Thank you again for engaging the Sermo community. It is very easy to see what Senator Stabenow, Reid and others are trying to accomplish with S.1776. This is a disgusting and blatant attempt to extort the support of physicians for a health care reform bill that we have yet to see, read or understand. This is a hollow promise and is fiscally irresponsible.
Yes, we all agree that the SGR is a flawed computational system to decide on physician payment in the Medicare program. But, repeal of the SGR should NOT be used as a bribe to extract physician cooperation for a badly flawed plan.
As you well know, there are fiscally responsible ways forward. Unfortunately, the democrats and the President are not listening. My hope is that we can move forward constructively with legislation that deals with the root problems without adding trillions of dollars to the national debt, without establishing a whole new level of federal bureaucracy and without strapping our struggling states with more unfunded mandates.
I urge you to help defeat S.1776 and the current health care reform proposals.
This to me is a "no brainer." Everything else about doing business will surely skyrocket in cost over the next 10 years, so effectively, a freeze of reimbursement amounts to a cut in pay too.
Please help to defeat this bill. I fear that there will be few Medicare participating providers by the time I reach 65!
The SGR is madness. Putting in place a system with no defined updates will drive Medicare out of business (and physicians crazy). Physician practices LOST money in 2008 and will for 2009. How long do you think that will last?
Costs increase at at least 5% per year....Congress must be reasonable. No tort reform. No regulatory relief. New mandates for electronic records and prescribing. New mandates for reporting information to the government. New penalties for practicing medicine appropriately for subspecialists. Bureacrats reducing payment schedules on a whim.
We need a balanced billing amendment to the Medicare program which permits us to individualize bills to each Medicare recipient. We collect on average less than 90% of the Medicare pay scale, which is 80% of the cost (not the charge) for the care. If Congress can't get this simple concept down, we just have to refuse all Medicare. Your wealthy supporters who are getting physician and government subsidized care are certainly going to be unhappy.
0% increase for 10 years is COMPLETELY UNACCEPTABLE, and if this passes, you will see many physicians (including me) opt OUT of Medicare and/or STOP accepting any new Medicare patients. This is a mistake which will significantly impact seniors' health. Also, ANY BILL, INCLUDING the overall "health care reform" bill that DOES NOT include SIGNIFICANT and EFFECTIVE malpractice reform is also UNACCEPTABLE. I think what I am saying is obvious and all physicians would agree with. It is common sense. Thank you.
Fixing the Medicare problem or not is not going to influence my support for health care reform. Why do people think that is an effective bribe? I see no quid-pro-quo here, unless they've worked something out with the AMA. If the Medicare cuts did go into effect, I won't be taking any Medicare next year. I am the only one of my specialty in my area.
My specialty has lost 78 percent of pay relative to inflation under Medicare over the last 15 yrs. Outpatient endoscopy center facility fees are to decrease 24 percent after a 7 yr. freeze we have already had to endure.
What if non Medicare patients are paid under reform at about Medicare rates? It will be impossible to survive in practice and doctor shortages will skyrocket.
Handing most of the money to hospitals is a horrible idea. They don't know the first thing about practicing medicine, limit physician and patient access to new equipment and will hoard most of the dollars under non fee for service schemes like APGs. A reward for the incredible inefficiency of most hospitals.
Medicine is practiced one patient at a time. Thankfully, we physicians fulfill our duties to patients in spite of every roadblock to efficiency regulation throws at us.
Agree with Sermo Doc 1. There are 2 separate issues. Healthcare reform is one. Paying those who provide it is the second. Clearly the patchwork solution arrived at up until now is not sustainable. Physicians have no one except themselves to champion their causes. As such we have been relegated to accepting NO increase in reimbursment for 10 years. There is NO OTHER business (thats right-business) in the US of A which is not allowed to raise its rates or organize collectively to bargain for their own benefit. These issues need to be addressed.
The payment for the Healthcare reform bill currently before us will bring predictable financial disaster on us all in the foreseeable future. So say the economists.
I thought extortion was practiced only by fringe elements like mafiosi..We now have the elected officials playing the same game. Horrible..We need to demand mass recall of elected officials.
As it is, I and my surgeons already see as 'few" medicare pateints as possible.
The payment for medical services rendered under medicare's formula has been under the cost of providing that service for some time. Almost all of us continue to see medicare age patients, out of a sense of duty and professional obligation, and those in charge have taken advantage of our collective good will. Now that many of us are finally treating this as a business decison, like most real businesses, you do not continue to provide goods and services at a loss, and expect to survive. You exit the business, and this is exactly what has been happening over the last 5 years, as phsicians have responded to market forces, and stopped accepting new medicare patients, and stopped participating in medicare altogether. This bill does nothing to change this trend.
Zero percent pay raises are a pay cut. As others above have already said, this is untenable. My office staff is wanting raises, my power/water/insurance/rent/supply/etc. costs continue to go up. So, I effectively am taking home less and less each year to keep my employees happy (?) and the lights on. The cost/revenue lines are already perilously close, and when they do cross it will no longer make sense to practice medicine in my current setting (solo practice Plastic Surgery). It certainly will not make sense to take Medicare, but the BIGGER problem is that the third party payers take their cues from Medicare and cut their reimbursements. It will not be a tenable situation for long, especially as long as the cosmetic patients are staying away in droves due to the economy.
I enjoy practicing medicine and I think of myself as a competent, concerned and caring physician. That said, the current state of our system, and the pervasive obsession with pushing our "reimbursement" as "providers" ever lower is discouraging enough that I often find myself daydreaming about finding another way to earn a living. I did not become a doctor in order to become wealthy, but I did anticipate earning a stable income commensurate with my education and the value that I provide to my patients. In the end I expect that the financial pressures we currently face and the changes which seem likely to occur will exacerbate the looming physician shortage. I for one will encourage any of my children who wish to enter one of the health care professions to go to dental school, so that they will be able to care for patients without relying upon what has become in essence a "handout" system, where those who provide the services receive whatever pay, on whatever terms, some third-party payer or government agency deems appropriate. The frustrated business person inside of me is looking for way out, and as much as I enjoy and care about my profession, I hope that I find one! Being at the mercy of a system such as ours is just not satisfying at all. Lest there be any confusion about my attitude toward the practice of medicine, I repeat, I enjoy my patients and my work very much - it is our broken reimbursement "system" which I find intolerable!
Medicare provides a significant portion of most physicians revenue and most insurance companies use Medicare fees to set their own fees. When you reduce or do not raise Medicare reimbursement the physicians salary is significantly reduced because his expenses of practice continue to increase. Please consider this example. A physician collects $100 in revenue. Most physician's expenses are 50-60% of revenue. If you reduce the revenue of $100 by 20% so that the physicians collections are now $80 and his expenses stay the same and for example are 50% or $50 then what has happended is the physicians take home pay has been reduced from $50 to now $30 which represents a 40% and not a 20% pay cut. How many businesses in this country can survive a 40% pay cut and stay in business? And to add insult to injury the landlord increases the rent, the malpractice insurance rates go up etc. If Congress is going to freeze Medicare reimbursement for 10 years then in all fairness they should attach an amendment that would freeze any expense amounts for the physician for 10 years. In other words tell my landlord that he cannot raise a physicians rent for 10 years. I wonder how that would go over? I appreciate the cost to the country but the main cause is that Medicare subsidizes care that is not paid for by the insurance companies. I have not been paid by Humana for over a year for one arcane reason of another. Who pays for the care those patients received? The insurance industry now has a system where they only insure mostly well people and they do not cover the sick people. Most studies show the insurance industry is making about 30% profit which goes to executive compensation and shareholder equity. The CEO of United Health CAre in the past 5 years has received salary and bonuses of 700 Million dollars! Those profits in a pure insurance system would have been spent on taking care of sick people and not CEO compensation. If the excessive profits of the insurance industry are put back to work paying for care then everyone will be fairly paid, the system will stabalize and Medicare fees will stabalize and not be needed to offset the losses physician suffer at the hands of the insurance companies. Personally I am not as concerned with the deficit in this regard. The deficit is about 11% of GNP and most Americans who own houses are allowed to carry a debt load of about 25% in order to own a house and most Americans eventually pay off their Mortgage or sell the house. To me a debt load of 11% should be able to be paid of as we increase productivity, put people back to work in new industries that America has the ability to create. I would also add one more thing. I am a practicing Geriatrician and the costs of caring for the elderly is increasing as these patients get older and older. At some point the care that we give them not only does not prolong their life but actually porlongs their death and suffering. I can attest to weekly seeing paitents being demanded by their families to be kept alive in ICU on ventilators because the adult relatives are living in the family home and cashing the parents social security check and living off of it. I know it sounds terrible and I know that most people would say no it does not happen that often but I can assure you that it does. There are of couse many other reasons elderly patients are kept alive in ICU when the outcome is futile. Religious beliefs, family just cannot let go, etc. But we need to have a debate in this country as to how we deal with this as opposed to screaming and hollering at a town meeting about "killing grandma". I am not an advocate of euthanasia and support patients rights to decide their own fate. But we are reaching a point that resembles a mass casualty exercise and somewhere sometime our society will be forced to make some very hard choices. In my opinion it is better to discuss it now than later.
