Insurers to pay doctors 30-40% less under exchange plans.

[eridani]

http://www.kaiserhealthnews.org/Stories/2013/November/19/doctor-rates-marketplace-insurance-plans.aspx

Doctors Complain They Will Be Paid Less By Exchange Plans

Many doctors are disturbed they will be paid less -- often a lot less -- to care for the millions of patients projected to buy coverage through the health law’s new insurance marketplaces.

“As it is, there is a shortage of primary care physicians in the country, and they don’t have enough time to see all the patients who are calling them,” said Peter Cunningham, a senior fellow at the nonpartisan Center for Studying Health System Change in Washington D.C.

If providers are paid less, “are [enrollees] going to have difficulty getting physicians to accept them as patients?”

Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors.

Comment by Don McCanne of PNHP: Insurers will be paying physicians less through their exchange plans than they do through their existing commercial plans. If the rates turn out to be typically 30 or 40 percent less, as this article suggests, they will have problems maintaining adequate provider networks. An insurance card is of little value if you cannot find physicians who will accept it.

As we said from the start, those designing health care reform were making a terrible mistake when they decided to make health insurance premiums affordable while largely ignoring health care costs.

Look what they did:

* They assigned very low actuarial values to the plans that most individuals will select, leaving 30 to 40 percent of health care costs to be paid by the patient, though some will receive inadequate subsidies.

* They designed plans with very high deductibles, causing the large percentage of patients who need less care to receive virtually no sickness or injury benefits from their plans.

* They reduced the size of their provider networks which will reduce spending by making care less accessible, especially specialized care.

* Now it appears that they will be reducing provider payments to levels that will be rejected by many physicians. Although employer-sponsored plans are moving in the same direction, it is likely that many physicians will limit their practices to these plans and cash-paying patients, while avoiding patients in the exchange plans and the chronically-underfunded Medicaid program.

* As part of the SGR fix, legislators are considering not allowing any inflationary increases in the Medicare program for the next ten years - keeping the payment rates flat. If so, physicians are apt to leave the Medicare program as payment rates approach that of Medicaid.

As we approach $3 trillion in health care spending, this is criminal! For that kind of spending, everyone could have high quality health care. Instead, we get a system that perpetuates disparities in health care while creating financial burdens for precisely those individuals who most need health care.

The entire health care system will not collapse, but this experiment will perform so miserably that most will consider it to be a failure. We don’t need to go back to the drawing boards. We merely need to enact a system that we already know will achieve our goals - an improved Medicare for all.

[tridim]

1. Why do all these "experts" always ignore economics 101?

As long as the insurance companies exist, let them fight it out with the providers... This is EXACTLY the way to implement legal price controls on the cost of health care. Market rules.

[eridani]

12. The market will always say that sick people should be executed for not having money

Fuck the market.

[tridim]

56. That's not the HC market, that's the investors.

The investors need to understand that things are going to change. If they don't like it, simply disinvest.

[eridani]

138. Markets have no legitimate role in providing public goods

Shopping for health insurance is as ridiculous as shopping for a fire department.

[JaneyVee]

2. Doctors in the US are paid way too much as it is.

[hobbit709]

4. some but not all.

[cherokeeprogressive]

5. What's your solution for that? Make it easier and cheaper to BECOME a doctor?

I'm curious to know how you're going to force them to work for less pay. Indentured servitude?

[Puzzledtraveller]

7. Exactly, what's the average length in school and student loan debt

for a doctor?

[JaneyVee]

9. I agree. Making it easier, cheaper to become a doctor would be a great step.

In France and most of Europe it's virtually free. They get paid much less than US doctors but they also have no student loans/debt.

[cherokeeprogressive]

13. That would have been the major tenet of my ACA.

Flood the country with doctors.

[JaneyVee]

17. I like your solution. We should also subsidize engineering degrees and other

Degrees as well to keep the best here in America.

[yeoman6987]

105. Doctor

You are absolutely wrong to say they should make it easier to become a doctor. I don't want any doctor who has it easy. I want the vigorously trained. I had a upper GI done in Italy and they still use old equipment and were even smoking during my procedure. My wife told me as she stayed in the operating room the whole time. If you think Europe is better than America with medicine then you better wake the heck up. You are wrong 100 percent!!!!

[Thinkingabout]

126. Having recently experienced health care in France for a broken leg and the upon my return to the

US had to wait 12 days to see an orthopedic. When I went for medical treatment in France I was seen by a doctor, had x-rays, saw an orthopedic specialist, had cast placed on my leg and leaving within 3 hours. The long lines is in the US. BTW, I paid $36 for my services in France. You receive much more treatment in France than you do in the US, we are better than this.

[mainer]

168. Because the French don't have the for-profit middleman

It's the "for-profit" middleman part that screws up US health.

[Thinkingabout]

170. I think you are right and I did not experience long waiting lines or months for health care.

I was reading today about health insurance company CEO's getting $83M in compensation, if this amount was directed to health care we could perhaps have $0 premiums.

[cherokeeprogressive]

181. I wasn't referring to training. n/t

[lumberjack_jeff]

189. The AMA won't allow that.

The AMA is the most effective trade union in the US.

[gasman09]

15. long and hard and expensive

Average length is 12 yrs. Give or take depending on specialty. Average dept is approximately $200,000. Residency programs are grueling, with 80 plus hours sent at the medical facility and countless more hours prepping and studying for your next day case load. Many people say healthcare providers are paid to much, but you don't take in account for the sacrifices they make to provide care to people and to save lives. By not accounting for that many are saying the a life is worth a set amount of money. As a anesthesia provider, I spent 10 hrs in the OR yesterday and then was called back in for three traumas and laboring mom spending most of my night at the hospital. Also have cases to do today. Saw my wife and daughter for approximately 1.5 hr in the last 24 hrs and missed my daughters first swim meet. Yes I know that I chose this profession and love what I do. But at the same time there some be compensation for the sacrifices healthcare providers and there families make to provide quality healthcare. Medicare and medicaid payments many times don't even cover the cost of the care provided to the patients and there for care is provided for free. I no other profession do you expect something to be done for nothing.

[JaneyVee]

18. Don't you get paid an hourly wage as well?

[gasman09]

20. Salary plus production bonus

Many healthcare provider have a base pay with a production bonus at the end of the year. And production doesn't mean per patient we see. It means covering all the cost of doing the care first and if there is anything left then a percentage of that will be part of the healthcare providers wage at the end of the year. But when reimbursement is at or less then the cost of doing the care then you do the care for free. I don't know of any healthcare provider that gets paid by the hour. If so hospitals and clinics wouldn't be able to afford the cost.

[Chuuku Davis]

117. You are kidding right?

[gopiscrap]

21. welcome to DU

[hfojvt]

32. and your average annual income for the last five years?

here's mine

2013 (so far) - $27,915.51
2012 - $31,329.74
2011 - $15,814.01
2010 - $13,130.28
2009 - can't find my tax form (okay, I found some parts of it, made $26, 463.25 including $15,181.31 in capital gains from some land I bought in 1987. So wages were about $11,000).
2008 - $11,968.74
2007 - $10,640
2002 - $10,198.29

I think that's a little bit more than five, but you know math majors can't count.

Did I mention I went to college for seven years and have two degrees?

[gasman09]

47. Envy is not becoming

Did I mention that I went to college for eight years and four years of residency. Did I mention if I make a mistake I can kill someone. I can't erase my mistake with a eraser and recalculate. Did I mention that I pay $28,0000 a year in malpractice. Did I mention that I have to have continuing education that I have to pay for at approximately $3000. Not including travel cost to get to them and the cost to keep my board certification. Did I mention that I have $175,000 in student loans. I can write a recommendation for you to go to medical school if you want through the rigorous education and training. I worked hard to get where I am at and I will not be made to feel guilty for my hard work!!!!!!!!!!

[hfojvt]

50. who said anything about envy?

you were talking about how tough you have it, and you continue to do so, but don't want to talk about how much you GAIN from your profession.

All those expenses.
All those unpaid hours.

Okay, fine, but how much do you take home? Like Smokey THE Bear says "Only you" can provide that data. Until you do, you are only telling half the story.

But let's not invade your privacy. No need for the nearest penny. How about a range? Multiple choice

a. over $50,000
b. over $100,000
c. over $150,000
d. over $200,000
e. none of the above

Envy is one thing. But if I look at a doctor and say "wow, you sure are rich" and then also notice that I have to pay about one DAY of my wages just to visit a doctor for fifteen minutes. It seems to me that at least a little bit of that doctor's high income is coming out of my hide.

Why about the emotion of empathy? Should the doctor feel some for those who make much less money. Or should he/she wag their finger and say "don't be envious. I worked hard (unlike you) so I deserve to be rich (unlike you)"

[uppityperson]

53. You pay 1 day of your wages to visit a doctor, true. How much of that does the doctor keep?

For me, a local visit to PCP is around $140. Let's say the doctor busts ass and is able to blow through 3 patients an hour (don't forget charting time). That means the facility makes $420 an hour. Oops, I mean charges that. Insurance pays the facility half, the other half is written off. Cash pay/no insurance, means they make maybe 2/3 of that since they typically provide a discount and then there are those who don't pay.

So, that drops it down to $210-280/hour. As people with insurance typically pay copays, rough it up to $260/hour. (could be a bit more or less, am using rough numbers).

