DocYuki

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Rising MS4 here. I'm going into FM, and as I told my adviser, regardless of political climate, peer pressure (+ or -), and all the chicken littles out there, I'm doing it because I couldn't muster the energy to get up and do anything else each morning. Beyond the versatility, broad-scope, and continuity of care offered, I just plain believe genuinely that a solid primary care base is vital to any country's health-care system.

Amid all the reform and such, I've been battered from every direction by opinionated doctors, nurses, drug reps. I'm wrapping up 3rd year on surgery and I hear all this going on, and don't take any of it to heart because people seem to love to just bitch and bitch. In all of it, I get a whirlwind of opinions but no real sense of what this is going to mean to me. When I'm finishing residency in 2014, what will things look like? Will I be able to repay loans or practice on medicaid patients?

And all I know is that people are shying away from FM more and more due to the decreased medicaid reimbursements and doom and gloom talk. For some reason, going into it against the grain because of my own personal convictions makes it all the more affirming as a choice :D

Also, I was wondering what Blue Dog thought of this article: http://money.cnn.com/2010/03/11/news/economy/health_care_doctor_incomes/index.htm?source=cnn_bin
 

doc20

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I think it will only get better, 30 million more patients will hit the roll come 2014, they are not gonna need primary care doctors, not hospitals to take care of their basic needs. i have a strong feeling this 30 million are healthy to begin with so they will just require basic stuff taken care by primary care.. I think there is a lot more interest in fp and primary care fields in general as seen by the match numbers this year.. I think the trend will continue to reverse and more medical student would see FP is a great field where a lot more money can be made if you are willing to work hard
 

Blue Dog

Fides et ratio.
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From the California Academy of Family Physicians (CAFP):

Health Care Reform Arrives-What Does It Mean for You and Your Patients?
After almost a century of effort by multiple Presidents of each party; after several close calls in previous Congresses, when health care reform almost happened; after successive highs and lows in the past 16 months, when reform efforts seemed alternatively dead on arrival or moving forward to completion, health care reform is finally the law of the land. Today, Tuesday, March 23, 2010, President Obama signed H.R.3590, the Patient Protection and Affordable Care Act, into law.

What does health care reform mean to patients, consumers, and primary care medicine-and academic family medicine? Below are some key issues included in the health care reform bill. Of note, while CAFM's advocacy efforts on the specifics of the bill centered on key academic primary care/family medicine issues, at each opportunity for moving the bills forward, we supported movement forward as the most important concept. The concept of health care reform in terms of health care for all was our prime objective.

First, Some Arcane Legislative Business:
Health care reform passed both the House and the Senate, and after the President's signature, the bill becomes law. Another legislative bill, called Budget Reconciliation, also passed the House of Representatives on Sunday, March 21. Today, it will begin to be addressed by the Senate. This bill will make some changes to the health care reform bill that was just passed, such as removing some of the more objectionable provisions of the Senate bill, including the "Nebraska compromise" and the "Gatorade" provisions. It also includes one primary care provision-to provide for parity for Medicaid primary care physician services equal to Medicare payment levels. Whether this budge reconciliation bill goes forward into law or not, health care reform as described below, remains in place.

Insurance and Eligibility Reform:
The health care reform legislation passed by the House of Representatives will have a profound effect on health care. According to the Congressional Budget Office, a non-partisan arm of Congress, this bill would provide an estimated 32 million people access to coverage who did not have it before. This increased coverage is achieved through the creation of state health insurance exchanges and the expansion of eligibility to Medicaid.

Sweeping insurance reforms are also included in the legislation. These reforms include: extending the age at which a child can remain on their parents' insurance plan to age 26, banning insurance providers from denying coverage to individuals with pre-existing conditions, removing lifetime caps, and including preventive care by new insurance plans. The bill also requires all individuals to purchase health insurance or face a fine unless they can prove financial hardship. Tax credits will be available to individuals and families who cannot afford to purchase their own health insurance through the state-based exchanges.

Cost Savings:
The $940 billion bill is paid for by cuts to and cost savings in Medicare, including the Medicare Advantage program, taxing "Cadillac health care plans," fines collected from individuals that do not purchase insurance, increasing Medicare taxes on individuals making high incomes, and creating a new Medicare tax on investment income. The Congressional Budget Office estimated that the entire bill would reduce the national deficit by $143 billion by 2019.

Primary Care Issues We Actively Lobbied for:
Our Washington Office actively lobbied on many key elements of the bill that directly affect academic family medicine. In addition, we joined our support to the AAFP's efforts on key family medicine practice issues. Below is a short list of some of the key provisions we were actively involved in that have become law.
  • Primary Care Bonus Payment: The law contains a 10% add-on to primary care physician services. This provision sends a clear signal that primary care payments should be enhanced. Obviously a higher bonus amount would be preferable, but this is a first step in acknowledging that current Medicare payment rates are not supportive of primary care and the need the nation has for more primary care providers.
  • Medical Home Provisions: The law allows states to create Patient-centered Medical Homes for chronically ill patients. Of key significance, the new coverage included in the new Insurance Exchanges allows plans to include qualified primary care medical homes.
  • Medicare Graduate Medical Education (GME) Reform: Many provisions are included that provide fixes to multiple problems CMS regulations have caused. Many of these have been issues we have worked on since 2003. Of note, resident training time can now be counted in all training sites as long as the hospital pays the resident stipends and benefits - no longer will the 90% rule apply. Additional changes to allow didactic training in all sites and resident vacation and sick leave were included. In another area of GME funding, there will be a new redistribution of residency slots from institutions that haven't filled over the last 3 years to other institutions that apply for those positions. Unlike the first redistribution of 2003, these new positions will be reimbursed at the same rate as others slots, not at a reduced amount. Priority for the new positions would go to primary care and general surgery, to states with low resident-to-physician ratios, and to rural areas.
  • Title VII Primary Care Cluster and Other Title VII Provisions: The Title VII primary care cluster was reauthorized at $125 million. While extremely important to our efforts to gain funding for our Title VII programs, we will still have an annual appropriations battle to increase funding for this program. A new provision would establish a grant program under Title VII for medical schools to help recruit students most likely to practice medicine in underserved rural communities, provide rural-focused training experiences, and increase the number of medical school gradua tes who practice in underserved rural communities.
  • Primary Care Extension Program: A new program would be established to support and assist primary care providers with the incorporation of techniques to improve community health. State hubs and local extension programs may be created. The purpose of this program is to provide practice improvement help to the field. Of note, primary care departments of medical schools can apply to provide such training.
For a more complete understanding of the health care reform provisions, the Kaiser Family Health Foundation has a very good interactive Web site: http://healthreform.kff.org/. For a check on the veracity of claims you hear about the bill, you can might want to take a look at the following Pulitzer prize-winning site: http://www.politifact.com/ .