Thursday, April 2, 2009

Reimbursement Shift

A topic I think worthy of some discussion. Should we decrease surgical and specialty reimbursements, or rather reimbursements for interventional procedures, and simultaneously increase payments for primary care?

Essentially, If I were health care "czar", my first action would be an across the board cut of 30% in payments (CMS) to surgical specialists and interventional radiology, cards, etc.etc.etc. And then increase reimbursements by 15% for primary care and hospitalist care. Emergency Room visits would remain stagnant, but not decrease. This would result in substantial health savings, and could start to address the issues in health reform that we face.

What say you?


Qkwan said...

I think this is a great idea. Primary care is under-appreciated. To cut surgeon's pay, it would probably help to place a cap on lawsuits or something to reduce insurance costs. At least that's my understanding of it as a first year student.

Bad Medicine, Good Solutions said...

Primary care doesn't need a shift from the government trough. Society needs to realize that it must pay for routine medical care out of pocket and only purchase catastrophic insurance plans to use insurance as it is intended. Our nation spends billions on CAM. If we have this much disposable healthcare dollars we can afford cash for a primary care physician. Priorities must be realligned.

physasst said...

In an ideal scenario, this is true, however, there are too many people that simply cannot afford to do this. Whether through poor financial decisions, or simply not enough income, they won't do that. People will simply forego medical care until problems become markedly excacerbated, and therefore markedly expensive. This is the problem with healthcare. Free market advocates, and believe me, I am, want healthcare to function like any other market, but it doesn't, it doesn't fit into the traditional free market paradigm.

Anonymous said...

Why should ER docs be stable? A typical private practice ER doc working 14-16 shifts a month will bring in 250,000-350,000 per year (or more). Oh yeah I remember now, you work there. NIMBY economics.

physasst said...

The last number I saw, which is likely in 2007 dollars was 227, 956 dollars, and if there are ED phyicians making over 250k per year, than YES, there should be reduction in ED reimbursements as WELL. I am not against ED cuts, but rather against cuts in areas that don't have substantial potential for improvement in payments.

Anonymous said...

That's all comers. Full time ER docs make more than 220 K. Believe it.
But let's change the argument
Most PA's I have met make a very nice five figure and fairly regularly low 6 figure salaries. Not bad money for an advanced two year degree. How about if I am king for a day (call me Obama), and I decide that you are way overpaid compared to a lowly FP making 120-150 K. How about if I knock down your "overpaid" PA salary and give it to the FP/MD. Heck they have spent 7+ years since undergrad including a 80plus hour a week residency whereas you spent two years with no real call. They take night call by themsleves, you don't. In reality your just have a two year tech degree with one of them watching your back at all times......

Sarcasm off: You see PA things are a little different when it is your field that is being minimized.

physasst said...

I would accept a small pay cut if it was needed. A large one, no, but I don't believe my services are consistent with a "two year tech" degree.

Oh, and when I was a student I did every third night call on my clinical rotations, and when I first started working, the department (Neurosurgery) at a different facility had me take every third night call for the first six months. I also know a LOT of practicing PA's that take call. So that is simply not true.

Oh, and if we don't try to fix the system now, we are ALL going to see paycuts, and I mean EVERYONE in healthcare. I am not trying to minimize anyones contributions, nor their profession, however, we have physicians in some specialties making obscene amounts of money. Nero indeed.

Anonymous said...

Come now you take call with MD backup...ALWAYS.

The small minority of PA's I have worked with take call. Again always with MD's.

But that is not the point.

"Oh" I see you didn't like it when someone else minimized your training...Pot meet kettle.

"Oh" and why you as king Obama you will take a "small" pay cut but not 30% as you forsee for overpaid specialists.

Most of those "overpaid" specialists
spent 9-12 years post-undergrad slaving away 80-100 hour weeks (pre 2003). About 5-6 times in year's your training, more than that in hours. I don't begrudge them a salary that is not even anywhere close to american executive level. I know a PA with their two year degree can make close to a six figure salary (actually fairly easily over 6 figures in private subspecialty practice). Following your reasoning your field could take a pretty big pay cut. I don't subscribe to that view. Frankly when you look at the hours put into training and the number of hours actually working per month an "overpaid" neurosurgeon or vascular surgeon gets screwed relative to an ER doc. Yeah rads is an outlier, but the simple fact is that in general young radiologists have lost their clinical interest. Frankly most of them are assholes when you try to actually speak to them about a patient. Oveseas telerads for the masses (not nighthawks) is on the horizon. Once the malpractice issue is worked out, market issues will come into play. At that time, then rads will have their golden egg taken away, which to me is not a bad thing. Frankly I woould rather talk to a radiologist in Bombay or Kiev who actually is interested in my patient than some american asshole radiologist.
But we digress, the answer lies not in "cutting reimbursement" by 30% in what you view as "overpaid" specialties, rather in making hard decisions in rationing care as a society. For all your whining about how some doctors are overpaid, the simple fact is doctors account for barely 20% of all medicare expenses....period. You could cut us (and you by the way) to zero, and the same problems would still exist. A system that will go broke in the coming decade. I am sure you know that over 1/2 of all dollars are spent in the 6 months of life and a small minority actually use the vast majority of health care facilities. We have tough decisions to make as a society. Cutting those "overpaid" specialists will not do squat, any more than the AIG executives giving back their 165 million will have anything to do with 180 billion pumped into AIG. It might be a populist thing to do, but it will not change the equation. We as a society need to realize that we cannot provide everything to everybody all the time. Look at the big picture here.

physasst said...

I have, and I have a whole nother post about rationing of care, as that needs to be an important part of the discussion.