titanjones

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For you Attendings out there, how do you see this healthcare reform impacting your practices if it makes it past the senate? On one hand..we will be getting a pay cut, however...with that the cost of medicine will be decreased, and more ppl will get healthcare plans, so wouldnt that increase the number of patients that participate in the healthcare system meaning more revenue?? How does this impact us financially?
 

RabbMD

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Medicare pays anesthesiology 33% of what private payers pay. No other specialty I have seen comes close to that raping. Pay will drastically decrease if everyone is shifted to a medicare based public plan with drastically reduced payment rates.
 
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This being the case, couldn't the fees paid by Medicare be readjusted to the upside (i know, i know, optimistic) for anesthesia renumeration under a huge sweeping healthcare reform that we possibly face?

In other words, even our wonderful members of congress and the white house "czars" could see a 67% pay decrease as devistating to the field, just as they're recognizing traditional shortcomings in primary care as being a main cause of lack of interest, and thus effecting PC?

I'm just not sure we should assume that a governmental system will maintain the status quo of medicare to the T, given that we're hearing rumblings of pay increases to PC fields. So, why couldn't a LESSER cut in government reimbursement be applied to anesthesia within the context of sweeping change?
 

Gimlet

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I don't know if I would hang my hat on that, cfdavid. From today's Washington Post:

Obama Eyes The Purse Strings for Medicare
Lawmakers Now Win Friends at Home by Setting Payout Rates

At the same time President Obama is asking members of Congress to take one of the most politically difficult votes of their careers, he is also pressing lawmakers to give up one of their most valued perks of office: boosting Medicare payments to benefit hometown providers.

Setting reimbursement rates for local hospitals, doctors, home health-care centers and other providers is a legislative ritual that amounts to one of the most effective and lucrative forms of constituent service. Delivering federal money through Medicare, the country's largest insurance program, can be a powerful tool on the campaign trail, allowing lawmakers to argue that they are creating jobs and improving the quality of health care for voters.

Longtime members of Congress have become masters at dominating the tug of war between keeping providers flush and trying to rein in the entitlement program's dramatic growth. House Ways and Means Chairman Charles B. Rangel (D-N.Y.) champions New York City's teaching hospitals. Charles E. Grassley (Iowa), the Senate Finance Committee's ranking Republican, makes sure rural health-care services are amply funded. Months before Sen. Ted Stevens (R-Alaska) left office, he secured a permanent 35 percent increase in Medicare payments for Alaska physicians.

Obama administration officials say they are determined to stem soaring Medicare spending, arguing that it is a root cause of the broader health-care crisis that they are trying to address with Congress. Behind the scenes, Obama is pushing for a mechanism that would take Medicare payment authority out of the hands of politicians and invest it in a separate entity, possibly under the executive branch.

"Structures that fundamentally alter the long-term costs are a must for real health-care reform," said White House Chief of Staff Rahm Emanuel. He called the Medicare payment debate "the least talked-about, most important issue on the table."

House Democrats' health-care proposal, released Tuesday, includes no measures aimed at reversing the long-term cost trajectory of Medicare, a fact that spurred a rebellion among conservative Blue Dog Democrats on the Energy and Commerce Committee, which will begin debate on the House bill today. Rep. Mike Ross (Ark.), a Blue Dog leader and panel member, told reporters yesterday that he has the votes to defeat the package unless it is "substantially amended" to address long-term cost concerns.

The Senate health committee approved its own bill yesterday on a party-line vote; that package also was silent on the issue of Medicare's growth.

"We need to make it happen," Senate Finance Committee Chairman Max Baucus (D-Mont.), whose panel has jurisdiction over Medicare, said of payment reform. Baucus is crafting a separate proposal to pay for expanded health-care coverage, but that task is complicated by the fact that he is also attempting to win the backing of lawmakers such as Sen. Olympia Snowe (R-Maine), a crucial swing voter who opposes White House efforts to shift control of the Medicare payment equation.

Snowe said Finance Committee members have debated payment reform at length in recent closed-door meetings, but did not reach a consensus. She said her chief worry is that providers would continue to look to lawmakers to protect their interests but that under a new system, she and others would be unable to respond to their concerns. Congress must retain the ability to "shape and influence" Medicare rates, Snowe said. "We're still going to be held accountable."

Obama urged House and Senate leaders to action during a White House meeting this week, and at the request of committee chairmen, administration officials yesterday sent two proposals to Capitol Hill aimed at addressing the problem. One would empower the Medicare Payment Advisory Commission (MedPAC), a nonpartisan body of health-care experts that serves Congress in an advisory role, to determine cuts and changes to Medicare, akin to the Federal Reserve Board. "It's not perfect, but it does a lot better job than what Congress is doing," Rep. Jim Cooper (Tenn.) said of the commission. Cooper, a Blue Dog, co-sponsored the proposal with Sen. John D. Rockefeller IV (D-W.Va.), a senior Finance Committee member.

The second proposal would create a similar entity, called the Independent Medicare Advisory Council, to make Medicare recommendations to the president. Lawmakers could vote to overturn decisions with which they disagreed but could no longer tailor Medicare spending to address local concerns.

Medicare and Medicaid spending now accounts for 5 percent of gross domestic product, and if both programs grow at the same rate over the next 40 years as they have for the past four decades, they will eventually hit 20 percent of GDP, according to estimates.

Congress is attempting to extract as much as $500 billion in Medicare cost savings to pay for health-care reform, but Obama administration officials are concerned that those savings would not result in the transformative fixes the system needs to be stabilized for the long term. White House officials say their own proposals for payment reform would make the system more flexible, allowing it to respond to developments such as breakthroughs in treatment.

"We're trying to create a structure where that would be easier to reorient the system towards higher value and lower cost in the future," said White House budget director Peter Orszag.

The long-term cost challenge has emerged as a major point of contention as new health-care legislation creeps closer to becoming a reality. White House officials and Democratic fiscal hawks worry that Congress could provide coverage to millions of uninsured people, expand the government's role in health care, and yet fail to "bend the cost curve," creating a fiscal disaster for the nation and a political disaster for their party. Republicans are warning that Democrats are charting a ruinous path, and those criticisms are beginning to resonate.

Senate Finance Committee member Ron Wyden (D-Ore.) said such concerns have elevated the Rockefeller-Cooper proposal from a nonstarter to an idea that is gaining traction. "That's getting a very serious look right now," Wyden said.

MedPAC was created in 1997 to address Medicare's grim prospects as health-care costs outpaced inflation and retiring baby boomers caused the program's ranks to swell. As the country's largest health-insurance program, covering nearly 40 million of the most expensive patients, the entitlement program also holds extraordinary influence over the health-care marketplace.

A flood of carefully researched MedPAC reports set forth specific ideas for addressing Medicare's many deficiencies. In testimony before the House in late June, MedPAC Chairman Glenn M. Hackbarth summed up his view of the problems. "The health-care delivery system we see today is not a true system: Care coordination is rare, specialist care is favored over primary care, quality of care is often poor, and costs are high and increasing at an unsustainable rate," Hackbarth told Energy and Commerce Committee members.