Physicians will be faced with 25-40 million new patients (depending on the "reform" plan), necessitating larger staffs, more support, etc, for less money (when adjusted for inflation).What may have been inconceivable now seems like a possible strategy: a national physicians union with the potential for work stoppages, etc.
"This bill adds over a quarter trillion dollars to the deficit with no offset. This bill is not paid for. To put this in perspective, this price tag amounts to over $5,600 dollars for every senior on Medicare right now. It is larger than all the government funding bills the Senate has considered this year - put together. "
LOL. Seriously? You're suddenly all against repealing SGR because the Democrats are behind it and it would help them keep the reform coalition together? Want me to go back and find the threads when we were fighting to keep those SGR cuts from going into effect last year and the year before that and the year before that?
Remember 3/4 of us physicians want health reform with a public option according to the NEJM survey, and even if I spot you a twenty point MOE, you STILL are in the minority!
And 8 of the 10 largest physicians organizations support HR 3200 which includes SGR repeal and a public option.
The basic reform that could solve a lot of the problems would be to repeal the ban on balance billing. Right now we have a "command economy" model that can never compensate for all the variations in geography and patient mix. The French system has a national fee schedule and the physician has the option to charge extra. Of course, that requires justifying that charge to the patient. If France can have a market-based reimbursement system, why can't we ? Medicare is going broke. These "fixes" are rearranging deck chairs on the Titanic.
There is a simple equation between what Medicare pays and what it costs to run an office. If the costs exceed reimbursement then we would have to stop seeing Medicare patients and go cash only. Our practice (PCP) isn't viable if Medicare and private insurers cut reimbursement. Basically if government cannot afford to pay a viable reimbursement we should return to allowing physicians to balance bill and let the market set the reimbursement rate. Putting physicians out of business or forcing us to go cash only are both bad options for patients.
Of course if you ask doctors if they want flat reimbursements for 10 years, we will all say "no". But what alternative is presented? Right now the only other choice is dramatically decreased payments (unless Congress "rescues us" each year). Senator Coburn: where does your "prescription for health care" address physician reimbursement? Please address this directly: where does your plan offer something specific that is different from ongoing cuts OR flat reimbursement?
I have found the solution. I opted out of Medicare. I have found this to have nothing but a positive effect on my practice. I now have more time to spend with my patients and this has improved my patient satisfaction. This has improved my medical practice and my reputation among patients and the physicians that refer them. I can also manage my administrative functions with less office staff because I don't have to keep up with all the mandates and regulations that are required as a Medicare provider. This helps the financial strength of my business. Like most of you, I did not become a physician to become rich. I enjoy the work that I do and take great pride in providing high quality medical care in a compassionate, and cost-effective, manner. Not having to worry about big brother looking over my shoulder to see if they agree with how I do things has relieved a great deal of the stress I used to feel in my job. My greatest concern now is whether President Obama is going to be successful in stripping the American public of the freedom to choose their own doctor by instituting a mandatory public insurance plan that requires patient and/or provider participation. Anybody know much about Costa Rica?
The Wall Street Journal has two relevant discussions on the SGR sleight-of-hand in today's issue (10/21/09), including it's lead editorial which ends with the statement "This doctor maneuver is such a cleverly dishonest solution to their many contradictory promises that we're surprised Democrats didn't think of it sooner."
Very strong words from a generally restrained publication, but sadly, they are true.
The editorial also rips the AMA for being "a cheap date" and states "Mr. (sic) Rohack seems prepared to trade away his members for a sack of magic beans."
As Sermo Doc 1 stated above, eliminating (or, in actuality, putting off) the SGR should not be a quid pro quo for support for an otherwise hopelessly flawed plan.
I will reiterate, once again, that the only solution that makes sense is to take steps to return the costs of medicine to the table that rests between the patient and his or her physician. At present, insurers negotiate with employers to price policies, and "negotiate" with providers to price payments, giving them full control of the entire economic process, and removing both the patient and the individual physician from any discussion of the costs of care.
John Mackey's solution at Whole Earth Foods fixes one end of the problem. By using HSAs, his company puts first dollar payment considerations into the hands of the patient, and the success of his approach is real and quantifiable. By leaving insurers free to dictate provider payments, however, Whole Earth's plan solves only half the problem.
Responsibility for patient payments to physicians and other providers must be returned to the patient - they must take on the responsibility for filing claims for their reimbursement, as they do now with great efficiency in the auto and home repair industries. Restrictions on how physicians price their services must be drastically altered by allowing physicians to reduce rates as they see fit. Lower costs for the poor will happen - that was the norm in the era before Medicare. Require physicians to post pricing for their most frequent treatments and procedures and consumerism will help drive prices down without heavy handed government policies - it's working now in plastic surgery and other fields unencumbered by current regulations. Shift insurance purchase tax advantages away from employers and offer them to patients instead - insurers will reduce their administrative burdens in order to compete for consumers, rather than increase them in order to please employer negotiators. Fixing med-mal to eliminate defensive medicine would complete the process, but should probably be addressed separately due to its own overwhelming complexity.
As for the SGR, it is a farce of epic proportions, and given the distrust most physicians (and Americans) have for long term federal government promises, neither a one year nor a ten year abatement will cause doctors to be any less wary of the system, or any more likely to continue participating in it. The 800 pounder in the room isn't a gorilla this time - it's an elephant. And it has a memory. Independent of anything proposed above, the SGR has got to go away, and do so permanently.
we cannot continue to care for medicare patients if one more dime is cut from our reimbursement and to freeze it for 10 years is absurd.
the medical profession agrees that our healthcare system is broken and needs to be fixed. however it should not be on the backs of physicians.
we need to address tort reform and take healthcare away from wall street whose only interest is double digit profits
ladies and gentlemen of the jury, there is plenty of money in the system, just look and see at what has been happening over the past couple of decades. In the meanwhile, clinical common sense training has gone downhill in favour of CYA high tech labs and tests, sometimes without a patient in the room. You want more money? Earn it. This all goes hand in hand with tort reform. Earn it. And judges must not expect us to extend life indefinitely like a bunch of old coot spring chickens. Are you alive? You are pre-existing. Denied. If we can get back to hands on care, use our senses, and think, then Medicare, and others, can expect a decrease in demands for its outflow of cash then have the cash to pay the doctor for legitimate efforts. And Mr Coburn MS (member of senate) is not the one I would nominate or vote to lead the charge for the people in general and the people in the profession in particular. The jury may deliberate.
Thank you for your action towards stopping the government irresponsibility.
My position is that there are a lot of empty promises being made - promises that do not make any financial sense - promises that are counter to the basic principles that have made this nation great.
In brief:
- The government needs to get out of debt.
- The government needs to provide SOME basic regulatory framework, but otherwise stay out the way. The economy will grow if WE THE PEOPLE are given incentives to succeed instead of incentives to quit. The government needs to keep its foot off our throats, let us breath and create jobs for those who want to work.
- Specifically regarding physicians - same principles plus an increased emphasis on staying out of the way of medical providers taking care of people. We have too much bureaucratic oversight as it is. I am personally tired of insurance companies and the government dictating how physicians and patients interact with each other.
- If Medicare and Medicaid patients had to pay at the time of service and be reimbursed by the government that would help prevent a lot of unnecessary visits. They know they don't have to pay anything so they have no restraints on going to the doctor's office or hospital when many times it is unnecessary. The doctor's office should not have to administrate Medicare and Medicaid. Medicare and Medicaid payments should be between the government and the person. Medical care should be between the doctor and the patient. The means of payment/reimbursement should be separated. This one simple change in the system would greatly help curtail cost, both for the government and for the medical offices. If you want to decrease medical cost then decreased the cost of doing "medical business."