Staff gets paid salary. Receptionist/billing, nurse/med assistant, computer tech person are the 3 main people needed. Oh, accountant also for taxes, etc. Let's pay them $15, 25, 25 an hour, but with benefits which doubles the cost. $65 X2= $130/hour for staff.

Now income is $130/hour.

Rent or loan payment for facility, electricity, heat, landline, telephone book monthly payment.
Continuing Education, mandatory.
Facility insurance.
Malpractice insurance.
Equipment, office and clinic/medical.
Office supplies, papers, etc.
Clinic supplies, gloves, table paper, tongue depressors, paper gowns or laundering of cloth ones, etc.

These are off my head basic costs of running this business.

There is no monetary cost to the stress of dealing with life and death. That doesn't cost money, but it does cost.

How much is left after all that to go to the doctor? How much of that goes to repay those huge student loans? How much do places that loan money at interest love to pull in said doctors, basing it all on predictions of being able to work and get paid decently for a number of years?

[hfojvt]

67. insurance pays half of that

and if you have no insurance, they don't give YOU a 50% discount.

[uppityperson]

71. I wrote ins pays 1/2, write off the rest. If you pay cash, typically there is a 10% discount, and

then there are those whose insurance does not pay and neither do they, ever. Since most of visits are paid by insurance, even more with the insurance part of ACA coming into play, I weighed that heavier.

[treestar]

120. still a lot

I mean, come on.

And the student loans will be paid off one day.

[uppityperson]

123. My PCP clears around 50K a year for 4 days a week. That is "still a lot"?

Talk to your PCP, or family practice doc that you might know. Their net income is not huge.

[treestar]

125. It should be respectably middle class but not huge

If by PCP you mean general practitioner. I don't know that the job is so terribly difficult. Nine to five type hours, simpler cases. Maybe I can be enlightened. The only danger is maybe not sending someone to a specialist with reason to. Though I would hazard a hypothesis they are the least sued for malpractice (the professional's big worry).

[uppityperson]

128. Just because a clinic's hours may be 9-5 does not mean that is the hours worked.

Having worked in several clinics, at minimum it would be 8-7 often staying later due to late patients, charting, telephone followups, etc. And I do not know what you mean by "simpler cases" as PCPs are the gateway to specialists, who people with problems typically see first, as well as working hard to keep patients from needing specialists. You don't think their job is "terribly difficult"? Do you understand that they have to know enough about a wide range rather than a lot about a few things? I do not think you get how much knowledge a Family Practiec or PCP has to have.

And their big worry is not being sued, but missing something, having the patient come to harm becaus eof aomething they did or sid not do. Being sued is taken care of by large insurance premiums but having caused or not stopped something or even being too late or dealing with a patient who is fine harming themselves? THAT is the biggest worry.

As far as malpractice rates, I found this link. I haven't read it yet but wanted to share.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204310/

[mainer]

147. "9-5 type hours, not terribly difficult?"

Wow. You make being a doctor sound like secretarial work. In which case why bother to go to a doctor for anything? Just do it yourself.

[treestar]

151. 9 to 5 types hours covers a lot of professionals

It is not just secretaries that do that.

I am making the point that a lot more people might be qualified to and want to be doctors, especially general practitioners. Also there are people willing to use midwives and nurse practitioners for simpler things. That would lower health care costs a lot. It's the AMA that makes them out to be dangerous etc. and limit the number of people who can graduate.

[mainer]

154. No, the AMA has been trying to increase # of medical schools

But medical schools are incredibly expensive to start and maintain. Who starts a medical school program? Colleges and universities. Who pays for most colleges and universities? State budgets. Which states are rolling in dough and ready to fund a brand new institution?

[treestar]

159. If it would lower health care costs

There might be good arguments to get states to contribute.

If we had single payer, to lower taxes that would pay for it, it might be do-able.

They probably cost so much more due to technology. I was wondering why college costs are so much higher in general, and it's probably because everybody has to have computers now.

[mainer]

155. And it's NOT just "9 - 5."

Who visits hospitalized patients, and when? What happens on weekends and nights? Do people only get sick during the day? Do secretaries get called in every weekend for emergency dictation?

[treestar]

160. They can.

I've heard of secretaries having to work at odd times over things like that.

Everyone works hard long hours in this country, if they can stay employed. It's practically bragging rights to some people. Nobody has a monopoly on that.

[gasman09]

58. discount

So you are saying healthcare providers should have the same take home pay as? I love it when people say healthcare provider do feel empathy for those less fortunate. There are a lot of expense to run a clinic. You have nurses wages, transcription wage, electric, heat, insurance, and supplies. So not as much of your fee to see the healthcare provider goes to the physician. Never said you didn't work hard and I am by far from being "rich". And I wasn't waging a finger at anyone. Just saying healthcare provider have great responsibility and risk and with that comes a cost.

[hfojvt]

69. "envy is not becoming"

that sure seemed like finger wagging, and like a lack of empathy.

Like others with high income, you seemed to say that your hard work justifies your high income. Which seems to imply that people with lower income "just don't work hard enough" and "by the way, why don't YOU goto medical school" or in some other way "pull myself up by my own bootstraps".

You are far from being rich? So the answer was "e"?

[gasman09]

75. Not "e"

First of none of your business what I make!!! Secondly, It is not "e". And not saying anyone isn't working hard. Just saying because of the adherent risk of taking someones life in your hands and if I make a mistake my career could be over and someones life could be lost. If anyone is waging a finger, it is you. Saying that my education experience and risk for caring for someones life isn't worth what I make. When is the last time you held a dying baby in your arms, when was the last time you place a needle in someone's back knowing that there is always the risk of paralyzing them. Every time I put someone to sleep there is always the risk that they have a heart attack, stroke or many other complications. Are you will to take that risk into your hands. I have and will continue you to do so. So all I am saying don't bitch about the money I make if you are not will to take no those same risk!!!!!!

[hfojvt]

87. sounds to me then

like you have conceded post #2

"doctors in the US are paid way too much as it is"

But "the haves" always think "I deserve it" for one reason or other.

Of course, it is none of my business what you make, but if you claim "I am far from rich" that is meaningless without some admission of just how much you make. Rich people are constantly whining that they do not have enough money, and want to define the word "rich" so that it only includes those on the Forbes 400, or maybe even just the top 10 of the Forbes 400.

And if you want to refudiate the claim that "doctors are paid way too much money" well talking about expenses and long hours and such simply does NOT answer the question "HOW MUCH do they make?"

And others have replied to me "talk to a PCP" and generally, especially since they are not ANONYMOUS (like say on a message board) they are gonna tell me ZERO about how much money they make. Because it is, as we all know, none of my business.

I don't see the big deal myself, as I demonstrated by posting my own annual income for various years. It is what it is, and I have, and I do, work pretty hard for my money.

[uppityperson]

95. My PCP told me how much he makes a year. Not to the dollar but in the range. Try it, you might be

surprised. But it is easier to continue to assume and complain on a message board, isn't it?

[gasman09]

113. lots of hate for healthcare providers!!!!

Think what you will because its obvious that no matter what I say will be wrong and you do respect the healthcare profession and think we are worth a shit. Let's use the national average of $360,000 for 6 yrs of experience. Which I haven't been doing it that long.

$360,000 X 0.30 for federal taxes = 108,000 probably not my fair share according to you?

360,000 X 0.08 for state taxes = 28,800 again probably not my fair share!

360,000 x 0.0145 medicare = 5220

113,000 X 0.062 social secruity = 7006

Malpratice = 28,000

Office rental = 12000

Student loans = 19200

=151,774

Mind you that is not what I make and doesn't include health insurance, office expenses, or any other expensive. I will not allow you degrade my profession and try to make me feel bad for the the money I make. I have work hard for it. And don't saying I am applying you don't because I am not. I didn't come from money and work my way through med school so don't give I don't give me that BS about the rich saying they deserve it.

[OwnedByCats]

118. Doctors should be able to make good money because their expenses are pretty high

and they should be afforded a nice lifestyle for their hard work and risk. The problem is it is getting increasingly difficult for patients to keep up with the high cost of health care which keeps going up with no end in sight. That's not the doctor's fault, but that's the reality.

I really should go see a doctor, but at present I'm uninsured. If I want to see a PCP, it's going to cost me around $120-$140, but that's not all. That doctor will want to do a blood test on me for sure seeing as how I have complaints and I've ignored them for so long. The last time I was charged for a standard blood test from a lab it was $800, and that was in 2008. I can't imagine what it must be now. So basically between the one visit and the lab work, I'm looking at almost 4 figures, or a little bit into 4 figures and that's madness for people who aren't earning 6 figures a year. Then my new PCP will want to do some other testing and send me to a specialist or two and I have no hope in affording that out of my pocket. I can't even afford the first visit!

You see I lived in the UK for 10 years. The healthcare system they have in place is really good. I paid a small amount per month in taxes for the health service and a flat 5 pound sterling copay for scripts, regardless of drug and quantity. That's it. I had no copays to see my GP, no copays for out patient services at hospitals, none for specialist visits, none for surgery, the ER or other hospital stays. I found the quality of care there to be comparable or better than here. Doctors make a bit less, but expensive malpractice insurance is not an issue, and the cost of their education is a lot less. It also costs them a lot less for giving care. Medical supplies are a lot cheaper. My husband had Hodgkin's Disease twice while I lived there with him in England, we would never have been able to pay for his care if that had happened here, unless we had really great insurance, which would have been unlikely and we would have gone bankrupt. I came back home in 2008, needed to see a doctor and just about had a coronary upon learning just how much care had gone up since 1997.