But for most lawmakers, resisting the armies of health-care lobbyists who are deployed to protect industry interests has proved difficult. "Basically, the cards are stacked against the member who has to confront these groups," said George F. Grob, who conducted numerous Medicare reviews through the Department of Health and Human Services' inspector general's office. "Look at who they're confronting -- the cancer doctors. Drug companies saying, 'We're the ones saving lives out there.' Hospitals saying, 'We're going to have to shut down.' "

Such concerns are often conveyed to politicians by former colleagues or aides who have joined industry ranks. "They're talking to their friends," Grob said. But also, he said, the lobbyists "make really good arguments. They really know their stuff, and they understand the process. They know what the life cycle of a bill is, they know who to talk to, they know what they're talking about -- and they reach everybody."
 

Planktonmd

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Is it possible that people who will get the government insurance option are actually the ones who don't have any insurance right now and as a result many of our uninsured patients that we take care of for free now will have some type of coverage?
 

lowbudget

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Medicare pays anesthesiology 33% of what private payers pay. No other specialty I have seen comes close to that raping. Pay will drastically decrease if everyone is shifted to a medicare based public plan with drastically reduced payment rates.
Wow. Private payers pay you guys 3x above Medicare rates? That's pretty good. That's damn good, actually. I think primary care is lucky when private payers pay AT Medicare rates, and I read in NYT that Congress is proposing that the public option (whether via federal government or through private cooperatives) will pay Medicare rates plus 5%. Conversation with a general surgeon 2 years ago was talking about how private payers were paying him 80% of Medicare (below Medicare).

Good for you guys!!! Sounds like anesthesiology will be quite alright even if Medicare drops its rates.
 

thegasman

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Wow. Private payers pay you guys 3x above Medicare rates? That's pretty good. That's damn good, actually. I think primary care is lucky when private payers pay AT Medicare rates, and I read in NYT that Congress is proposing that the public option (whether via federal government or through private cooperatives) will pay Medicare rates plus 5%. Conversation with a general surgeon 2 years ago was talking about how private payers were paying him 80% of Medicare (below Medicare).

Good for you guys!!! Sounds like anesthesiology will be quite alright even if Medicare drops its rates.
Are you kidding - we are talking about taking a 67% paycut and you say we will be quite alright?
 

RabbMD

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Wow. Private payers pay you guys 3x above Medicare rates? That's pretty good. That's damn good, actually. I think primary care is lucky when private payers pay AT Medicare rates, and I read in NYT that Congress is proposing that the public option (whether via federal government or through private cooperatives) will pay Medicare rates plus 5%. Conversation with a general surgeon 2 years ago was talking about how private payers were paying him 80% of Medicare (below Medicare).

Good for you guys!!! Sounds like anesthesiology will be quite alright even if Medicare drops its rates.

This is not because private payers overvalue our services, it is just because medicare so drastically undervalues it. What congressman is going to volumteer a 67% pay cut to pay for healthcare reform huh?
 

lowbudget

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This is not because private payers overvalue our services, it is just because medicare so drastically undervalues it. What congressman is going to volumteer a 67% pay cut to pay for healthcare reform huh?
I see. Interesting. I was under the notion that private payers usually peg their reimbursement rates to Medicare rates to define what they consider reasonable and customary. Medicare plus 5, 10, 20%. Or in some cases minus 5, 10, 20%. Medicare mines its data base and picks a rate. They publish it so it's public knowledge. Private insurance companies look at it and picks their rate, and doctors look at it and picks theirs as well.

Sounds like Medicare's not even close to private pay in your case. Why is there such a discrepancy? Do private payers have other formulas they base their reimbursement rates from? And if so, why is the private payer reimbursement or their formula more appropriate in valuing anesthesia services? (If you tell me private payers pay better than Medicare and that's why private pay is more appropriately values the services, I'm gonna say, well duh of course, but is there another argument?)

I guess my real question is how do you know that Medicare's rate inappropriately values (i.e. undervalues) anesthesia's services when the rest of medicine (generally speaking) uses Medicare rates as their standard?

Thanks, just curious.
 

miamidc

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This is from my chairman here at UM, he is also the president of the FSA (Florida Society of Anesthesiologists). Do your part call today!!!!!We really can prevent these medicare rates to be passed along to a new public program. I will post here any news pertaining to this. We can and will fix this, it is to much of a discrepancy, but we must let our congressmen and women so that they know this is going on.

July 16, 2009

Language is being sponsored in the House Bill that will address our concerns about payments to Anesthesiology in the House Bill.

As soon as I have details I will forward this to you.

The optimum thing to do is:

1) Call your Representative

2) Email your Representative

This MUST be done immediately that you receive the message. Time is of an essence here.

Many thanks,

Sincerely,



Michael C. Lewis M.D.

President of the FSA
 

NotAMD

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with all the minds working on this new health care plan, i hope there is some voice of reason that understands that health care provider salary, whether it be MD, CRNA, RN, PA, whatever, is not the problem with healthcare, cut them in half or double them, its insignificant to the ROOT problem which is IMO wasted dollars dictated by fears of lawsuits and unreasonable decision making by patients ( 90 year olds in icu for weeks, fat people not dieting, ordering cxrs/cts for every pt in the er, DIALYSIS for futile reasons, big ortho cases on 80+ year olds) etc..

i think planktons point is interesting..
i think that could be somewhat true.
the concern is will the private insuranc cos FOLLOW that rate dictated by the gvmt
 
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I guess my real question is how do you know that Medicare's rate inappropriately values (i.e. undervalues) anesthesia's services when the rest of medicine (generally speaking) uses Medicare rates as their standard?

Thanks, just curious.
Supply and demand. If you look at what we make, versus what Medicare pays, someone has to make up the difference. We make what we make because there is still a shortage of us from the last time someone tried to reinvent medicine in the US! The shortage is relatively unique to anesthesia; Medicare, which does not tend to recognize concepts like supply and demand, simply ignores it.
 

BlueJasper

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AMEN!!!!!!! thank you!!



with all the minds working on this new health care plan, i hope there is some voice of reason that understands that health care provider salary, whether it be MD, CRNA, RN, PA, whatever, is not the problem with healthcare, cut them in half or double them, its insignificant to the ROOT problem which is IMO wasted dollars dictated by fears of lawsuits and unreasonable decision making by patients ( 90 year olds in icu for weeks, fat people not dieting, ordering cxrs/cts for every pt in the er, DIALYSIS for futile reasons, big ortho cases on 80+ year olds) etc..

i think planktons point is interesting..
i think that could be somewhat true.
the concern is will the private insuranc cos FOLLOW that rate dictated by the gvmt
 

Gimlet

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The AMA is supporting the public plan....got this in my e-mail last night:

The following is a message is from American Medical Association Presidents Drs. Repack, Wilson and Nielsen.

The AMA Board of Trustees believes that physicians and patients are not well served by the status quo and is committed to advancing long overdue health system reforms.