The true fix to the current issue is to find a way to get the patient and the physician together. I think this is through a medical savings account with a provision for catastrophic illness to be taken care of with secondary insurance. In the current situation, insurance companies are simply brokers with no added value in the health care equation. They are an added level of expense without an accompanying benefit. Change will come but we must be active in guiding that change. Our dislocation will be simliar to that expereinced by Eastern Europe when communism finally failed and people were without the government for guidance, support or direction. A health economy with MSAs,without insurance companies but with secondary government supported catastrophic health insurance would be the optimal way to get individuals to take responsilibity for their lives and their health. Right now, medicine is an all-you-can-eat buffet. the more you eat (or consume with tests or studies) the more value you are getting for your money (insurance premium). Tort reform is a critical piece of reform if the Texas and Florida experience is to be believed.
Freeezing pay rates for 10 years? Okay, i'll just call my malpractice insurer and tell them i can't pay an increase over the next ten years. Ditto, my landlord, my staff, my utility company, the company that was trying to sell me an overpriced EMR( mandated by the government), my equipment supplier, and--- oh yeah----my bank account.
With all due respect, the caliber of people we have on BOTH sides of the aisle in congress is embarassing, and certainly not up to the standard of the founding fathers.
Republicans held down increased re-inbursement for years in the name of controlling costs, which allowed third-party payers to follow suit, and now they want to portray themselves as the cavalry arriving in the nick of time, to rescue physicians? Please! Everybody is dirty and dishonest here.
We have all said it before. You cannot be serious about controlling costs, and therefore look at re-imbursement, until you do real work on tort reform and eliminate the costs of defensive medicine.Without that, everything else is nibbling around the edges, and will not work in the long run.
This survey insults our intelligence! I'm sorry, but since the deficit continues to rise, and businesses continue to get bailed out, I have to say that medical care is more important than whether or not a car manufacturer goes belly up. The entire insurance system is a joke. There are no other professionals that have to beg for payment. Not to mention the game the insurance companies (including Medicare) play where we practically have to guess how to bill to improve our "chance" of getting paid! We have to hire more staff to even stay afloat! We have to get insurance companies and lawyers out of the government pockets and sort this out. Good doctors cannot continue to go personally into debt any further. As it is, we all ready make less per hour than a plumber or electrician. Where will future doctors come from when we can't make a living (oh and don't forget the loans for med school!) I wish I had an answer, but clearly "freezing" reimbursements that all ready don't cover our cost is not the answer. ARGH!
I agree with Sermo Doc 16. I and most other physicians support health care reform with a public option.
Also, I agree with clinped that Sen. Coburn is definitely not the person I would pick to be in charge of getting us out of the health care mess we are in as a nation and as physicians.
Would any other US worker accept a job if told that they were to have the same pay for the next ten years? I think not. If it passes, I'll step even farther out of Medicare. I already do not take new patients.
I think Sermo Doc 16 makes a good point. The repeal of SGM has been supported by doctors for years. It's only now that substantial healthcare reform is on the table and it's a Democratic effort we see those like Dr. Coburn coming forward and trying to couple SGR repeal and an obviously stop-gap measure, S1776, as something diabolical.
Thankyou Sermo Doc 14,for your comments The 21% cut needs to be stopped.The future reimbursement changes ,can be dealt with later. The "concept,that the bill isn't perfect", has always been used,as an excuse to do nothing.
There are a few very active posters who want the system to collapse,but my concern is what happens to our patients and our practices if this occurs.
Does the Sen support balance billing,and will he advance legislation to do this?
Will he work to force private insurers to act like insurance companies and not the profiteering rackets they have become?
Finally:Yes its not "paid for" but neither is the war in Iraq. May be we should cancel that also.
Thank you for that information, I hate to say it but I would unaware.
With that information at hand, S. 1776 is a ridiculous solution to a overwhelming problem.
I do think we all agree that something must be done to change the course. The problem is that all proposals have an agenda and hidden messages that will ultimately only hurt the situation. Polishing a poison apple doesn't make it any less dangerous to eat.
To simply freeze reimbursement is not only unacceptable, but would be a pay reduction. Anyone ever heard of cost of living increases, particularly when our inflation is where it is, and only going higher.
The solution is to put the responsibility back in the patients hands. As a patient we all have to be culpable for our care and the costs. The "free care" option is neither free nor care.
I appreciate the efforts of all legislators trying to honestly deal with this problem.
SGR should have been discarded when Bush and the Republicans controlled all three branches of government a few years ago. But it wasn't. That was a complete mistake.
If there is strong bipartisan support to repeal the SGR, then DO IT!
It makes no sense to fix Medicare payments for the next ten years. As earlier posts pointed out, all of our overhead costs are paid for out of physician fees. The result would be physicians opting out of the system, substantial job losses for educated people (nurses, etc. who also vote!), and a net loss to many communities of an important resource and economic engine.
Washington promised many years ago to take care of our seniors. Millions are relying on that promise now. It is too late for them to make other plans. When you took office, you in essence agreed to maintain that responsibility. Live up to that promise now!
let us balance bill and go ahead with the cut. we will no longer be hostage to the price fixing the government has done and the market will keep fees competitive
A medicare freeze on payments for 10 years isnt a solution.Again I agree politicians are using this bill as a form of coercion.Call it blackmail if you will.Forget it.I agree with repealing the ban on balance billing.The alternative for many of us will be to be nonparticipating in any ins,private or govt.We will bill patients and they will be responsible to pay just like you do when you go to have your car fixed.It will be like if they have an extended warranty.After they pay the bill they will deal with medicare/medicaid or ins co to get THEIR money.Other options for me would be leave clinical medicineand do something nonclinical.Its ok to cut medicare by21.5%,No COLA for ss But hey lets give seniors $250 payment anyway this year.Politics is Dirty,and its exposed now to all of us who didnt know how bad and to what levels it extends.I have no faith in our present govt.
Let's frame the question differently -- either S 1776 eliminates SGR with a promise of no further decrease over 10 years, or fees are cut 21% in January.
I chose S 1776. Otherwise, I stop treating Medicare patients.
The 10 year freeze on fees included in the bill is somewhat of a red herring. It is analogous to the reductions in fees included in the SGR legislation 10 years ago. Future members of congress will patch that as needed.
Tort reform is a good idea, but adding it to this measure is wrong. It is too easy to screw it up - for example to set it up so that it pre-empts state measures that work, like MICRA in California.
Dr. Coburn- Thank you for this very important explanation. AMA Grassroots network was out in force this past weekend encouraging everyone to call their legislators in support of S 1776. The 10 year payment freeze was not mentioned.
As someone mentioned above--Balance Billing and direct contracting with patients is the only way out of this mess. Our nation cannot continue to balance the elderly healthcare budget on the backs of younger taxpayers and the doctors who provide the care. All of us have Medicare patients who have the means to pay a substantial amount more than the pittance that Medicare approves for their visit--in fact, they would WILLINGLY pay, if allowed to.
To deny a competent patient the right to contract with their own physician with mutually agreeable terms is a travesty of justice.
As a small internal medicine practice in rural Georgia, we stopped accepting new Medicare patients two years ago. We plan to opt out in 2010.
SGR should be eliminated. No fixed payments, What about annual COL increases as a bare minimum? And finally, there will be very little physician support of all of this nonsense if tort reform is not included.
Why is it assumed that if we are not part of the discussion/decision making process, that we will be there to clean it up when it's done.
I'm beginning to like the idea of "Concierge Obstetrician/Gynecologist".......it has a nice ring to it.
When Senator Baccus first released his bill there were more than 500 amendments to fix what members considered problems. So if S1776 is not perfect, where are your amendments to the bill to fix its inadequacy. Understand your concern about the offset, so let me provide one. Price Waterhouse Coppers study suggests that tort reform and defensive medicine can account for more than $240 billion dollars- that's your offset with meaningful med malpractice legislation. The way things are going now, Congress is doing a good job of putting physicians out of business and providing reasons for them to not take or keep medicare patients. That is an access to care issue and affects me in the emergency department every day. Remember unintended consequences, EMTLA- an unfunded mandate to see and perform a screening exam on all comers. Since 1986, uncompensated care in excess of $140,000 annually for each Emergency Physician in this country more than 10 x the amount of the next identified physician specialty. We need answers, but more importantly we need solutions. As stated in the 60's-70's- "you are either a part of the solution or part of the problem." Which are you?
