Medicare cuts
As reported at the Indiana State Medical Association Indiana State Medical Association - e-Reports, Oct. 23, 2006, our congressmen have let physicians down again.
They have failed to pass legislation to prevent the proposed 5.1% cut in reimbursement slated to begin on January 1, 2007.
The goal was to have them stop the proposed cuts that the decade-old formula in physician payment was to trigger and to then tie Medicare payments and any increase to actual practice costs.
The AMA and physicians believe it is critical that Congress return during the lame-duck session. Otherwise, just as with Medicaid here in Indiana, more and more physicians will cease seeing new Medicare patients. With the baby boomers increasing in age, this will become a huge burden.
They have failed to pass legislation to prevent the proposed 5.1% cut in reimbursement slated to begin on January 1, 2007.
The goal was to have them stop the proposed cuts that the decade-old formula in physician payment was to trigger and to then tie Medicare payments and any increase to actual practice costs.
The AMA and physicians believe it is critical that Congress return during the lame-duck session. Otherwise, just as with Medicaid here in Indiana, more and more physicians will cease seeing new Medicare patients. With the baby boomers increasing in age, this will become a huge burden.
posted by Anonymous at 6:10 PM
23 Comments:
You wrote:
"... our congressmen have let physicians down again."
That is one way to look at it. Another is that congress (there are women there too, you know)didn't let taxpayers down by continuing to let Medicare expenses get further out of control.
As you also said: "With the baby boomers increasing in age, this will become a huge burden." That is true of Social Security payments and taxpayer funded Medicare and Medicaid costs. These cuts may not be a lot of fun for doctors, but the cost of funding all these government programs has the potential to create huge taxpayer liabilities in the coming years. Something has to be done and somebody, maybe everybody, is going to feel some pain.
Suck it up. Why shouldn't physicians feel the pain just like everyone else. All businesses and consumers alike have had to adjust the way they do business and no one gave physicians a free ride. It really irks me that you continue to put forth the threat that physicians will cease seeing new Medicare patients. If you continue to drop peoples Insurance and Medicare you just might be able to join all the unemployed down at the local Unemployment Agency. You will then get a taste of the real world.
You wonder where such anger and discontent comes from in these comments.
Rather than addressing the issues they continue to vent such disdain.
We have a broke, antiquated system that needs an overhaul.
There are plenty of patients and we do have the luxury of choosing which ones to see. That will cause increasing problems.
We can be proactive and try to fix things, or continue to accept the broken system.
You wonder where such anger and discontent comes from in these comments.
Rather than addressing the issues they continue to vent such disdain.
I don't expect you'll accept it any better than the last time we discussed it, but it's perfectly easy to figure out from where the anger and disadain come.
The average salary of a family practioner in the U.S. is about $123K. The average overall salary for all workers in the U.S. is about $37K.
At the $123K mark, a doctor individually makes more money per year than about 85% of all households in the country, including those with dual wage earners. Over 50% percent of all households make less than half of what the average family practioner brings in individually.
Given that information, it's not unreasonable to conclude that the average doctor could reduce their patient load by one-half, effectively doubling the amount of time and attention spent with each remaining patient, and still singlehandedly make about $24K more per year than the average household.
Further, when one is sitting in the waiting room for a second hour in anticipation of their often extremely brief visit, not because of an unforseen emergency but simply because the doctor oversheduled his or her office again, it often occurs to patients, while wondering if they're going to be able to pay for whatever services the doctor deems necessary, that the only real reason that their time and concerns are being treated so disrespectfully is because the doctor in question wants to maintain or increase that discrepancy in income.
The problems with our medical system are myriad but the fact that doctors seem to feel entitled to well over three times the average person's income is, in fact, a valid issue whether you recognize it or not.
IN RESPONSE TO THE ANONYMOUS DIGS...
I have to agree with HB's follow-up comment at on this one...why so much anger, folks? HB is just trying to put out some food for thought. And in response, you folks come and take shots at him anonymously. Why not stand up, put your money where your mouth is? Put on the name badge, stand up for your thoughts. I signed up and did. Why don't you?
I dont certainly do not always agree with the HB, Bluegill or the New Albanian (and they rarely ever agree with each other), but I respect each of them for both having the chutzpah to stand by their thoughts without hiding behind the anonymity of the internet.