Again, you as a doctor should be able to make good money and it's not your fault people are getting priced out of healthcare, but if ACA fails to make a good enough difference, we have to do something about this or the only people who will be able to afford care in a few years time will be the very wealthy. We should have implemented Medicare for everyone decades ago. If other countries can manage it, why can't we?

[davekriss]

112. The answer is "d", if anyone's interested

The national average compensation for anesthesiologists with 6 years experience is $360,000 per year.

Source: http://www.profilesdatabase.com/resources/2011-2012-physician-salary-survey

I am glad the physicians that have attended me over the years are well compensated. Physicians should be at the top of the pay scale amongst professionals.

$360,000 is about 7x the median household income (often with two wage earners). The problem is not that doctors are paid too much, it's that the rest of us are paid too little. The latter is the social injustice that needs to be corrected, not doctors' comp.

[redstatebluegirl]

81. Thank you for what you do.

A really good neurosurgeon got me back on my feet a few years ago, he was wonderful and yes, he was worth what it cost. I don't begrudge doctors what they make.

My husband is a professor, he went to school for a long time, we have lots of debt and I grow weary of people here and elsewhere who are envious of people who put in the time to get a good education in something (my husband hard science, research), that pays them a bit more than the average history major makes (not dishing history majors just making a point).

We are not rich, as people know who see my posts, but we make it. He loves his research as you seem to love your profession. I have a friend who went to medical school, his debt was crazy high! His residency cost him is marriage and family. He is a great trauma surgeon and if you were in an accident he is the guy you want. I do question the price he has paid for it. If we make it less expensive for a person to get a medical degree they don't need as much monetary compensation, but I agree, if they make a mistake someone dies, most of us can't say that.

The people I have issues with regarding salary, are the wall street big wigs, 30 something millionaires who daddy sent to school with no loans. They are raping the country not helping.

I'm not into dishing doctors who save lives, sorry.

[hfojvt]

89. actually my own daddy sent me to school

and my useless degree is in math. I too, went to school for a long time. Seven years.

I must have broken a mirror back in 1980.

It always seems backward somehow that people who "love their job" typically make more money that somebody like me who hates theirs.

But for me, it isn't the job as much as it is the people.

[redstatebluegirl]

90. My husband loves teaching and research.

He loves the kids he works with and mentors, the doctors who use his research in their practice. I am envious of him, he goes to work with a smile on his face every day. and Yes, people who love their work tend to do better overall.

Are you new to the job market or been in it for a while. Most Math majors I know work for business or the government in some type of "data crunching jobs". There are a lot of them in various departments at the University as well.

Not downgrading your issues, but that is not a bad degree normally.

[hfojvt]

94. I got my BA in 1985

quit my job with DOD in November 1986 went to graduate school in August 1988 because I could not find a job. Got an MA in 1990, taught for a year, opened my own bookstore in 1991 (another broken mirror), bought a building in 1993, sold the building in 1998.

worked as a temp for Kraft food for 3 years
worked at entry level customer service for Citi for seven months.

if those two major corporations had any use for a math major they sure didn't show it.

But I did know enough about computers to cost Kraft some $12,000 in lost production by staging a one man sit-down strike. (their computer went down and I refused to fix it for an hour (because they were paying me to empty trash, not to fix computers, and even after I fixed their computer and got the million dollar line running - my reward was zilch.))

[treestar]

124. How much lower would it have to be before you'd quit?

If the ACA really makes such a big cut, would you quit and do something else rather than this?

Do you dislike it when a new class graduates to compete with you? What if so many graduated that is lowered your income?

It's interesting. In law, we are always groaning at the number of new lawyers they churn out at law school each year. I don't make a lot of money at it, but it is my profession. So I haven't quit. I think that would be the question.

If you are a liberal, I suppose you would not think in terms of gloating over others' envy (and you were quick to assume that), but in terms of helping and being willing to make enough to live on middle class. To me going with envy so quickly and first indicates a possible conservative.

[uppityperson]

129. You are a lawyer complaining about how much doctors make?

huh

[Adsos Letter]

135. Not all lawyers make bank. n/t

[uppityperson]

136. Same applies to doctors.

[Adsos Letter]

140. Oh, agreed. Pediatricians come immediately to mind.

As well as PCP's, etc.

[treestar]

149. Did you read my post?

I did not complain about what doctors make? I don't make much? I asked a question and you made a completely irrelevant post.

[gasman09]

171. Not a conservative

First of all I am not a conservative!! Just tired of healthcare providers being accused of making to much money! If you want to bitch about people making to much money then bitch about the actors/actresses, any professional athlete, many CEOs and many politicians in DC including the President. And I'm sure you will degrade me because I put the president in there.

And I don't mind new competition at all. Drives me to stay on top of my own knowledge and keep up to date on current technology.

And you are so clueless on the amount of knowledge a family practice doctor needs to know. They manage many complex health needs of
their patients. That includes them managing them when they are in the hospital when the hospital doesn't have a hospitalist. I love it when someone that has never worked in healthcare or not educated in healthcare try to dictate healthcare providers practice. And there are reasons why they have standards to get into medical school and a rigorous training standard and they should not be lowered so more unqualified people can put MD or DO behind their name.

As for treating patient fairly. I treat all my patients the same. I give the best care I can in and out of the OR. It wouldn't matter if it was the president, someone less fortunate or whether they have insurance or not!!!!

[Travis_0004]

61. why does it matter what he makes.

If the money is so good why didnt you choose to become a doctor.

Im not a doctor, and I make less than almost all doctors. If you do a present value calculation doctors dont make a ton more compared to a lot of oppurtonity cost they incure. I was out of college making money while doctors were still in school racking up debt.

Also if a doctor makes 200k, that is only about 60-70 an hour. I realize 60 an hour is a lot. More than double what I make but doctors pay is not what is making insurance so expensive, so instead of bitching about somebody elses pay why dont you work on improving yours?

[hfojvt]

74. whee

another "why don't you pull yourself up by your own bootstraps" post.

Why does it matter what he makes?

Well the statement was made "doctors make too much money" or words to that effect.

Well, in the old Carson shtick the question was "HOW COLD WAS IT?" To prove or disprove the statement, one needs the information, or at least a rough amount. How much DO they make? So there is a doctor here telling about how tough they have it. Okay, so it is tough, but at the end of the day, how much money do you walk away with? Because I might be able to put up with that toughness for half of that amount and STILL count it all joy.

As for, "why didn't I choose to become a doctor?"

Well, the funny thing is, when I was young and foolish, I was not all that greedy.

Okay, I was greedy, but I was also optimistic. I thought I was sorta automatically gonna be rich because I was smart.

I hate to even type that because it demostrates how stupid I was, but there it is. So I did not look at college as "what should I study so I can make lots of money?" But probably many doctors, I hope, do not become doctors just because of the money. But I went to school to learn, and not really just to learn ONE thing, or ONE field, but to learn EVERYTHING.

I scoffed, and I still kinda scoff, at specialisation. I thought I was a polymath.

Actually, I was, am, a dilletante. But I work hard too.

[joeglow3]

66. Honestly, blame part of the on the very reimbursements this thread is discussing

Many here scream medicare/medicaid for all. Friends of mine (husband and wife) own their own OB/GYN practice. The reimbursements they get from the government are shit. Quite often, they incur physical expenses (equipment, drug, supplies, etc.) that cost MORE than they receive. That means, not only do they get zero compensation for their time, they actually LOSE money by purchasing the items needed for the treatment.

Looking at this cost structure makes it clear they HAVE to recoup that money elsewhere. Any guesses where? I'll give you a hint: you stated it in your response above.

It has gotten so bad that now that their practice is established, they are no longer taking new medicaid patients. I would not be surprised in Medicare follows suit for them.

[hfojvt]

76. the dentist I know

said he doesn't even take insurance patients. I feel bad when my dentist bills $120 but only get paid $80 by the insurance company. But I think there should be copays too. Considering I generally get $900 of "free" dental care a year, some $120 in copays would not be unfair. And it would lower the cost for everybody, particularly those who take better care of their teeth.

[rusty fender]

116. I'm not yet a Medicare patient, but

every time I call a doctor's office to make an appointment, the first thing they ask is if my insurance is Medicare, because they are not accepting Medicare patients!

[Act_of_Reparation]

70. You aren't looking at this correctly

So, you are angry over the cost of healthcare. I get that.

But there are two things to blame here, neither of which are doctors.

1) Cost of medical school: I work in an administrative capacity at a decent state university. Here, one year of medical school is $80,000 if you live out of state. That's over $300,000 on post-grad schooling ALONE, never mind what you spent as an undergrad. As others have noted, you can't start making substantial payments until you're through with your residency. So, what's a few years' interest on $300k? It ain't cheap.

For all the risk, work, and general unpleasantness required of doctors, it makes sense that they should be well-paid for what they do. They perform an essential task, and we need to attract people to the job.

