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Medical Care
Posted by: DaveS
Date: January 10, 2012 10:17AM
Is the new medical care legislation (for lack of a more specific name - "ObamaCare" ) a cause or a cure?

Doctors going broke
[money.cnn.com]

...Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors' lack of business acumen is also to blame.


Six stories...
Doctors: Why we can't stay afloat
[money.cnn.com]
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Re: Medical Care
Posted by: cbelt3
Date: January 10, 2012 10:26AM
'lack of business acumen'.... harrumpf.

Short of gun dealerships, there isn't a small business that is more regulated, controlled, harassed, and pestered by Government than private practice doctors. Exactly WHAT 'business acumen' can be applied when your costs are always going up and your income is controlled by various external organizations, and set to always go down ?

Single point reference, of course, but both doctors I take my family to have specifically told their children to NOT go into Medicine for this reason. And they recently sold their large family practice to a growing local hospital chain.
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Re: Medical Care
Posted by: Grace62
Date: January 10, 2012 10:42AM
GP's and pediatricians in the UK, Canada, and France are better paid than in the US.
A big part of health care reform is to restore the health of our primary care system and entice med students to pursue those fields, because those docs are on the front-line of preventive care and of holding down costs.
We're just beginning to reform - the problems addressed in these articles are the very problems that health care reform is intended to address. And most of that law has NOT gone into effect.
Health care spending as a percent of GDP has stabilized this year, and should begin to decline over the coming years.

Oh and another thing!

Our country screwed the pooch by setting up a system where specialists made millions selling drugs and tests with little oversight over effectiveness or rising costs. We ignored, at our own peril, the strength of the primary care system. We also messed up with our employer-based private for profit insurance system, which did little to control costs and left increasing numbers of people out in the cold, dependent on under-funded gov't programs.

So yeah - big problems to fix. But we're on our way. Acknowledging the first problem is the first step.



Edited 1 time(s). Last edit at 01/10/2012 10:51AM by Grace62.
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Re: Medical Care
Posted by: Filliam H. Muffman
Date: January 10, 2012 11:02AM
When you have a loan for six figures to pay for med school, you don't become a GP. Med school is the main part of the problem, they have turned it into a business to make money off of students rather than produce doctors.



In tha 360. MRF User Map
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Re: Medical Care
Posted by: Grace62
Date: January 10, 2012 11:11AM
Quote
Filliam H. Muffman
When you have a loan for six figures to pay for med school, you don't become a GP. Med school is the main part of the problem, they have turned it into a business to make money off of students rather than produce doctors.

Yes and we overwork and pay slave wages to residents.
Med school cost is addressed by HCR.
My brother borrowed over $100K for medical school, and is now a private practice family doc in a small southern town, where the patients aren't particularly well off. The first practice he joined after school agreed to pay off his loans in exchange for his signing of a multi-year contract with them. When that was done he left and started his own practice with a few others. He's doing fine, pretty well actually. There are not enough GP's where he is so he's very busy.
Some specialists aren't making it anymore because the way they set up their "businesses" is a failed model. Specialties have been overly valued, no question. The gig is up.
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Re: Medical Care
Posted by: dad@home
Date: January 10, 2012 11:24AM
The problems with MD reimbursement has a very long history.

My income has decreased in each of the last 6 years (hard to blame Obama for that). My wife's peak income (she is also a doc) peaked in 2004. The costs and hassles of billing mount every day and the reimbursement we get for this is, at best, stagnant and more typically decreasing.

Medicare reimbursement for Anesthesiologists is about the same now as 1984. Does that mean that they paid too much in 1984?
I don't know! I was a 3rd year medical student at the time... still 6 years from my first billing!

I know this sounds like whining but I don't think that "they" can cut much more from MD pay without damaging the delivery of health care. Docs will retire.... lower paid (less well trained) physician extenders will take over more and more care.....qualified college students will see how unhappy docs in practice are and will opt to go to law school or B-school. My daughter, a high school senior, is taking about pre-med studies in college...... we've told her this is probably nuts.


dad, MD
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Re: Medical Care
Posted by: Grace62
Date: January 10, 2012 11:37AM
Anesthesia

Anesthesiology is a lucrative specialty even though these doctors don't have their own patients or staff their own practices.