But then again, its easier to just sit back and complain, rather than try to make a difference, isnt it?
AS TO BLUEGILL....
Do you really think most physicians act out of a sense of entitlement? If any of your physicians ever make you feel this way, you should find another one. There are plenty of good ones out there.
I would also say the same thing about any other job - I dont give my money & business to restaurants, car dealers, plumbers, contractors, accountants or any other trade, business or profession who treats me with less than the respect I would give them in return. Its just a fact of life - there are schmuks in every walk of life.
And, I'll say that I've seen and dealt with a number of arrogant physicians, both personally and professionally, but I've also met an equal number of corporate CEO's, school teachers, salesmen, sales clerks and even general laborers whose attitudes needed a good bit of adjustment. I think that characterizing one profession in and of itself as one of "entitlement" is a little short sighted.
As to physician compensation, remember that all these folks spend 4 years in college studying molecular biology, chemistry or something equally fun, then go to medical school for three more years, then take 4 years of internship & residency training (and then a fellowship, if they can spare another year or two) and one as almost 12 years spent in training before opening the doors of your practice and earning your first real nickel. I happen to know this to be true...I have a young radiologist in my family, and after paying his student loans, mortgage and car payment each month, there is not a lot left over.
Yes, most physicians are rather well compensated, and I am sure there are some who make outlandish money, but again, to say that earning $123k a year is too much, I respectfully disagree. Now, if you want to argue about compensation of professional athletes and college athletic coaches, I'm totally on board with you there....
I guess that while I'm usually the very last guy that will usually waive the physician banner, I think your post misses the forest for the trees. With all due respect, of course...
But that's just my two cents.
thanks lawguy,
and comparing salaries to the general population rather than comparing it to another profession with more equal educational levels and time spent in formal training, you will find the salaries are not as far off. But comparing to everyone with minimum wage jobs, little formal education and grouping them all together is misleading.
We have problems in healthcare. Things need changed and it will take persistance and a different mind-set.
No one has ever waited in my office for that length of time and I would change physicians if that were an ongoing issue.
LawGuy and HB: I think you are missing the point about the income issue. It is not so much that the income earned is out of line with other similar professionals as it is that doctors as a group are already well compensated. They appear greedy or silly when they expect taxpayers to constantly dig deeper to help MD's maintain life styles that most taxpayers can only dream about.
Thanks for the thoughtful response, Lawguy. Certainly, an entitlement blanket doesn't cover all physicians (nor attorneys, for that matter, judging by your moniker).
However, much-higher-than-average physician salaries most certainly contribute to the high cost of medical care and need to be considered when examining the state of our health system and possible remedies. After all, HB has often pointed to the high salaries of administrators and corporate officials as part of the problem. While I tend to agree with him on those points, it's hardly fair to whip them with that yard stick while refusing to apply it to others who reap great profits from the system.
Doctors, regardless of motivation, undoubtedly have legitimate grievances that should be addressed. The situation, though, is often presented as if large numbers of physicians are struggling to make basic ends meet and that's simply not the case in a majority of situations.
Whether or not the average family doctor deserves their position in the upper 15% of all wage earners is debatable but to casually dismiss such income discrepancies as immaterial breeds the exact resentment expressed by a lot more people than just anonymous Internet trolls and further justifies doctors being stereotyped as arrogant, out of touch, etc. Let's just call it what it is, rather than painting a picture of someone struggling to eke out a living on six figures.
BTW, medical residents and fellows often earn more per year than the national average wage. I'm sure it changes based on hospital and region but numbers around $40K are common.
Lawguy ... welcome to the blogosphere, and your strong stance against anonymity is much appreciated.
Bluegill - I'm delighted that my earlier note was recieved in the spirit in which it was intended. Its sometimes hard to gauge "tone" in emails, and I hope we can all discuss, debate and even argue points while understanding its all done with mutual respect.
New Albanian - I'm glad to be dipping my toes into the "blogsphere" (as you call it). It should be an interesting ride. As to your stance on anonymity, I wholeheartedly agree. If one feels strongly enough to speak out loud, especially if being somewhat critical, one should be brave enough to stand beside one's thoughts. I have no trouble with strong and sometimes cutting debate, but to do so behind a veil of anonymity is pathetic.