At the 2009 AMA Annual Meeting, we outlined the following definitions of success for health system reform legislation:

Expand affordable coverage
Permanent repeal of the SGR
Quality improvement vs. profiling
Adequate physician payment
Administrative simplification
Medical liability reforms
Empower physician practices with antitrust relief and breaking down existing silos

The AMA House of Delegates also adopted new policy to "support health system reform alternatives that are consistent with the principles of pluralism, freedom of choice, freedom of practice and universal access for patients."

Based on that guidance, the AMA Board of Trustees reviewed H.R. 3200, the "America's Affordable Health Choices Act of 2009." The AMA Board determined that H.R. 3200 was consistent with AMA policy in the following respects:

According to the non-partisan Congressional Budget Office, it would provide health insurance coverage for nearly 97% of legal non-elderly U.S. residents.

It includes essential health insurance market reforms such as eliminating coverage denials for pre-existing conditions.
Medicaid eligibility would be expanded to all non-elderly adults and families up to 133% of the federal poverty level and payments for primary care services would be increased.
A health insurance exchange would be established to provide choice of plans to uninsured, self-insured and small business employees.
Coverage for preventive services would be improved.
It erases the SGR debt and substitutes more favorable expenditure targets for Medicare physician updates.
Medicare primary care payments would be increased, without offsetting cuts in reimbursement for other physician services.
Workforce investments would be made to address primary care shortages.
Efficiency bonus payments would be provided for physicians in low-cost localities.
Administrative simplifications would be implemented to reduce costs and hassle factors for physicians and patients.

Further, H.R. 3200 provides substantial funding for the physician community at a time when other health care stakeholders are facing steep cuts. The Congressional Budget Office estimated that the bill includes more than $230 billion in positive investments for physicians. The breakdown is as follows:

$228.5 billion to eliminate the accumulated SGR cuts
$1.6 billion for PQRI quality reporting changes (bonus payments only, no penalties for non-reporting)
$5 billion for the primary care bonus
$1.8 billion for the medical home pilot
$1.3 billion to extend the floor on Medicare's geographic adjustment for physician work

On the negative side of the ledger, H.R. 3200 would cut payments for imaging services by $4.3 billion and generate projected savings of $1 billion by banning new physician-owned hospitals and restricting those in current operation.

Although the bill as introduced does not include any medical liability reform, we are working with a member of the Energy and Commerce Committee on a possible amendment to pilot alternative reforms such as health courts and safe harbors for physicians who adhere to best practice guidelines.

We will also continue to work with advocates in the House for physician-owned hospitals to preserve physicians' rights and investments.

The Senate Health, Education, Labor, and Pensions (HELP) Committee completed its mark-up on legislation that addresses many key issues. However, that Committee does not have jurisdiction over Medicare, Medicaid or revenue authority. The Senate Finance Committee is expected to publicly release a different framework for health reform legislation very soon. The Senate Finance Committee framework is expected to include some of the elements mentioned above but is also expected to differ in key aspects. Additional changes will be considered during Senate floor debate.

This underscores the point that we are in the early stages of developing health reform legislation. Working constructively with Members of Congress and the Obama Administration improves our position for the critical end game negotiations on health reform that will occur when congressional leaders and the Obama Administration reconcile the differences between the House and Senate bills. That, of course, is also when the outcome on key issues such as Medicare physician payment and the details of any public insurance option and financing will be determined.

Favorable action on H.R. 3200 is an important step among a number that will be needed to advance our health system reform objectives. The AMA will continue to aggressively work to improve legislation being considered in the House and Senate.

Your help is needed now. Please join us in urging members on the House Education and Labor, Energy and Commerce, and Ways and Means Committees to support H.R. 3200. We also need to engage the patient community.
Anyone feel like they're throwing us under the bus?
 

miamidc

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From my program director. CALL TODAY!!! I just did. This is the ONLY, I repeat ONLY way for you to secure a a relativly good paycheck in the future. It has to be done in congress by your congresspeople, and they will only push for it if they get swamped by anesthesiologists. So do it NOW!!

uly 17, 2009

I need you all to take action.

Each of you are to write to your Representative to support Congressman Frank Pallone’s language that would a reasonable proposal for an alternative fee schedule that provides reasonable anesthesia rates.

This needs to take place ASAP.

I may ask for follow up correspondence as this unwinds.

Many thanks,







Michael C. Lewis M.D.

President : FSA
 
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Let's look at AMA's conclusions.

It includes essential health insurance market reforms such as eliminating coverage denials for pre-existing conditions.
I want the same thing for my car insurance. I'm going to drop coverage, but then if I wreck, I'll buy insurance that includes my car's "pre-existing condition."

Medicare primary care payments would be increased, without offsetting cuts in reimbursement for other physician services.
This sentence can be taken two ways.

1. The increase in primary care payments will not require cuts elsewhere to offset its cost.
2. The increase in primary care payments will not change the cuts planned elsewhere.

I think #1 is how we are intended to take it, but #2 may be closer to the truth considering that our pay is to be slashed by 2/3.

Workforce investments would be made to address primary care shortages.
Efficiency bonus payments would be provided for physicians in low-cost localities.
Administrative simplifications would be implemented to reduce costs and hassle factors for physicians and patients.
No mention of tort reform, I notice. Small wonder, considering the traditionally cozy relationship between the Democrat party and the trial bar. We are expected to work harder ("efficiency bonus payments"), but if we make an error while doing so, we are still exposed to the full lawsuit-lotto range of consequences.

Call your congressman!
 

Gimlet

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From my program director. CALL TODAY!!! I just did. This is the ONLY, I repeat ONLY way for you to secure a a relativly good paycheck in the future. It has to be done in congress by your congresspeople, and they will only push for it if they get swamped by anesthesiologists. So do it NOW!!

uly 17, 2009

I need you all to take action.

Each of you are to write to your Representative to support Congressman Frank Pallone’s language that would a reasonable proposal for an alternative fee schedule that provides reasonable anesthesia rates.

This needs to take place ASAP.

I may ask for follow up correspondence as this unwinds.

Many thanks,







Michael C. Lewis M.D.

President : FSA
Can we get some more information on the proposal by Pallone? I haven't been able to find anything about it.
 

miamidc

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From my program director

July 17, 2009

12:18pm

I just got word from ASA Washington Office saying that there are a number of attempts to change the wording of the Bill and asking if we could hold off for an hour or so until they further review the situation.

If you have not called/ written please hold off until you hear from us again

I will keep updating ASAP, it is essential that we work on this together, people really are hearing us, we just have to make sure they listen.
 
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2win

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The AMA is supporting the public plan....got this in my e-mail last night:



Anyone feel like they're throwing us under the bus?
AMA represents only 15% of the physicians in the USA. They used to support us but seems that there is a change of attitude. This organization is used by Obama as a political weapon to show the support of physicians...
Why for God sake anyone will be a member of this organization???
 

racerx

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I like how the chart, in the upper right hand corner, has "nurse education and training". Nowhere on the chart is there mention of physician education and training. Looks like our Beloved Comrade Leader and his henchmen say, '**** you all'.
 