Overall: $332,000
Northeast: $298,000
Southeast: $358,000
Midwest: $392,000
West: $310,000
Five years ago: $303,000
Ten years ago: $222,000

[www.forbes.com]
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Re: Medical Care
Posted by: Ted King
Date: January 10, 2012 12:08PM
[www.beckershospitalreview.com]

Quote

1. The average annual anesthesiologist salary in 2011 was $364,689, based on full-time employment.

2. Anesthesiologist salaries have increased over the past four years, jumping from an average of $336,375 in 2008 to an average of $364,689 in 2011.

3. While salaries for all anesthesiologists have increased in the last four years, salaries for female anesthesiologists have seen the most significant jump. Female anesthesiologists earned an average of $296,704 in 2008 and an average of $349,545 in 2011, an increase of $52,841.

4. Owners or partners of a practice or group made more than salaried employees in 2011. According to the report, owners or partners made an average of $394,333 in 2011, compared to $348,406 for salaried employees.

5. Anesthesiologists with 13-20 years of experience made more than anesthesiologists with other levels of experience — including those with 21-30 years of experience or more than 30 years of experience.

6. Less-experienced anesthesiologists (those with five years or experience or less) made less in 2011 than in 2009. In 2009, these anesthesiologists made an average of $357,780, compared to $353,875 in 2011.

7. 93 percent of anesthesiologist respondents said they currently accept Medicare patients.

8. Anesthesiologists said an average of 39 percent of their patient population is enrolled in Medicare.

9. 66 percent of anesthesiologist respondents said Medicare reimburses less than their cost for the encounter.

10. 73 percent of anesthesiologist respondents said the upcoming reforms to Medicare, as part of the Affordable Care Act, will not be beneficial to them.



e pluribus unum
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Re: Medical Care
Posted by: $tevie
Date: January 10, 2012 12:13PM
Why are we zooming in on anesthesiologists? I feel like we are piling onto dad@home for the crime of sharing his experience with us.



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Re: Medical Care
Posted by: swampy
Date: January 10, 2012 12:38PM
Saw this coming and spoke to it some time ago. It's not going to get any better and I feel sad for _all_ doctors.

My GP had a concierge practice. $1000 a year got you all the basic services you needed (including normal lab work, vaccinations, etc.) He had several hundred patients, was easy to make an appointment, could take his time with you and even made house calls. He passed away a year ago and I cannot express how much I miss him as a friend and a doctor.



If you don't stand for something, you'll probably fall for anything.t
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Re: Medical Care
Posted by: mattkime
Date: January 10, 2012 12:49PM
i think its awfully hard to draw any conclusions on the information provided. this is just one part of a very complicated system. there are moving parts above, below, and next to this isolated bit.



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Re: Medical Care
Posted by: Grace62
Date: January 10, 2012 12:53PM
I posted income figures because when someone says their income is declining and that it's a systemic problem, you'd expect that to show up somewhere in the median salary figures. Anesthesiology was the specialty mentioned, so there you go.

The Medicare law was set up so that reimbursement rates rise and fall with the economy. For the past 8 years Congress has not followed that law, and has refused to cut Medicare rates in a declining economy. The AMA is one of the most powerful lobbying interests in the US, so it's ridiculous to imply that poor doctors' interests are not attended to.
Many states have programs to help doctors pay their malpractice insurance and have increased rates for reimbursement sometimes as much as 10% a year to help doctors offset costs.

All of us want doctors to be fairly reimbursed and we want them to earn a good living. Absolutely. But in order to keep doing that they need patients who can pay, and a sustainable system, so that's what we're after, right?

And I didn't get that dad disagrees with any of that, but I'm sorry to hear that he wouldn't encourage his daughter to pursue medicine as a career. Yes we've got to keep working on reform. The profit motives that drove care in the past have caught up to us, drugs and testing in particular.
We need more doctors, and the future for them is bright. I hope she goes for it, if that's her dream.
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Re: Medical Care
Posted by: Ted King
Date: January 10, 2012 01:01PM
Quote
$tevie
Why are we zooming in on anesthesiologists? I feel like we are piling onto dad@home for the crime of sharing his experience with us.

I wasn't piling on at all. Look at the statistics in what I quoted:

"Less-experienced anesthesiologists (those with five years or experience or less) made less in 2011 than in 2009. In 2009, these anesthesiologists made an average of $357,780, compared to $353,875 in 2011."

"66 percent of anesthesiologist respondents said Medicare reimburses less than their cost for the encounter."



e pluribus unum
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Re: Medical Care
Posted by: $tevie
Date: January 10, 2012 01:04PM
Sorry folks, I seem to have misinterpreted what was going on. mea culpa.



