Doctors Are Opting Out of Medicare

[Sgent]

Source: NY Times

EARLY this year, Barbara Plumb, a freelance editor and writer in New York who is on Medicare, received a disturbing letter. Her gynecologist informed her that she was opting out of Medicare. When Ms. Plumb asked her primary-care doctor to recommend another gynecologist who took Medicare, the doctor responded that she didn’t know any — and that if Ms. Plumb found one she liked, could she call and tell her the name?

Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.

<cut>

In a June 2008 report, the Medicare Payment Advisory Commission, an independent federal panel that advises Congress on Medicare, said that 29 percent of the Medicare beneficiaries it surveyed who were looking for a primary care doctor had a problem finding one to treat them, up from 24 percent the year before. And a 2008 survey by the Texas Medical Association found that while 58 percent of the state’s doctors took new Medicare patients, only 38 percent of primary care doctors did.

<cut>

Before giving up on a doctor who will not accept Medicare, a patient should ask about signing a private contract that stipulates the patient will be responsible for paying the doctor’s fees and lists exactly what those fees are and what they cover. Some doctors may be willing to negotiate and tailor prices to what patients can afford.

Read more: http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html?_r=1&ref=health

[WriteDown]

1. Please tell me again...

how a great many doctors are not just greedy parasites in it for the money and the trophy wife and house.

[pattmarty]

5. Next to the Wall st types, the doctors are fucking pikers.

[WriteDown]

8. Relativism nt.

[pattmarty]

18. Yeah............... And??????

[WriteDown]

19. That child molester is a much better person

than this serial killer. Never killed one person. :).

[No Elephants]

59. Totally ludicrous to compare two violent crimes with differences in earned income. Having earned

income, low of high, is not a crime. Neither is being a physician.

This is bizarre, especially from someone who had no problem with Wall Street bonuses.

And, yes, when someone compares a doctor's income with an AIG exec's income, relative numbers are the issue. (duh.)

[WriteDown]

62. Once again, you're thinking of someone else..

My post was a description of relativism or did you not read the thread?

[totodeinhere]

6. Not true. It costs a lot of money to run a medical practice and Medicare just does not pay them...

enough to allow them to stay in business. It is not being "greedy" to want to make enough money to support your family.

[WriteDown]

9. Yeah, I've heard that excuse before....

And yet many doctors drive off in their Porshe's everyday at 4PM to their 5K sq ft houses.

[Mojorabbit]

11. You are not talking family practice

physicians. They are lowest paid on the totem poll.

[WriteDown]

15. Not sure...

My general who graduated from Baylor has work hours from 9-4 M-TH and 9-12 on Friday. He has it rough.

[hootinholler]

47. Those would be his office hours.

Then he will have any patients in the hospital that need seen, reviewing lab results, dictating records entries, and etc, which doesn't count things like continuing education or board recertification. Plus he has to pay the receptionist, nursing staff, equipment, rent, utilities...

-Hoot

[newtothegame]

26. If the government reimbursed at a sustainable level, it wouldn't be an issue.

Are car insurers expected to just take an automatic loss on certain customers? Home insurers? Why does the government get a break here?

[WriteDown]

27. See post 24 nt.

[wysimdnwyg]

33. Your view is myopic and stereotypic

Are there doctors out there who are in it strictly for the money? Of course. But those are most likely to be the ones who perform cosmetic surgery and the like, not general practitioners and specialists like the one mentioned in the OP. But one can use the top x% of many professions to show that group of people as greedy bastards.

Further, for the ones under discussion here - namely those who would be participating in Medicare - the practice demands the vast majority of the revenue. From real estate, to personnel, to medical expenses, these doctors are paying a lot of money just to keep their practices running. Would you believe that it costs a doctor $1 just to file a single claim? That does not count all of the other expenses, including the personnel, paper, ink, electricity, computer costs, etc. That is JUST to file the claim. Now add in all of that other stuff I mentioned. And if they get one thing wrong, they have to do it all over again, utilizing all of the personnel, paper, ink, etc again. So you can see how all of the things beyond the cost of the actual doctor and medicine can really add up for them.

Now, look at the medicine and medical supplies. Go down to your local medical supply wholesaler. It's easy to see why the doctor is charging you (or your insurance) so much for that bandage. And drugs! Holy crap, those things are expensive!

Finally, now that the vast majority of the money is already accounted for, we get to the doctor. Your doctor spent four years going to under graduate college. Then he spent another few years going to medical school. Then he was an intern, and then a resident. It probably took him 12 years to get to the point where he could even join someone else's practice, and another 5-6 before he was ready to start his own. Whereas other professions are ready to go right after the first four years of college, many of them making similarly high salaries in just a few years. And think of the loans the doctor must pay back. Hell, it costs $10k/year at a cheap school these days. Imagine what a quality pre-med and medical school degree costs. So your greedy doctor now has to pay back a hundred thousands dollars or more in student loans. And while doing all of this, he probably spent his first 10+ years working 60, 80, 100 or more hours per week. (That's a salaried position, mind you. No overtime pay.)