2) Low Insurance Reimbursement Rates: A doctor's visit that costs you $140 out of pocket costs me $20 in copays. I doubt my insurance carrier reimburses at the doctor's out-of-pocket price. Maybe they pay him $100. Maybe.

It only gets worse as procedures get more complicated. A surgery that would cost you $20,000 without insurance will cost an insurance carrier $4,000. Prescriptions are even worse; that RX for Nexium that costs you $200.00 out of pocket... insurance companies reimburse pharmacists less than $50.00 for that stuff.

The reimbursement rates for vaccines are so low some PCPs aren't even administering them anymore. Insurance will cover the AWP cost of the drug, but not the overhead costs of refrigeration or the labor cost of administering it.

So, if you have no insurance, and you need to go to the doctor, then yes, you're getting screwed... but not by the doctors, but by the insurance companies and the universities.

Of course, we could fix both with a single-payer system and free college educations.... but that would be socialist <_<

[hfojvt]

80. wait "if you live OUT of state"

of course it is more expensive for out of staters.

My classmate who went to medical school and his two brothers also, got the Army to pay for medical school, and undergraduate as well.

But that was another type of debt. They then owed the Army about 15 years of service.

I definitely think we should be producing more doctors at lower cost.

I think the problem there though is that college professors make too much money

[Act_of_Reparation]

109. In-state isn't cheap either...

...but where you go to medical school is largely determined by who accepts your application, not where you live presently.

And no, professors are not the reason college is so expensive.

You're still looking at this wrong the wrong angle. It isn't that doctors make too much, it is that average Americans make too little. THAT is what we need to fix.

[Laelth]

127. Insurance companies are killing us all (while making record profits).

Why doctors continue to defend health insurance companies is beyond me.

-Laelth

[hfojvt]

184. but the world does not work that way

doctors make $360,000
professors make $90,000
minimum wage is $7.25 or about $15,000 for a full time worker
I make $15.50 (about)

Since you think I make too little, we need to triple the minimum wage.

Let's wave a magic wand and suddenly triple the minimum wage.

Boom, now the minimum wage is $21.75 an hour.

Okay, what happens to MY wage in this scenario? There are four options.

a. it goes to the new minimum wage
b. it is a little bit more than minimum wage
c. it triples as well
d. (in the best of ALL possible worlds) it MORE than triples

d is obviously gonna make me really happy, whereas a is really gonna tick me off. And I am not gonna be happy about b either.

As for c. That kinda leaves us in the exact same place except we get to play with bigger numbers. Because the price of everything is likely to triple as well. Sellers and producers will push the price up because of their new higher cost. Buyers will pull the price up because of their new higher incomes.

But ask the same question about the doctor and professor. Are they gonna be happy with their $90,000 if minimum wage triples? Are they gonna be happy if their own income does not triple? Is the professor happy to make $90,000 when the minimum wage worker makes $45,000? I highly doubt it.

[renate]

104. welcome to DU!

I won't ever say doctors make too much money, not as a group, anyway. Terrible doctors exist (boy howdy, do I know that from a family member's horrific experience) but the good ones improve people's lives dramatically and even save them. It takes a lot of time and training to do that, it takes a lot of money to learn to do that, and it takes a lot of emotional and mental effort to always be performing at the level required in such a high-responsibility job.

This is NOT to say that doctors work ten times harder than people who make ten times less money than they do. I don't think anybody who truly belongs on DU would even think such a thing. People bust their asses and make huge sacrifices at every income level. But that's no reason to begrudge doctors their earnings--income inequality isn't the fault of MDs.

[Adsos Letter]

57. For my oldest daughter?

Last edited Sat Nov 23, 2013, 12:22 AM - Edit history (1)

13 years, if you include BS, MD, residency, and fellowship. And about $250,000 if you consider only the med school portion of that (we paid for her undergraduate BS at a UC campus). And the 5 years spent in residency and fellowship were done at a low wage, considering the hours involved.


Edit: I received a BA (History) so I tend to automatically refer to every 4 year degree as a "BA." She actually earned a BS.

[Puzzledtraveller]

68. That's a lifetime investment.

A close friend of mine is a researcher and OB/GYN at Columbus in Ohio. He is a year older than me, I'm 40. Last we spoke about this topic he said he was still paying and when he came to visit for the Kentucky Derby last year he was by no means living extravagantly.

[BlueStreak]

114. New rules

We are giving them a guarantee that almost all of their customers will have good insurance, including coming in for regular check-ups. That makes a big difference in the cost of running a medical practice. Unless you are a specialist, the really sick patients are not the profitable ones. They take a lot of time that you may not be compensated for. Regular check-ups are better for the patient and more profitable for the provider.

My point is that there are several variables at play. We are reducing the non-collectables, and getting more patients into the office. Taxpayers have also subsidized the modernization of record-keeping. which also makes the practice more efficient. In return for these things, providers should be willing to give some. I want them to be well paid. I want the most capable people to want to pursue a career in medicine. But they don't all have to make a million bucks a year or more.

I know the education is expensive. I'd be all in favor of greatly increased grants for those going into medicine so that the don't emerge with $500,000 of debt before they take their first patient.

I have had a great deal of contact with the medical world in the past year. My parents have both had extensive issues requiring them to need a lot of care, and I've had to change my own PCP and Ophthalmologist. My little window on the world is hardly a scientific sample. But what I have seen is this: 24 months ago, every doctor I saw was grousing about "Obamacare". (And before "Obamacare", they were all grousing about the insurance companies, managed care, Medicare and everything else.) 18 months ago, they were still bitching about "Obamacare" in general, but mostly cranky about having to upgrade their records systems.

But the past 6 months, I haven't met with a single doc that expressed this kind of dissatisfaction. Some of them have mentioned the changes going on, but not really in a hostile way. And every one of the seems to have embraced the vastly improved records systems. It is letting them practice better medicine and spend more of their day with patients. And another thing these systems does is enable the Docs to delegate more tasks to NPs, confident that they can look into the complete customer record at any time.

I'm not saying every doctor is happy, or that any of them are happy being squeezed financially. But overall, I think they have a pretty good thing going right now.

[duffyduff]

173. You do know medical schools limit enrollment for the reason they could make outrageous pay.

They limited the supply.

It's over for them. There is no way to have any kind of health care system and still allow them to make obscene pay.

Of course not all of them do.

[pangaia]

177. Indentured servitude?

How many poor doctors do you know?
My PCP, an internist, is a friend of mine. He makes about $160,000 in a town of about 25,000 in upstate NY, not far from Rochester. And that's about the bottom. He works in a medical group with maybe 20 doctors and assorted PA's and nurses.

[cherokeeprogressive]

180. So, he makes too much? Are you proposing some kind of law limiting doctor pay? n/t

[pangaia]

182. Not at all.

Maybe a law limiting 3rd basemen's pay.

[mainer]

16. Certainly not primary care physicians

Considering the hours worked and the responsibility for peoples' lives, they are not overpaid.

I know quite a few doctors who left practice because they were burned out. The money was not worth it.

[Adsos Letter]

60. And especially not Pediatricians.

Some of the lowest paid in the field.

[magical thyme]

24. oh really? and you base your statement on what?

Your inside information on how much it costs to go to med school? Your inside information on how much it costs to maintain you board certification? Your inside information on how much it costs to set up a practice? Your inside information on how much malpractice insurance costs?

Provide us with some data on the costs involved, along with the actual income, not to mention the hours worked. And links, please, so we can verify the facts you base your claim on.

[hfojvt]

38. why so defensive?

Do you have your own inside information?

Most of us are not that close to doctors to know exactly what their income is like. But I would base it on various things I have seen. One doctor's wife had a jeep with a personalized license plate "doc's toy". I served on a board with a dentist and he made regular vacation trips to Hawaii and the Caribbean. One of my sisters married an eye doctor. They just built a brand new home on a lake where they bought property. True, that gives them three loans to pay, and maybe some student loans too.

[magical thyme]

46. my questions are legitimate, not defensive...

The OP has made a broad-brush claim about an entire large group of people without any data presented to back it up. It's up to the OP to provide some support.

My experience is working directly with doctors and a year of shared education (med lab tech school starts out with a year of pre-med level sciences.) Brutally hard education. Even going to community college is not cheap.

I've seen plenty of specialized license plates not owned by doctors. They aren't really all that expensive. Just because her jeep is labeled "doc's toy" doesn't mean squat, so I really don't get your point.

The doctors I know either work in hospitals and work brutally long hours and shifts, under extreme stress, or are in private practice and barely squeaking by. My personal doctor is the latter, and he doesn't charge a heck of a lot, spends time with you and finds the cheapest places to get lab tests, etc.

The doctors I know earn their keep. They have a right to take vacations, too. So what if they take out huge mortgages once their able to buy. They're already debt slaves...

[hfojvt]

52. vacations are one thing

vacations to Hawaii are things that MOST of us cannot afford. Certainly not every year.

Buying a 2nd brand new home is not a sign of NOT being rich.

What is a debt slave anyway? I have ZERO debt, even a little bit of money in savings, but I still have to slog to my job five days a week and have the stupid thing following me home more often than not.

As for the personalized plate. That is not the point. The point is the jeep. A nice little $15,000 "toy". At the time I saw that, I did not even own one car and worked two jobs. I certainly did NOT have the money for a $15,000 'toy' nor the money to buy a plate to boast about it to the community.