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Re: Medical Care
Posted by: Grace62
Date: January 10, 2012 01:47PM
Quote
Ted King

"Less-experienced anesthesiologists (those with five years or experience or less) made less in 2011 than in 2009. In 2009, these anesthesiologists made an average of $357,780, compared to $353,875 in 2011."

"66 percent of anesthesiologist respondents said Medicare reimburses less than their cost for the encounter."

Aren't those salary figures what you'd expect to see in a stagnant/low inflation economy where most wages have fallen? What's more interesting is that average salaries for new anesthesiologists are so high.

And yes, Medicare has not kept up with increasing costs, and is not sustainable. That's why the focus has to be on controlling costs.
Interestingly, the professional society that represents this specialty opposes the very measures that would help bring efficiency and accountability to the cost side of the equation. Not sure how we're going to have it both ways.
Doctors want high rates of reimbursement, with no strings attached. Sure, go for it. But expect some push back from the people who pay the bills.
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Re: Medical Care
Posted by: the_poochies
Date: January 10, 2012 02:09PM
I remember sitting on a jury in the 1990s during an auto accident case. The plaintiff's attorney brought an expert witness (who was a doctor) to testify on the stand how severe the plaintiff's injuries are.

The defense attorney asked the plaintiff's expert witness how much he earned last year testifying on behalf of auto accident victims.

The plaintiff's doctor replied "$400,000."

Then the defendant's insurance company brought its expert witness to the stand (he was also a doctor) to testify on how the plaintiff's injuries could not have been caused by the car crash.

The plaintiff's attorney asked the defense's expert witness how much he earned last year testifying against auto accident victims.

The defense's doctor replied "$325,000."

It was at that moment where I realized that I wanted to be a doctor rather than a lawyer. big grin smiley
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Re: Medical Care
Posted by: Lux Interior
Date: January 10, 2012 02:15PM
What I got from that article is doctors are getting less back from medicare (hey fiscal conservatives, isn't that a good thing? Less taxpayer money going out!).

And now the baby-boomer generation is getting old and going on Medicare, so it would seem logical that Dr's incomes would also drop since the boomers are moving from private insurance to Medicare.
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Re: Medical Care
Posted by: michaelb
Date: January 10, 2012 02:32PM
To the OP, my take/memory is that yes, this is a substantial problem that the ACA (affordable care act, AKA obamacare) is intended to address. I can't now remember all the details, but it does change and reform some of the reimbursement problems with Medicare. So starting after 2017 or so, we will start really seeing these changes. The ACA changes will be much less disruptive to providers than single payer would have been, and of course the old way was crazy and unsustainable and about to collapse.

I also haven't seen any specific news on this, but I am pretty sure the 21% cut to medicare reimbursement mentioned in the article didn't happen as part of the budget "process" in Dec. Basically, and I can't remember when this was adopted (Reagan, maybe Gingrich, maybe even the Dems), thought it would be great idea to cut Medicare reimbursement to save money. So they set up a schedule of phased in cuts. But each and every year since Congress has waived the cut and so they have basically never happened and at this point, won't ever happen. Of course if they Repubs had shut down the Gov't, or not passed an extension, they maybe this would have gone into effect (but I am sure they would have retroactively reversed them later).
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Re: Medical Care
Posted by: Ted King
Date: January 10, 2012 02:36PM
Quote
Grace62
Quote
Ted King

"Less-experienced anesthesiologists (those with five years or experience or less) made less in 2011 than in 2009. In 2009, these anesthesiologists made an average of $357,780, compared to $353,875 in 2011."

"66 percent of anesthesiologist respondents said Medicare reimburses less than their cost for the encounter."

Aren't those salary figures what you'd expect to see in a stagnant/low inflation economy where most wages have fallen? What's more interesting is that average salaries for new anesthesiologists are so high.

And yes, Medicare has not kept up with increasing costs, and is not sustainable. That's why the focus has to be on controlling costs.
Interestingly, the professional society that represents this specialty opposes the very measures that would help bring efficiency and accountability to the cost side of the equation. Not sure how we're going to have it both ways.
Doctors want high rates of reimbursement, with no strings attached. Sure, go for it. But expect some push back from the people who pay the bills.