Now, in my job, I work as an intermediary between doctors (private practices and hospitals) and insurance companies. I see all of the rules that are in place, many of them seemingly implemented for the sole purpose of making it harder on the doctors to get claims paid (thus saving the insurance company money). I can tell you with 100% certainty that the only insurance with more red tape than Medicaid is, you guessed it, Medicare.

Ready to give doctors, as a group, a break with the bashing yet?

[davepdx]

61. You also have to add in the cost of malpractice insurance

Excellent post. Malpractice insurance rates vary quite a bit depending on where you live in the country. My wife is an internal medicine physician and she met some physicians from South Florida (where I am originally from) and they said that internal medicine physicians have to pay between $43,000 and $45,000 just for malpractice insurance. The rates here in Portland are less. There is a regional overhead cost variation as well.

Most physicians I've known are not greedy bastards. They are working in medicine for the right reasons. Some people have a hard time understanding that overhead costs are pretty damn high for physicians.

[Dreamer Tatum]

50. You should get your perspective from real life, not TV dramas

Most family practice doctors don't do near so well. Those in private practice often lose money on Medicare. Why should a business continue to operate in a money-losing enterprise?

[WriteDown]

60. See post 38 nt.

[emilyg]

97. They earned it. I don't have

a problem with doctors living well.

[Taverner]

Not only that, during the past 8 years Medicare ended up rejecting 1/2 of the visits docs submitted

Even though they qualified

[shireen]

21. considering the kind of work they do, doctors deserve to be paid well.

Let's put things in perspective.
major league football and baseball players -- million dollar contracts.
banking executives -- billions stolen from US taxpayers who are bailing them out
medical insurance executives -- useless parasites
big pharma executives-- outrageous prices paid by people in the US, while other countries get great deals. Meanwhile a lot of basic research leading to drugs are funded by the NIH.
- these people do not deserve what they earn.

there may be some lawyers and doctors who over-charging clients/patients.

But most of the doctors i know deserve a high salary. Every cent. And more. I once saw the bill for a complex surgical procedure i had undergone some years ago. i was shocked at how little was paid by my insurance company. As someone with a complex medical history, i have come to deeply appreciate the work of people who have chosen to work in medicine -- doctors, nurses, lab techs, nurse assistants, paramedics. They perform a critically important duty in our society, along with teachers, first responders, and the good folks who maintain our infrastructure. They deserve the highest salaries, not those crook bankers, insurance executives, or guys who toss balls around to each other.

[WriteDown]

28. See post 24 nt.

[NashVegas]

23. There's a Huge Side Issue

The paperwork that's arisen as a result of fraud cases.

My recommendation: instead of all the paperwork, for a first offense, suspend the license the fucking license of any medical personnel who commits medicare fraud for six months. Second offense they lose the license for good and go to jail.

[mainer]

56. I'm pretty sure medicare fraudsters ARE put out of business

Not only that, they do go to jail.

From what I've seen, a lot of so-called fraud is simply sheer confusion about all the medicare paperwork regulations. Doctors practice medicine. They're not lawyers, accountants, and clerks. If every doctor who made an honest mistake in billing were put in jail, there'd be NO ONE left.

[NashVegas]

90. Ever Heard of a Little Company Called "HCA"?

They cut a deal to settle a multi-million dollar fraud case for chump change, two days before Bill Frist became Senate Majority Leader.

For my own part, I've had a walk-in clinic doctor prescribe me two additional, unrelated, medications when I walked in for sinusitus. (Not Medicare related.) 'Say, you have tension headaches, don't you?' 'No, not really.' 'Really? I could have sworn you said something about that last time. Why don't you try these?'

[SharonAnn]

115. Yes, they were actually fined more than $1.2 BILLION by Medicare for fraud.

That was the settlement with Medicare. Since they settled for that, the actual charges were probably way more than that.

At that time Sen. Frist's father was Chairman of the Board of HCA and his brother was President.

HCA, the Frist family business! And like the Bush family, their business model is to find some way to tap into the tax revenue stream that comes from taxpayers and then siphon it to their own pockets.

They're leeches, parasites, crooks. And I'm feeling generous today.

[saigon68]

71. I know a few of those Mother Fuckers

I used to caddy for them when I was a kid

Their children (the Mother Fuckers) are worse than their parents.

They drive Lexus SUVs and belong up against a wall for their social views--all I Know are Repukes

[ShareTheWoods]

111. They drive Lexus SUVs and belong up against a wall for their social views

Stalin? Fidel? Is that you?

Firing squad for the offense of differing views? What have we become?

