashed masses of humanity and to this end politicians think we should be lucky to drink clean water and sleep in bed let alone get paid.

Perhaps we can just sign out every skin tumor as "acanthoma" and hold the blocks and slides hostage?

 

[univlad]

What is pathology's unique way to profit?

 

[Mad Jack]

Im thinking that at some point in the past physicians were very much blue collar type folks, like mason or plumber. They werent the smartest or most ambitious but had a solid attention to detail like an auto mechanic. Then post WW2 it went from a tradesman type thing to an academic endeavor and went off the rails into higher income white collar profession only since the 1950s?

Dont know, but I dont think physicians generally ever made a ton of $$, maybe this all cyclical and in a few years you will do surgery in the morning shift and put in a p.m. shift at Taco Bell.

Article: The millennial doctor – A blue collar worker?

The millennial doctor – A blue collar worker?

The practice of medicine in the UK has changed so significantly over the last 20 years that we risk tomorrow's junior doctor transforming into a blue collar worker. This doctor will merely be a tick-box competent worker bee who clocks in and out of rigid shift patterns of work. We fear they will still be working within a system similar to what we see in 2016; one that is still ‘underfunded, underdoctored and overstretched.

Im not 100% sure...someone correct if Im wrong, but I dont think Upton Sinclair in 1930 included physicians as strictly "white collar workers" when he created the system. I think white collar was management only and physicians may have been purple..
Purple collar – Skilled workers, typically someone who is both white and blue collar
?
So a Bernie Sanders future where doctors in America make around 80K a year is not only probable, but highly likely.

Chinese annual average income is around 10K and U.S. is 80K so that 15K per year in China would actually be equivalent to 120K here so even Chinese slave wages might be too generous for where we are going.

The thing is, it is highly unlikely that a doctor would work for those wages in the United States, and there is no class of worker in the country that is mandated to only accept government payment for anything, so I find it highly unlikely that private practice would be outlawed. Hell, a good percentage of psychiatrists only accept cash and make well over 300k+, and I doubt their customers would just stop paying tomorrow. Other fields might just have to establish similar arrangements outside of the reimbursement model.

 

[deleted314957]

The thing is, it is highly unlikely that a doctor would work for those wages in the United States, and there is no class of worker in the country that is mandated to only accept government payment for anything, so I find it highly unlikely that private practice would be outlawed. Hell, a good percentage of psychiatrists only accept cash and make well over 300k+, and I doubt their customers would just stop paying tomorrow. Other fields might just have to establish similar arrangements outside of the reimbursement model.

You are right. No way, no how can the gov’t screw with us. We are major league alphas with a powerful lobby employed by our professional organizations. They will shut that crap down.

 

[gschl1234]

I can't comment on the private sector, but I heard that the average public doctor in mainland China earns ~$US 15K / YEAR, with some public surgeons (?plastics, ?neurosurgery) earning up to a whopping $US 40K / YEAR...

Granted, they have minimal university debt, and the cost of living is lower than in a western country, but the pay seems pretty crap considering their working hours, patient / caseload and responsibilities.

It's no surprise that within their public sector, there's a significant portion that accept bribes in the form of "red packets" to expedite treatment / investigations. Ironically this "discriminates" against the patients who can't afford these "red packets", which undermines the intended egalitarian nature of their healthcare system.

Over there, it's apparently easier to get accepted into medical school than it is to study finance or engineering, which doesn't surprise me...

As the saying goes, "You pay peanuts, you get monkeys"...

A friend of mine from China says that there is a lot of "under the table" payment. When she got sick on a visit home, her mom had to bride a doc to see her (in a timely manner) so doctors' "official" pay is just a fraction. People who can't pay cash end up waiting in the usual queue.

 

[Centropyge]

A friend of mine from China says that there is a lot of "under the table" payment. When she got sick on a visit home, her mom had to bride a doc to see her (in a timely manner) so doctors' "official" pay is just a fraction. People who can't pay cash end up waiting in the usual queue.