Just to be clear - the only reason I posted the link was to provide more fine-grained contextual information, not to argue for any particular conclusions. I just focused on those quotes to show $tevie that I had no intent to pile on.



e pluribus unum



Edited 1 time(s). Last edit at 01/10/2012 02:37PM by Ted King.
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Re: Medical Care
Posted by: mrbigstuff
Date: January 10, 2012 02:37PM
Quote
Grace62
Quote
Filliam H. Muffman
When you have a loan for six figures to pay for med school, you don't become a GP. Med school is the main part of the problem, they have turned it into a business to make money off of students rather than produce doctors.

Yes and we overwork and pay slave wages to residents.
Med school cost is addressed by HCR.
My brother borrowed over $100K for medical school, and is now a private practice family doc in a small southern town, where the patients aren't particularly well off. The first practice he joined after school agreed to pay off his loans in exchange for his signing of a multi-year contract with them. When that was done he left and started his own practice with a few others. He's doing fine, pretty well actually. There are not enough GP's where he is so he's very busy.
Some specialists aren't making it anymore because the way they set up their "businesses" is a failed model. Specialties have been overly valued, no question. The gig is up.


I have said this time and again ( and a few times here) - Med School cost is at the HEART (pun) of the whole health care crisis. Because the cost of Med School establishes the benchmark for the ridiculously inflated prices of the whole ecosystem of health care.

As for student debt, I have known a few people with loans nearing $200k for med school. These are people who got out in the last 5-7 years. How do they pay down those loans?
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Re: Medical Care
Posted by: dad@home
Date: January 10, 2012 03:08PM
Quote
Ted King
[www.beckershospitalreview.com]

Quote

1. The average annual anesthesiologist salary in 2011 was $364,689, based on full-time employment.

2. Anesthesiologist salaries have increased over the past four years, jumping from an average of $336,375 in 2008 to an average of $364,689 in 2011.

3. While salaries for all anesthesiologists have increased in the last four years, salaries for female anesthesiologists have seen the most significant jump. Female anesthesiologists earned an average of $296,704 in 2008 and an average of $349,545 in 2011, an increase of $52,841.

4. Owners or partners of a practice or group made more than salaried employees in 2011. According to the report, owners or partners made an average of $394,333 in 2011, compared to $348,406 for salaried employees.

5. Anesthesiologists with 13-20 years of experience made more than anesthesiologists with other levels of experience — including those with 21-30 years of experience or more than 30 years of experience.

6. Less-experienced anesthesiologists (those with five years or experience or less) made less in 2011 than in 2009. In 2009, these anesthesiologists made an average of $357,780, compared to $353,875 in 2011.

7. 93 percent of anesthesiologist respondents said they currently accept Medicare patients.

8. Anesthesiologists said an average of 39 percent of their patient population is enrolled in Medicare.

9. 66 percent of anesthesiologist respondents said Medicare reimburses less than their cost for the encounter.

10. 73 percent of anesthesiologist respondents said the upcoming reforms to Medicare, as part of the Affordable Care Act, will not be beneficial to them.

Makes me wish I was more average!!!! LOL

Ted and Grace it really is complicated and a good understanding of it requires more that just looking at statistics (I have only one perspective, in one small area of the country so I cannot claim to understand the issues fully).

However note item 9: Medicare (and the closely tied Medicaid) are money losers..... reimbursement doesn't pay the costs of billing/staff/overhead. Most anesthesia practices that are hospital based would go out of business without subsidies from the hospital. Our hospital was providing a subsidy but has abruptly ended it.

My practice includes 65% (and rising yearly) Medicare, Medicaid and self-pay/no-pay/charity. It also is a tertiary care center with heart transplants, children's hospital, trauma and active invasive pain management. Every member of my department is Board Certified and about 1/2 are double boarded in pain management, critical care, have taken fellowships in pediatric anesthesiology or have second doctorates in Pharmacology. We pay our new partners (often out of fellowships) 95% of what fully partners make with full benefits.....you have to pay for good people.

We give extraordinary care for a Walmart price.

Also note that Medicare's conversion factor (the rate at which we are paid) varies depending on your area of the country. Where I practice is located in one of the lowest conversion factor areas in the country (double whammy).

So maybe in trying to gravitate upward toward the mean I should leave my hospital and adopted city......
Nah I like it here.

dad



Edited 3 time(s). Last edit at 01/10/2012 03:15PM by dad@home.
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Re: Medical Care
Posted by: Grace62
Date: January 10, 2012 03:30PM
Quote
michaelb

I also haven't seen any specific news on this, but I am pretty sure the 21% cut to medicare reimbursement mentioned in the article didn't happen

The 21% planned cut did not happen. That is correct.
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Re: Medical Care
Posted by: Grace62
Date: January 10, 2012 03:53PM
Quote
mrbigstuff
care.