[uppityperson]

55. Your point about the jeep is they called it a "toy"?

[magical thyme]

134. so go to medical school, become a doctor and you too can own those things...nt

[uppityperson]

51. You admit you do not know what doctor's income is, yet assume. A jeep means they are filthy rich, or

is you issue they can afford a vanity plate? Or is it that someone DARED to pay for a vanity plate saying their jeep is a "toy"?

A dentist you served on a board with made "regular vacation trips" to Hawaii and the Caribbean, proving doctors make too much money?

A brother in law is an "eye doctor" with 3 loans and student loans proving he is paid too much?

How are any of these proof of over payment of doctors?

It might behoove you to talk to some PCPs, some Family Practice doctors, find out what they make after paying all the costs associated with being a doctor. I have and was very surprised. Yes, specialists can and do make a shitload of money, but those regular doctors that provide the majority of care? Nope.

The income you posted in another post, with math major and 2 college degrees, looks rather like mine has over the last 20 years. But to use my,or your, underpaid employment, my unemployment and resulting difficulty finding a job that pays decent to say a person getting a decent salary is paid too much is wrong. Those of us in the underemployed, unemployed, low paid employment need to have better pay and full time jobs when we want them. A different issue than "doctors get paid too much, I don't know what they get paid but they can afford to buy funny vanity plates, and go further into debt with huge loans".

[hfojvt]

64. 3 loans is one thing

a brand new house is something else.

I am not sure he has student loans now almost twenty years out, but he went to a private school too.

When you can buy a car for a toy, then you are clearly doing better than those who cannot afford a car. Filthy rich? Maybe not, but doing pretty well. Doing better than the people getting your walletectomies.

My own salary was not meant to be a contrast. Simply that since I was asking for financial information, I provided my own, just to be fair. If somebody makes $40,000 a year I am not gonna say that makes them rich just because I often made much less. But if they make $120,000 a year or $180,000 a year, then yes, they are quite a ways up there.

They seem to be doing pretty good, and from where I sit, they charge big fees.

[uppityperson]

72. So you want him to pay the same amount, get a loan for the same amount, but an older house?

I have a friend who is struggling and calls her car her "toy" though she uses it as I do mine. Your complaint is they refer to their car as a "toy"?

They charge big fees but have big expenses also. Talk to a couple PCPs, find out what their net income is. You would probably be surprised.

Having been in and out of healthcare over the years, I've talked to many. I've also seen the system changing and getting worse and worse. Too many clinics are being bought out by corporations. Too many are getting paid too little and have to resort to that which then makes it more and more difficult to provide truly decent health care, instead being forced to go faster and faster and do bandaid care while ignoring the fact that people are complicated. This is very stressful to work in, with life and death decisions needing to be made by the dollar clock hour rather than by what is needed. And the providers' incomes keep dropping.

See the problem where it lies. Not in greedy doctors but in the insurance industry that exists for one reason. To make money.

[Deep13]

77. specialists and often dentists often are, but not usually GPs. nt

[mainer]

84. Is $160,000 a year too much?

Because that's what the UK thinks its family doctors are worth.

http://www.telegraph.co.uk/health/healthnews/10463755/Britains-GPs-are-the-best-paid-in-the-industrialized-world.html

[Sgent]

98. Which is more than

a large chunk of GP's in the US -- and they don't have 200K in student loans (nor the pressure of eating that money if they don't complete school or want to leave the workplace / work part time for other reasons).

[elias7]

115. How do you figure that?

What is way too much, and for what work and decisions?

[Beausoir]

142. Yes! Doctors should be paid at the same rate as you are!

[duffyduff]

172. The gravy train for doctors in this country is about over.

The days of "fee for service" where doctors could charge whatever they wanted and had insurance companies pay for it regardless are long over. Medicine is not going to be that lucrative anymore for doctors as a whole.

[hobbit709]

3. My beef with ACA has always been that it was insurance instead of health care.

It's better that what there was but it's a long way from being what it should be.

[jbond56]

6. For the last 15 years I have been expected to produce more for less at my job.

[Bonhomme Richard]

10. +1 n/t

[magical thyme]

25. so have doctors...

I've yet to hear a doctor praise the 15 minutes insurance companies allot to see a patient. Not to mention the time they waste on bureacratic paperwork.

[Adsos Letter]

65. And the number of patients they are being expected to see is actually increasing.

The workload on docs and staff are increasing in the current environment, even with the SEIU, etc., supporting the rights of MA's, LVN's, etc.

[magical thyme]

133. I know. That's why it's ludicrous for people to claim they're in collusion w/insurance companies

Insurance companies make it impossible for them to really do their jobs. It takes time to really get a history, listen and question the patient to get a real sense of what's going on, etc.

Assembly-line medicine is lose/lose for everybody except the insurance companies.

[mainer]

8. Take out the middleman. Pay the doctors, starve the insurance guys

It's the only solution.

[Hoyt]

27. Might be good, but even under Medicare, insurance companies do most of administrative work.

Yep, insurance companies like Blue Cross, Cigna, etc., pay the claims, answer patient questions, and the like.

In fact, 28% of Medicare beneficiaries have opted to get Medicare through insurance company Medicare Advantage Plans that are owned by insurance companies.

Fact is, government probably doesn't have the resources or expertise to handle all the stuff that insurance companies do in managing Medicare and Medicaid. Nor does government want the financial risk involved.

Not saying it's good, just saying what it is.

[FarCenter]

30. Claims processing for basic Medicare is also done by insurance companies

CMS contracts with insurance companies to do the actual administration.

Medicare Administrative Contractors
http://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/MedicareAdministrativeContractors.html
http://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/MACJurisdictions.html
http://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Downloads/MACs-by-State-August-2013.pdf

For NJ the MAC is Novitas Solutions, Inc.

Highmark Medicare Services Inc Becomes Novitas Solutions Inc

Physical therapists in Delaware, New Jersey, Pennsylvania, Maryland, and the District of Columbia should be aware of a name change for the Part A and Part B Medicare Administrative Contractor (MAC) for Jurisdiction 12 (J12).

In January, Diversified Service Options Inc, a wholly owned subsidiary of Blue Cross and Blue Shield of Florida Inc, acquired MAC Highmark Medicare Services (HMS) from its parent company, Highmark Inc. As a result, HMS changed its name to Novitas Solutions Inc.

Effective March 10, Novitas Solutions will begin to migrate the current HMS Web site to the new Novitas Solutions Web site, www.novitas-solutions.com. Novitas is targeting completing the name change to all active Web page content by March 30. Although main headers throughout the Web site will be changed, some historical documents, such as Medicare reports issued under HMS, will not be changed to reflect the new name.

http://www.apta.org/PTinMotion/NewsNow/2012/3/9/Novitas/

[Hoyt]

39. I know, insurance companies do most of admin work. Plus, drug coverage is through insurance

companies. Medigap is through private insurance companies.

30 years ago, I worked for a state Medicaid agency (best job I ever had too). At that time, the government handled claims adjudication and it was really screwed up because they would not put the money needed into it to make it efficient. Then they contracted out to private companies to handle claims payment, it works better, but is still messy at times.

I cannot help but laugh when people think Medicare for all would remove the insurance companies from the equation. It might remove a bit of profit motive -- which would be good -- but would not eliminate it anytime soon.

We've got a perverse health care system that needs major surgery.

[mainer]

165. So pay the insurers and starve the doctors?

because insurers do all the admin work?

How about you go to an insurance agent next time you need an appendectomy?

Consider this. Who is more important to healthcare? The doctor or the guy pushing papers?

[Hoyt]

166. Apparently you missed the point. But, see how quickly you get an appendectomy without insurance

from most doctors. And if you find one, they'll expect you to pay a lot more than if you had insurance.

[mainer]

167. See how fast you get an appendectomy without a doctor

Did everyone in the old days just die because there were no insurers around? Old sawbones in the 1800s couldn't get a thing done without the guy filling out your forms first?

And yes, even the uninsured get emergency appendectomies.

Can you POSSIBLY BE SAYING that the insurer is more important than the healthcare provider?

That's like saying you don't need the farmer to grow your food, but you absolutely must have the clerk at the grocery store.

[Hoyt]

169. I did not say that, you need to read the posts again. Only this time

try to read in chunks of information, rather than pointing at each word with your finger.

I'm saying we need some big changes because the dang insurance companies are involved in every phase of our health care system, including Medicare and Medicaid. And they are but one of the greedy profiteers.

[gulliver]

11. Anti-ACA threads are counterproductive and should be ignored.

A thread like "What Medicare for All Would Look Like" would be useful. Let's see some constructive effort. Bashing the ACA and undermining it will simply destroy single payer prospects.

[frustrated_lefty]

14. Because ignoring things always makes them better

[philosslayer]

131. wow, THANK YOU

I've beeen trying to make the same point on another thread. Some people are none too happy about it

[stevenleser]

19. Two simple questions. How do they know it is an exchange policy? & Since they arent in force

How do we know which ones doctors will or wont accept?

Why are we allowing a stigma on people who choose exchange policies? There should be no indicator. Each health insurance company offers dozens if not hundreds of policies. There should be no indicator that one is an exchange policy.

[flamingdem]

22. They do know if it's an exchange policy by group #

I'm already seeing how this will play out.

