Doctors once you are over 70

[mtwarden]

While hospitals and drug payments are paid at cost plus, physicians are paid by medicare on a fee schedule based on 1968 fees.

Happen to have a link for this?

 

[yfarm]

Happen to have a link for this?

https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.8.1.5?journalCode=hlthaff

The Medicare Fee Schedule unveiled: an account of physician payment reform - PubMed

On January 1, 1992, the Medicare program unveiled a new method for paying physicians known as the Medicare Fee Schedule (MFS). The new fee schedule is a complex system of administrative pricing based on the resource inputs used in producing physician services. The MFS consists of three parts...

pubmed.ncbi.nlm.nih.gov

You may or may not want to continue reading, apologize for the lack of paragraphs. To appreciate how medicare devalues care look at a medicare beneficiary notice on yourself or someone you know on medicare and think about rural health care where most patients are on medicare or medicaid. Medicaid pays below medicare.

After the implementation of the changes in 1992 we saw continued manipulation of rvu valuation downward for various services and bundling penalties that prevent you from doing multiple things on the same day.
Examples Left heart cardiac cath payment was $900, now $200 and falling.
Cataract replacement do one eye get paid $200, do both $200, used to be $900,so no one does both on the same day. Work up a new lung cancer patient, do a brain MRI, Pet Scan and biopsy on the same day get paid for one procedure versus doing each on separate days on paid for each one.
For radiologists the original procedure everything else was compared to was a chest xray which was one rvu, now a ct scan is one rvu and paid at the same level. Read recently the only group that received a pay increase for 2024 were nurse practitioners and PAs. Plumber I know told me he charges $250/hr and if people dont like it find another plumber, said he couldn’t imagine having the government dictate to him what he charges. The mandate for electronic medical records was the last straw for the independent primary care practice due to cost.
If you fail to document specific words in your office notes, medicare penalizes you by 5-10% for the visit. Procedure reports are required to have specific words used or payment is denied. Surgeons are paid one fee for an operation with no payment for presurgical consults or follow up care, spend all the time you think the patient needs but we won’t pay for your time. How many businesses function in this environment? Only way out is to become nonparticipating or work for someone else that can hide your costs in a non rvu based payment system as the hospitals do. Think about hospitals along the border where uncompensated care to illegals may exceed 50% of their care, and are mandated to provide it under federal law. Border patrol used to turn pregnant women back at the border back in the 80s, rules changed to require passage then go to the closest hospital to deliver a new US citizen with preferential immigration of the parents, so called chain migration. All OB care from the physician and hospital uncompensated. This goes back 40 years now.
Pretty dismal outlook and haven’t mentioned the entry of private equity into medicine and the drivers there. Elizabeth Warren recently admitted that there were unintended consequences to Obamacare that are only now being recognized. Vertical integration with pharmaceutical and insurance companies buying multiple health systems. So when you see changes in your local medical community which all seem negative understand the drivers are almost entirely the federal government.
I loved what I did, I think at least once a week about returning to work. Was sitting in a blind hog hunting a couple of years ago and phone rang, it was a gyn 1400 miles away calling me about a patient of his I saw the week before and wanted to know why I was whispering, explained I was hunting, he apologized, I said nonsense. Being given the privilege of caring for people in some of the most difficult times of their life is immensely gratifying and makes you forget about all the other crap on the periphery.

Rant over, sorry for the length.

 

[willfrye027]

https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.8.1.5?journalCode=hlthaff

The Medicare Fee Schedule unveiled: an account of physician payment reform - PubMed

On January 1, 1992, the Medicare program unveiled a new method for paying physicians known as the Medicare Fee Schedule (MFS). The new fee schedule is a complex system of administrative pricing based on the resource inputs used in producing physician services. The MFS consists of three parts...

pubmed.ncbi.nlm.nih.gov

You may or may not want to continue reading, apologize for the lack of paragraphs. To appreciate how medicare devalues care look at a medicare beneficiary notice on yourself or someone you know on medicare and think about rural health care where most patients are on medicare or medicaid. Medicaid pays below medicare.

After the implementation of the changes in 1992 we saw continued manipulation of rvu valuation downward for various services and bundling penalties that prevent you from doing multiple things on the same day.
Examples Left heart cardiac cath payment was $900, now $200 and falling.
Cataract replacement do one eye get paid $200, do both $200, used to be $900,so no one does both on the same day. Work up a new lung cancer patient, do a brain MRI, Pet Scan and biopsy on the same day get paid for one procedure versus doing each on separate days on paid for each one.
For radiologists the original procedure everything else was compared to was a chest xray which was one rvu, now a ct scan is one rvu and paid at the same level. Read recently the only group that received a pay increase for 2024 were nurse practitioners and PAs. Plumber I know told me he charges $250/hr and if people dont like it find another plumber, said he couldn’t imagine having the government dictate to him what he charges. The mandate for electronic medical records was the last straw for the independent primary care practice due to cost.
If you fail to document specific words in your office notes, medicare penalizes you by 5-10% for the visit. Procedure reports are required to have specific words used or payment is denied. Surgeons are paid one fee for an operation with no payment for presurgical consults or follow up care, spend all the time you think the patient needs but we won’t pay for your time. How many businesses function in this environment? Only way out is to become nonparticipating or work for someone else that can hide your costs in a non rvu based payment system as the hospitals do. Think about hospitals along the border where uncompensated care to illegals may exceed 50% of their care, and are mandated to provide it under federal law. Border patrol used to turn pregnant women back at the border back in the 80s, rules changed to require passage then go to the closest hospital to deliver a new US citizen with preferential immigration of the parents, so called chain migration. All OB care from the physician and hospital uncompensated. This goes back 40 years now.
Pretty dismal outlook and haven’t mentioned the entry of private equity into medicine and the drivers there. Elizabeth Warren recently admitted that there were unintended consequences to Obamacare that are only now being recognized. Vertical integration with pharmaceutical and insurance companies buying multiple health systems. So when you see changes in your local medical community which all seem negative understand the drivers are almost entirely the federal government.
I loved what I did, I think at least once a week about returning to work. Was sitting in a blind hog hunting a couple of years ago and phone rang, it was a gyn 1400 miles away calling me about a patient of his I saw the week before and wanted to know why I was whispering, explained I was hunting, he apologized, I said nonsense. Being given the privilege of caring for people in some of the most difficult times of their life is immensely gratifying and makes you forget about all the other crap on the periphery.

Rant over, sorry for the length.

That was a good rant. I am at the beginning of my career and it is painful to think about how much better things used to be in medicine. I do love my job and wouldn’t change a thing. Most of the other physicians I interact with are good people who are doing the best for our patients. The system is more or less broken and it makes the job that much harder.

I will say, if you are someone who wants/needs more time with your physician, consider buying better health insurance. We just had a kid and put him on my wife’s PPO plan instead of my crap HMO plan. That opened the doors to the better pediatricians in our town who won’t take HMO. We’ve had excellent in office care and the practice is not trying to cram a million patients through the doors.

Don’t be afraid to shop around a bit. Even different doctors in the same office. Personality is a huge part of it and some physicians are able/willing to spend more time and stay later than everyone else to do clerical work.