As for student debt, I have known a few people with loans nearing $200k for med school. These are people who got out in the last 5-7 years. How do they pay down those loans?

Median debt for med students completing a public medical school is around $130K, so what your friends have is on the high side. Students need to plan that out before they start school, but it is manageable and doable with current physician salaries:
[www.aamc.org]

I'm all for subsidizing medical education, we already do this with our public universities.
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Re: Medical Care
Posted by: Grace62
Date: January 10, 2012 03:58PM
Quote
dad@home

We give extraordinary care for a Walmart price.

Also note that Medicare's conversion factor (the rate at which we are paid) varies depending on your area of the country. Where I practice is located in one of the lowest conversion factor areas in the country (double whammy).

dad

So it sounds like you're able to pay for good people. That's good. So that's not a "Walmart price." Your patients aren't paying much, but the providers are paid well. Am I understanding you correctly?

The percent of the population on Medicare is only going to grow, so it makes no sense to fight reforms that will help that and similar programs work better. As private insurance moves out of reach of more people, there is nothing else out there that is going to pay for the excellent and important care that you are providing.
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Re: Medical Care
Posted by: Dennis S
Date: January 10, 2012 04:10PM
My doctor retired last year before he wanted to. He told the son of a friend who wanted to be a doctor "Don't do it." He suggested Nurse Practioner. He also predicted widespread "Docs In A Box" before long, especially in Walmart.
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Re: Medical Care
Posted by: dad@home
Date: January 10, 2012 04:28PM
Quote
Grace62
Quote
dad@home

We give extraordinary care for a Walmart price.

Also note that Medicare's conversion factor (the rate at which we are paid) varies depending on your area of the country. Where I practice is located in one of the lowest conversion factor areas in the country (double whammy).

dad

So it sounds like you're able to pay for good people. That's good. So that's not a "Walmart price." Your patients aren't paying much, but the providers are paid well. Am I understanding you correctly?

The percent of the population on Medicare is only going to grow, so it makes no sense to fight reforms that will help that and similar programs work better. As private insurance moves out of reach of more people, there is nothing else out there that is going to pay for the excellent and important care that you are providing.

Grace,

You're right, it isn't really a Walmart price in that 65% are getting BMWs and pay almost nothing for it. Medicare/Medicaid then pays us used Yugo prices for our care and says take it and be thankful. Participation in Medicare prohibits billing for anything except what CMS allows. This is why physicians lose money on Medicare and many choose not to participate at all in the program.
Perhaps the Walmart comparison applies to our "paying" patients. Our unit price (a measure of complexity and time) is comparatively low (free market driven) so that even those who are well insured are getting a deal paying their 20% co-pay. We can't charge New York units out here in the boonies.

We pay our new employees "well" in that they make 95% of the substantially lower-than-average salary of the full partners. We give them partner benefits and partner vacation from day one. We do right by the new guys (and gals).

My issue with public reimbursement is that it is already unsustainably low and no one is talking about fixing the problems with it.

dad
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Re: Medical Care
Posted by: mattkime
Date: January 10, 2012 04:30PM
i'm not sure the high cost of school is a problem. most doctors don't have trouble paying it back. the larger problem is that the work to limit the number of doctors.



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Re: Medical Care
Posted by: Grace62
Date: January 10, 2012 04:31PM
Quote
dad@home

My issue with public reimbursement is that it is already unsustainably low and no one is talking about fixing the problems with it.

dad

What? EVERYBODY is talking about this. This is what health care reform is about - trying to make our health care system affordable and sustainable.

Do you live in Texas by chance?



Edited 1 time(s). Last edit at 01/10/2012 04:38PM by Grace62.
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Re: Medical Care
Posted by: dad@home
Date: January 10, 2012 05:06PM
Quote
Grace62
Quote
dad@home

My issue with public reimbursement is that it is already unsustainably low and no one is talking about fixing the problems with it.

dad

What? EVERYBODY is talking about this. This is what health care reform is about - trying to make our health care system affordable and sustainable.

Do you live in Texas by chance?

Grace,

Everyone is talking about the total costs......
NOBODY is talking about the "doctor fix". How many years has it been "kicked down the road?

