What's Your Plan for After the Medicare Cuts?

[drusso]

Does anyone think that the D's will come to the rescue?

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[buddababa]

No. They don't care.

 

[TheLoneWolf]

Without going into the rabbit hole of conspiracy, could this be a concerted step towards a mostly PE and hospital-employed physician model and toward a single payer system where standalone guys can't survive from a financial standpoint?

 

[drrosenrosen]

Without going into the rabbit hole of conspiracy, could this be a concerted step towards a mostly PE and hospital-employed physician model and toward a single payer system where standalone guys can't survive from a financial standpoint?

I go back and forth between believing that there's some grand conspiracy like you describe, and believing that the braintrust in congress just says "we need to cut healthcare expenditures! but how? I know! Doctor's are rich - let's cut their share of the pie!" [applause]

As old Abe said, never attribute to malice that which can be explained by incompetence.

 

[buddababa]

I go back and forth between believing that there's some grand conspiracy like you describe, and believing that the braintrust in congress just says "we need to cut healthcare expenditures! but how? I know! Doctor's are rich - let's cut their share of the pie!" [applause]

As old Abe said, never attribute to malice that which can be explained by incompetence.

same.

 

[jwalker12]

I many times wonder if its even worth to do clinical medicine, get paid 50 bucks for a procedure but can get sued for 50million if it doesn't go right.

 

[TheLoneWolf]

I many times wonder if its even worth to do clinical medicine, get paid 50 bucks for a procedure but can get sued for 50million if it doesn't go right.

When I ran the numbers and found that I didn't even get paid on some difficult patients ans challenging procedures, I was a little peeved

 

[Multimodal]

same here. I found out medicare is only paying ~$300 for BL lumbar RFAs at my ASC (where im not an owner). we have since gotten a good deal on an RF generator and have started doing these in clinic where reimbursement is at least double if not triple. plus having our own equipment will make it easier to transition to cash based as time goes on.

challenging procedures?! hah. my first few years out of training, I was constantly on a zebra hunt. doing weird nerve blocks and pulsed RFA. after getting beat down with denials, laughable payments or refusal to reimburse after a procedure, I have hung up my zebra hunting gear and am just trying to eek out a decent living in this job helping who I can, not everyone in pain.

in all honesty, I think that we're going to have to limit new medicare patients if these cuts or whatever they want to do with the bundled codes goes through.

 

[drusso]

I go back and forth between believing that there's some grand conspiracy like you describe, and believing that the braintrust in congress just says "we need to cut healthcare expenditures! but how? I know! Doctor's are rich - let's cut their share of the pie!" [applause]

As old Abe said, never attribute to malice that which can be explained by incompetence.

It goes back to Hillary Care and the Clintons. What is happening today is not an accident.

 

[SSdoc33]

We had this exact same discussion 10 years ago. And guess what? Everybody still accepts medicare. Old patients are our lifeblood. Even if there is a cut, you all will still accept medicare bc you wont have much of a choice

 

[drusso]

We had this exact same discussion 10 years ago. And guess what? Everybody still accepts medicare. Old patients are our lifeblood. Even if there is a cut, you all will still accept medicare bc you wont have much of a choice.

Every man builds his world in his own image. He has the power to choose, but no power to escape the necessity of choice.

Ayn Rand

 

[lobelsteve]

Every man builds his world in his own image. He has the power to choose, but no power to escape the necessity of choice.

Ayn Rand

Silly. Power to escape choice. The government chooses for you.

 

[drusso]

Silly. Power to escape choice. The government chooses for you.

Go eat 100 grams of activated charcoal until you vomit up the Blue Pill, Lobel.

 

[SSdoc33]

This is a sickness, russo.

 

[Ferrismonk]

challenging procedures?! hah. my first few years out of training, I was constantly on a zebra hunt. doing weird nerve blocks and pulsed RFA. after getting beat down with denials, laughable payments or refusal to reimburse after a procedure, I have hung up my zebra hunting gear and am just trying to eek out a decent living in this job helping who I can, not everyone in pain.

This digs deep. So true. It sucks when you know there is a treatment option out there that could possibly help someone, but it'll be a huge fight to even attempt to get it covered and will pay you $35 or not at all when payments come through 3 months from now.

The only way to get treat zebras now is fancy new things until they're squashed. One of the reasons we have so many new flash-in-the-pan treatments.

 

[drrosenrosen]

We had this exact same discussion 10 years ago. And guess what? Everybody still accepts medicare. Old patients are our lifeblood. Even if there is a cut, you all will still accept medicare bc you wont have much of a choice

My practice is 55-60% Medicare and MC advantage plans. Cutting them out is just not feasible, nor really is reducing the number of new Medicare patients accepted.

 

[drusso]

Working more and more for less and less is what hell looks like.

 

[10KHertz]

Medicare is now allowing waivers for non covered benefits. So start charging Medicare patients for repeat epidurals and don’t feel bad about it . The dems gutted Medicare beneficiary benefits , not us … tell the patients it’s due to this administration and his CMS director, they get it .

 

[drusso]

Medicare is now allowing waivers for non covered benefits. So start charging Medicare patients for repeat epidurals and don’t feel bad about it . The dems gutted Medicare beneficiary benefits , not us … tell the patients it’s due to this administration and his CMS director, they get it .

It’s always been this way. People can still pay cash for health care. We’ve not become totally socialized…yet. Third level RF’s, sedation, Regen, HA for joints other than the knee, etc. It’s all available to order off the a la carte cash menu for Medicare patients.

 

[10KHertz]

It’s always been this way. People can still pay cash for health care. We’ve not become totally socialized…yet. Third level RF’s, sedation, Regen, HA for joints other than the knee, etc. It’s all available to order off the a la carte cash menu for Medicare patients.

Actually it’s still somewhat illegal
to directly charge a Medicare patient as a contracted Medicare provider.
Your state pain society should contact Medicare directly and get a response in writing …

 

[bedrock]

Q

Actually it’s still somewhat illegal
to directly charge a Medicare patient as a contracted Medicare provider.
Your state pain society should contact Medicare directly and get a response in writing …

no it isnt. You can charge cash for whatever Medicare doesn’t cover , patients just have to sign an ABN.

Otherwise you are literally taking away their freedom to seek the care they want. This is no different from not allowing Medicare patients to see a personal trainer, buy supplements etc. thankfully we do still have some freedoms in this country.

 

[drusso]

Q

no it isnt. You can charge cash for whatever Medicare doesn’t cover , patients just have to sign an ABN.

Otherwise you are literally taking away their freedom to seek the care they want. This is no different from not allowing Medicare patients to see a personal trainer, buy supplements etc. thankfully we do still have some freedoms in this country.

This is the correct answer.

 

[drrosenrosen]

Actually it’s still somewhat illegal
to directly charge a Medicare patient as a contracted Medicare provider.
Your state pain society should contact Medicare directly and get a response in writing …

You can charge cash for noncovered treatments if the patient signs an ABN. You can't however, charge for undercovered treatments (e.g., how they recently cut reimbursement for j-codes on HA to the point that you lose money).

 

[drusso]

You can charge cash for noncovered treatments if the patient signs an ABN. You can't however, charge for undercovered treatments (e.g., how they recently cut reimbursement for j-codes on HA to the point that you lose money).

Choose a HA that doesn't have a J-code and then have the patient sign an ABN. The government can't make you work for free caring for Medicare patients.

 

[drrosenrosen]

What brands don't have a J code?