I think the question of compensation, especially if raised in earlier posts by HB, is certainly relevant to the discussion about medicare cuts. However, in my view and experience, the most troubling facet of health care right now is not the physicians' efforts to seek higher rates of reimbursement, but rather, the appalling corporate profits and salaries of healthcare executives and insurance corporate executives. I'll look later in the archives for HB's earlier post, as I do know not the levels of compensation given to our local CEO's. One can only imagine the bonus and incentive packages tied into the performance of the new ER and Cardiac Surgery wings....
However, I was incredibly appalled last year at the article in the Courier-Journal about the two "retirement packages" in the amounts of $10 million and $5 million to the retiring CEO and VP of Jewish Hospital, especially in lieu of the Hospital's $20 Million net loss that year. Yeah, I'm sure there is some profound accounting explanation to explain why the retirment parachutes and the operating loss were not interrelated, but it defies my common logic. Where was the public outrage then?
Why does the public criticize the physicians who are actuallly performing the health care servies and turn a blind eye to the corporate world reaping the benefits of our ever increasing health insurance premiums?
Does anyone ever look at their EOB's in the mail after seeing a physician to see what amount of reimbursement is being given? The suggestion was made earlier to halve the number of patients. Perhaps physicians wouldnt need to see so many patients if the insurance companies paid their charges and didnt write off so much.
Dont get me wrong, I have my own professional issues with the medical community. I'll be glad to debate tort reform another day. However, its not the physicians who are wrecking our system of healthcare, just as its not the lawyers and the "malpractice crisis" as the AMA has suggested. Its corporate America, pure and simple.
Ever been to the Humana Suite at Churchill Downs? What about the Jewish Hospital Suite at Papa John's Stadium? I often wonder when I'll get my invitation to enjoy a game at Papa Johns or a day at the races in their boxes when writing my health insurance premium each month. For some reason, I doubt that day is coming...
Anyhow, my point is simply that yes, physicians make a very nice living. Many lawyers do too. There are some business owners in town that do quite well too. However, as a whole, I do not see physicians as greedy folks as a whole.
Again, just my own two cents.
What is disdainful by taking issues with threats. You said: "Otherwise, just as with Medicaid here in Indiana, more and more physicians will cease seeing new Medicare patients."
Granted Healthcare is broken but with statements like that some Physicians are not trying to help fix it.
Thanks Bluegill, you said it all.
Quite eloquently, I might add.
Well Hungarian (…a clever name, by the way)
I certainly did not intend my comments regarding the compensation package given to the Floyd CEO to be a "blow" against him, and in looking at my thoughts again, still do not feel they were any kind of personal attack, subtle or otherwise. I’m not sure why you seem to think they were intended as such.
However, having actually reviewed a number of physician provider agreements and executive compensation agreements in the health care arena myself, its no great secret than the compensation package for many healthcare executives these days (and physicians too!) often contain significant incentives (i.e. bonuses), which are in turn tied to performance in a number of areas. Thus, it’s really not an insult to suggest that (or wonder if) the Floyd CEO's compensation may have incentive based bonuses for the performance of the new product lines being offered at Floyd which he, in essenece, pushed through. If anyone has information either way, I'd be curious to know.
Suffice that it’s not my intention to bash anyone, at least, not in the postings on this topic. I will reserve the right to be more direct in the future, and I’ll definitely be more candid.
However, I do think it’s a legitimate question whether “keeping 300 to 350 heart patients in New Albany” is worth the outlay of tens of millions of tax dollars in county bonds. I think the “economic impact” that you believe might exist, after the expenses to do so are considered, may well be in the red. As tax payers, I think it’s a fair question for all of us to debate how we, as Floyd County residents, are being “served”. Being a visionary is one thing; but spending millions of dollars wantonly is another. I think the jury is still out on this one.
And, by the way... the number of hearts operated upon at Floyd this year will fall rather short of the 300 mark. Not that future years might not increase, but it’s not going to happen this year by any stretch.
By the way, for purposes of accuracy, the number of heart surgeries to date is just over 70. [See "Chairman's Corner" page on the Floyd Memorial website]. As the program did not commence until March, a "12 month" total would approximate 100 hearts.
Again, the number may well increase in the years to come, but to the extent its been suggested here that the investment will mean "300 to 350 hearts" a year, at this point, its a long way off.
300-350 per year would imply that approximately 1 per day was being sent to Louisville. This # is far from accurate.