I'm in LA and the ACA plans are not being accepted by any hospital other than the county hospitals (think gang members being dragged in bleeding to the emergency room).

That's the same solution as the medicaid patients get and those without insurance. If you're having a major issue go to those emergency rooms.

Of course with ACA you're a step above medicare because you can get appointments with doctors. However if you're in an EPO, an entity between a HMO and PPO you're going to have to see the primary first and get a referral. AND worst of all is that you're limited to a narrow network, or group of doctors.

This insurance is going to SUCK. But it's cheap. We must all continue to see it as catastrophic at this point, or a system that will be hit and miss for solving problems.

However, after several calls I do get the idea that it will be ironed out. You can't have all the area hospitals and doctors rejecting so many patients. It might take a couple of years though.

[PasadenaTrudy]

23. LA

as in Louisiana or Los Angeles? I'm in Pasadena and Huntington Hospital accepts exchange plans...

[flamingdem]

40. LA as in Los Angeles. It's by zip code and my hospital would be UCLA Harbor

which is a county hospital and where all the medicaid patients go plus non insured. It's a zoo with 8 hour wait normal for emergency room care. From what I've heard Medical patients are pretty much being told to go there and wait since at least for right now during this transition it's near impossible to see a specialist or get quick care anywhere.

That's what I'd be stuck with on ACA and not UCLA with it's high end Reagan Hospital, very close to me, or any other good hospital in my area.

Pasadena is too far but I'd consider it if that's a good one BUT I won't be allowed, it's not covered on my plan due to the controls defined by ACA currently.

[stevenleser]

26. What do you mean "aren't being accepted"? That is present tense. That is not possible.

These policies are not in force. No one can present them at a hospital.

[Hoyt]

28. Insurance companies contract with physicians. Apparently some -- maybe a lot -- are not accepting

the contracts the insurer is offering, especially where the insurers are offering rates less than Medicare. I doubt that many physicians will accept rates less than slightly above Medicare. If insurance companies think they will, they've based their premiums on too low of rates. That is a concern.

[stevenleser]

31. Well, I've contacted two hospitals there to find out.

We'll see.

[Nuclear Unicorn]

29. I would imagine it means the hospitals have reviewed the fed regs and policies

and made a decision as to whether or not they will accept ACA group numbers prior to actually receiving any patients under those groups. The ability is there.

[stevenleser]

34. I reached out to UCLA medical center and Cedar Sinai to see what they have to say.

They are rated as two of the area's top hospitals.

[FarCenter]

36. Some NY Hospitals Opting Out of Health Exchange Plans

If consumers buying insurance on health exchanges have their heart set on particular hospitals or doctors, they better do their homework.
Some hospital systems, such as NYU Langone Medical Center and New York-Presbyterian Hospital, are available as in-network choices in relatively few of the plans offered on the New York state exchange. Other systems, such as Mt. Sinai, Northshore-LIJ, Montefiore and Maimonides, are available in many more plans.

“We were able to come to some good agreements with plans,” said Kate Rose, senior director of public policy and government relations at Montefiore Medical Center, which dominates the Bronx health care market and is expanding into southern Westchester County.

Consumers can go to whatever hospitals and doctors they want, but other than for emergencies, their insurance plans only guarantee payment, if the provider is in-network. If not, providers can charge patients whatever they want. (There are some plans that allow out-of-network options, but they tend to be either limited or expensive.)

Networks are a result of negotiated contracts the two sides agree to. Insurers say that the best way to limit costs to patients is to drive a hard bargain with providers – and offer them less money for treatments and tests. If hospitals and doctors don’t think the price is right, they do not go into the insurer’s network.

http://www.wnyc.org/story/wide-difference-interest-among-hospitals-participating-health-exchange-plans/

Many providers say negotiations with insurers are ongoing, but here are some examples of major New York hospitals and how many insurance plans for individuals they are participating in, as of October 1:
◦Montefiore will be in-network for seven out of the nine insurance plans offered in the region—all except for Fidelis Care, a Catholic non-profit, and MetroPlus, the insurance arm of the city’s public hospital system.
◦Mt. Sinai Health System, which recently grew to include Beth Israel, St. Luke’s Roosevelt and other facilities, is in-network for six insurers.
◦Maimonides Medical Center, in Brooklyn, is in-network for five.
◦Medisys, which includes hospitals in Flushing and Jamaica, is in seven plans.
◦Brookdale Hospital is in four.
◦Northshore-LIJ, the state’s largest hospital system, has its own insurance plan – and is in-network for five others.
◦NYU is in-network for three insurers, Fidelis, Affinity and United.
◦New York-Presbyterian is in-network for United, Emblem and Aetna.

[flamingdem]

41. I can already tell you that Anthem Blue Cross and Blue Shield are not covered by them

That was very important to me so I called around and found this out.

If they say they are covered by PPO then they are ignorant of the PPO ACA plans.

You'd need to call Anthem. They've been the most detailed and honest.

Blue Shield has twice sent me to an agent to answer questions. What they do is tell you that ACA is useless and they try to sell you a high priced policy.

[Nuclear Unicorn]

43. I look forward to reading what they have to say. Perhaps an OP would be in order.

Regardless, please send me a reply/PM to alert me to your post.

Thank-you in advance.

[stevenleser]

145. Response #1 (UCLA Medical Center)

From: Moster, Roxanne
To: Steve Leser

Steve,

Here’s what I found out for you.

“UCLA hospitals and physicians will accept health insurance exchange members, however, it varies by health plan as to whether they consider us in-network or out-of-network. Under Covered California, for example, UCLA is contracted only with the Anthem Blue Cross EPO plans, and the Health Net PPO plans. Members who enroll with other plans under Covered California should check with their health plan to confirm if UCLA providers are considered in-network, and for which services, so that the member can determine how much they will have to pay out-of-pocket.”

Thanks,
Roxanne Moster
Director, UCLA Health Sciences Media Relations

[flamingdem]

157. Thanks Steve, very interesting that Anthem does cover them

or supposedly does cover them. That makes me think that they'll eventually work with Blue Shield that offers a PPO. I don't like the EPO plan idea since it doesn't allow visits outside the network, but maybe it's worth a look.

I also think that there are multiple catches. I did call Anthem and gave them names of doctors at UCLA and if I didn't mix up something I remember they were not on the plan. Maybe it was a question of talking to the right person who knows how to access the information. I'll try again and let you know if its' different from what you found out. Thanks for getting those names at UCLA for follow up.

[stevenleser]

185. Response #2 Cedars Sinai. Looks like they have fully embraced ACA

From: "Bashaw, Tracy
To: Steve Leser
Sent: Monday, November 25, 2013 6:43 PM
Subject: Message from Cedars-Sinai Medical Center

Mr. Leser,

Thank you for your recent email inquiry and interest in the Cedars-Sinai Health System. We have information about Healthcare Reform on our Web site. For your convenience a direct link follows below:

http://cedars-sinai.edu/Patients/Insurance-Exchanges/index.aspx

Should you need additional information, we invite you to contact our insurance information line at 1-800-213-3586, Monday - Friday 8 a.m. to 8 p.m., and/or Saturday 9 a.m. to 5 p.m.

Again, thank you for your message.

Cedars-Sinai Web Services

[flamingdem]

187. Yes exactly Anthem and Blue Shield are excluded

I didn't check the others but please open the link to read, just because it's on a list doesn't mean it's accepted

http://cedars-sinai.edu/Patients/Insurance-Exchanges/Options-for-Purchasing-Individual-Coverage.aspx

Anthem Blue Cross’ new individual and family plans for 2014 will exclude the majority of Cedars-Sinai physicians from its new narrow network of providers.

If you currently have an individual or family plan from Anthem Blue Cross that includes Cedars-Sinai, you may be able to keep that plan through a process called grandfathering.

Please call the member services phone number on the back of your insurance card to find out if you are eligible. If so, all you need to do is continue to pay your premiums and you automatically will keep your current plan.
Anthem Blue Cross will not allow grandfathering if your coverage started after March 22, 2010. If your plan began after that date, you will need to change plans before Jan. 1, 2014.
*Information updated Nov. 7, 2013


Blue Shield of California
Blue Shield’s new individual and family plans for 2014 will not include Cedars-Sinai Medical Center and its physicians in its new network of providers.

[flamingdem]

188. Anthem EPO looks like it works with UCLA doctors / hospital but when

I called a clinic there they said they will not be taking ACA. I'll try again with the specifics that you fortunately found, it really is helpful because at least I know that Anthem is offering access, but after speaking with Anthem and calling a clinic I am not optimistic that it's wide access. But maybe they don't know, even those who work the phones for Anthem.

On UCLA hospital site:

* Health Net was looking good until I realized that they don't accept Silver at UCLA. What a crazy patchwork, plus they exclude doctors on campus, that's really not good

Covered California (California's new marketplace for purchasing insurance coverage)
Effective Jan 1, 2014

There are two Covered California plans that provide full coverage for care from UCLA Health and our physicians. Learn more »

Anthem Blue Cross EPO (Pathway-Tiered)
Individual plans: Bronze EPO, Silver EPO, Gold EPO and Platinum EPO
Health Net PPO*
Individual plans: Bronze PPO and Catastrophic PPO Plan
Small group plans: Bronze PPO, Silver PPO, Gold PPO and Platinum PPO
*Note: At this time, Health Net PPO only includes UCLA Medical Group physicians in the general West Los Angeles and Santa Monica areas, including Malibu, Marina del Rey, and Manhattan Beach.