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Planktonmd

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If Michael Lewis says something I usually listen.
Give him my best regards please because he is the only one I ever voted for and did not regret it later!



From my program director. CALL TODAY!!! I just did. This is the ONLY, I repeat ONLY way for you to secure a a relativly good paycheck in the future. It has to be done in congress by your congresspeople, and they will only push for it if they get swamped by anesthesiologists. So do it NOW!!

uly 17, 2009

I need you all to take action.

Each of you are to write to your Representative to support Congressman Frank Pallone’s language that would a reasonable proposal for an alternative fee schedule that provides reasonable anesthesia rates.

This needs to take place ASAP.

I may ask for follow up correspondence as this unwinds.

Many thanks,







Michael C. Lewis M.D.

President : FSA
 

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"I guess my real question is how do you know that Medicare's rate inappropriately values (i.e. undervalues) anesthesia's services when the rest of medicine (generally speaking) uses Medicare rates as their standard?

Thanks, just curious."


Ok. I'll try. The basic reason is that medicare reimbursement is at or below cost of services PRIOR to any MD fees. If the anesthesia is delivered by a medically directed CRNA, that CRNA, over 1 year MAY provide 10,000 units of anesthesia billing service. At $20/unit, that is $200,000 gross. The CRNA total compensation incl. benefits is likely $160-180k/year or $16-18/unit. Per the MGMA, the average cost of billing and administration for anesthesia groups is, I believe, $5 per unit - for some groups it is more. Adding these two numbers up gives you an overhead figure at or above what medicare pays.
The important point is that this is all before the anesthesiologist gets 1 thin dime. THAT is why medicare underpays us. Even cutting CRNA total compensation to $100k per year (or $10/unit), would only give the anesthesiologist in this setting (directing 4 CRNAs at a time) a max total compensation incl. benefits of $200k per year if my math is right. ( $10/unit CRNA + $5/unit billing leaves $5/unit for the MD. 4 rooms with 40,000 units times $5 gives me that figure). Perhaps this is fair compensation in the greater sense, but our group does not have the number of CRNAs required to make this type of change - we, therefore, would fare even worse.
 

proman

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AMA represents only 15% of the physicians in the USA. They used to support us but seems that there is a change of attitude. This organization is used by Obama as a political weapon to show the support of physicians...
Why for God sake anyone will be a member of this organization???
American College of Surgeons is also supporting this. I think the support comes from the anticipated change in the SGR found in the House bill:

TheHill.com:
The new physician payment formula in the House bill would cost up to $300 billion over 10 years. The Senate Finance Committee is not considering a permanent fix to the payment issues, meaning that physician groups' endorsement of the House’s bill does not necessarily mean they will support the final healthcare legislation.
 

2win

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WTF????
This is from Gorback - pain forum and a great guy:
'
I wonder how they plan to run their health care system without any doctors.

July 17, 2009
Mass. Panel Backs Radical Shift in Health Payment
By KEVIN SACK

BOSTON — A high-level state commission recommended Thursday that Massachusetts seek to rein in health care costs by radically restructuring the way doctors and hospitals are paid.

The commission's action kicks off the second phase of a health care overhaul that has succeeded in covering nearly every resident of the state but done little to slow the relentless growth of spending.

The recommendations, if approved by the legislature and Gov. Deval Patrick, would make Massachusetts the first state to end the practice of paying health care providers for each office visit, laboratory test or procedure.

Instead, primary care physicians, specialists and hospitals would group themselves into networks that would be responsible for a patient's well-being and would be compensated with a flat monthly or annual fee known as a global payment.

The 10-member commission deferred many central decisions to the legislature and to a new authority that would be created to establish and oversee the new payment system. In doing so, it preserved cautious support from the state's hospital association, medical society and leading insurers for a proposal that resembles guiding principles more than bill language.

Representatives of those groups joined in a unanimous commission vote for the recommendations. But they made clear that their continued support might depend on devilish details, the kind that will determine whether their members are net losers and, if so, by how much.

It was only by keeping those stakeholders at the negotiating table that the state succeeded in 2006 in vastly expanding subsidized coverage for the uninsured. Maintaining that coalition is expected to be more difficult as the state tries to slow the growth of costs, an effort that typically translates into less revenue for providers and insurers.

The existing "fee for service" system has been roundly criticized as offering incentives that encourage doctors to provide more treatment than is necessary, a significant contributor to the high cost of health care.

Global payments, it is thought, would reward health care providers for keeping their patients well rather than for merely treating their ailments. If the cost of treating a patient was less than the global payment, the provider networks, called accountable care organizations, would keep the difference as profit.

Changing the payment system has also been central to the health care debate in Washington. Thus far, those discussions have focused more on providing financial rewards for high-quality preventive care than on demolishing the fee-for-service system.

The Massachusetts commission was created last year by the legislature and was led by Mr. Patrick's chief finance and health policy advisers. But on Thursday the governor, a first-term Democrat, stopped short of endorsing its recommendations, saying only that they "bring an important focus to cost containment and quality."

Top state legislators said that they recognized the political challenge in enacting such a plan but that Massachusetts' circumstances demanded it. Senator Richard T. Moore, co-chairman of a joint legislative committee on health care financing, said he expected to hold hearings on the recommendations this fall.

The committee's other leader, Representative Harriett L. Stanley, said, "It's going to be a very long haul, but it's a trip worth taking."

The commission stressed the importance of changing the way doctors and hospitals are paid not only by private insurers but also by Medicare and Medicaid. That would require permission from the federal government.

Global payments are hardly a new idea, as the concept closely resembles the capitation model that incited a backlash by consumers who accused health maintenance organizations of skimping on care. But members of the Massachusetts commission said their plan would offer financial incentives for performance that would transform physicians into care coordinators rather than gatekeepers.

"This is not about containing costs by sacrificing quality," said Mr. Patrick's finance director, Leslie A. Kirwan, a co-chairwoman of the commission. "That's been tried and rejected, and rightly so."

The commission recommended that its plan be carried out over five years. The state would not set rates, which would be negotiated by insurers and the new provider networks. But it would require those payment rates to account for variations in the health condition and socioeconomic status of patients seen by individual doctors and hospitals.

The report left the details of such risk adjustments to the new authority that would be established. It also made no projection of what it would cost to set up the new system.

Interest groups with heavy stakes embraced the proposal, but warily.

"Hospitals want to be part of this historic endeavor," said Lynn B. Nicholas, president of the Massachusetts Hospital Association. But Ms. Nicholas added that "the success of moving to a global payment system is not a foregone conclusion" and expressed concerns about how risks would be adjusted and how start-up costs would be covered.

The president of the state medical society, Dr. Mario E. Motta, also urged caution. "A big transition like this has never been done on such a broad scale," Dr. Motta said, "so it must be done very carefully, deliberately and thoughtfully."

The commission issued its recommendations three years after the state enacted one of the most sweeping restructurings of health care in the country's history. By requiring nearly all residents to have health insurance, and providing subsidies to those earning no more than $66,150 for a family of four, the state has managed to cover 97 percent of its residents.