[nyy1998]

92. F*** you

My father is a doctor and a good man. He tries to do a lot of charity work and cares a lot about the natural environment. He's a positive influence on my life so I take offense in making that association that every doctor is a scumbag. Yes, there is large number of scumming egotistical doctors, but there's still a decent amount doctors who actually care about treating patients of all kind

[BrklynLiberal]

2. I am sure that instead of improving Medicare, the big noise will be about eliminating it.

The doctors already have too much paper work from insurance cos, HMOs, and the govt insurance co's

There are some that are just charging a flat rate...in cash...for each visit, and coming out ahead.
Isn't that what was done before the insurance industry created the golden goose of medical insurance??


I worked in a doctor's office for a couple of years. You would not believe the crap that we had to put up with..paper work, denials, limits on what was allowed to be done, reimbursements that were either miniscule or took so long to arrive, that the patient's file had been archived. I remember the doctor getting a check for $.93 as a reimbursement once....yes...They took the time and the expense to write a check for ninety-three cents!!!

[Mojorabbit]

10. My husband has a framed check from medicare

for one cent. He is family practice and takes medicare which does pay really low rates.

[BrklynLiberal]

16. Isn't it pathetic?????

[aquart]

102. Single payer would eliminate most of the paperwork, wouldn't it?

How does France do it? Norway?

[Donnachaidh]

3. This is NOT news to anyone who has to use Medicare

And for that matter, plenty of doctors are opting out of the Schip programs - they don't want to have to service the poor in this country.

Personally, I think if any doctor wants to ply their trade in this country, they should be REQUIRED to have at least one third of their patients on Medicare, medicaid, or any schip program. The doctors who opt out should be put OUT of business. Period.

[totodeinhere]

12. And who is going to make up the difference between what Medicare pays and what the true costs...

of what the doctors services are? The problem is not the doctors. The problem is that Medicare does not reimburse doctors enough to allow them to stay in business.

And BTW, do you know how much it costs to get through medical school? It takes many doctors years to pay of the debt they ran up paying for medical school.

[dbackjon]

24. I am a controller for a large medical practice

And when a doctor tells you they don't make money off medicare, they are lying.


They just don't make ENOUGH money off of medicare to support them in the lifestyle they want.

And once you have billing set up CORRECTLY, medicare is actually one of the EASIEST insurances to deal with.

And, with electronic transmittal, you get paid in 14 days.




Bottom line - most physicians are LOUSY businessmen, who don't have a clue as to how to properly run a business.

[county worker]

41. I was a controller at a medical clinic with 21 doctors and I agree with you 100%

I have been in accounting for over 20 years and had doctors as clients and employers. I can't think of one who didn't have $'s on the brain 24/7.

They are good at medical practice but most are not smart about much else.

If you have good coders and billers you can make money on Medicare. You have to be efficient and that is a hard place to get to.

[totodeinhere]

42. I think I would rather have a good doctor. I don't expect him to be a good businessman. n/t

[dbackjon]

45. And that is why a SMART doctor

Will hire people to help him. Unfortunately, the mindset of many is that since they are brilliant at medicine, they know everything.

[county worker]

63. I had doctors who would walk out of treatment to come to the phone and answer a tax question I had.

That use to blow me away. The nurse would tell me that they were in treatment somewhere and couldn't come to the phone but when I said that I was doing their tax return and had a question they came to the phone.

[saigon68]

72. most physicians are LOUSY businessmen

They are also republicans

[nyy1998]

93. Not true

Majority are actually Democrats.

As for the business part, I couldn't agree more.

[Donnachaidh]

75. Thank you!

As a Nedicare patient, I know how difficult it is to FIND a doctor who will take Medicare. And the ones who do insist on going through any other insurances first, because they feel they will get paid more, even though they have to jump through more hoops, etc.

If we do have some sort of forced medical insurance, they should make it so that the doctors MUST bill Medicare first. And they MUST take Medicare patients if they want to practice in this country. If not, they can go to other countries and try their luck there.

[christx30]

95. Then the doctors wouldn't be here

and there would be no one to treat you.
And other countries are clamoring for qualified doctors.

[SharonAnn]

80. Our neighbor, a radiologist said "I never thought I'd see the day when Medicare was my favorite

insurance, but it is. You know what the requirements are, what they'll pay for, how to get pre-approval, and you get paid! And quickly! That's not true of any of the other insurance I deal with. Requirements seem to be always changing. Even though there's pre-approval after volumes of paperwork and phone calls, they'll still deny paying for the procedure. At a certain point, we have to give up because it's too expensive to keep fighting them. But Medicare? They tell you the rule, they abide by the rules and if you abide by the rules you get paid and quickly!

Medicare lets me be a doctor and do what I'm trained to do. Other insurance companies make me deal with paperwork, bureaucratic denials, lengthy phone calls, etc. And I might not get paid even after all that. Then it's cost for performing the procedure and then again for all the hassle trying to get paid. And I still might not get paid!"

[JeanGrey]

112. Oh really? I am a stage four cancer patient and very sick.

I just spent three weeks in the hospital. I got a letter from the hospital saying medicare was refusing to pay (THIS time) because they believed they were not the primary insurer. (I've been disabled five years) and I HAD to call their COB dept and report back with the name of the person I spoke to.