[flamingdem]

190. I found out more about the Anthem EPO after another round of calls

Let me know if you're still researching this.

It's a complicated situation. For example each UCLA doctor can chose whether or not to accept ACA. So it not only varies by health plan but it varies by office and by doctor.

The only plans being accepted by UCLA are Anthem EPO and not all doctors as I said and Health Net but only the Bronze plan.

It's disappointing but at least there are more price options.

However this could really be shown to be a mess. Think about it if you're paying as much as before and not getting access to as many doctors when the plan was sold as being much better. OUCH. An agent told me that this was the plan all along and he blamed Claire Mckaskell for master minding it, not sure about that but this is NOT very good health insurance, but it is for me more affordable. I'd be upset if I was paying as much as before for Anthem and getting only a lower deductible. That would be a bad trade off for not getting to see some of the better doctors.

And get this -- I might have an exception made for me with one of these top doctors because I was a patient previously. So now I have to hope I'll make it past their scrutiny with what they consider to be inferior insurance. Besides that, which is my assumption but is not really the whole story, there is the question of doctors not wanting to be flooded with patients who don't pay that much.

Another wrinkle to consider. I really wish I knew how this would pay out in less urban areas. They may not be able to restrict as much there. This makes me concerned about the future of the program, but maybe there was no other way.

[TheKentuckian]

35. The contracting logically would have to be in place before the plans go effective.

No plan has to be presented to know if it will or won't be accepted.

I don't expect this issue to be significant over an long term because in the not too distant future the cartel will be motivated to ease allowable charges up to increase their bottom lines. Of course doctors would be seen as labor and so they may wish to break them first and then increase allowable on labs, procedures, equipment, and other areas after the price of labor is set, working in parallel with administrators.

[flamingdem]

45. How would they break them?

Most of the better doctors have their patient roster very full. Those patients will continue coming from plans that are via businesses and they still pay well.

What would make the doctors take less moolah?

[TheKentuckian]

54. Already in progress. Increase nurse practitioners and make them a less valuable commodity

increase education costs to make the fields less functionally lucrative and therefore attractive to new entrants which in turn increases the demand for lower paid substitutes.

Increase reliance on testing and equipment which adds more specialists which by human nature leads to dependence and loss of holistic understanding.

Bring on the teledoctoring so more can be outsourced and see more patients from anywhere in the world.

Squeeze them via allowable charges just as described using exchange plans as a basis and then just do the same with group plans.

Of course this will have limited impact on higher profile specialists, those folks may even do better but that describes the few rather than the many. The top is not the best gauge, most of us don't see those folks and many of them are going concierge anyway.

In the end Walmartization will entangle almost anyone that makes their money serving consumers, it is already happening.

[cbdo2007]

49. Insurers don't contract by group number/type, they contract by type of policy - HMO, PPO, etc.

I work for an insurance company and generally we have two rates - HMO and PPO. We aren't renegotiating with ANY providers in 2014 based solely on the ACA and the exchanges, our new members will just be thrown into the same HMO or PPO networks as everybody else.

[stevenleser]

146. That seems to be the case judging from my first response from UCLA. See above nt

[FarCenter]

33. Instead of "Medicare for all", ACA is more like "Means-tested Medicaid for all".

[treestar]

37. The AMA works hard to limit the number of doctors

They bring that on themselves; getting used to the artificially higher pay.

[JNelson6563]

42. Hey man! It costs money to be wealthy!

And doctors like to be wealthy! A co-worker of mine who is getting chemo for breast cancer told me each visit to her doctor these days she is with doctor maybe 5 minutes and the cost is over $450. She gets a shot before each treatment that costs $1000. One thousand fucking dollars. What on earth could possibly be so valuable that they are putting into that syringe that it is worth $1000?? (Thankfully I work in place that is union and provides good, affordable insurance!)

I call bullshit on the whole shake-down operation that is our form of modern medicine. Those gouging, bloodsucking motherfuckers.

Julie

[flamingdem]

59. Agree

and it will be hard to break this, once they figured out how to cash in like that!!

[taught_me_patience]

44. My wife (primary care physician) found out she needs to re-enroll

for ACA exchange plans, even though she is on the provider list for the same insurance companies. It's a pain and hassle to do and apparently you need to be "invited" to be on the provider list. If the reimbursement rates are indeed 30% less, then she probably just pass... too much work for too little money. Her panel is already nearly full anyway.

[cbdo2007]

48. Medicare is lowering all of their mental health rates by 3%-25% in 2014....

so this is hardly an ACA exclusive issue.

[uppityperson]

62. Does anyone need more proof insurance companies are bloodsucking assholes? The thread title sums

up the problem here. " Insurers to pay doctors 30-40% less"

[Lifelong Dem]

63. Too many "if's" in this story coming from the right wing propaganda machine

If providers are paid less, “are going to have difficulty getting physicians to accept them as patients?”

If the rates turn out to be typically 30 or 40 percent less, as this article suggests,

If so, physicians are apt to leave the Medicare program as payment rates approach that of Medicaid.

An insurance card is of little value if you cannot find physicians who will accept it.

If the sky falls.

[pnwmom]

73. Wouldn't doctors on single payer complain about the same thing?

Wouldn't a public option have also paid doctors less?

I'm wondering how these rates compare to what Medicare pays . . . because Medicare pays less, too.

[NoOneMan]

79. Yes

Thats why some doctors educated in those countries (with state money) move their greedy asses to the US to rake in the money. Its a problem. Honestly, this is moving the US in the right direction (though the multi payer deal is still ridiculous). But I can't imagine some docs in the US wont be looking to practice elsewhere if they have no ties and that ability

[flamingdem]

82. Most good doctors I've called take Medicare but NOT ACA

So ACA rates should rise to the level of Medicare.. or these doctors are in wait and see mode.

[cbdo2007]

85. I work for a large health insurance company....

with millions of members, and doctors won't have any idea which members are ACA or not, nor are we lowering rates on anyone because of the ACA. Any doctor who is specifically saying they won't see ACA members are some extreme outliers who are saying it just for the attention.

[flamingdem]

86. You're not informed. I called insurers, doctors and hospitals

as a consumer I need to know.

They will know the nature of your insurance via the group number. Many hospitals and doctors have opted out of ACA.

In my case in LA the only hospital I can access is the county hospital, and it sucks

[cbdo2007]

91. LOL....I do this as my job everyday.

Who is your ACA insurance with and what level are you?

We insure more than 5 million people (none in California), and the new ACA members are going in the exact same member bins as everyone else - either HMO or PPO - and the providers get paid the same for ACA or non-ACA people. We have literally had ZERO providers say they will not see ACA members.

[flamingdem]

92. Silver Level Blueshield PPO - could do Anthem EPO but that's more narrow

Please do check it out and let me know what you find out.

This is for the Westside of Los Angeles. Here's a zipcode you could try:
90401

I want to be able to go where I always went under Blue Shield PPO - UCLA hospital - that means Reagan Hospital not UCLA-Harbor in Torrance, not Daniel Freeman in Marina del Rey, also a bad institution as locals know.

Reagan is on the campus of UCLA in Westwood.

Also I want to access my regular doctors including those at Jules Stein at UCLA.

Other than that I'd be happy with Cedars but that's not included either.

Now that you have sounded so sure please don't disappear and let me know what you find out

[cbdo2007]

97. Have you called Blueshield PPO to ask about their network?

Again, it should be the same BlueShield PPO Network it has always been, so call them and ask them if your specific hospital is still in network - don't ask the Hospital, and don't refer to it as an "ACA plan" because that doesn't mean anything to anybody. When I checked the Blueshield CA website it shows Reagan Hospital in network for them, but still call and ask them to be sure.

I don't know how it works specifically with BCBS California, but like I say, with our health plans (which are also BCBS) there is nothing changing about the networks.

[flamingdem]

99. So you're not going to do any work to prove your claim after all?

Of course I called them. I told you what I've learned. You are supposed to be proving that this is not true and I wish you'd use your claimed knowledge to do so! I would like the confirmation or anything else you could learn as an insider.

[cbdo2007]

106. You said you called the doctors and hospitals and asked them if they "took ACA"....

you didn't say you called Blueshield PPO and asked them which hospitals are in network under your plan.

Also, I'm not "proving any claim"....in the BCBS plans I work for, I know exactly how it works....and nothing is changing about the PPO or HMO networks in our plans, that's what I know, so I'm guessing it works the same in most places around the country, and the Blueshield website seems to agree with that assumption because it is showing them in network for your plan.

[flamingdem]

108. Look again under Covered California nt

[mainer]

83. UK pays doctors a decent income

Average family doctor there earns 103,000 pounds a year. (Over $160,000)

http://www.telegraph.co.uk/health/healthnews/10463755/Britains-GPs-are-the-best-paid-in-the-industrialized-world.html

I think many US family doctors would be happy to not have to worry about paperwork and insurance headaches and the other stresses US doctors have to deal with, if they could earn that much.

So no, single payer docs wouldn't necessarily complain about the same thing.

[pnwmom]

88. We have a shortage of family doctors because specialists make

so much more. Hundreds of thousands of dollars more. Also, it is extremely expensive to get through medical school, so doctors expect high salaries to help them pay that off.