The budget deficit and national debt are abominations of our American system of government and finance which are readily ignored by those looking out for themselves and promptly pointed out by those looking to be obstructionist to new spending.
The Republican party had years under the last administration to fix the SGR, the national debt, tort reform and a million other issues. Similarly, the Clinton administration and Democrats had the same opportunity and failed to do so (although at least the US was enjoying a budget surplus by the end of Clinton's term)
Is S1776 ideal? Of course not. There is not a single bill in Congressional history that is without its detractors. Should doctors have to bear the burden of a 21% cut in Medicare reimbursement because the economy is in the toilet thanks to a myriad of other greedy people? Again, no. But if this is the vehicle for change at the present time, then I support it.
A 10 year freeze is a huge cut in pay unless you also pass a law that freezes my office rent, office salaries, malpractice premium, gas and car, and heck just about everything else for 10 years. Let's see, when in history have price controls ever worked other than to cause an artificial shortage of the controlled product? I strongly urge all SERMO members to call their senators and tell them to vote NO on S. 1776. The bill is nothing but a bribe to physicians for this year that will result in terrible pain in the years to come. Let the SGR go ahead and cut reimbursement 21%. Then when seniors can't find a physician to take of them congress will have to fix the reimbursemsnt system properly.
I am 100% against a "government option" I am of the opinion that medicare and mediaid need to go away. I can not go to the grocery store, purchase food and have a third party pay the bill. Medicine is practiced between a patient and a physician. SGR needs to go away.
Wall Street is the root of all evil in this country. They are allowed to have double-digit annual profit increases for their small role in health care, but physicians, the folks who actually provide the care, are supposed to take cuts. The buffoons on Wall Street are also allowed to highly leverage themselves, commit fraud by securitizing loans that they knew were doomed to fail, and profit substantially from selling products and then turning around and betting against those same products. My question for the Senator and everyone else in Washington: why are you bailing out those criminals and targeting physicians for pay cuts? The simple solution to rising health care costs is to target those who have profited the most over the past 15 years: Wall Street and the entire financial crime syndicate. Washington will only get the message when "healthcare blackouts" start happening across the nation: physicians en masse must call in sick for weeks at a time. Crippling the entire healthcare system is the only means we have to be heard. This approach kills two birds with one stone: Washington and Wall Street.
Sermo Doc 45, And after you make Medicare and Medicaid go away, I suppose that by extension you want all third party insurance payments to go away too. You seem to be blinded by an overly romanticized patient-physician golden ages type of ideal. Well, medicine has long, long since priced itself out of the range of your one patient paying you directly for your services and their pharmacy bill and their hospital bill and their surgical bill. Medicine is not now a free market in any way. We need strong healthcare reform with a public option. Otherwise you'll have patients coming to your office and paying you with nickels and quarters dropped into your hat.
To repeat sgmorr- this bears repeating: alamodoc, Thanks for the link to bubbaworld. That kind of hits the nail on the head concerning this senator. I agree with Sermo Doc 16. I and most other physicians support health care reform with a public option.
Also, I agree with clinped that Sen. Coburn is definitely not the person I would pick to be in charge of getting us out of the health care mess we are in as a nation and as physicians
How about a comprehensive bill to get rid of fraud, provide tort reform and if provider reimbursement is to be frozen for 10 years it would only be fair to also freeze pharmaceutical payments and SENATE/CONGRESSMEN salaries 10 years. That ought to make a dent in the deficit! I'm willing to tighten my belt if others step up.
Why don't our US Senators and US Representatives cut the amount of Foreign Aid the US spends to cover Health Care reform? Why aren't American Citizens number one for help? I don't know all the answers for Health Care reform, but whatever Congress approves, they and their families should have to be part of it so they will experience their final product first hand. This should be mandated in the bill.
Also, I feel Congress should be looking at other cost cutting options than just decreasing what they pay overworked physicians!
For all of you who want to take this opportunity to diss Senator Coburn...don't kill the messenger. Read the background information about S.1776 and Harry Reid's 5 minute arm twisting meeting with the AMA and other groups which occurred last Friday. If you can still support the AMA's position after you read a bit...then heaven help you!
This is a legislative scam...pure and simple. NO ONE in Washington is honestly addressing the real problems! Wake up doctors! The rug is being pulled out from under you and if you don't realize it...you lose!
Nowhere does S 1776 freeze the conversion factor update for ten years!
What S. 1776 does is eliminate the SGR as the basis for calculating 2010 and subsequent years' changes in the RBRVS conversion factor. Because SGR will no longer be the basis, and trying to pass a new complex formula is impossible in such a short time, the placeholder number "0 percent" is used.
A BILL
To amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Medicare Physician Fairness Act of 2009'.
SEC. 2. MEDICARE PHYSICIAN FEE SCHEDULE UPDATE FOR YEARS BEGINNING WITH 2010.
(a) Update- Section 1848(d) of the Social Security Act (42 U.S.C. 1395w-4(d)) is amended by adding at the end the following new paragraph:
`(10) UPDATE FOR 2010 AND SUBSEQUENT YEARS- The update to the single conversion factor established in paragraph (1)(C) for 2010 and each subsequent year shall be 0 percent.'.
(b) Conforming Sunset of Sustainable Growth Rate- Section 1848(f)(1)(B) of the Social Security Act (42 U.S.C. 1395w-4(f)(1)(B)) is amended by inserting `(ending with 2008)' after `each succeeding year'.
Calendar No. 178
The $247 Billion budget effect comes from eliminating the calculated ten years of savings that results from keeping the SGR and cutting Medicare physician fees by 40% over that time under current law.
Which is better, a 40% cut or a 0% change for one year? Using CBO logic this bill increases physician fees by 40% over the next ten years. And physicians are against it?
Do physicians think the issue of physician pay will never come up again until 2019?
Hospitals, labs, surgicenters all are NOT subject to SGR and have all done better than physicians since 2002. Yes, we can do better, but we can't do better Right Now.
We've been fighting SGR for 12 years, with a battle every year, and now here is a bill to kill it and doctors are saying, "it's not good enough"?
You take your victories where you find them, and then pick up your sword and wade back into the war.
The SGR is a bribe to physicians to be complicit in the complete takeover of healthcare in our country. Nowhere in the Hippocratic Oath does it state that physicians will sell-out their patients for profit. We should all understand right now that there will never be healthcare reform without doctors. Not only do we reject this on principle but, we will refuse any legislation that continues to strangle patients, physicians, and hospitals. When Congress is truly ready to fix the ailments of healthcare we will be ready to support them. But, until then I am opting out of anything that involves the current legislation. Let's be clear, there will NEVER be healthcare reform without physicians. We are in the driver's seat. In-order to receive our support we must see the following 5 principles integrated into this legislation at a minimum.
1. Ultimately, medical decisions need to be made by doctors and their patients.
2. No legislation should become law without serious tort reform.
3. Insurance can be made more affordable by allowing competition drive down costs.
4. Transform the reimbursement and billing systems that are strangling physician's practices.
5. End the unfair censuring of doctors without due-process.
As you can see these 5 principles represent the word U.N.I.T.E. That is what the physicians of the www.millionmedmarch.com will be doing to protect our patients on Nov 21st. Politician's have intruded into the practice of medicine one too many times and it ends today. It is time for politicians to start listening to their doctor's.
I think this is a terrible bill. Of course we need to fix the SGR, but not at the cost of freezing pay for the next 10 years. What other business would accept no pay increase for 10 years as expenses continue to increase? There is no tort reform, and no relief from overreaching regulation. How can physicians pay for EMR when their pay is effectively being cut?
Please do not support this bill
Sermo Doc 50, you missed the point. The SGR should have been repealed long ago. Why do you think this is suddenly and urgently on the democrat's agenda? This is a bribe, pure and simple. Harry Reid met with representatives of the AMA, ACS etc. last Friday for 5 minutes and said..."you support our reform bill and go easy on the tort reform stuff and we'll repeal the SGR".
This is the only reason that S.1776 was introduced now. He wants us to all fall in line for the health reform bill that is being crafted in secret that no one has seen. Falling for this ploy is just plain dumb.