That is by far the highest rate of any state, and elements of the plan have been adopted by President Obama and Congressional Democrats in their proposals to revamp the national health care system.

But to maintain political support for expanding coverage, Massachusetts political leaders deliberately deferred any serious discussion then about how to control health care costs. Those costs have continued to rise at what state leaders acknowledge is an unsustainable annual rate of 6 percent to 9 percent. Although the state's new subsidized insurance program, Commonwealth Care, has kept a lid on premium increases, it is now straining the state's budget for the second consecutive year.

"We are among the highest-cost states," said Sarah Iselin, Mr. Patrick's health policy adviser and the other co-chairwoman of the commission. "Without intervention, our projections are that spending on a per-person basis could double by 2020."
__________________
 

timtye78

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I think it would be a smart move for all of us to have a backup plan in plan if these devastating changes are coming. Maybe we should all move to primary care! j/k ughhh.

Back while I was in medical school, all the students were talking about the need for a backup plan if medicine goes to hell. Sounds like to me it is getting terribly close.

Physician-owned hospitals are not looking so attractive right now either. In addition, by cutting back or getting out of medicine we would force the demand to go up again, and maybe get a little power back. Maybe this whole this could swing back in our favor if we told this movement that we were not going to work in it. Hmmm..

What if we were all strong and demand that we be compensated appropriately or move out and bring the system to its knees when people cannot get anesthesia for their hip operation or their labor epidural.

I promise I will seriously be re-evaluating things if things get that bad. My position entails Q3 call, and I won't do that for 125K.
 

proman

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Mar 5, 2002
1,858
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Physician-owned hospitals are not looking so attractive right now either. In addition, by cutting back or getting out of medicine we would force the demand to go up again, and maybe get a little power back. Maybe this whole this could swing back in our favor if we told this movement that we were not going to work in it. Hmmm..

What if we were all strong and demand that we be compensated appropriately or move out and bring the system to its knees when people cannot get anesthesia for their hip operation or their labor epidural.
The problem with that idea is now there are non-physician midlevels to fill the gap. Lower quality care but who cares about that?
 

BLADEMDA

ASA Member
10+ Year Member
Apr 22, 2007
17,687
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Public plan
House Democrats bill
Would establish federally-run “public plan” available through the insurance exchanges. The goal would be to force down costs by competing with private-sector insurers. On average, the public plan would pay doctors and other medical providers Medicare reimbursement rates, plus 5 percent.

Senate health bill
Similar to the House bill.
 

BLADEMDA

ASA Member
10+ Year Member
Apr 22, 2007
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ASA has already begun to urge lawmakers to address anesthesiology's "33% problem:" the fact that Medicare pays 33 percent of what private insurers pay for anesthesia services. This payment level simply does not reflect the costs of providing anesthesiology medical care. As such, Congress should not use this payment level as a model for the new "public health insurance plan."
We need your assistance to also communicate our specialty's message to lawmakers. Through the din of outside groups carrying their message, it is critical that our voices be heard.
Please call your Representative today to tell him or her that:
  • It would be unsustainable for the medical specialty of anesthesiology to operate within a public plan option based on Medicare payment rates.
  • Payment levels for anesthesia services provided through the new "public health insurance option" must be fixed.
 

ProRealDoc

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Jan 2, 2009
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Not the public option. The current administration can have all the oublic options they want provided they pay at higher than the current low medicare rate.

That should buy us time until we change the make up of the current congress.
 
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miamidc

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ok fellas everyone should try and do this before noon, or during lunch If you truly want the specialty to remain viable and fairly compensated. It's easy and will take less than 5 min out of your day. Tell everyone you know.

July 19, 2009
*
Dear Colleagues
*
The time for ACTION is now
We need as many of you to call tomorrow morning Monday July 20th between 9am and 5pm
Please follow the script given by going to the link below
*
http://capwiz.com/asa/callalert/index.tt?alertid=13737681
*
*
Just plug in your zip code
I urge you to mobilize as many of our colleagues to this action
*
The use the bulleted points available.*
*
*As you will note in the bullet points, if the Member of Congress is on the Energy and Commerce Committee there is one message.* If they are not on the committee they are being urged to contact the Committee leadership to urge action.
*
As always, call me if you have any questions.
*
If you have any questions please contact me
*
*
Michael Lewis MD
President of the Florida Society of Anesthesiologists
*
*
 

Chrysanthemum

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I already have about 10 of us calling tomorrow morning in the NJ/NY area. Everyone here spread the news and call!!



ok fellas everyone should try and do this before noon, or during lunch If you truly want the specialty to remain viable and fairly compensated. It's easy and will take less than 5 min out of your day. Tell everyone you know.

July 19, 2009
*
Dear Colleagues
*
The time for ACTION is now
We need as many of you to call tomorrow morning Monday July 20th between 9am and 5pm
Please follow the script given by going to the link below
*
http://capwiz.com/asa/callalert/index.tt?alertid=13737681
*
*
Just plug in your zip code
I urge you to mobilize as many of our colleagues to this action
*
The use the bulleted points available.*
*
*As you will note in the bullet points, if the Member of Congress is on the Energy and Commerce Committee there is one message.* If they are not on the committee they are being urged to contact the Committee leadership to urge action.
*
As always, call me if you have any questions.
*
If you have any questions please contact me
*
*
Michael Lewis MD
President of the Florida Society of Anesthesiologists
*
*
 

Chrysanthemum

PGY-1
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15+ Year Member
Sep 29, 2003
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0
38
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I think it would be a smart move for all of us to have a backup plan in plan if these devastating changes are coming. Maybe we should all move to primary care! j/k ughhh.

Back while I was in medical school, all the students were talking about the need for a backup plan if medicine goes to hell. Sounds like to me it is getting terribly close.

Physician-owned hospitals are not looking so attractive right now either. In addition, by cutting back or getting out of medicine we would force the demand to go up again, and maybe get a little power back. Maybe this whole this could swing back in our favor if we told this movement that we were not going to work in it. Hmmm..

What if we were all strong and demand that we be compensated appropriately or move out and bring the system to its knees when people cannot get anesthesia for their hip operation or their labor epidural.

I promise I will seriously be re-evaluating things if things get that bad. My position entails Q3 call, and I won't do that for 125K.

What all doctors should do is either work a loooootttt s l o w e r and/or not take on anymore patients with medicare. Why don't we just do this?! I don't understand!! Within a few days they'd be begging us to come back with double the repayment!
 