[flamingdem]

93. Once one is older we need specialists

That's why I am upset.

Unless I pick the only PPO policy offered I'm stuck in a narrow network.

What if it turns out the specialist I really need, for whom I've gotten recommendations, is not in my network?

That is a real reduction in care, and dangerous to the patient

[pnwmom]

107. I'm going to ask our primary care doctor which insurances

they recommend for their networks. Hopefully there will be an answer.

[treestar]

121. True, it's an interesting bash coming from the left

Naturually doctors and insurance companies are against all this, but they will do fine as usual.

[NoOneMan]

78. This is great news!

Maybe all the Canadian doctors will return and Canada can increase its doctors per capita ratio, since the money is now a wash

[uppityperson]

100. Here, from the article...

But information cobbled together from interviews suggests that if the Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70.

[cyberswede]

102. It was my understanding...

[uppityperson]

103. I know

I am just no fun

[cyberswede]

111. You & your fancy numbers & stuff!

[freshwest]

144. Which is why I hid behind the door when that talent was offered. What can I say?

[BlueCheese]

101. To those who say that doctors are overpaid.

I'm sure the AMA often behaves like a guild, perhaps keeping the number of doctors here artificially low. Certainly there are many more people who want to go to medical school than are accepted. Of course I can't speak about the qualifications of those who aren't accepted-- it's possible they're good enough, but there aren't enough schools.

However, I know a lot of doctors, and given how much time they put in to become doctors, and how much they work, the last thing I would call them is overpaid. Believe me-- for people of their intelligence and dedication, there are many, many easier (and less useful) ways to become rich. Law, MBAs, Wall Street, etc. Keep in mind that if doctors' income goes down, the effect is that we'll have fewer doctors, not more.

[treestar]

122. IMO the AMA probably makes the difficulty, too

It is a terrific responsibility, but then there is a lot of technology to help. And things don't change; that is, when a new discovery is made it just helps, the human body doesn't get more complicated.

t don't think these grueling studies are necessarily required, just a trump up to keep people from being qualified.

[uppityperson]

130. Health care has gotten a lot more complicated, the more is known, the more technology there is

It used to be you love or died. You had leeches applies to suck out the humors. You got an infection, you healed or very often died.

As more has been learned about the body and how it operates, as more technolgy and medicines become available, the art of health care has become a LOT more complicated.

[Adsos Letter]

139. Tell me about it.

My oldest is an Ophthalmologist who does lots of eye surgery. Standing in one position, working through a microscope, using small needles, forceps, knives, etc. And often doing this work within the eyeball. Some of those surgeries can go hours, and require a good deal of stamina and endurance. Not to mention that, depending on the procedure involved, she will often do more than one in a day.

Plus, as you mentioned, the simple degree of knowledge and education (which has to continue throughout their career) as well as the responsibility one assumes can make medicine a very demanding job.

And the hours can be very long, what with being on call, etc.

I know you already recognize this stuff. Just sort of keying off your post to take the opportunity to express some general frustration about this subject. Certainly there are lots and lots of people whose jobs are very demanding, and don't pay nearly as well. I had one myself for well over 30 years. It's just that being a doctor often isn't simply a license to print money, as so many seem to think.

I now return you to your regularly scheduled programming...

[treestar]

150. But I was talking about GPs

Not surgeons.

[mainer]

152. Perhaps you're not aware of what "GPs" actually do

The word "GP" today -- otherwise known as a PCP or primary care physician, means family practitioners and internal medicine doctors. They have gone through the college plus 4-year medical school training, plus an additional three years of residency training. They are not glorified nurses. They diagnose metabolic diseases, cardiovascular diseases, cancers, etc. For many patients, the PCP is the only one they'll ever see or need. They are the first to recognize which aches are benign and which require specialty treatment.

To say they have simple jobs is, well, staggeringly ignorant.

[treestar]

161. Every profession has people in the lowest ranks

or the simpler jobs, where others take the more complicated jobs. It is oversimplification to say that all doctors are the same. A GP is not the same as a surgeon - it's bound to be the easier job.

And there are many simple medical issues, as such, people are willing to go with advanced nurse practitioners, to a point. That's to lower the costs.

[mainer]

164. The lowest rank of doctor is still 11 years of training

which you seem to think is no more worthy than any other profession.
Here's a suggestion DON'T GO TO DOCTORS when you get sick. Since their service is so trivial to everyone's health.

Who needs doctors? They're just like plumbers!

[gasman09]

183. Yep GPs just are stupid know nothing Drs.

Wow you truly are clueless.

[HereSince1628]

110. So, let's figure out how to get more folks into primary care...

things that would end the competitive log-jam for med schools:

Expanding the roles of qualified non-MDs who aren't so expensive in areas of preventive and routine care that don't require the savant-like memory skills in association of symptoms and diagnosis. Perhaps in association with computer guided algorithms for care that would ensure referals to persons with advanced diagnostic training and skill.

Creating a training program for transiting proven, experienced, capable, non-MD practitioners to accreditation as PCPs.

Helping with med school financing in return for work as PCP's. Something like assuming 2 years service as a PCP for every 50K or part of additional 50k paid. I'd even let them enroll to have their undergrad loans paid of at the same rate.

Enrolling graduating MD's into a national medical service, same deal on payment of med school debt, guaranteeing a minimum salary, paying for malpractice and paying for the establishment of an office/clinic if the MD elects work in an underserved area of the country.

[Demo_Chris]

119. So we basically want to ensure that NO ONE goes into medicine then. Good plan. nt

[XRubicon]

132. Doctors should be insulated against their patients poverty

Why should they have to charge less just because their patients cannot pay? Am I right or what?

Fricken high five on that!

[RBInMaine]

137. Please explain how Medicare For All will PASS??? Your entire post is a moot point.

[eridani]

141. State by state, obviously

It certainly isn't going to pass at a national level.

[RBInMaine]

148. OK, but we needed something nationally NOW, and MANY states will never pass Medicare For All.

Look, I would LOVE to see Medicare For All TOMORROW. Let's see how Vermont does with it. BUT, we still had to do something nationally. The ACA was the best we could get. Let's mend it where needed, but let's make it work as best we can. MA is a liberal state, and they actually like RomneyCare which is the ObamaCare model.

[Incitatus]

143. PLease inform me if I am wrong, but doctor/hospitals choose which insrurane plans

to accept, based on those plans reimbursement offers, no?


No law forces doctors to accept medicaid or any other plan that I am aware of.

[valerief]

153. Medical treatment will be outsourced. nt

[99Forever]

156. Average salaries for physicians...

... at the low end:

Physician / Doctor, General Practice: $133,116.

At the high end:

Physician / Doctor, Oncologist: $244,115

http://www.payscale.com/research/US/People_with_Jobs_as_Physicians_%2f_Doctors/Salary

I'll save my compassion for people that actually deserve it.

[duffyduff]

174. Those days are about over. That can't be sustained. n/t

[Tien1985]

158. Welp

Hopefully, a whole lot of doctors start jumping on the bandwagon of trying to increase the minimum wage and get everyone in this country away from poverty level. Secondly, maybe a whole lot of doctors should start fighting to get schooling for the next generation of doctors subsidized.

I'll be right alongside them helping to fight for those things.

It's not that I think doctors make too much. It's that everyone else, many of which are also in dangerous, stressful or 60-80 hour a week jobs, don't make enough. My first priority is always going to be people who can't eat or keep the heat on, and although there are a few doctors in that category, the reality is most aren't.

We could let this further divide us or we could all get on the same damn page and demand some changes that would help us all. Doctors who essentially take their ball and go home can go suck an egg. Real change would make it better for doctors whether we have Single Payer or ACA. I'd prefer single payer, but that's not happening right now.

If single payer advocates posted more about how to make single payer work, instead of why ACA sucks, maybe we'd be getting somewhere. Criticism is fine, but after a while even people who want single payer start tuning out the noise.

[kestrel91316]

162. Well, that sounds like an attempt by insurance companies to sabotage healthcare

reform.

Fire the insurance companies. Single payer NOW. Make the writing and selling of medical "insurance" illegal in the US.

[fadedrose]

163. My family doctor is worth 30-40% less

But my spine/neurology doctor is worth every penny....

[bhikkhu]

175. With improved medicare for all, there's still a shortage of doctors, and they'll still be paid less

I'm not arguing that any of the OP is wrong, but that the solution offered isn't a solution at all, and doesn't argue towards actually fixing the problems listed.

[eridani]

179. With Medicare for All being paid less only decreases gross income

Net income is likely to stay the same because billing expenses will be way, way down. When single payer was passed in Saskatchewan, average provider income went up by 30% due to being paid by the government to take care of postponed medical needs.

[lostincalifornia]

176. How about the middle men, or the hospitals that charge 8 dollars for an aspirin. Where do the

Higher costs really come from. How much do hospital administrators make?

[woo me with science]

178. The goal is ALWAYS to suck profits to the very top.

The goal is *always* to suck profits to the corporate owners, the One Percent, even though they are never the ones who actually provide the services.

Skilled and educated employees of all types have learned this. Doctors will, too.

The One Percent hope to turn doctors into technicians, so that they can be paid the same shit wages as the rest of us.

[solarhydrocan]

186. exactly. great post.