"This bill repeals, but does not replace the SGR. Instead, this bill freezes physician Medicare reimbursement rates with a 0% increase over the next decade. There is no guarantee of anything further and it does not address what happens after the ten years are up."
The Senator has obviously not read the bill....... Or is being intentionally disingenuous.
God help our seniors if we continue getting squeezed from the government, insurance industry, attorney's. patient expectations,etc., etc.
Watching incomes drop yearly wih increasing overheads would drive many business owners to change their business model. We unfortunately are physicians who have taken an oath to heal and provide high quality care.
Our office is on the brink of dropping out of Medicare, we will balance bill these patients and let them collect their money from Medicare. They can fight their appeals and denials. We are sick of it. A public option will be " Medicare for the rest of us".
This bill is a joke. It is window dressing on a much bigger problem.
Tort reform is a must, cost of living raises is a must, allowing patients to take responsibilty for their own care is a must. Allowing seniors access to their physicians expertise without insurance industry of government control is a must.
Where is our bail out money, Mr. OBAMA!!!!!
We have had enough!!!!!!!
It is hard to believe that any physician in the United States would be for a
PUBLIC OPTION.
WE (the majority) DO NOT WANT SOCIALIZED MEDICINE.
The founding fathers nor the constitution suggest even the slightest hint of the idea that the government should provide or administer public healthcare.
These socialistic ideologies need to give way to common sense and the principles that our nation was founded upon. Socialized medicine has never been, nor should ever be considered.
This is a bait and switch, pure and simple, and the AMA leadership has fallen for it.
"Most physicians support a public option" is Dem talking points, NYTimes hogwash. Other polls of real physicians, not the phonies at the WH photo op - yes thats us out here in "Bubbaland", are 2/3rds against.
Medicare with no raises for 10 years, plus a public option whose express goal is to have every man, woman and child, legal or illegal, eventually on a government run medicare fee schedule, is 10 year slide towards indentured servitude.
Keep your drivers licenses current you all will be driving cabs for pocket change like the eastern european MDs . . .
One additional idea in dealing with balanced billing, under-insured, and uncompensated care--TAX CREDIT OFF THE TOP- DOLLAR FOR DOLLAR WITHOUT A CAP. Then, if there is a freeze on medicare, it does not matter because the Federal government would be charged in the form of a tax credit.
If this bill passes, you can count me out of Medicare and Medicaid. Have three boys looking at college in the next couple of years, and just heard that those prices are going up. Anyone planning on stopping that???
We are all dissatisfied with insurance companies and our current system - NO DOUBT
However, IT IS STUPID TO CALL FOR A PUBLIC OPTION because we want reform with our current system. A public option is not the solution. ONLY L wing liberal idealogs would think more government involvement is the answer to our problem.
If you can find it in the C-span 2 archive from today, watch Senator Joe Lieberman's explanation for voting no on cloture today on S.1776. A reasoned response...good for Joe.
Medicare is already an inferior insurer in terms of money paid for services so I do not consider SGR repeal to be any sort of grand gesture. It is a necessity to undo a previous error by Congress.
In real dollar terms, medicare reimbursement has not kept pace with inflation. Adding a 21% pay cut may be what it takes to cause the program to unravel as practices shun medicare patients because its payment are less than costs. The same thing might happen with a 10 year freeze on payment increases.
The message being sent to medicare recipients that the government has so little commitment to paying for their health care that it is unwilling to pay enough to pay to ensure that medical practices can see them without incurring a deficit.
Another thing Senator Lieberman had the good sense to point out today in his remarks...I'm paraphrasing..."In all of my years in government, I have never witnessed the solution to a market based problem, being the creation of a new government company to compete with the private market." For all who believe that this is the way to deal with the private health insurance companies...look at the upcoming insolvency of Medicare, do a little soul searching and ask yourself if the politicians are truly acting in the best interest of America.
Hi Senator Coburn from Sooner state... My question to u sir ;; would u guys in Washington take a 10 year freeze on yr salary and perks? I guess NOT ! What happened abt the Tort reform? No tort reform NO reform of any kind is acceptable...U are a doc and u should put yr foot down and dont compromise on anything till the others accept a major tort reform!.Can u do this for us? That would be the greatest service u can do for ALL the docs u represent in Washington. Forget all the other mumbo-jumbo. AMA is a joke and sucks. SGR rule or law will be a great excuse for mass exodus from Medicare and Medicaid---then what?
All of us should get out of all the ins.plans and bill the pt for our services. lets see costs will come down!! I wont need an authorisation or numerous billing collectors to chase down the deadbeats. I would add to Dr. Blue's comments...Fed govt should ask medicare pts to pay a copay...hopefully they will stop wasting my and their time in our medical offices..doc shopping? or ck out a new doc in town? etc.etc.
So Dr. Coburn the message is explicit:::: Fix tort reform....Looser pays + peers in same speciality decide the validty of the complain+ have special courts for malpractise like they have for Workers comp..Something to chew on. Wish u the best..
In order to contain costs the governement has to do health insurance and malpractice refrom. Every time when there is a questionof cost containment the payments for the physician are cut first as if they are the source of main expenditure. As a matter of fact payments to the physicians make only 10% of total medicare reimbursements. If doctors are not paid appropriately to cover the expenses of their practices, it will lead to closure of hundreds and thousands of practices across the country. Not only the payments to the primary care should increase the payments to the specialists should not be reduced either. Argument that primary care does higher mental work does not undermine the fact that the issues they cannot figure out are referred to the specialists in that field who will yet higher mental wor to find soluation for that problem.
This is economics 101: if the price paid for a service declines below the level of cost to provide the service, the service becomes unavailable. A "zero percent fee cut" amounts to a fee reduction that equals (at a minimum) inflation. Physician overhead has been increasing much faster than inflation due to external mandates such as CPT.
If the government wants and needs to pay less for health care, then The People need to pay more. Otherwise health care providers will 1) adopt business models that exclude patients who won't balance pay, or 2) take their brains into other fields entirely.
Mr. Senator, the answer is catastrophic insurance policies combined with MSA.
Health care finance in the US is "broken" because it is a socialist system grafted onto a capitalist economy. Socialism = somebody else pays for what you consume.
Dear Senator Coburn: The only way to fix Medicare is to introduce proven, well-established, practical, and logical market forces. Patients need to have a stake in what their doctors are charging and what tests are run. They must have a stake in how their premiums and their government spends their (and all taxpayers') money. Without this control, no amount of laws, orders, regulations, rules, or other tricks will be able to control government expenditure on Medicare. Here are a few simple ideas: 1. No direct reimbursement to physicians. (Patients will "see" and "feel" the bill each time they come to the doctor's office. It will help control costs by forcing patients to see what their charges are. 2. A mandatory co-pay that each patient must pay according to their income level which will help: a) offset the costs b) will remind patients of their responsibility in their healthcare costs.
I also believe that Americans are yearning for a national "Catastrophic Health Insurance Plan" paid for by general taxes and covering everyone. this program will serve as the backbone of the healthcare system. It should cover only those illnesses that are life-threatening. Just as we all pay for roads and public schools and the police, we should pay for and be covered for these life-changing illnesses such as major trauma or cancers. This system again must include some measure of responsibility and involvement by the patient.
It's only a matter of time before physicians en mass decide to drop Medicare...a herd mentality necessary for survival. A 21% Medicare cut would probably do it. This bill will eventually do it as well. We cannot expect to see these patients PLUS the Medicaid population (which my state just enacted a sudden 9% cut on) at current rates as the cost of everything else goes up. Of course, the government also wants us to all go out and spend money on EMR, and I have already heard that government dollars available for that will be (surprise) hard to get without a lot of red tape and costly hoops to jump through.
I truly feel we are headed for a mass exodus from Medicare/Medicaid by physicians. The lines of rising overhead/declining reimbursement are converging, and being offset less and less by well insured patients due to the economy. We are tired of subsidizing Medicare/Medicaid by accepting horrible reimbursement (on top of already paying into the system more via higher taxable incomes).