ChcltSltyBlls

Who wants dessert?
10+ Year Member
Feb 11, 2009
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As a med student I did away rotations in various hospitals throughout europe. They were all under the "single payer" system. What basically happened was that the specialists realized that they were making no money and left the government run hospitals. Anesthesia, Ortho, Plastics, ENT and Urology opened up their own hospitals. At the end of the day, those with money are willing to pay more and get immediate care. In terms of the hospital run by the govn't, no surgical cases started after 2pm. Whatever cases went beyond 4pm were finished by another team. Around 3:30 the surgical and anesthesia teams switched over and new surgeons and anesthesiologists+ CRNAs came on. They finished all ongoing cases and only emergent cases started after 4. Patients would come to first day surgery and they would do as many cases as they could before 2pm. One patient that I saw came to first day surgery everyday for 3 weeks just to get her knee fixed. This was after being on the 3 month waiting list just to get on the waiting list for first day surgery. During this entire time she was not working and collecting money from the government for disability. 4 months of lost productivity and government money when she could have gotten her knee fixed in our current system in a matter of days, started PT and recovered enough to start work again in a month. If americans only knew what healthcare was really like in single payer systems they would realize how lucky they truly are.
 

2win

10+ Year Member
Apr 25, 2008
1,177
33
Status
Attending Physician
As a med student I did away rotations in various hospitals throughout europe. They were all under the "single payer" system. What basically happened was that the specialists realized that they were making no money and left the government run hospitals. Anesthesia, Ortho, Plastics, ENT and Urology opened up their own hospitals. At the end of the day, those with money are willing to pay more and get immediate care. In terms of the hospital run by the govn't, no surgical cases started after 2pm. Whatever cases went beyond 4pm were finished by another team. Around 3:30 the surgical and anesthesia teams switched over and new surgeons and anesthesiologists+ CRNAs came on. They finished all ongoing cases and only emergent cases started after 4. Patients would come to first day surgery and they would do as many cases as they could before 2pm. One patient that I saw came to first day surgery everyday for 3 weeks just to get her knee fixed. This was after being on the 3 month waiting list just to get on the waiting list for first day surgery. During this entire time she was not working and collecting money from the government for disability. 4 months of lost productivity and government money when she could have gotten her knee fixed in our current system in a matter of days, started PT and recovered enough to start work again in a month. If americans only knew what healthcare was really like in single payer systems they would realize how lucky they truly are.
Absolutely right! The money will be made outside of the system. surgeons and anesthesia(pain) will use the state system to channel cash patients in their own clinics...The atmosphere is laid back (see VA system). If there is a reason to postpone a case - that reason is found. Turnover time??? Who cares anymore if you have a fixed salary. The surgeons also will lose any interest of overdoing cases. The quality of medical schools applicants will drop ( or already did...) and the worse is just starting. Physicians will start to have side gigs - whatever they are. They were able to cope with medical school and residency - they will be able to survive in the new system better than others. And I could speak about the "socialist" system from the former Eastern block. Even there the physicians were one of the fortunate. I hope that the debt will be reduced or even forgot for the young physicians that they will find themselves without the expected income after graduation and an impressive amount of debt.
For me it is easier - keep the pain management clinic cash only, move my "fortune" in Europe, reduced the amount of money made in US at minimum taxable, find any loopholes, do some locums if the situation is getting worst. However I will not sacrifice more time than I do now (instead to spend it with my family) for some extra greens. Interesting times fellows!
 

radslooking

10+ Year Member
Apr 25, 2008
771
3
Status
Are you kidding - we are talking about taking a 67% paycut and you say we will be quite alright?
No, you'll get the 5% above medicare. Then you'll only take a 62% paycut. You lucky ducks.

I can't wait for the conversation to change to "i love taking care of all a patients problems and following them long-term", and "i love the breadth of general practice" when they start earning more than gas. ;) just kidding, it won't get that bad. But it probably won't look good for most of us.
 

RabbMD

ASA Member
10+ Year Member
May 13, 2008
216
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Status
Attending Physician
No, you'll get the 5% above medicare. Then you'll only take a 62% paycut. You lucky ducks.

I can't wait for the conversation to change to "i love taking care of all a patients problems and following them long-term", and "i love the breadth of general practice" when they start earning more than gas. ;) just kidding, it won't get that bad. But it probably won't look good for most of us.

Wow, is math really just not learned by medical students anymore? a 67% pay cut is 33%. yes. However adding 5% to 33% does not equal 62%. Here is an example to make you understand. 67% of 100 is 33. If I increase 33 by 5% then that new number is 34.65. That of course is 34.65% of 100 and thus 100-34.65 = 65.35. Not 67%. Percentages are NOT additive. thus if you lose 50% in the stock market then a 50% gain does not make you whole, you are still bigtime in the red.
 

miamidc

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July 20, 2009

PLEASE DO NOT FORGET TO PHONE YOUR CONGRESSMAN TODAY!

I SENT YOU THE INSTRUCTIONS YESTERDAY

THE BILL THAT LEFT THE ‘WAYS AND MEANS’ COMMITTEE CONTAINS LANGUAGE VERY UNFRIENDLY TO ANESTHESIOLOGY

THE BILL GOES TO ‘ENERGY AND COMMERCE’ TODAY IT IS IMPORTANT THAT THE LANGUAGE OF THE BILL IS CHANGED!

Call congressperson

Ask to speak to the Health Care legislative assistant

The Message is:

1)


I am calling you as a constituent and an anesthesiologist.

2)


As currently written, H.R. 3200 will harm private practice and academic anesthesiology.

3)


Using Medicare payment levels for anesthesia services under the “public health insurance plan” is unsustainable for me and my anesthesiology group.

4)


Anesthesiology is unique. Payments for anesthesia services are calculated using a completely different formula than that used for other physicians.

5)


According to the Government Accountability Office (GAO) - the investigative arm of Congress, Medicare pays only 33% of what private insurers pay for anesthesia services. Meanwhile, Medicare pays an average 80% of what private insurers pay for most other specialties.

6)


The Energy and Commerce Committee must fix payment levels for anesthesia services provided under the "public health insurance plan”.

7)


[For lawmakers who are not Members of the Energy and Commerce Committee] Please contact the leadership of the Energy and Commerce Committee to ask that they fix payment levels for anesthesia services provided under the "public health insurance plan”.]





Michael C. Lewis M.D.

Professor, Department of Anesthesiology, Assistant Dean for International Graduate Medical Education, University Miami, Miller School of Medicine

Program Director, Anesthesiology, Jackson Memorial Hospital, Miami, FL
 

miamidc

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Two VERY Important Websites

1) In order to find your Representative and Communicate you can either go to:

A) The House of Representative Website

http://www.house.gov/

B) The ASA website

http://capwiz.com/asa/callalert/index.tt?alertid=13737681



2) To follow the deliberation of the House Energy and Commerce Committee



http://energycommerce.house.gov/



Please call your Representative Today!!







Enclosed below is the list of members on the committee.



