pathstudent

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It is just terrible. I was sort of holding out hope that an increase in the insured via obamacare would help us out as we do quite a bit of work on uninsured people. However, this authority that obamacare has given cms to cut our bread and butter cpt codes is absolutely ruthless. (88305 cut last year, PC on 88342 cut 80% this year, next year FISH will be slashed to at cost for TC with PC likely seeing the same 80% slash as IHC). It is terrible. I think it is part to reduce interest in non-primary care and part social engineering (it is not fair that specialist physicians make more than teachers and social workers in the eyes of Obama, pelosi and warren. Only career politicians, Hollywood actors, trial lawyers and union leaders should be allowed to live large)
 

levels x3

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(it is not fair that specialist physicians make more than teachers and social workers in the eyes of Obama, pelosi and warren. Only career politicians, Hollywood actors, trial lawyers and union leaders should be allowed to live large)
I'm as upset as most everyone else (see my post in LADoc00s's thread) but really? Obamacare is the vehicle today, but is it because of the Democrats? Or are we, physicians, not just pathologists, just easy targets? I have long thought that we as providers are simply the easiest target. Health care costs spiraling out of control? Who cares where the real waste is; doctors have fragmented, weak lobbies...let's cut there. I think blaming any particular politician misses the forest for the trees. Don't expect a Christie/Ryan administration to reverse these changes. Nobody is giving you your money back.
 
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LADoc00

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Once the end comes for us levels there will be PLENTY of time for revenge mind you. The rest of our careers will be a series of score settling on this one.

The practice of pathology HAS been permanently damaged, no question but there is a very very clear group of us who supported Obama in this and these traitors will be branded.
 

levels x3

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Brand me if you like. (Political commentary: I cannot support a party that is anti science; climate change??? evolution???...seriously) I will continue to support Pathology interests. I will keep fighting for my share of the pie. But I don't think it matters a bit which party is in power. Health care costs are going to be cut one way or another. But who has the more influential lobby? Hospital systems and insurance companies, or the CAP, AMA, ACS, etc.? This was going to happen no matter who won the last election. And the next election won't change anything either. A Limbaugh/Bachman administration won't restore your reimbursements.
 
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malchik

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It's a bit of an oversimplification to just throw your arms up and say "health care costs are going to be cut one way or another...this was going to happen no matter who won the last election." There are different ways to cut health care costs, and the parties are not equivalent in their approaches to this. For example, the republican party has supported things like tort reform which the democrats won't consider.
 

Thrombus

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Brand me if you like. (Political commentary: I cannot support a party that is anti science; climate change??? evolution???...seriously) I will continue to support Pathology interests. I will keep fighting for my share of the pie. But I don't think it matters a bit which party is in power. Health care costs are going to be cut one way or another. But who has the more influential lobby? Hospital systems and insurance companies, or the CAP, AMA, CAS, etc.? This was going to happen no matter who won the last election. And the next election won't change anything either. A Limbaugh/Bachman administration won't restore your reimbursements.
You sound like you have been listening to what leftists say about republicans rather than listening to conservatives themselves. Obama and his ilk can't stand physicians as they are both educated and think for themselves (plus they haven't historically been dependent on politicians...which is about to change thanks to them).

Did you hear O in his campaign for health care years ago describe how doctors amputate legs instead of treat DM because it pays us more? (Probably not because his media doesn't report such things).

The AMA is a regulatory and price fixing machine all of which is horrible for docs and will ultimately reduce access for 95% of all Americans.
 

icpshootyz

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It's a bit of an oversimplification to just throw your arms up and say "health care costs are going to be cut one way or another...this was going to happen no matter who won the last election." There are different ways to cut health care costs, and the parties are not equivalent in their approaches to this. For example, the republican party has supported things like tort reform which the democrats won't consider.
That would be fine if tort reform had any chance of significantly reducing actual healthcare costs, but it doesn't. Medical malpractice costs, in the grand scheme of things, are not a main driver of increasing healthcare costs. Technically, neither are physician salaries, but we're low-hanging fruit that's easy to pick. Overutilization (for us too many IHC stains, maybe) should be the main target - unnecessary tests, imaging, etc. However, people expect to get the grand slam workup for all their problems. We order PET CTs on every cancer. We get MRIs for every sore shoulder. We get huge infectious workups on everyone with a fever. Everyone with cancer gets genetic profiling of their tumors. We want these things (even if there's low yield), but somehow we don't expect to pay more for them. So, we slash reimbursement for common things because we keep spending too much on new things. *shrugs*
 