Well Medicare's COB dept had the long, drawn out recording and none of the responses led me to a human. I had to call main Medicare and beg someone to pipe me through (sick as a dog the entire time I am enduring this).

The COB department says they had "information" that I was working and another carrier was primary. Guess who they thought I was working for? BLUE CROSS (my secondary insurance carrier).

How they managed to screw THIS up is beyond me!

Please don't talk to me about Medicare. It is a bureaucratic NIGHTMARE.

[SharonAnn]

114. Try dealing with Cigna or Blue Cross with this kind of mixup. You'd still be on the phone.

[JeanGrey]

120. I do deal with Blue Cross all the time. They are easy

compared to Medicare.

[mainer]

117. That's been our experience with Medicare, too. Easier than private insurance.

The paperwork is minimal, and reimbursement is quicker. So I don't know why doctors would opt out of Medicare, unless they're going to a system of patients paying out of pocket, or boutique medicine.

[Buck Laser]

13. Funny you should say that...

I've been on Medicare since 2000, and I've never had a single problem with a doctor or a hospital accepting it. I have far more problems with my supplemental insurance, which often runs 6 or 7 months late in paying claims.

I've used Medicare hard, too: since retirement, I've had problems with heart, cancer, diabetes and dialysis. If Universal Health Care works half as well as Medicare, it'll be great.

[Donnachaidh]

76. In Los Angeles, when I first got on Medicare it was IMPOSSIBLE

to find a doctor who would take it. And here in Atlanta it's not AS bad, but close to it. Doctors who want to practice in the US should be REQUIRED to take Medicare patients. Period.

[newtothegame]

31. Again, why would they?

Why does the government get to choose to pay unsustainable rates? If you ran a business, how would you like it if you took a loss on a full third of your customers? And you were told "that's just the way it is." No wonder we who are on commercial insurance get ripped off; docs have to make the money somewhere.

[wolfgangmo]

66. And you are applying for medical school ...

... when?

Because if your idea becomes law the exodus of primary care doctors from America will be huge. That law will have many docs heading to Canada and other countries, pronto.

Our clinic is primary care. We dropped ALL insurance years ago and have been doing well since. By cutting out the overhead and expense of never getting paid by any insurance company in any timely manner, we are now in a position to offer lower cost treatments to patients and we can afford more pro-bono work now.

Not only are doctors dropping medicare, many of us are dropping all insurance.

And before I get flamed by the uneducated , let me say that we still offer billing that has all the relevant and updated insurance and diagnostic coding on their bills. Most of our patients get reimbursed if they have insurance

[Donnachaidh]

77. yeah right -- that's why so many doctors are coming HERE from Canada

NO ONE has guaranteed you a profit, but the way things are set up NOW, doctors profit FROM the broken system we have.

Threaten to go to Canada if a Medicare for all program comes here? Don't let the door hit ya where the good lord split ya. I'm sure the Canadian government won't put up with padded bills and whining about *profit* from doctors looking to emigrate to Canada. As a matter of fact, you'll be waiting on line, behind all the Canadian doctors returning to their country, because they won't be able to *profit* off the backs of the insured down here anymore.

[diamidue]

78. Now that is the truth. I've seen it first hand. n/t

[drm604]

105. Doctors will be going to Canada to avoid treating patients who are under government insurance?

In what way does that make sense?

[KamaAina]

88. The way lawyers are required to do some pro bono work

by the bar association, not the gummint.

[Hassin Bin Sober]

4. Yet my parents had several doctor's offices fighting over them for their business.

Maybe it's a regional thing or high-rent-district thing but my parents never had any trouble here in Chicago. The practice we used for years was purchased by a major hospital so a couple of the docs spun off on their own. They used to send letters to my parents begging them to sign up with the new practices. Maybe it helped to have a couple chronic illnesses - I used to joke with my folks that they were a doctor's cash-cow.

[OneBlueSky]

7. if insurance companies weren't skimming a third or more of our healthcare dollars . . .

off the top for their profits, marketing and advertising, corporate perks, etc., there would be a lot more money available to actually put toward healthcare . . .

[BrklynLiberal]

17. THAT'S the truth!!!

[cosmicone]

14. This is not about not servicing the poor

The reimbursement system is too skewed towards procedures and pays poorly for basic services. For example, an emergency room consult which takes 2 hours of a doctor's time is reimbursed at about $95 while a procedure like GI scoping or cataract surgery which take the same amount of time and skill are reimbursed at $980 and $2,300 respectively.

This is true not just of medicare but also of many insurance companies but the paperwork hassles, claim denials and claim underrating is extremely common with medicare.

An average primary care doctor's small office with two nurses, a receptionist, and a billing/collections person has a fixed overhead of $20,000 a month. If each patient visit was reimbursed at an average $45, it would take 444 visits just to break even before the doctor makes a penny. That is after getting in debt of $200,000 or so on education and not being able to earn a living until one is at least 32 years old.

