April 20th, 2010 by BobDoherty in Better Health Network, Health Policy, Opinion
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Once again, Congress is playing with fire by not enacting a permanent solution to the Medicare SGR (sustainable growth rate) physician payment cut problem.
Congress got itself tied up in knots trying to figure out a way to reverse a 21% cut in Medicare payments to doctors that went into effect yesterday. It ended up agreeing to legislation, which was signed into law late Thursday evening by President Obama, to restore payments to the pre-cut (2009) levels through the end of May.
The action, though, may have come a dollar short and day late. CMS has indicated that it had no choice but to tell carriers to begin processing claims with the 21% cut, starting yesterday. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
April 5th, 2010 by Stanley Feld, M.D. in Better Health Network, Health Policy, Opinion
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By Stanley Feld MD, FACP, MACE
Physicians in practice work hard and have little time for political and legal trickery. They assume their leadership will look out for their interests while they take care of patients.
The problem is that physicians do not have effective leadership, explaining the difficulties practicing physicians have every day with the healthcare insurance industry, hospital administrators, the government and the threat of liability. Most physicians are caring professionals who are not looking to rip off anyone. Physicians do expect reasonable compensation commensurate with their training, level of expertise and level of responsibility.
I recently presented a physician income survey to a group of corporate executives. The executives were astonished by the level of physician income relative to their level of responsibility.
The unanimous reaction of these corporate executives was the average physician’s income was that of a low mid-level manager. It is true some practice specialties earn more but the average income of practicing physicians is not commensurate with their knowledge and responsibility. Read more »
*This blog post was originally published at Repairing the Healthcare System*
April 5th, 2010 by BobDoherty in Better Health Network, Health Policy, Opinion
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You may have noticed, uncharacteristically for me, that I haven’t posted a blog in week. I thought it would be better to allow the readers to post their own reflections, and you did — with comments ranging for unabashed pride to skepticism to disdain for the law and the American College of Physician’s (ACP’s) role in bringing in about.
I respect the principled arguments made by those who believe that the legislation gives the government too much control or those who fear that it will add to the deficit and public debt, even though the Congressional Budget Office (CBO) says otherwise. But there is one claim made by some of the critics that sticks in my craw, which is that the legislation will result in “massive cuts” to Medicare. Here are the facts. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
April 2nd, 2010 by DrRob in Better Health Network, Health Policy, Humor, Opinion
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Name: “21” (% to be cut from Medicare)
Protagonist: Dr. Rob and a cast of thousands of physicians (Kiefer Sutherland wouldn’t work for such small payment.)
Villain: Evil SGR (Sustainable Growth Rate) conspiracy to cut Medicare by 21% across the board.
Victim: The elderly population depending on Medicare for payment of their medical care.
Plot: A follow-up to the popular drama “Lost” where members of congress were stranded in Washington D.C. with the task of reforming healthcare without any contact or communication from doctors and patients. This new drama “21″ tells the tragic tale of an industry under siege and a population facing possible disaster.
Already stretched to the limit by the paltry reimbursement from Medicare for primary care office visits, Dr. Rob and his band of physicians is hit by the evil conspiracy of SGR, a secret society whose goal is to harm the elderly people in the country by driving away all people willing to give them care. The congress, tired out from haggling over the healthcare reform bill, allows evil SGR to exert its power in the name of “fiscal responsibility.” Read more »
*This blog post was originally published at Musings of a Distractible Mind*
March 31st, 2010 by KevinMD in Better Health Network, Health Policy, Opinion, Primary Care Wednesdays
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Medicare’s sustainable growth rate, or SGR, has been the bane of doctors for years now. To encapsulate, this is the reason for Medicare’s annual threat to cut doctors’ fees by 20% or more, only to be staved off at the last minute.
Emergency physician Shadowfax has a nice take on it, explaining why it has devastated primary care:
Primary care has many fixed expenses in addition to those we bear: they pay rent, nurses and techs and secretaries, healthcare costs for their employees, equipment, scheduling software, etc etc. The fixed costs portion of a typical office practice can be much higher, consuming 60-80% of gross revenue. Worse, many of these “fixed costs” for primary care are not truly fixed, but increase annually consistent with inflation.
I wrote several years ago that primary care is the “cheap DVD” of the medical profession — a loss leader to bring people in the door for more lucrative services. Shadowfax agrees, arguing that it’s unlikely there will be any independent primary care practices in the near future:
I predict that, if nothing else changes in the overall model of physician reimbursement, within a decade there will be almost no independent primary care left in existence — they will all have been subsumed into hospital-owned or group practices to serve as “loss leaders,” existing solely to drive referrals to profit centers like surgical services and imaging facilities.
Bingo.
*This blog post was originally published at KevinMD.com*