gbwillner

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That would be fine if tort reform had any chance of significantly reducing actual healthcare costs, but it doesn't. Medical malpractice costs, in the grand scheme of things, are not a main driver of increasing healthcare costs. Technically, neither are physician salaries, but we're low-hanging fruit that's easy to pick. Overutilization (for us too many IHC stains, maybe) should be the main target - unnecessary tests, imaging, etc. However, people expect to get the grand slam workup for all their problems. We order PET CTs on every cancer. We get MRIs for every sore shoulder. We get huge infectious workups on everyone with a fever. Everyone with cancer gets genetic profiling of their tumors. We want these things (even if there's low yield), but somehow we don't expect to pay more for them. So, we slash reimbursement for common things because we keep spending too much on new things. *shrugs*
This... and this doesn't even touch the fact that 1/3 of all medical expenses incurred happen in the last month of life of individuals. The underlying issue is deciding once and for all if medicine is a fundamental right or a commodity. If it is somewhere in the middle, can we at least all agree on where the line is? Should we be forced to provide any and all medical care to those who cannot afford it? What about some? Should medicare pay for surgery, chemo, and rads on a patient who presents with stage 4 disease and no studies have shown significant benefit from any treatment? How much money alone would we save by telling people with unresectable GBMs to just get prepared to die at peace at home with your loved ones?
 

malchik

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That would be fine if tort reform had any chance of significantly reducing actual healthcare costs, but it doesn't. Medical malpractice costs, in the grand scheme of things, are not a main driver of increasing healthcare costs. Technically, neither are physician salaries, but we're low-hanging fruit that's easy to pick. Overutilization (for us too many IHC stains, maybe) should be the main target - unnecessary tests, imaging, etc. However, people expect to get the grand slam workup for all their problems. We order PET CTs on every cancer. We get MRIs for every sore shoulder. We get huge infectious workups on everyone with a fever. Everyone with cancer gets genetic profiling of their tumors. We want these things (even if there's low yield), but somehow we don't expect to pay more for them. So, we slash reimbursement for common things because we keep spending too much on new things. *shrugs*
Direct malpractice costs are around 2% of healthcare spending, I agree that is not a lot. But what about indirectly affecting the way physicians practice? Isn't a lot of the overutilization you're talking about a result of defensive medicine? It is not the only way to curb defensive medicine, but tort reform could have an impact there.
 

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Non evidence based regulation is the largest cost. Instrumentation, reagents, drugs, medical equipment, etc. is so overpriced it is sickening as it has to be regulated and certified with no evidence behind the regulating/quality assurance etc. There is no cost/benefit data or reasoning to this circus.
 

Path or bust

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Direct malpractice costs are around 2% of healthcare spending, I agree that is not a lot. But what about indirectly affecting the way physicians practice? Isn't a lot of the overutilization you're talking about a result of defensive medicine? It is not the only way to curb defensive medicine, but tort reform could have an impact there.
You're absolutely right:
CBO revises assessment on impact of tort reform
Direct costs include the costs of medical liability insurance premiums, settlements, jury awards, and any legal or administrative costs not covered by liability insurance.

Indirect costs include the “the use of healthcare services through changes in the practice patterns of providers.” This statement could be interpreted to include the costs associated with the practice of “defensive medicine” such as the tests and procedures that physicians order to lower their risk of being sued for medical malpractice. This, apparently, was the elephant in the middle of the room that was being ignored.

http://www.aaos.org/news/aaosnow/feb10/managing4.asp
 

Willard

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Did you read the article though? “The combination of direct savings in malpractice costs and indirect savings in healthcare services would reduce national health spending in response to the proposed reforms by roughly 0.5 percent.”
 

icpshootyz

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Even if there is significant tort reform, would I still not practice defensive medicine? Part of the reason I practice defensively is because I simply don't want to be wrong and I don't want to miss something. I have great malpractice insurance that would cover just about any lawsuit. But that doesn't make me order less immunos or work up cases to a lesser extent. I just don't think that would change much even if there was massive tort reform. Doctors don't like to be wrong. And for me personally, that means I hate it when I diagnose something and then the patient shops for a second opinion downtown and they disagree with me.
 
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schrute

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Brand me if you like. (Political commentary: I cannot support a party that is anti science; climate change??? evolution???...seriously) I will continue to support Pathology interests. I will keep fighting for my share of the pie. But I don't think it matters a bit which party is in power. Health care costs are going to be cut one way or another. But who has the more influential lobby? Hospital systems and insurance companies, or the CAP, AMA, ACS, etc.? This was going to happen no matter who won the last election. And the next election won't change anything either. A Limbaugh/Bachman administration won't restore your reimbursements.
Bit of an exaggeration, and not sure how you can honestly think the progressive approach is better for medicine than the conservative, as one has quite freaking clearly put us on the track to a one-payer system... And I have no doubt that in the future physicians will be FORCED to take a certain % of medicare/Medicaid patients in order to maintain state licensure / hospital accreditation...one guess as to which party already tried passing legislation to that effect... 'When everybody is poor, nobody will be.'