As for tort reform...an Ophtho friend just shared a nice story. They see premature babies to do exams in the NICU to evaluate for retinopathy of prematurity (which if untreated can lead to blindness). The exam means a special trip for them to the hospital, and is a more difficult exam than your average eye exam. To perform this exam, they pay $10,000 PER PHYSICIAN in additional malpractice insurance because of the risk of lawsuits. Medicaid (a high percentage of the preemies are Medicaid) pays about $35 for this special exam. Of course, this means they are LOSING MONEY to provide this service. Logically, they are having to talk with the hospital about making other arrangements as they can no longer afford to do this.
The system is broken on the physicians' side as well as that of the patient. We need relief!
Having read the above, I'm inclined to say 'No' to the S. 1776 given its lack of either COLA (cost-of-living) protection for MD fee schedules or med-mal tort reform (let alone both!).
Nonethless I'm intrigued by landesbw's explanation that the S. 1776 may be the better half of a bad situation--anyone to counterpoint (constructively) landebw's critique.
As to DrBlue (capitalist?) & Sermo Doc 29 (socialist?), as I've said many times before in Sermo at large: Socialized medicine? Anytime you want--as long as you take what must go with it, if such a system is to function cost-effectively & affordably in a large & diverse nation (like the USA or the former Soviet Union)--in contrast to compact, homogeneous, affluent, self-contained societies of Sweden or Switzerland--namely, rigorous & ubiquitous Soviet-style command-control of health services providership- supply & consumer-demand.
The following is a copy of an email I received from someone in the know who received this from someone else in the know. I can't cite the source as I don't know who it is but very reliable:
Minutes ago the Senate voted on a motion to invoke the cloture on the Motion to Proceed to S. 1776, a bill, by Senator Stabenow (D-MI), the SGR repeal bill. The vote failed, 47 to 53. There have been talks to amend the bill to transform it to a two-year or a 4 year patch possibly paid for by a "millionaire's" tax (congratulations) or pay it with "unused" TARP funds.
The to-be-merged Senate health care reform bill will likely contain at a minimum a one year SGR fix that is paid for. The House bill is also likely to contain a fix to the SGR, however, we are hearing that the original full SGR fix included in the House Tri-Committee bill is likely to be scaled back due to the cost. Therefore, if the House and Senate bills are conferenced, the issue will be subject to change but very likely will end up as a 1 year or 2 year fix. The AMA has stated they will actively oppose anything that does not repeal the underlying SGR formula. It will now be interesting to see what the AMA says about health care reform bill(s) that don't fix the SGR.
Dear Dr. Coburn,
Agreeg SGR fix dont agree with price freeze. We cant even talk or unionize and we are getting the shaft.
Please bring some common sense to Wash for us. I could talk at lengh on how to fix this mess. Important Points
Tort reform- Get us our own court with court appt expert witnesses, make the loser pay for the winners lawyers, punish the ambulance chasers. Defensive medicine is rampant. I saw three patients in one week thathad anaphylaxis and the ER wanted to keep em overnight to be safe. I went in and discharged them saving almost 10 K. The only reason they were admitted was for CYA reasons
ICD-10- Do we want this expense?
EMR- Is it worth it to spend 50K/doc X 100,000 doctors=~ 50-100 billion dollars over 10 years for a not-ready-for-prime-time system? In a budget crunch your going to force me to become less productive? Show me the people who say they are more productive with hunt and click EMR and I will show you a rarity. I have yet to have a patient tell me they like their doctors nose in a laptop while they talked to them. Yesterday I saw 26 patients and they all had adequate time spent with me. Then I didnt go home on the computer to finish charting like my friend does with EMR.
Insurance- Make regulations nationally and allow inter-state competitiion between companies and we will see rates drop. Make Insurance companies standardarize in how they ask for information and make refusals. Give teeth to the Insurance overseeing agency to punish spurious decisions
End of Life- Old people often say to me Let us die ! I saw a 87 y.o. in the ICU with maggots coming out of his nasal septal necrotic ulcer! He had spent a month in ICU after a gallbladder surgey. He had Alzheimers and had not been self-aware for 10 yrs, not walking for 5 yrs and not eating with J-tube for 3 yrs and was in the hospital for 6 weeks. Why are we wasting our talent and money on this guy when the 40 yr old woman who lost her job and cant afford her cobra couldnt pay for her medications yesterday. Who is more deserving of charity? This makes no sense
Good luck. I donated to your reelection fund today. If doctors dont support doctors in Wash we are in trouble. Here is his web for donations
www.coburnforsenate.com Please put your dollars where your mouth is.
Sermo Doc 65, Maybe you should research Sen. Coburn's "end of life" positions before you throw all your support behind him. As I recall he gave much credence to the Sarah Palin et al "death panel" distortions. You may find out that he views these end of life issues differently than you put forth in your post. Or perhaps that was just some of his political posturing and pandering to his teabagger base. We'll never know.
Please realize, this is not about Senator Coburn, his party or his message. Just read the language of S.1776 and the details of how it came to be at this juncture of the health reform debate. This is not a democratic or a republican issue. This is, and should be an issue for all Americans. The SGR is a flawed compensation calculation. The idea to repeal it has merit...on it's own. Offering to repeal it as part of a backroom deal in exchange for a commitment from organized medicine to support a flawed health reform bill that we haven't even seen yet is the part that I vehemently oppose.
Health care reform in this country doesn't need to proceed in this manner. Can you trust those in Washington to honor their word on this or any other issue? I'm not just talking about the party in power here. I'm talking about the process.
As the other anesthesiologists on this forum know, anesthesia was strangely singled out long ago with a bizarre formula that ripped the heart out of our Medicare reimbursement. Not one surgeon I work with even realized this. The 33% of average negotiated insurance company payments that we receive, has already driven many fine anesthesiologists out of hospital practice here in California, where in addition, Medicaid rates are the lowest in the nation, and HMO's first moved in an ugly way. Continued cuts in Medicare payments, especially if spread to a public option, will deal a massive blow to anesthesiology, which has made so many advances in patient safety over the past 3 decades. As the economy rebounds, taxes rise and fees fall, we will see loss by attrition of early retirees, even with less than they dreamed of in their retirement plans. There will be little incentive for new trainees, and more reliance on nurse anesthetists and foreign grads. Of course, members of Congress will never have to worry .
ADDING TO THE DEFICIT FOR AN ENTITLEMENT ( as opposed to a one-time stimulus) IS IMMORAL. Either our grandkids are stuck with it , or more likely, they'll start printing money after the next election in 2012. ( Zimbabwe here we come. )
The answer is quite simple- a gasoline tax. Canada , with its "utopian" health system, has a gasoline tax such that 35 % of the cost goes for taxes. The US rate is 20%.
This tax will help the environment, decrease our dependency on foreign oil and be a more equitable source of income. Those travelling on long vacations pay more.
The tax on trucks could be reduced.
And let's adopt the Canadian tort system while we are at it.
Given the relatively low Medicare reimbursement, I recommend keeping the current rates, but adjust for inflation each year. That way inflation-adjusted costs do not go up. If inflation adjusted reimbursement goes down, physicians will either drop out or see less Medicare patients, or patient visits will shorten and they will come in more often to maintain total reimbursements. That ends up burning out doctors and care suffers.
I think it's wrong that the best and worst physician in the US get paid the equally for the same procedure or office encounter type. Balance billing, however, would possibly increase costs (it might decrease it if patients seek less care) and seniors would not be able to afford the increased cost. Therefore I propose that physicians be allowed to balance bill a portion of their patients (say 50%, and possibly based on patient income). Those paying more might get longer visits scheduled. Yes, it' would be a two tier system, and politically might be a hard sell, but the lower level would still be good care, similar to how it is today. Already those with more money have access to better food, clothing and shelter, and can afford the higher copays of 2nd and 3rd tier medications. If patients did not like the higher charges, they could find another doctor. Presumably the higher quality doctors would be able to command the premium. It could also be variable. It might be an extra $10 per visit for one, or $100 for another depending on what the doctor wants to charge, and what the market might bear.
Like most others, I did not go into medicine for the money, yet I feel I deserve to get fairly reimbursed. My family suffers the long hours I put in, yet vacations, new cars and college educations strain my budget.