Member Name


DC Phone


DC FAX


Email

Henry A. Waxman (D-CA) [Chairman]


202-225-3976


202-225-4099


http://waxman.house.gov/Contact/

John D. Dingell (D-MI) [Chair Emeritus]


202-225-4071


202-226-0371


http://www.house.gov/writerep/

Ed Markey (D-MA)


202-225-2836


202-226-0092


http://markey.house.gov/index.php?option=com_email_form&Itemid=124

Rick Boucher (D-VA)


202-225-3861


202-225-0442


http://www.boucher.house.gov/index.php?
option=com_content&
task=view&id=645&Itemid=

Frank Pallone, Jr. (D-NJ)


202-225-4671


202-225-9665


http://www.house.gov/pallone/contact.shtml

Bart Gordon (D-TN)


202-225-4231


202-225-6887


http://gordon.house.gov/contact/contact_form.shtml

Bobby L. Rush (D-IL)


202-225-4372


202-226-0333


http://www.house.gov/rush/zipauth.shtml

Anna G. Eshoo (D-CA)


202-225-8104


202-225-8890


https://forms.house.gov/eshoo/webforms/issue_subscribe.htm

Bart Stupak (D-MI)


202-225-4735


202-225-4744


http://www.house.gov/stupak/IMA/issue2.htm

Eliot L. Engel (D-NY)


202-225-2464


202-225-5513


http://www.house.gov/writerep/

Gene Green (D-TX)


202-225-1688


202-225-9903


http://www.house.gov/green/contact/

Diana DeGette (D-CO)


202-225-4431


202-225-5657


http://www.house.gov/formdegette/zip_auth.htm

Lois Capps (D-CA)


202-225-3601


202-225-5632


http://www.house.gov/capps/contact/send_an_email.shtml

Mike Doyle (D-PA)


202-225-2135


202-225-3084


http://doyle.house.gov/email_mike.shtml

Jane Harman (D-CA)


202-225-8220


202-226-7290


http://www.house.gov/harman/contact/email.shtml

Janice Schakowsky (D-IL)


202-225-2111


202-226-6890


http://www.house.gov/schakowsky/email.shtml

Charles A. Gonzalez (D-TX)


202-225-3236


202-225-1915


http://www.gonzalez.house.gov/index.php?
option=com_content&task=view&id=170

Jay Inslee (D-WA)


202-225-6311


202-226-1606


http://www.house.gov/inslee/contact/email.html

Tammy Baldwin (D-WI)


202-225-2906


202-225-6942


http://tammybaldwin.house.gov/get_address.html

Mike Ross (D-AR)


202-225-3772


202-225-1314


http://ross.house.gov/?sectionid=77§iontree=7677

Anthony Weiner (D-NY)


202-225-6616


202-226-7253


http://weiner.house.gov/email_anthony.aspx

James D. Matheson (D-UT)


202-225-3011


202-225-5638


https://forms.house.gov/matheson/contact.shtml

G. K. Butterfield, Jr. (D-NC)


202-225-3101


202-225-3354


http://butterfield.house.gov/contactinfo.asp

Charlie Melancon (D-LA)


202-225-4031


202-226-3944


http://www.melancon.house.gov/index.php?
option=com_content&task=view&id=205

John Barrow (D-GA)


202-225-2823


202-225-3377


https://forms.house.gov/barrow/webforms/issue_subscribe.htm

Baron Hill (D-IN)


202-225-5315


202-226-6866


http://baronhill.house.gov/IMA/issue_subscribe.shtml

Doris Matsui (D-CA)


202-225-7163


202-225-0566


https://forms.house.gov/matsui/webforms/issue_subscribe.htm

Donna M. Christensen (D-VI)


202-225-1790


202-225-5517


http://www.house.gov/writerep/

Kathy Anne Castor (D-FL)


202-225-3376


202-225-5652


http://www.house.gov/writerep/

John Sarbanes (D-MD)


202-225-4016


202-225-9219


http://sarbanes.house.gov/federal.asp

Chris Murphy (D-CT)


202-225-4476


202-225-5933


http://www.house.gov/formchrismurphy/ic_zip_auth.htm

Zack Space (D-OH)


202-225-6265


202-225-3394


http://space.house.gov/?sectionid=61§iontree=2661

Jerry McNerney (D-CA)


202-225-1947


202-225-4060


http://mcnerney.house.gov/contact.shtml

Betty Sutton (D-OH)


202-225-3401


202-225-2266


http://sutton.house.gov/about/emailform.cfm

Bruce Braley (D-IA)


202-225-2911


202-225-6666


https://forms.house.gov/braley/webforms/issue_subscribe.html

Peter Welch (D-VT)


202-225-4115


202-225-6790


http://www.house.gov/formwelch/issue_subscribe.htm



Minority Members (Republicans)

Member Name


DC Phone


DC FAX


Email

Joe Barton (R-TX) [Ranking Member]


202-225-2002


202-225-3052


http://joebarton.house.gov/ContactJoe.aspx?Type=Contact

Ralph Hall (R-TX)


202-225-6673


202-225-3332


http://www.house.gov/ralphhall/IMA/zipauth.htm

Fred Upton (R-MI)


202-225-3761


202-225-4986


http://www.house.gov/writerep/

Cliff Stearns (R-FL)


202-225-5744


202-225-3973


http://www.house.gov/writerep/

Nathan Deal (R-GA)


202-225-5211


202-225-8272


http://www.house.gov/deal/contact.shtml

Edward Whitfield (R-KY)


202-225-3115


202-225-3547


http://whitfield.house.gov/contact/index.shtml

John Shimkus (R-IL)


202-225-5271


202-225-5880


http://shimkus.house.gov/?sectionid=54§iontree=5154

John Shadegg (R-AZ)


202-225-3361


202-225-3462


http://johnshadegg.house.gov/Contact/ContactForm.htm

Roy Blunt (R-MO)


202-225-6536


202-225-5604


http://www.blunt.house.gov/Contact.aspx

Steve Buyer (R-IN)


202-225-5037


202-225-2267


http://www.house.gov/writerep/

George Radanovich (R-CA)


202-225-4540


202-225-3402


http://radanovich.house.gov/Contact/email.htm

Joe Pitts (R-PA)


202-225-2411


202-225-2013


http://www.house.gov/pitts/contact.shtml

Mary Bono Mack (R-CA)


202-225-5330


202-225-2961


http://bono.house.gov/Contact_Mary/ContactForm.htm

Greg Walden (R-OR)


202-225-6730


202-225-5774


http://walden.house.gov/ContactGreg.Home.shtml

Lee Terry (R-NE)


202-225-4155


202-226-5452


http://www.house.gov/formleeterry/IMA/issue.htm

Mike Rogers (R-MI)


202-225-4872


202-225-5820


http://www.mikerogers.house.gov/Contact.aspx

Sue Myrick (R-NC)


202-225-1976


202-225-3389


http://myrick.house.gov/zipauth.shtml

John Sullivan (R-OK)


202-225-2211


202-225-9187


http://sullivan.house.gov/zipauth.html

Tim Murphy (R-PA)


202-225-2301


202-225-1844


http://murphy.house.gov/?sectionid=7§iontree=47

Michael Burgess (R-TX)


202-225-7772


202-225-2919


http://burgess.house.gov/Contact/Offices/

Marsha Blackburn (R-TN)


202-225-2811


202-225-3004


http://blackburn.house.gov/contactform/

Phil Gingrey (R-GA)


202-225-2931


202-225-2944


http://www.house.gov/formgingrey/IMA/issue.htm

Steve Scalise (R-LA)


202-225-3015


202-226-0386


http://www.scalise.house.gov/contactform_zipcheck.shtml



Lawrence S. Berman
 

radslooking

10+ Year Member
Apr 25, 2008
771
3
Status
Wow, is math really just not learned by medical students anymore? a 67% pay cut is 33%. yes. However adding 5% to 33% does not equal 62%. Here is an example to make you understand. 67% of 100 is 33. If I increase 33 by 5% then that new number is 34.65. That of course is 34.65% of 100 and thus 100-34.65 = 65.35. Not 67%. Percentages are NOT additive. thus if you lose 50% in the stock market then a 50% gain does not make you whole, you are still bigtime in the red.
Yes, you are right, I wrote it hastily. You will take a theoretical 65.35% paycut instead of a 62% paycut i quoted.