Nobody is talking about known issues of unfairness within the conversion factor mess. For example if I do an invasive pain block I get reimbursed by Medicare about 35% of what I get from private insurance. But if I am working instead in a surgical group and do exactly the same procedure I get paid using a surgical conversion factor which is about 50%.

Identical procedure, identical training/expertise, identical city, identical procedure room and nurses but because I am in an anesthesiologist group I get paid less! This is typical of the kind of thing that makes us all CRAZY!

So if we the anesthesiologist group hired a token surgeon and renamed the group a surgical specialty group our Medicare reimbursement would go from "unsustainable" to "cruddy but ok".
Of course we would all go to jail for Medicare fraud if we tried anything like this....... hmmm maybe retirement would help to keep my brain from exploding.......

I think your question about Texas is rude.

I live Washington State..... and no, I am not a fire-breating, chest thumping, conservative but a good democrat and Obama supporter. I am in favor of health-care-reform but I am not interested seeing the un-holy mess that is Medicare be expanded for all.

dad (must do my breathing to keep head from exploding....in 2,3.....out,2,3.......)



Edited 1 time(s). Last edit at 01/10/2012 05:08PM by dad@home.
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Re: Medical Care
Posted by: Grace62
Date: January 10, 2012 05:23PM
Sorry I didn't mean to make you mad. I live in Washington state too, Puget Sound region. I'm not sure why that question is rude. (I'm a southerner by birth, I'm not one of the people who are insulted by the notion of being southern. Some are I suppose.)

You're complaining about state reimbursement rates, and Texas has some of the lowest rates. That's why I asked. I didn't know that reimbursement rates were that variable, even within a state.

And I know you're an Obama supporter, I've read your other comments.

I'm sympathetic to your concerns and I take it seriously. It's very complex and I think one of the biggest challenges of our generation.
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Re: Medical Care
Posted by: Ted King
Date: January 10, 2012 05:23PM
I actually have no problem whatsoever with doctors being in the top 1% income bracket. It takes a huge amount of ability and commitment to just become a doctor and the value to society that doctor's add through the improvement in people's quality of life makes such incomes justifiable in most cases.

So if a doctor is not covering their costs when they provide treatment to Medicare patients, then there certainly is a big problem. But obviously society can't afford double digit increases in medical costs year in and year out, either. We need to find a way to provide doctors with fair compensation but also constrain costs.

I think some of the constraint does have to come from leveling out after-cost income that some specialist doctors make. But that's probably only a small part of the solution. I was reading somewhere earlier today that doctor's salaries in general are only about 10% of medical care cost in total. So we are going to have to look at the other costs much more than doctor's salaries. Other medical professionals, like nurses, are also fairly well paid. The cost to pay them in total is even more than the cost of paying doctors. They may have to take a reduction in pay. But I think their higher pay is also generally justifiable so I don't think there are a lot of justified savings from going after their pay, either.

In a typical medical practice, the biggest cost is administration. I think that that is a place that we can look to find considerable savings. Why are administrative costs so high? What can be done to reduce those costs? I don't know, but I'll bet there are a great many things that can be done without having too great of a negative impact on patient care.

Equipment and pharmaceutical costs can also probably be reduced - especially the drug costs. The profit margins on many drugs are probably bigger than they need to be.

I think a lot of convincing studies have shown that too many hospitals have practices that cause extra costs and harm patient health. We probably need to be much more rigorous about insisting hospitals move toward best practices.

But, unfortunately, ultimately much of the reduction in costs is going to have to come from reducing patient care. That's going to be tough. Should it be based exclusively on the ability to pay? Medicare sort of makes that part of the question screwy even if you are inclined to otherwise think ability to pay should be a central criteria in limiting skyrocketing costs. Anyway, I really don't even like the whole idea of care being rationed by ability to pay. So for people like me, we are going to have to look at something we really don't want to - cost to benefit analysis. A lot of the time some of the most costly procedures happen with very little in benefit to the patient. For example, an 87 year old who is barely holding on but with a costly operation they may survive for a few more weeks. Often the kin to that person feel like they just simply must do everything they can to keep grandpa alive. It's an understandable impulse, but collectively we just can't afford it anymore. It's tough and I wish we didn't have to make those kinds of judgments, but I think we will have to do that more and more.



e pluribus unum



Edited 1 time(s). Last edit at 01/10/2012 05:29PM by Ted King.
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