Senator Coburn - Here is my to-do list, if S. 1776 passes:
1) Check with my office staff, landlord, utility companies, suppliers etc to verify that none of them will expect a raise or increase their prices over the next ten years;
2) Check with my wife to make sure that our household budget will not need to increase at all over the next ten years;
3) Check with all of my patients to make sure that they don't mind me having less time to spend with them when they come to see me, so that I can squeeze more patients into my schedule in order to maintain a stable income, at least relative to expenses and inflation (if that is even possible!);
4) Check with other professionals - my accountant, lawyer, etc, to see if they anticipate earning the same amount of money (or less, adjusted for inflation and increased costs) every year for the next decade;
5) Check with my congresspeople and senators to find out if they will be receiving cost of living driven pay increases over the next decade;
6) Check with the drug companies to see if their prices are going to change over the next decade;
7) Check with some healthplan executives to see if their pay will increase at all over the next decade;
8) Call my health insurance company to see if my personal and family medical insurance premiums will be the same every year for the next decade...
Sermo Doc 67, I think anesthesiology is a lost cause. Our forefathers and foremothers sold this specialty out long ago with the strange mix of anesthesiologists and nurse anesthetists that was present early on. I really don't know how to correct this in our specialty. I'm sure the future of anesthesia provision will largely be based on CRNAs.
The absurdity of the idea is mind boggling!! Physicians are closing their offices now because they can't survive with the current reimbursements and you want to freeze it for another decade. Obviously, there is no interest in keeping physicians in practice nor any interest in listening to what we have been saying. You know what? Do what you want, we will simply become non-providers.
To those who disagree with Dr. Coburn based on bubbaworld.com, you are very shortsighted and easily influenced. Please learn more about him; visit and read his website. If we had several more like him in congress we would not be in near such a mess. He is willing to tell everyone how it is, without regard to re-election goals. He brings a very refreshing perspective.
Dr. Coburn: Thank you for all your work. I am in favor of a tort reform component to any legislation. But I fear that a 0% increase over 10 years is actually better than what our economy can support long term and that making a deal like that now would be the lesser of two evils.
This bill is another reactionary attempt by our government to "buy off" our support. While we look at the 21% cut in Medicare for 2010, I can only extrapolate that it will be even higher in 2011. The gap will widen unless we see several things happen. 1. TORT reform 2. Medicare/Medicaid fraud resolution which costs $$$$. 3. Novel idea: Increase the age of Medicare eligibility to to within 3 years average age of death for men and women. What was the average life expectancy in 1965, you'll see my point. 4. Open up the ability for citizens to buy insurance from ANY insurance company, anywhere in the US.
Ridiculous. I do not accept Medicare, but other reimbursement is tied to it. Costs to do business go up yearly and inflation exists and will increase. This means that 0% increase is a yearly cut, compounded 10 years.
Reform, interesting word. I'm concerned that the patients in the long run will be the ones to suffer. I for one find it unbelievable that our profession and the public find it OK that lawyers can bill for time on the phone but when I am called and make life changing decisions I am not paid. A mechanic not only charges for putting in a new muffler but charges for the muffler too. I on the other hand can charge the patient to see them in the office but cannot charge them for the new trach I put in. Now we want to continue to reform. Many physicians are not far from either not practicing anymore or not taking insurance at all and charge cash for service, the patients will be the ones who suffer. Until this population decides that their personal health and responsibility is more important than the NFL reform changes the cards but not the game.
Sermo Doc 44 I did read it and that is great unfortunatly a society changing problem is still out there. I also agree with a prior posting about reimbursment being equal between the best and worse doctors, that being said with the healthcare information in the state that it is in and one computor system unable to talk to another one will find it impossible to verify who is the best or worse in their given specialties. One could argue outcomes, complications, length of stay are not constant and unstable given the flux of enviornment that different physicians practice under. If you come up with a solid plan I would love to hear it.
Oh yes, one comment on the preventative medicine issue. Yes, I think it is important. Don't try to make it out that this will decrease cost of medical care. A significant amount of medical costs are in the last six months of ones life. We are all going to die sometime, so unless one can find a across the board way to deal with that don't tell me it will decrease cost.
With all due respect Senator, this is all utter bullshit. Stop insulting my intelligence with your recent blackmail offer.
The continued oppression of physicians is a done deal; the mechanism is irrelevant. We should-- for once-- be smart enough to see the imminent destruction of our beloved profession. Physicians need to stop this madness and opt-out of Medicare and drop commercial insurers.
For God's sake people, save your patients. Save yourself.
I am so glad my financial advisor tells me I can retire in 3 yr. That will be a total of 39 yr not counting post grad training. That is what FP does for you. Makes you rich. If the whole country goes to Armageddon, I'll trade my services for eggs and ham. That will be far more satisfactory than catering to medicaid cheats and other entitled whiners. I am at teh point where I want to secure medical care for my family, friends and other like-minded people. And everyone else can go to hell. My level of frustration is not a whit higher than those who posted before me. Get ready America for the new order.
I can not believe congress feels that providing health care is the financial responsibility of those of us that have a calling to help others and love medicine. Last time a looked I had 4 kids not 3,000<that is how many active patients I have in my practice> I already subsidise their immunization by being under cut by private payors for them. Now I have to continue to cover more? ! Pediatricians get an average of 60% of medicare allowable as it is via Medicaid. if we take a 21% cut from that , and have to negotiate contracts with payors that on average give no more than 85% of medicare allowable to pediatricians in our area Oh WELL....../////.........
WE ARE GOING TO HAVE TO OPEN A HORSE AND PONY SHOW OUT IN THE PARKING LOT. CHARGE THE PARENTS AN ADMISSION FEE TO KEEP AT LEAST ONE DOOR OPEN NEVER MIND BOTH DOORS.
S. 1776 IS the blackmail offer. The SGR was created by bureaucrats and CMS policy wonks, and was designed to effectively suppress physician reimbursement despite the enormous rise in practice overhead over the last eight years. The current offering is the same type of bait that Pharma and the insurance industry latched onto.
The promise: We won't make it worse (eliminate the SGR), but it will never get better (S. 1776). Don't you see that the current proposal of eliminating the SGR is linked to the future proposal of no increase in reimbursements, which is exactly what has been happening for the last 8 years!!
Feel free to be a lamb. Your destination is ensured...
Like you, I do not agree with the bill because it does not specify a replacement formula, which I believe should at least be indexed to cost of living. My employees get a raise every year, my rent goes up every year, but my revenue is fixed. That means my income goes down every year. So a so-called payment freeze is actually an annual decrease in physician take home pay.
Second, paying doctors $250 billion a year for services provided to society to keep people productive is money far better spent than any of the "handout" programs currently in existence and being proposed. Let's stop giving money to people for nothing in return, and use that money to pay people to provide a service or build something. Pay people to build roads and bridges. Pay teachers to teach students. Pay firefighters to save people's homes. Pay for scientists to develop new cures for diseases. Pay doctors to keep citizens healthy and working and providing for their families. Cut out the entitlement programs that provide nothing to society in return. That's how you pay for this.
Finally, medical liability reform seriously needs to be addressed, but that is another topic that should be addressed in another bill. One thing at a time here. Why do all bills have to be 1000 pages and address hundreds of issues, encouraging political bargaining and vote trading. Can't we debate one issue on its own merits until we reach a compromise that's best for the majority, and then move to the next issue?
I can see future physicians working for 50% less reimbursement, with no hope for increases due to the political machine controlling our tax dollars. The incentive for getting up in the middle of the night to treat a patient, or give up family time for doctor time, is going to melt away. The attorneys, on the other hand, see fresh meat in the offering since government mandated care "guidlines" can open up malpracitce issues due to poor outcomes. Restriction of medical decisions by bureaucrat is similar to what we have in California under the worker compensation system. Plus low payments for the care, barely maintaining the overhead costs.
We as doctors have painted ourselves into a political corner. I suggest we revolt, stop seeing government sponsored patients, illegal aliens, and al payments coming from bureaucratic dicision making.
If enough of physicians slow down, stop working, and see only private patients, it may make a difference with the AMA, AARP, Big Drugs, Big Labor, Big Attorney lobbies which all make our profession be a problem to work in.
As a practicing Nephrologist, the majority of my reimbursements are from Medicare. I certainly agree with the previous post. Each year our overhead increases via raises to our office staff and rent increases, not to mention inflation. However, our income remains the same and may be in jeopardy of decreasing by 21%. I can't think of another profession where one is expected to contribute so much with such dismal prospects.