We need a major overhaul of how doctors are reimbursed for various services so that the inequalities between primary care docs and surgical specialties are corrected.

[totodeinhere]

22. What you said is entirely true, but the people on this board who want to bash doctors and call...

them "greedy" don't want to hear that. The problem is with the system, not with the individual doctors.

[WriteDown]

29. See post 24. nt

[wolfgangmo]

67. see post 87463529876 n/t

yup

[mainer]

55. People who bash doctors shouldn't go to them.

Why don't they just go to their local, oh, faith healer instead?

[mopinko]

20. scare tactics

that's all this is.

[newtothegame]

25. This is why convincing doctors to endorse national healthcare is near impossible...

If they already take a loss/near loss on every single government patient (Medicare/Medicaid), and can only make up for it through commercial payers, why would they want ALL their patients to be government patients?

[WriteDown]

30. See post 24.

Loss? Haha.

[newtothegame]

34. I'm a HC administrator at a non-profit hospital in Iowa; yes, LOSS..

More than one source is advisable friend. How would we ever recruit doctors if everyone thought like you? You must never receive services from doctors since you disdain them so much.

[Sgent]

35. Especially if you include

all the uncompensated care that you are required due to accepting Medicare (ER, etc.)

[WriteDown]

36. Uh...

People who actually love to help people instead of people seeing dollar signs? Just a crazy though I know.

[newtothegame]

37. Do you work for free?

Oh wait not even free, do you PAY people to give THEM services?

[WriteDown]

38. Read up

http://www.studentdoc.com/salaries.html

Here's just family practice

Physician Specialty: Family Practice
Lowest Reported Average Reported Highest Reported
$128000 $204000 $299000

[totodeinhere]

46. In this day and age that's not really much money when you take into account how much...

it costs them to get through medical school. $128,000 is middle class and by no means rich. Heck, it costs that much every year to put two kids through a good college.

[WriteDown]

48. So now 128K minimum isn't enough?

I give up. How much is enough? 300K? 1M?

[No Elephants]

57. Yet, you have no problem with Wall Street salaries and bonuses. Unreal.

[WriteDown]

58. Find me a post where I said that.

Plenty of problems.

[mainer]

54. Ha ha. That's a laugh.

I don't know ANY primary care doctor in my area who's making more than $150,000 a year. And that's working 50 -60 hours a week.

[wolfgangmo]

70. Not one of our docs make the lowest you quote.

Those figures are figured for larger urban incomes. Lots of us out here among the unwashed masses are outside of your imaginary bell curve.

[KansDem]

49. Maybe its time for the government to step in and offer free medical school...

...for anyone who is qualified and who agrees to work as a Medicare doctor following graduation. He/she would not take any other insurance--just Medicare. They would work in a Medicare-only medical office. If he/she decides to "go private," then they would be required to pay the government back for their medical school.

Something needs to be done--this way you would get doctors who actually "love to help people" (and who wouldn't be saddled with med-school debt after graduation) and a system in place to benefit senior citizens...

[dbackjon]

44. Hospitals have a different payment structure

And yes, theirs DOES need to be raised.

[Mithreal]

40. More than half of U.S. doctors now favor switching to a national health care plan.

Yeah, and some of the others are Republicans. Convincing Republicans of anything that helps us all without first making their wallets much MUCH fatter is near impossible. Most of us understand that if we were all paying into a universal healthcare system there won't be a privateer level payment and a destitute level payment for individual treatment. At this time, more than half of us are paying for 100% of the healthcare treatment and all the extra profiteering. Doctors can always put up a tip jar too.



Thanks to DU member unapatriciated, the following is direct from post

Doctors support universal health care: survey
WASHINGTON (Reuters) - More than half of U.S. doctors now favor switching to a national health care plan and fewer than a third oppose the idea, according to a survey published on Monday.
http://www.reuters.com/article/healthNews/idUSN31432035...

http://www.pnhp.org /
Our Mission: Single-Payer National Health Insurance
Greg Silver, MD (Fl.)
The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 47 million without health coverage and millions more inadequately covered.
This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.

http://www.naturalnews.com/021921.html
Nurses launch national "Scrubs for SiCKO" campaign to endorse universal health care following Michael Moore's film
Starting June 29th, the launch day of the SiCKO documentary, nurses, doctors and other health care practitioners are launching a national campaign to urge support for a shift to a universal health care system. They'll be handing out flyers and recruiting people to support a campaign to shift America away from its current greed-based system of medicine to one that offers universal health care to everyone

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=385x284118

[fascisthunter]

64. wrong

[wolfgangmo]

69. Thought I should update you.

Your posts on this subject tend to be pretty spot on.

