Well this is nice!

[bravotwozero]

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So as a MS3 interested in EM, is this specialty shattering in terms of reimbursement? Let's assume that all 50 states ban balance billing as a worst case scenario. Combined with this new rule, will this completely destroy EM physician salaries?

I know money isn't the most important thing in choosing a field, and it's not, but I have to look at all aspects of a specialty before going into it. And this seems really bad.

Too early to say at this point. Too many things can happen. ACEP has had legislative victories in the past, they could win. But if the scenario you mention does come about, the entire system will collapse like veers mentioned, and something would need to be done.



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[Restart13]

So as a MS3 interested in EM, is this specialty shattering in terms of reimbursement? Let's assume that all 50 states ban balance billing as a worst case scenario. Combined with this new rule, will this completely destroy EM physician salaries?

I know money isn't the most important thing in choosing a field, and it's not, but I have to look at all aspects of a specialty before going into it. And this seems really bad.

Same boat as you...and now we're late in the game to see how this plays out.

 

[exsanguination]

Same boat as you...and now we're late in the game to see how this plays out.

This all seems devastating.. I'd stay away from EM. All pendulums swing back, anesthesia had there's, and this legislation seems to be the impulse to send EMs pendulum back towards poor reimbursement

 

[bravotwozero]

This all seems devastating.. I'd stay away from EM. All pendulums swing back, anesthesia had there's, and this legislation seems to be the impulse to send EMs pendulum back towards poor reimbursement

Do what you like man. And anesthesia is still doing pretty good these days


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[Old_Mil]

I know money isn't the most important thing in choosing a field, and it's not, but I have to look at all aspects of a specialty before going into it. And this seems really bad.

When you're 30 or older by the time you enter the workforce and are carrying anywhere between $200,000 and $500,000 of nondeductible student loan debt, the last thing you have to do is apologize for looking at what a particular field pays.

 

[RG3forPresident]

Actually one thing I'm wondering now is if these regulations have been in place since 2010 via the interim regulations, and these new official regulations are almost the exact same, shouldn't the field have already felt the horrible effects by now? I know that OON payment has decreased (2 companies reducing OON payments by 600 million annually), but this doesn't seem to be reflected in the salaries according to medscape ER compensation and such.

 

[GeneralVeers]

Actually one thing I'm wondering now is if these regulations have been in place since 2010 via the interim regulations, and these new official regulations are almost the exact same, shouldn't the field have already felt the horrible effects by now? I know that OON payment has decreased (2 companies reducing OON payments by 600 million annually), but this doesn't seem to be reflected in the salaries according to medscape ER compensation and such.

There are several competing factors at play. While balance billing, EMTALA, and other legislation drive down our salaries, the national shortage of EM physicians is driving things the other way. In TX alone, the advent of freestanding EDs has taken the equivalent of 600-1000 ED physicians out of the "regular market". The result is that hospitals and groups have to pay more to keep their staffing adequate.

As long as there's a physician shortage, I can't seen nationwide salaries decreasing much. In particular markets that have egregious balance billing laws, we should see reimbursement go down.

 

[deleted480308]

There are several competing factors at play. While balance billing, EMTALA, and other legislation drive down our salaries, the national shortage of EM physicians is driving things the other way. In TX alone, the advent of freestanding EDs has taken the equivalent of 600-1000 ED physicians out of the "regular market". The result is that hospitals and groups have to pay more to keep their staffing adequate.

As long as there's a physician shortage, I can't seen nationwide salaries decreasing much. In particular markets that have egregious balance billing laws, we should see reimbursement go down.

but as hospitals aren't allowed to not have an EM doc won't those hospitals have to start subsidizing if enough docs walk from those poorly reimbursing regions?

 

[Restart13]

Being optimistic, 2016 can bring some (good) change to healthcare. Personally I never thought the ACA was here to stay definitely, whether it go to single-payer or some other scheme.

 

[GeneralVeers]

Being optimistic, 2016 can bring some (good) change to healthcare. Personally I never thought the ACA was here to stay definitely, whether it go to single-payer or some other scheme.

So single payer would be BETTER than the ACA?

 

[UnderwaterDoc]

I'm curious if anybody has actually seen a pay cut as a result of this. I have friends that work both at CA and NY, where balanced billing has been banned for some time, and they have not seen a change in their pay (yet).

I'm not in a position to give much advice since I have only been out for a year and a half, but issues like this are why I still live like a resident and save 90% of my salary. When the **** hits the fan I want as much financial freedom as possible.

 

[QueenJames]

I'm curious if anybody has actually seen a pay cut as a result of this. I have friends that work both at CA and NY, where balanced billing has been banned for some time, and they have not seen a change in their pay (yet).

I'm not in a position to give much advice since I have only been out for a year and a half, but issues like this are why I still live like a resident and save 90% of my salary. When the **** hits the fan I want as much financial freedom as possible.

Somebody read the white coat investor book huh??

😉

I see you. You the real MVP!

 

[UnderwaterDoc]

Somebody read the white coat investor book huh??

😉

I see you. You the real MVP!

Hellz yeah!!

 

[QueenJames]

Hellz yeah!!

Lol I'm currently like 3/4 the way through it. Figure I could learn some of what they don't teach you in med school before I start this year! Great book!

 

[bravotwozero]

UPDATE: ACEP is suing the federal government over this. http://email.acep.org/c/3/?T=TmpFek...051216/?_cldee=ZmFoYWQuc3llZEBnbWFpbC5jb20%3d


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[Zebra Hunter]

ACEP appears to like what Connecticut has done with their balanced billing legislation which requires a minimum benefit standard of the 80th percentile of charges as reported in a benchmarking data base maintained by a nonprofit organization specified by the Insurance Commissioner. I'm not sure what other's opinions are of this legislation, but I would love to hear them.

 

[sum dude]

ACEP appears to like what Connecticut has done with their balanced billing legislation which requires a minimum benefit standard of the 80th percentile of charges as reported in a benchmarking data base maintained by a nonprofit organization specified by the Insurance Commissioner. I'm not sure what other's opinions are of this legislation, but I would love to hear them.

It's the best Balance Billing bill passed so far in this latest wave of bills. My state, FL, got a suckier version. NY's is so-so. 80 percentile FairHEalth charges is actually reasonable and eliminates need for Balanced Billing. Problem is that it took a last second hail-mary in the legislature to pass.

Also, most balance billing bans only affect State PPO's (not national ERISA plans, which are govt PPO's). For now, most of the passed thus far bills shouldn't affect compensation too much (with exceptions being CA and IL, both which got the worst versions of bans). They certainly will curtail any future increases in EM compensation. CT and Texas prob. got best version of ban. For now, you are better off in states which allow BB, but rest assured, your state will follow--the degree to which they set UCR in a balance billing ban will have a big impact on your group's compensation

 

[weasel23]

any updates on this? im an ms3 interested in EM and was curious. thanks!