To my mind, the city's annual contribution to the YMCA/Scribner Place project, and the conceptual basis of it, differs from the hopsital/heart thread in at least two substantive ways.
First, $137,000 a year is miniscule.
Second, this expenditure has not yet led to a juncture where the YMCA leverages its position to prevent local competition. I seem to recall this being the case with the hospital.
Apples and oranges to me, but perhaps I'm misreading.
Regarding the state of today's healthcare industry, I conintue to see the description of the problem (largely framed in terms of doctors' income levels), but nothing even approaching possible plausible solutions. Now we have the suggestion that the problem lies in the the profit levels and executive compensation of the big healthplan companies and that if the governement would (somehow) regulate these, then the doctors would receive higher reimbursements?
Anony 11:11 a.m.
While I'm definitely aghast at the profit being earned by the insurance companies and many healthcare executives in the face of the increasing issues in our healthcare system, I absolutely do NOT think the solution lies in governmental regulation. I dont want the goverment telling anyone how much they can and cannot earn.
However, figuring out the solution is a sticky wicket for sure. I dont know enough about socialized health care to know whether its an option, but i seem to doubt it. I guess i just cant believe that there isnt a way that the physicians can somehow unite and unify themselves AGAINST THE INSURANCE CARRIERS that they'll no longer accept the ridiculously low rates of reimbursement, or the write-offs of their charges. How to accomplish this, however, is more than I can figure out.
There are plenty of ways physicians'could unite and thus weild more market power, but they would have to give up their ownership of the small medical practices that make up the present "cottage" industry and merge into larger provider groups. This would also require capital investment - also not sometning doctors like to do. In short, even with all the carping they like to do, I think most MDs conclude that the present system is more profitabble than what these other alternatives might produce.
While I certainly agree that the insurance corporations play a larger role in distressing our medical system than doctors, I'm not sure it's been established that reimbursement rates are ridiculously low.
I think it's safe to say that insurance premiums are ridiculously high given current reimbursement rates but that's an entirely different argument.
If we simply require insurers to raise reimbursement rates, they'll make a little less and doctors will make a little more. Patients, taxpayers, and business owners, however, will be stuck in the exact same position.
The focus should be on lowering premiums. Unfortunately, the AMA and a lot of doctors have totally bought into the malpractice myth, letting the insurance industry off the hook while increasing the burden on patients. That's not only ridiculous, it's really poor strategy in garnering public support for a united effort.
Bluegill wrote:
"the AMA and a lot of doctors have totally bought into the malpractice myth, letting the insurance industry off the hook while increasing the burden on patient".
I say "Amen, brother".
I would also add that your point about the difference in high insurance premiums vs current reimbursement rates is well taken.
Lawguy,
Based on your earlier use of quotation marks, I thought you may agree about malpractice. It accounts for only one half of one percent of overall healthcare costs.
I'd be interested in hearing your views of tort reform. The insurance industry's own studies reflect that capping pain and suffering damages does nothing to reduce premiums. The companies assume less risk, keep upping premiums for both doctors and patients anyway, and just put the extra money in their pockets.
Meanwhile, the average insurance CEO makes more money per month than the $250,000 lifetime cap they say should adequately compensate someone who's been legitimately maimed, blinded, or disfigured.
If doctors, lawyers, leftists, conservatives, etc., want to make a substantial difference in health care and elsewhere, we really need to collectively reexamine what passes for economic justice in this country.
Bluegill -
Not surprisingly, I have a lot of thoughts on tort reform and caps, but I'm too weary today to go into in detail after a long night spent listening to the wind. Plus, I dont want to hijack this thread any further than I already have. I'll either email you my thoughts, or touch on it in future posts which are directly related to the issue.
Suffice that your thoughts about the monthly earnings of the CEO's in favor of tort reform exceeding the lifetime cap on damages for the injured sums up the argument rather nicely.
I am in favor of limits on damages, just not to the ridiculous extent proposed by the President (and also in the Kentucky sentate) of $250K. Limiting the insane run-a-way verdicts we see on TV from Florida, California and Texas is not a bad idea. Just not to the inherently unfair and arbitrary sums proposed by Congress.
Again, we'll talk more another day.
Let's see, 33% of $250,000...Why you're right, that is unconscionable.
Should the very top earning attornies representing plantifs in these medical malpractice suits have their incomes limited also?
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