There is a growing herd of docs who want single payer. It's just that most of the specialists aren't interested. Primary care is all over that though. http://www.pnhp.org/

[Princess Turandot]

84. One issue to keep in mind however is that the docs who want single payer..

at least the pnhp.org ones, believe that they will be paid more because of the ability to negotiate payment rates with the 'single payer' entity. That does not presently happen with Medicare or Medicaid - hell, I think many HMOs offer participation on a 'take it or leave it basis'. The pnhp contention at the end of their single page discussion of their plans (the last time that I read it) briefly mentions that this should not cost more because there will be a re-allocation of monies within types of specialties. Do you think that an anesthesiologist or cardiothoracic surgeon is going to reduce their fees so a guy in primarily an office based practice can earn more money?

They're not even really the problem though: my apologies to family practice guys/gals here, but some specialists should make more money. The larger problem is with physicians in specialties which do procedures such as gastroenterologists. It's not that the procedures are bad, it's that several years ago, Medicare ratcheted up the physician payments for stuff like endoscopies and colonoscopies, in favor of office based examinations. Neither of those procedures are bad of course, and colonoscopies save lives. It just motivated some MDs to do more of them.

I used to work in hospital finance and recall once getting a note from a hospital's CEO asking me to check into a complaint he was getting from a very active (and highly skilled) urologist whose patient was getting 'too many bills' from the hospital. It turned out that the man was fully covered for everything through Medicare and other insurance; what he was confused by were notices coming from the insurance companies saying that that they had paid his bills. (He had indeed called the hospital and been told this but since those EOBs kept coming, he was still confused.) He was around 90 years old, which probably was contributing to his confusion.

After I went through the paperwork, I sent the CEO a memo explaining what had happened and then on the phone, mentioned to him that this urologist was doing cystoscopies (tube up the penis to examine the bladder) at least 4 times a year on this 90 year old guy and that he might want to ask him about that.

[newspeak]

110. this reminds me of something that happened after * was selected

I lived in a small tourist town and worked in my friend's shop. A woman came in after the election and wanted to know if we had any china tea sets for her daughters. She was on her way to pick them up and catch a flight to New Zealand. She was a doctor and after *, she said she no longer wanted to remain in this country with the current medical set up. So, New Zealand has a socialized medical system, don't they? I believe she was a very caring person who believed the social system was more fair in treating all patients. There are doctors in this country who care for the people they treat. Our friend (hippy long hair:smoke:) interned in a hospital that mainly serviced the poor--anyway, he moved back to SF. He'd rather charge a patient a low rate than see them not coming in to be treated.

[2Design]

32. we need universal health care - one payer - get rid of these

over priced over paid services and take the insurance companies out of it

[fascisthunter]

65. exactly

[Indy Lurker]

39. doctors still get paif very well

Median income for age 25 and above is: $32,140.

http://en.wikipedia.org/wiki/Personal_income_in_the_United_States

[Dreamer Tatum]

51. Now make it apples/apples

And discount that future income stream against the investment in education. The gap isn't nearly as huge as you think.

[wolfgangmo]

73. In addition to the investment in education...

... in terms of time and money to be repaid also factor in the fact that they work on average 70 hours a week or more.

Let's do some figuring.



Family docs earning 131K a year would make about $38 a hour <131k / 12 months per year / 4 weeks per month / 70 hours per week >.

Your medium income person with a high school or college degree making 32K per year would make about $16 per hour. Many of their jobs also include health care insurance as well as a 401 K wherein docs are independent and pay for their own benefits.

Ah yes, the joys of a higher calling. Why I don't understand why doctors just don't work for free. Oh wait, we call those people homeless. That'll recruit them in droves.

[LuckyLib]

43. And every doctor who gives up on Medicaid/Medicare needs to send a steady stream of letters to

their Congress-critters explaining how and why the insurance companies have screwed folks over, AND the paperwork required for these systems has followed the ic model and is simply untenable. Processing paperwork has become a huge portion of a doctor's business. Remove all the shit middlemen, and get down to the business of giving folks access to the medical care they need.

Doctors need to be vocal, active and angry!

[mainer]

52. My husband always liked working with Medicare. They made billing easy.

He preferred them over dealing with private insurance.

I suspect part of the problem here is that Medicare patients are older, more complex, and require a LOT more time than does a young patient with insurance. In the time you need to go through a 70-year-old's long problem list, you could see five young patients with sore throats.

That said, he quit medicine several years ago because of burnout. The so-called "big bucks" he was earning was hardly worth it.

So.. tell me again that doctors have it so great.

[Mithreal]

53. Did any of us think there weren't any Republican doctors?

Doctors are not immune to the Republican lies. Doctors are still paid very well with many fewer frustrations in the other first world countries.

[glowing]

68. Many doc's are refusing any insurance plans. I wouldn't be surprised if

the Doc sent out letters to all her patients. It is cheaper for the doc to not pay 5 or 6 diff. ins. billing staff and hire a couple of more nurses and do a plan. Many in my area are refusing ALL ins, not just medicare.