Bottom line, a large percentage of people just don't want to pay for what health care costs, and that's coupled with the fact that each year, medicine becomes increasingly complex--pathologists still made plenty of money before IHC...before FISH...before [x, y, z]...every physician in every specialty made money before the implementation of expensive imaging, $50k chemo drugs, etc. But the COST of doing medicine has gone up exponentially, and that's been coupled with the expectation that every patient have access to everything. And like everyone has already mentioned, high volume tests are easy targets. Through whatever combination of hospital valuation, lobbying efforts and insurance company clout, more value is placed upon some specialties than others--I don't know an orthopod that makes less than $500k, and plenty that make closer to $750...and aside from the rigors of the training, you'll have a hard time convincing me 'orthopedics' is more valuable to the field of medicine, but in the current reimbursement system they do bring in more money.
 

pathstudent

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Brand me if you like. (Political commentary: I cannot support a party that is anti science; climate change??? evolution???...seriously) .

I bet there are just as many people in the democratic party that pray to god, believe in creation or some other hokey religious story from some ancient book.

I am pro-gay rights, pro-choice, OK with some level of affirmative action, pro-entitlement programs to an extent, pro-environment, pro-national parks, pro strict gun control. But I am not going to support a party that is run by multi-multi-multi millionaires who go about demonizing hard working people that are successful enough to earn 350k, 500k whatever. Obama will spend the rest of his life doing speaking engagements for 500k per event. Yet he thinks an orthopedic surgeon or pathologists that earns 500k a year is selfish and the "biggest threat to the economy" for creating economic "inequality"
 
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levels x3

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I bet there are just as many people in the democratic party that pray to god, believe in creation or some other hokey religious story from some ancient book.

I am pro-gay rights, pro-choice, OK with some level of affirmative action, pro-entitlement programs to an extent, pro-environment, pro-national parks, pro strict gun control.
That's fair. Late night posting. Not right of me to paint with such a broad brush.
 

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Path or bust

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Did you read the article though? “The combination of direct savings in malpractice costs and indirect savings in healthcare services would reduce national health spending in response to the proposed reforms by roughly 0.5 percent.”
Yes, the money saved by doing this would account for half the money needed to repeal the SGR.

"In December 2008, the CBO estimated that reforming the medical liability system would save the federal government $5 billion during the 2010–2019 cycle. Less than a year later, however, in October 2009, the CBO estimated that tort reform would reduce the federal budget deficit by $54 billion during same time period—a figure 10 times greater than previously reported!"
 

yaah

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I don't think blaming liberals is productive. What is the real conservative alternative? It seems to be as though it is likely preservation of high-value health plans and such (so-called cadillac plans) but these are kind of limited in what kind of people can sign up. The main volume is not going to be from this., And most conservative proposals I have seen call for "more skin in the game" i.e. higher deductibles. This is part of the problem with obamacare too - higher deductibiles mean more patient worry and care about pricing.

The problem with the consevative opposition to obamacare has been the total lack of responsibility in helping to fix it or modify it. They are just saying no. That isn't practical or realistic. It isn't going to help physicians, for certain. Medicare costs are going to keep rising due simply to aging population, let alone consideration of utilization. How are conservatives going to fix that if they won't pay for the increased cost?

I am no liberal but I have seen very little action or responsibility on behalf of the conservative faction. It is VERY EASY to just oppose obamacare, blame everyone who supported it for every problem you can see, and claim things will be much better if it is repealed. But this is complete hogwash. Progress is going to require more than sticking your head in the sand and yelling no no no over and over again.
 

Thrombus

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The house has passed many bills that have been ignored by them leftist media and senate.

For cost savings we should start by demanding all quality/regulatory measures demand a cost/benefit analysis to stay in place. the FDA certifying medical equipment would be a good place to start as medical supplies have 1000% markup in many cases.

I would also stop subsidizing big academia and pay 50% of a resident salary from CMS instead of 300-400%.
 

yaah

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The house has passed many bills that have been ignored by them leftist media and senate.

For cost savings we should start by demanding all quality/regulatory measures demand a cost/benefit analysis to stay in place. the FDA certifying medical equipment would be a good place to start as medical supplies have 1000% markup in many cases.