However, I don't know why you are giving those ridiculous examples. adding 5% to 33% does not equal 62%? All i did was add 5% to 33% instead of taking 5% OF 33%.
 
Last edited:

RabbMD

ASA Member
10+ Year Member
May 13, 2008
216
0
Status
Attending Physician
Yes, you are right, I wrote it hastily. You will take a theoretical 65.35% paycut instead of a 62% paycut i quoted.

However, I don't know why you are giving those ridiculous examples. adding 5% to 33% does not equal 62%? All i did was add 5% to 33% instead of taking 5% OF 33%.

I tend to skip steps in math, I always have, sorry...

You stated that a 5% bonus to 33% would be 38% and thus only a 62% pay cut. What I meant to say is adding 5% to 33% would not be 38% AND thus not equal to only a 62% pay cut. It would in fact be a 65.35% paycut. You just stumbled upon a pet peeve of mine of people adding percentages, which is mathematically wrong.
 

radslooking

10+ Year Member
Apr 25, 2008
771
3
Status
I tend to skip steps in math, I always have, sorry...

You stated that a 5% bonus to 33% would be 38% and thus only a 62% pay cut. What I meant to say is adding 5% to 33% would not be 38% AND thus not equal to only a 62% pay cut. It would in fact be a 65.35% paycut. You just stumbled upon a pet peeve of mine of people adding percentages, which is mathematically wrong.
No, actually I appreciate it, your point is a good one. I shouldn't perpetuate idiot math. :)
 

kmurp

Junior Member
10+ Year Member
Apr 23, 2005
362
64
Status
Wow, is math really just not learned by medical students anymore? a 67% pay cut is 33%. yes. However adding 5% to 33% does not equal 62%. Here is an example to make you understand. 67% of 100 is 33. If I increase 33 by 5% then that new number is 34.65. That of course is 34.65% of 100 and thus 100-34.65 = 65.35. Not 67%. Percentages are NOT additive. thus if you lose 50% in the stock market then a 50% gain does not make you whole, you are still bigtime in the red.
Actually, it's different than that. A 67% decrease in gross revenue produces a greater than 67% decrease in salary. That is because the costs of running the practice (overhead) and the benefits package do not change. Therefore all of this 67% decrease in revenue must come out of the physician salary. If the overhead numbers (CRNAs, billing, physician benefits) are more than 33% of gross revenue (as they surely are) you end up with a negative number left for the MD.
 

LonghornJPS

Member
10+ Year Member
7+ Year Member
Oct 3, 2004
80
0
NC
Status
Attending Physician
To those who havn't called your representative to ask that the House amend or revise H.R. 3200 to fix payment levels for anesthesia services provided under the public insurance plan... The ASA provides the phone number and talking points - use the following link and scroll down. Please make the phone call. It is easy!

http://www.asahq.org/news/asanews072409.htm
 

2win

10+ Year Member
Apr 25, 2008
1,177
33
Status
Attending Physician
To those who havn't called your representative to ask that the House amend or revise H.R. 3200 to fix payment levels for anesthesia services provided under the public insurance plan... The ASA provides the phone number and talking points - use the following link and scroll down. Please make the phone call. It is easy!

http://www.asahq.org/news/asanews072409.htm
Little gems from the Health Care Bill
:thumbdown:

http://www.freerepublic.com/%7Ecms/

• Page 16: States that if you have insurance at the time of the bill becoming law and change, you will be required to take a similar plan. If that is not available, you will be required to take the gov option!
• Page 22: Mandates audits of all employers that self-insure!
• Page 29: Admission: your health care will be rationed!
• Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)
• Page 42: The "Health Choices Commissioner" will decide health b enefits for you. You will have no choice. None.
• Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.
• Page 58: Every person will be issued a National ID Healthcard.
• Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.
• Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (example: SEIU, UAW and ACORN)
• Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.
• Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans)
• Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens
• Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan.
• Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter.
• Page 124: No company can sue the government for price-fixing. No "judicial review" is permitted against the government monopoly. Put simply, private insurers will be crushed.
• Page 127: The AMA sold doctors out: the government will set wages.
• Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives.
• Page 126: Employers MUST pay healthcare bills for part-time employees AND their families.
• Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll <>BR • Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll
• Page 167: Any individual who doesnt' have acceptable healthcare (according to the government) will be taxed 2.5% of income.
• Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them).
• Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records.
• Page 203: "The tax imposed under this section shall not be treated as tax." Yes, it really says that.
• Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected."
• Page 241: Doctors: no matter what speciality you have, you'll all be paid the same (thanks, AMA!)
• Page 253: Government sets value of doctors' time, their professional judgment, etc.
• Page 265: Government mandates and controls productivity for private healthcare industries.
• Page 268: Government regulates rental and purchase of power-driven wheelchairs.
• Page 272:20Cancer patients: welcome to the wonderful world of rationing!
• Page 280: Hospitals will be penalized for what the government deems preventable re-admissions.
• Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government.
• Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies!
• Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.
• Page 321: Hospital expansion hinges on "community" input: in other words, yet another payoff for ACORN.
• Page 335: Government mandates establishment of outcome-based measures: i.e., rationing.
• Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc.
• Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals.
• Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone).
• Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia?
• Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of time.
• Page 425: Goverment provides approved list of end-of-life resources, guiding you in death.
• Page 427: Government mandates program that orders end-of-life t reatment; government dictates how your life ends.
• Page 429: Advance Care Planning Consult will be used to dictate treatment as patient's health deteriorates. This can include an ORDER for end-of-life plans. An ORDER from the GOVERNMENT.
• Page 430: Government will decide what level of treatments you may have at end-of-life.
• Page 469: Community-based Home Medical Services: more payoffs for ACORN.
• Page 472: Payments to Community-based organizations: more payoffs for ACORN.
• Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage.
• Page 494: Government will cover mental health services: defining, creating and rationing those services.
 

BLADEMDA

ASA Member
10+ Year Member
Apr 22, 2007
17,687
3,914
Southeast
Status
Attending Physician
The situation remains very dangerous for Anesthesiology.
We must keep up the pressure.
We may ask you to pay personal visits to your representatives in August.
Keep up the letter writing and phone calls.
The ASAPAC is in need of $$$ to fund this campaign. Our victory and your futures are dependent of this organization.

ASA
 
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