[Abq_Sarah]

82. It makes sense if you can afford it.

I carry a catastrophic policy and my doctor lowers the rate for routine stuff because he's paid up front. It saves me a ton of money and he gets his money before I walk out the door.

[pinto]

74. Anyone have national stats on this? I'm on Medicare, have never had any trouble

with primary care or specialists - including gastroenterologist, hematologist, ophthalmologist. And all have accepted assignment (agree to take Medicare as full payment).

I've heard the bottom line complaint from all of them about the level of Medicare reimbursement. Rates haven't been adjusted for a long time in my area (considered rural) to reflect cost of living and cost of doing business. It's a sore point to them all - yet I've had no refusal of service in 20 years, outside of dental, which I knew to be the case upfront.

[bemildred]

79. Who gives a shit. Let the greedy assholes opt out.

What kind of "health care" are you going to get from "Doctors" that are all about the money anyway?

[everyman]

85. Greedy bastards

Is it so wrong after years of doing without, not getting paid, real lost wages to some of the most intelligent people in our country, and in primary care most of those people have good hearts and are in medicine for the right reasons, to properly pay them enough to pay off all their debts, make up all those years of lost wages while studying and training, and finally start saving for themselves and their own families? Oh wait, they are a bunch of greedy bastards. Anyway, bemildred go find yourself a quality doctor that will provide services for free. Good luck with that.

[bemildred]

86. Doctors should not be paid on the basis of what procedures they do.

They should have a salary that they get paid for showing up and doing their job. Do you want to have a lot of procedures you don't need and drugs that are not really beneficial? This whole little tin-pot-enterpreneur deal is wrong.

[GinaMaria]

103. What if they were paid for outcomes?

What if they made more money the more a patient's health improved? What if they were incented to prevent illness and promote health? What if the big bucks were in peole not needing as much healthcare because Doctors do more than heal the sick; they prevent illness in the first place through a strong relationship with patients? Is it possible we have been rewarding the wrong behavior without realizing it? There are many things to consider when talking about healthcare reform. One of things we consider, should be rewarding and paying docs who keep people healthy. This would reduce the number of procedures and tests and change the focus of medicine not just for healthcare providers but also for patients. Just my 2 pennies.

[bemildred]

106. An interesting thought.

I have a feeling most of them won't be eager for that change. One ought to allow some slack for doctors that specialize in "difficult" illnesses. I'd settle for more humility and less greed.

[GinaMaria]

108. I'm pushing for outcome based rewards

even with difficult diseases. Take diabetes, a patient who maintains a good A1C or reduces his/her A1C has an improved outcome. Maybe that doesn't require more procedures or tests but does require some interaction and intervention on the part of the doc. I think we'd see a shift in reliance on drugs to a reliance on nutrition, exercise and social activity. The docs who would truly be successful in a model like this, are those that truly care. We would attract the right people to this profession for the right reasons.

[bemildred]

113. Well, I'm not saying it's a bad idea.

Certainly having published comparative statistics on physicians outcomes, charges, patient approval, etc. would be a good thing. Same with hospitals and other "providers". You can't expect to have better patients while keeping then ignorant of material facts.

And certainly the mechanical, assembly-line manner in which "care" is dispensed is part of the problem. People are not widgets, and "efficiency" ought not be the highest value pursued. It is true that your average MD is useless when you want help with "lifestyle" issues, that takes far too much time and attention. But then the truth is you don't need an MD for that, they are not really suited for that sort of thing.

But the costs of medical school need to be addressed too, and the way doctors are trained is medieval.

And you want to spend some time thinking on what I will call "fairness" too, being ham-handed about it could raise other issues. the object ought not be punishment, in general, but correction, guidance, and encouragment of better practices.

And of course we have to destroy the Insurance companies.

[mainer]

118. no one would want to take care of cancer patients, then.

If you only got paid if your patient recovered, where would be the incentive to take care of truly sick patients, or terminal cancer patients? Every dying patient would end up a losing proposition for a doctor. Your patient has metastatic lung cancer? Don't expect to get paid if you can't produce a miracle!

Since no patient survives life, every doctor would be deemed a failure for not being able to come up with the fountain of youth.

[bemildred]

87. I mean, nobody made them go to medical school.

They made a bad investment. They have a lot of company these days. I don't owe them squat.

[and-justice-for-all]

81. Horrible! just Horrible I say...

Why do you people expect doctors to only have 1 BMW and 1 house!! what's the hell is the matter with you!!?:sarcasm:

[shadowknows69]

83. Well there's my last hope potentially down the toilet

[KamaAina]

89. Medicaid's always been like this

In Hawai'i, the state often has to fly patients from the Neighbor Islands up here because there simply isn't anyone on their island in the specialty they need who will take Medicaid.

Now we see this spreading to Medicare. Tell me again why we don't need single payer (i.e. docs would have to take it, or restrict themselves to the few who can pay out of pocket)?

[gulfcoastliberal]

91. That's weird since private insurance payments mirror medicare reimbursements.

So I guess those poor doctors are not going to accept any private insurance either, since they pay medicare rates. What a crock of shit.