I would also stop subsidizing big academia and pay 50% of a resident salary from CMS instead of 300-400%.
The house bills are not really that serious though. No one is ignoring any serious right wing proposals. Previous right wing proposals were more serious until some aspects of them were incorporated (modified) into the ACA, at which point they ceased being right wing proposals. And you will knock me over with a feather if the republican party ever takes a significant stand against the medical device industry. The established industries benefit from having FDA regulations in there because it prevents upstarts from getting in the game.

Good luck with the last proposal. I don't think anyone is going to support that (even republicans) without some kind of giveback - hospitals are already facing huge financial obstacles. If residency funding is significantly cut they will find other ways to fill residents' roles other than residents. That will likely have the impact of removing physicians more from daily care - is that something you want? The only way to reduce funding from CMS for residents is to increase pay in other ways so that hospitals have an incentive to actually train residents. Unless residency becomes a volunteer position - is that ok with you?
 

Thrombus

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Yaah you sound pretty closed minded to ideas. The entire rep. party is being overhauled for libertarian ideas instead of the same ol cronyism. I submit that given a limited pool of resources, every expense should be examined for its contribution to patient care and if there is no cost effective evidence for benefit, it harms patient access. We should start with the ABP and end with the regulatory agencies that stymie competitive products ranging from the lab to the bed to the IV drip. End the cronyism!
 

yaah

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Yaah you sound pretty closed minded to ideas. The entire rep. party is being overhauled for libertarian ideas instead of the same ol cronyism. I submit that given a limited pool of resources, every expense should be examined for its contribution to patient care and if there is no cost effective evidence for benefit, it harms patient access. We should start with the ABP and end with the regulatory agencies that stymie competitive products ranging from the lab to the bed to the IV drip. End the cronyism!
Are you serious? Closed-minded to ideas? Have you read anything I have posted?

The "new" republican party may be ditching the old cronyism but it's replacing it with a purity test which rewards "holding the line" instead of actually solving problems and creating new ideas that actually help non-politicians. There are some politicians who are presenting ideas (Rand Paul at least does this, I may not agree with lots of them but at least he has ideas) but these are rarely acted on to a significant extent.
 

Thrombus

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The whole Constitutional Republic was designed to "hold the line" against bad ideas. Medicine itself is supposed to be a first "do no harm" profession.

It is ridiculous to pass a 2200 page law written with fill in the blanks, disrupting an entire sector that the entire country depends on, without acknowledging there will be a near endless list of harmful consequences, intended or unintended. If such a thing were imposed on a patient I would first to say Stop, Do no Harm!

Then let's fix it piece by piece with evidence behind legislation; legislation that is understandable and that all have actually read!!; and legislation that recognizes competition to produce cost effective benefit as our resources are finite. Now overly subsidized academia and cronyism by regulation are 2 sources that dry up resources with no legitimate evidence of benefit. (Note I say overly subsidized academia and do not care for a mindless jump to charity residencies as your first response.
 

yaah

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I agree with that - I have no idea why legislation now has to be so voluminous. Even bills that rename post offices can't be less than 5-10 pages. Well, I have an idea why it so long, it's because of legal issues and loopholes of course. But it doesn't have to be that way. And it is incredible that a bill can be that long and leave so much open to interpretation or executive choice/fiat.
 

LADoc00

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I am considering becoming a neo-Fascist as this point in human history I feel the "democracy fad" is inevitably coming to an end.

I would like to be Praetor of the new Roman Empire, whatever form it takes. Of course I will remember all you SDN posters and use whatever influence I have with your local Plebian Aediles to help ensure you do not end up in the arena..

Ave, Imperator, morituri te salutant
 

stickyshift

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I agree with that - I have no idea why legislation now has to be so voluminous. Even bills that rename post offices can't be less than 5-10 pages. Well, I have an idea why it so long, it's because of legal issues and loopholes of course. But it doesn't have to be that way. And it is incredible that a bill can be that long and leave so much open to interpretation or executive choice/fiat.
The bureaucracy is the fourth branch of government. This is the branch that will actually write the detailed regulations that are the banes of our lives.
 

2121115

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I am considering becoming a neo-Fascist as this point in human history I feel the "democracy fad" is inevitably coming to an end.

I would like to be Praetor of the new Roman Empire, whatever form it takes. Of course I will remember all you SDN posters and use whatever influence I have with your local Plebian Aediles to help ensure you do not end up in the arena..

Ave, Imperator, morituri te salutant

Benevolent dictators.

Philosopher kings.