Sundarban1

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Tigerstang

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you clearly lack any understanding of this nation's health care financing system. please, stick to writing prescriptions and delivering babies.

Sundarban1 said:
DALLAS, Nov 7 - The AMA has laid out the prospect of a major exodus of physicians from Medicare if Congress doesn't rescind or modify plans to cut Part B payments to physicians by 4.4% next January. And this time, said the AMA, it's serious.

http://www.medpagetoday.com/PublicHealthPolicy/MedicaidMedicare/tb/2083

Take action:

http://www.ama-assn.org/ama/pub/category/13097.html
 

DrBowtie

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Tigerstang said:
you clearly lack any understanding of this nation's health care financing system. please, stick to writing prescriptions and delivering babies.
Where did that come from? He didn't write the press release.
 

BMW M3

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Tigerstang said:
you clearly lack any understanding of this nation's health care financing system. please, stick to writing prescriptions and delivering babies.
if you do, please enlighten us
 

Uncle_Tbag

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30% in the last couple of years, 4% more now, 26% more in the next 6 years.

What really sucks is this doesn't just affect Medicare, other insurance companies tend to set reimbursement schedules based on Medicare.

Doctors start cutting coupons now.
 

Law2Doc

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Dr GeddyLee said:
30% in the last couple of years, 4% more now, 26% more in the next 6 years.

What really sucks is this doesn't just affect Medicare, other insurance companies tend to set reimbursement schedules based on Medicare.

Doctors start cutting coupons now.
Well, at least it's still looking peachy for that guy who was on here a while back indicating that all he needed was $30K per year. :rolleyes:
 

Uncle_Tbag

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Law2Doc said:
Well, at least it's still looking peachy for that guy who was on here a while back indicating that all he needed was $30K per year. :rolleyes:
Ross something or other? "You can get a 2-bedroom apt for $400 and you're set. . . " :laugh:
 

C.P. Jones

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BrettBatchelor said:
Where did that come from? He didn't write the press release.
hahahaha, that's exactly what i was thinking
 

EvoDevo

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Tigerstang said:
you clearly lack any understanding of this nation's health care financing system. please, stick to writing prescriptions and delivering babies.
Not cool, dude. That kind of harassing behaviour and unprovoked attack is a violation of SDN TOS. Play nicely or else.

Peace,

The Management
 

riceman04

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BMW M3 said:
if you do, please enlighten us

You know I was thinking the same thing....this fool comes on here and makes a bold a$$ statement and then does not even demonstrate his supposed mastery of the subject at hand!
 

mshheaddoc

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I had an elaborate post then deleted it because I can't publish the "supporting evidence" from NEJM without too much of a hassle.

Although, being a future doctor and having earnings based on medicare (as it is 33% of funding for health care expenditures) ... medicare has actually INCREASE health management payment while reducing the amount of procedural reimbursement. Funny thing is ... with increasing techonology (as well as cheaper technology) the decrease in reimbursement would make sense. As cataract surgery isn't as expensive as it used to be.

I understand the whole financial impact of this but medicare has actually been increasing "basic" reimbursements. I love how noone fights the insurance companies when they only pay a fraction. I read an article last year about how insurance and medicare reimbursements aren't really that far apart ... if only I could find that article. :cool:
 

themadchemist

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Doctors need to suck it up. American physicians are paid much better than those in most other countries (including developed countries) and that actually is a significant burden on the system.

Would I like to be fabulously wealthy as a physician? Sure, but at the cost of denying access to patients who need it? Gosh, I hope not.
 

Uncle_Tbag

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themadchemist said:
Doctors need to suck it up. American physicians are paid much better than those in most other countries (including developed countries) and that actually is a significant burden on the system.

Would I like to be fabulously wealthy as a physician? Sure, but at the cost of denying access to patients who need it? Gosh, I hope not.
You don't have to deny services, you can see all patients you want for free.

People overseas make substandard wages in most if not all sectors of business compared to the US (yes even in developed countries). I don't think factory workers here should "suck it up" and work for 25 cents an hour because it's a standard in a third-world nation.
 

jbrice1639

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Dr GeddyLee said:
You don't have to deny services, you can see all patients you want for free.
actually, you cannot. if you have a practice, you must have established charges for your services that have to be the same across the board. you cannot just decide to waive a fee. you cannot even waive someone's co-pay legally.

unless you were referring to working in a free clinice...which is obviously acceptable. but, as the system stands, a doctor cannot simply choose not to charge patients.
 

Uncle_Tbag

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jbrice1639 said:
actually, you cannot. if you have a practice, you must have established charges for your services that have to be the same across the board. you cannot just decide to waive a fee. you cannot even waive someone's co-pay legally.
You certainly can be lax in sending out bills and deciding whether to send to collection. Happens all the time.

edit: actually, you may be wrong on the issue, at least on some points:

Waiving Co-Pays

The most common ways physicians reduce the cost of care for patients are waiving the co-pay ("insurance only") and giving the patient a discount on the care. In most situations, both private insurers and the federal government ban waiving the co-pay. (Medicare has some provisions allowing the co-pay to be waived for documented indigency.) They do this because the co-pay is meant to discourage casual trips to the physician. The theory is that making the patient share the cost of treatment will make the patient a more sophisticated health care consumer. The reality is that the co-pay limits access to care for many people. The less care the patient seeks, the less money the health plan has to pay to physicians and hospitals for that care. Both private insurers and Medicare require the physician to make reasonable efforts to collect co-pays that are billed to the patient.