[Sgent]

99. Not where I live

they use medicare payments as their base, but can be 125%-300% or more depending on the specific service.

[GinaMaria]

104. yes and no

Similar thinking and structure for paying for doctor's office visits (same E and M codes used in billing, but Medicare was structured with a focus on illness not prevention (because that's what medicine was when Medicare was founded). Medicare also doesn't pay or cover many things that private health insurance covers. http://www.medicare-partd.com/PartD-NotCoveredUnderMedicarePartAandB.php

12 years ago, Medicare would only pay for 6 months of hospice, so doctors had the unfortunate job of trying to predict when a patient had no more than 6 months left to live. 1 day over the 6 month mark, and the care would not be covered. Some patients didn't receive the full benefit of hospice due to a fear of starting it too soon and going over 6 months.

[Telly Savalas]

121. Can you provide a source to back up that claim?

[roamer65]

94. There is one "union" that I do believe should be busted...the AMA.

American Medical Association.

Bust it and graduate 10x the doctors from medical schools that we do now. Then doctors will be ready to accept socialized medicine.

Doctors should be seen as essential, public service employees.

[everyman]

101. Doctors as Public Service Employees

Yea, I definitely agree that doctors should be public service employees. It will be great to have my doctor take on the customer service style of the DMV. I can't wait.

[Pavulon]

96. Med school is not free

we were in for about 350k. Docs dont make shit the first few years. So unless they plan to pay student loans you cant blame people for trying to earn. FED loans cover about 200 k or so, after that you pay big interest. 3 grand a month was hanging around for a while.

reality check time, sure you can get cheaper docs, but do you want them?

[harpboy_ak]

98. This has been happening in Alaska for years

Many Alaskans find their primary care docs dropping them when they turn 65 and go on Medicare, since even those with private insurance find that their insurance carriers require anyone Medicare eligible to use Medicare as their primary insurance.

The problem here is that costs of running a practice in Alaska are much higher than elsewhere in the country. Malpractice insurance rates are sky high, and offices cost more whether rented or purchased. Staff salaries are higher, as well as utilities, and shipping costs are much higher than elsewhere.

My doc has assured me that when I turn 65 and get Medicare, his family practice will keep me as a patient, but many practices aren't doing that, and he's the same age as I am and likely to retire about the time I go on Medicare.

[ConcernedCanuk]

100. Ahhh - the "old days" are gone even up here - I remember "house calls"

.
.
.

Our family doctor, the one that delivered me and my 3 younger siblings,

came to our house for colds, sniffles, measles chicken pox, etc.,

sit on the side of the bed, look down our throats with a tongue depressor, take our temperature, look into our ears and eyes

and even TALK TO US!

Now

having no family doctor, I go to our local hospitals' emerg, wait for an hour or so sometimes, then the doctor gets impatient with me regarding my "issue" telling me he has only 8 minutes to figure out my problem.

Mostly they give me a script for something and send me to the pharmacy.

No general checking of temperature, pulse, throat, ear, eye check like they used to (that takes about 2 minutes)

BUT

If I have a heart attack, need major surgery for one reason or another

I'm covered for that by our health-care system.

So I guess my "whine" is a little out of proportion for what most people/nations have to put up with.

I still miss that REAL family doctor though.

(sigh)

[mainer]

107. We left medicine. We're much happier. Non-M.D's are clueless.

Yep, there are two M.D.'s in this family. All those years of training! We practiced as doctors for a while. Both of us left because the compensation was NOT worth the stress, the long hours, and the fact that you are never off duty. We have different careers now, and are much happier -- not to mention much better compensated. I know many doctors who love treating patients and they want to do what they can to help people, but they got burned out. And then they have to put up with the attitude on this thread about doctors being nothing but money-grubbers. If you talk to docs, about 50% would leave medicine if they had another option. They're rich bastards? Yeah, go ahead and keep saying that they don't deserve what they're paid. Then I'll hear you whining and screaming when you can't find a doctor to treat you. Only then will you appreciate what doctors are worth.

Don't you dare tell me that doctors do it to get rich. The money is not worth what they go through. I should know, because I've been there and left it.

If you think the money's so great and the job's a piece a cake, YOU go to medical school Then come back and tell us about your Mercedes. (We couldn't afford anything but a Toyota when we were doctors.)

[unkachuck]

109. we all must follow rules....

....if you wish to drive a car, you must obtain a drivers license and not cross the double yellow line....if you wish to stay out of prison, you must pay your taxes and refrain from murdering people....if you wish to be a member of DU, you must not needlessly attack fellow members....

....if you want to practice medicine in the United States and its territories, you must accept Medicare patients....

[mainer]

116. Where is the rule written that docs must accept Medicare?

I can't seem to find that law on the books.

[ohio2007]

119. maybe that rule is on the floor in congress

limit doctors salary in exchange for limited malpractice payoff suits