Exactly. Most of the income for senior/reputable Chinese doctors come in the form of "red packets". The patients expect to offer these red packets, and the doctors expect to receive them.

 

[bronx43]

Exactly. Most of the income for senior/reputable Chinese doctors come in the form of "red packets". The patients expect to offer these red packets, and the doctors expect to receive them.

This actually generates a lot of ill will towards Chinese physicians amongst the Chinese populace. Violence towards physicians is widespread, and one of the contributing factors is the acceptance of “red packets.”

Trust me, you don’t want to be a doctor in China. If this becomes how medicine is in the US, we would all be better off quitting.

 

[Unty]

There’s a reason why there are so many Chinese docs who come here get their PhDs and go into pathology after. It’s a trend I see A LOT in Chinese pathologists in the US.

 

[Mad Jack]

A friend of mine from China says that there is a lot of "under the table" payment. When she got sick on a visit home, her mom had to bride a doc to see her (in a timely manner) so doctors' "official" pay is just a fraction. People who can't pay cash end up waiting in the usual queue.

Yeah, in a lot of areas if you don't pay a bribe you have to go in line at the start of each day and get a ticket. If the line ends before you reach the front, your ticket is worthless and you have to come back the next day.

 

[Mad Jack]

You are right. No way, no how can the gov’t screw with us. We are major league alphas with a powerful lobby employed by our professional organizations. They will shut that crap down.

I'm just saying, they would have to do unprecedented things in the history of American labor law to make the things you are claiming to be possibilities happen. I find that highly unlikely, as the implications it would have for other fiends (and the distaste those implications would have for Republicans) would make such options untenable. Most likely all hospital work and most clinic work would be government owned and operated, but they wouldn't ban private practice in order for the GOP to have a way to let doctors leave the system so that the system becomes understaffed and collapses and they can blame the failure on the Democrats planning poorly.

 

[FourCandles]

Pathology has a very unique way to profit off this change but I definitely agree that Rads and Gas would be completely wrecked. I think this is all part of very careful strategy to destroy private practice, fee for service and physician compensation so that instead of having to fight with doctors for a single payer system, you will eventually have doctors begging for it.

This is the exact playbook Nikita Khrushchev used in Cold War.

Physicians are the single easiest professional group to bully, even accountants would be engaging in guerrilla war planting explosives and taking up AKs if they faced a similar career destruction. But physicians are supposed to have only done medicine to help unwashed masses of humanity and to this end politicians think we should be lucky to drink clean water and sleep in bed let alone get paid.

The day of reckoning is coming and we ain't gonna like it!

 

[y2k_free_radical]

I'm just saying, they would have to do unprecedented things in the history of American labor law to make the things you are claiming to be possibilities happen. I find that highly unlikely, as the implications it would have for other fiends (and the distaste those implications would have for Republicans) would make such options untenable. Most likely all hospital work and most clinic work would be government owned and operated, but they wouldn't ban private practice in order for the GOP to have a way to let doctors leave the system so that the system becomes understaffed and collapses and they can blame the failure on the Democrats planning poorly.

We could get the worst of both worlds.Nationalized medicine administered by insurance companies.Many state medicare programs are contracted out to private insurance companies.

 

[Mad Jack]

We could get the worst of both worlds.Nationalized medicine administered by insurance companies.Many state medicare programs are contracted out to private insurance companies.

That is a very likely scenario. I deal with the nightmare of this almost daily with Medicaid psych patients

 

[sum dude]

We could get the worst of both worlds.Nationalized medicine administered by insurance companies.Many state medicare programs are contracted out to private insurance companies.

I'm starting to think that's why Insurance is calling the shots on these bills--the GOP handed the keys to the kingdom for the stupid medicare advantage plans. Many red states have Private Insurance Medicaid--it's the worst of both worlds