Discounts

A discount is a reduction in the normal charge based on a specific amount of money or a percentage of the charge. Just as the hardware store can give you $5 off on all tools or a 10% discount on your total purchase, a physician may take $5 off or 10% off of the bill for an office visit or a surgery. However, there are things that the physician must beware of in doing this. The discount must apply to the total bill, not just the part that is paid by the patient. If the patient owes a 20% co-pay on a $25 charge ($5) and you are giving a discount of $5 then the patient pays $4 and the insurance company pays $16. If the patient owes a $5 co-pay regardless of the amount of the charge then the patient must pay $5 and the insurance company pays $15. In this situation, the discount would only benefit the insurance company.

Discounts raise the issue of the physician’s customary charges for a procedure. Many private insurance plans and some federal programs have a "most favored nation" clause in the contract with the physician. This entitles the plan to pay the lowest charge the physician bills to anyone. Any systematic pattern of discounts could trigger a reduction in the physician’s allowable reimbursement schedule to the discounted price.

"No Charge"

As far as the authors have determined, none of the private insurers bans waiving the entire charge for the care. You may also charge for some visits and not for others. Many pediatricians do not charge for the first follow-up visit for otitis media. This increases the likelihood that the child will be brought back for the recheck The insurance company is also getting a free visit, but at least the patient is getting the care.

"No charge" visits are prohibited if they are part of a fraudulent scheme. For example, a no charge visit is still a patient care encounter and must be fully documented. Assume that a patient has severe asthma and is waiting out a one year preexisting illness exclusion in a health insurance policy. If that patient requires treatment a month before the end of the year waiting period, you have to fully document the treatment even if you do not charge the insurance company for it. You cannot use "no charge" to hide medical information.

You may also deliver non-reimbursable care as part of an otherwise justified office visit and bill the company for the authorized part of the visit. For example, if the insurance doesn't cover immunizations, then you could do the immunizations at the time you do an authorized well-child check up, or when the child is in for some other medical condition that is not a contra-indication for immunizations. You cannot, however, bill for an office visit when the only reason the patient is being seen is to deliver care that is not authorized under the policy. It would also be improper to "no charge" as a way to waive a co-pay in order to generate ancillary business for the physician’s office lab or other health services business. In other words, you cannot no charge for the visit and bill the insurance company for $100 worth of lab work that it would not have approved as part of a reimbursed visit.

http://biotech.law.lsu.edu/Articles/Professional_Courtesy.html
 

thegenius

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jbrice1639 said:
actually, you cannot. if you have a practice, you must have established charges for your services that have to be the same across the board. you cannot just decide to waive a fee. you cannot even waive someone's co-pay legally.

unless you were referring to working in a free clinice...which is obviously acceptable. but, as the system stands, a doctor cannot simply choose not to charge patients.
My dad does not charge a small percentage of patients he sees (like 2-4%) because they cannot afford it.

He owns a private practice in Michigan. Are you suggesting this is illegal?
 

Gavanshir

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Canada is certainly a developed country and physician salaries are almost significantly lower than in the States.
 

jbrice1639

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thegenius said:
My dad does not charge a small percentage of patients he sees (like 2-4%) because they cannot afford it.

He owns a private practice in Michigan. Are you suggesting this is illegal?
that is what i have been told by multiple doctors...i'm obviously no authority on the matter, but i have been told that you cannot choose who to charge...there has to be one price for services. because, as much as it makes sense to charge those who can afford it, and not charge those who can't, it would open up a can of worms no one would want to deal with. it also requires the doctor to make a judgment on what level of income is necessary to be charged. additionally, if income were an acceptable reason to choose who to charge, it would open the door to people claiming discrimination based on other criteria. so as it has been explained to me, if you charge any patients, you must charge all...otherwise, you have to refer those who cannot pay to a free clinic/urgent care center.

again, i haven't really looked into this too much...just repeating what i've been told by a few doctors...could vary by state as well...
 

Indryd

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jbrice1639 said:
that is what i have been told by multiple doctors...i'm obviously no authority on the matter, but i have been told that you cannot choose who to charge...there has to be one price for services. because, as much as it makes sense to charge those who can afford it, and not charge those who can't, it would open up a can of worms no one would want to deal with. it also requires the doctor to make a judgment on what level of income is necessary to be charged. additionally, if income were an acceptable reason to choose who to charge, it would open the door to people claiming discrimination based on other criteria. so as it has been explained to me, if you charge any patients, you must charge all...otherwise, you have to refer those who cannot pay to a free clinic/urgent care center.

again, i haven't really looked into this too much...just repeating what i've been told by a few doctors...could vary by state as well...
Either way, it's not true in Oregon. I have many docs who do both consults and also chronic care pro-bono for our patients. They just tell their office staff: do not bill this patient.
 

Uncle_Tbag

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I really doubt it would vary by state as these regs are set by medicare.