Now certainly our subspecialty is in no position to opt out of Medicare. However, as reimbursements decrease and/or remain the same patient care will suffer directly. In order maintain cost flow we simply have to see more patients in a shorter period of time. Our other option is to hire physician extenders. This does not improve the quality medical care. I can't think of any provider that wants to work harder for less of a reimbursement and provide lower quality care.
the sgr needs to be eliminated, not just repealed.
there should be a set formula for cost of living, cost of running a practice increases every year and incentives for higher payment.
as an internist i can save more money for the system if reimbursements were higher and therefore compensate for the defecit spending. bottom line, reimburse me appropriately for the time i spend with pts, then i will take the time in effort to provide a higher quality care that can reduce costs by limiting testing, specialist referral etc that comes with having to feel rushed.
in summary, i agree wtih my colleges, s 1776 is a sellout and does not do our profession justice. we deserve better and should expect it.
Somehow 250 billion seems too big after a couple of trillion were spent for the TARP and Stimulus package. Se. Coburn - please don't think we don't see through these political moves. I can believe I am disagreeing with Sermo Doc 1 and agreeing with cmhughes on this, although I don't support the Public Option.
Why should tort reform be linked to SGR repeal? Is it not possible that these measures can be passed individually? I think the Republicans will loose a fair amount of physician support on this Senate vote.
This does not matter to me - we have already stopped accepting new Medicare patients. The govt can keep their money and balance their budgets - not on my back!
I went into medicine to help people. My mother was ill for most of my childhood. She died a premature death at age 53 due to aftereffects of an untreated strep throat she suffered as a child in war torn Europe that led to rheumatic heart disease and destroyed her mitral valve. It was this daily exposure to my mother's illness as a young boy that led me, in the 4th grade, to solemnly vow that I would become a physician one day.
I graduated from medical school in 1981. My mother was proud of her son, the doctor, until the day she died a few years later.
While I went to medical school with altruistic goals, I have found over the ensuing years that the practice of medicine has, at its core, a subset of expectations and demands placed on physicians like no other endeavor. I still hold true to the 'old' version of the Hippocratic oath, not the newer 'politically correct' version.
I never had expectations of riches, fame or fortune by becoming a doctor. However, I never expected that I would have to take a vow of poverty either.
The practice of medicine is not the same that it once was. It is certainly not the medical field I envisioned when I entered medical school in 1977.
Physicians have been demonized, marginalized, sued, over-regulated, nickel and dimed by the insurance companies as well as Medicaid, locked out of medical staffs and insurance plans for want of board certification, etc. The list goes on and on.
I had hoped and wanted to practice medicine until my 60's. It is no longer my desire to do so. I feel unwanted and unappreciated on so many fronts that my burning desire to be a physician has dimmed to a dying ember. It saddens me.
I do not appreciate being used by either political party for its own ends. If you have the desire, I encourage you to read my four part "Thoughts of a physician" posted on Sermo just three months ago. It goes into more depth than I can here.
I have a mentally handicapped son who suffers from autism. I fear for his well being in this 'new America.' I also have two other 'typical' children. One has expressed a desire to become a physician. I have actively discourage this!
Come what may, I am expendable as is everyone else. I will leave the practice of medicine and do something, anything else, to feed, clothe and house my family. Maybe, just maybe, life will be worth living again.
It is with a distinctly bitter taste in my mouth that I state "I am not leaving medicine, rather, medicine left me."
We are philosophically on the same page. My criticism is with catering to politicians who only want to use you as a pawn to propagate their own personal interests. The AMA has succumbed to such flattery, contributing to the demise of practicing physicians. As individuals, we should not subject ourselves to the blatant, pathetic enticements that have ultimately undermined our professional stature.
As much as I can appreciate SOME voice in the present debate, I recognize that the lure is only Congressional grandstanding. In the end, we will lose because we cannot comprehend the political and financial forces pitted against us.
I'm tired of kissing an ass that will never recognize my personal and professional contribution to humanity.
Medicare and Social Security are immoral programs that take money from the producers and give it to thoes who "need" it. Both progams along with the entire welfare state should be phased out starting now. It would gradually stop the evil act of government taking the property of some to give it to others in violation of the individual rights of those being robbed. Whether done by an act of Congress signed by the President, or a thug with his gun in one's back on a dark street at midnight, theft is theft.
Read the Declaration Of Independence and recognize that our nation was founded on the moral principle of INDIVIDUAL RIGHTS to life, liberty, property and the PURSUIT of happiness. It does not say an individual has the right to have others provide him with property or happiness. The government is required by the founding documents to use force to protect us from those who would harm us by using force that would prevent us from thinking and acting in our own selfish interest to create the values our lives and happiness require. Sadly government has become the most flagrant violator of our rights not our protector. Wake up and reverse course before our nation becomes a complete fascist dictatorship!
Sermo Doc 84, in this discussion, I have not linked tort reform with repeal of the SGR. My ONLY point here is that the "promise" of SGR repeal in S.1776 by Stabenow and Reid was attempted political blackmail which failed. In the process, the AMA, ACS and others were exposed as fools.
The AMA tried to sell this as a good thing, as the basis for the "hope" of better treatment in the upcoming reform bill. The senate saw through this attempted fiscal scam today, which is a good thing. Did you see Joe Lieberman's comments on the floor of the senate? Connecticut should be proud that they have him.
1. The SGR is not useful or realistic any longer - just a little common sense to consider.
2. We'd get further in guaranteeing the highest quality of care for all by replacing the SGR with something logical, and removing geographic disparities in payment with one swoop.
Thanks to you for your communication and for soliciting input.
I really hope you read all of these comments and pass some of the sentiment on to other leaders. After the vote today failed to STOP the 21.5% reduction in fees I can sum up my response in 2 words.
I QUIT.
I, like many other physicians am barely able to get through the month at current pathetic rates. This kind of cut makes it easy to decide what to do but painful and sad to realize that my skills are thought to be less valuable to society than the Sears repairman who checks out my washer as his fee is almost double mine. Wont the Senate be surprised when millions of Medicare patients no longer have a physician willing to work for wages that are laughable. Don't expect to bring in many new physicians at these rates as the smart students already know NOT to go into medicine. If the Senators think the town hall meetings were emotional before, imagine 60,000,000 people not having any doctor to see, at all. Wow, that truly is health reform. Nice job.
The answer is a formal physician union, plain and simple.
Collective bargaining is the only means to protect ourselves against the powers that be. Interesting that the powers that be took the only real tool we have away, as that is illegal.
Interesting that all other parts of medicine [nursing, PA/CRNA/NP, Staff, and even administration] have the right to organize form a union, and protect themselves.
United we would stand, divided we are falling.
Physicians are the key to medicine, but are treated like the red-headed step child [no offense to red heads]. It blows my mind that we are discussing what we are. We have to defend our existence, defend and fight to be paid what we are worth, yet we all sit her on call tonight, at the whim of whomever needs us.
What would a legal consulation at night cost us if we needed it? I doubt that the gov't would state that after hours legal need is "part of their role and oath to uphold the laws of the land and our constitution".
Honestly!!! Freeze reimbursements? patch the SGR? avoid 21% cuts by January? Does any of that sound even remotely appealing or comforting at all? You cannot value medical expertise/skill/judgement with an equation/modifier or cofactor/coefficient. It doesn't work that way. How about valuating physicians for their contribution to daily life, health care, H1N1 vaccines [ha ha], Polio vaccines, Trauma care. It is amazing how valuable people think you are when they are dx with cancer, have perforated viscus, are incapacitated. No so much later, after you render services and then they get the bill. At that point, you really didn't do that much to help them, right?
Legislators need to wake up and be wary of devaluing something that they cannot quickly replace. We are all replacable, but not very quickly. How valuable were President Reagans surgeons? Dwight Eisenhower had Ulcerative colitis, do you think his physicians were of any value?
You see value is a subjective, market based product. Like housing, this product is worth what people are willing to pay to get it. "Free healthcare", or Medicare valuations will never allow that to mature, as it puts a false ceiling on that value [based on nothing that relates to what the true value is], which then becomes the reality for the average Joe or Jane to start from.....doomed before it ever begins.
Medicare patients tend to be the sickest, most complicated, most time-intensive patients. Physician compensation for services rendered to these patients is pathetic as it is, yet we have to beg to prevent Medicare cuts every year. And the best this "fix" offers is to freeze our rates at 0% for 10 years? This is insulting. Society damn well better figure out how to compensate its physicians better to care for its sickest, most complicated members or society won't have any physicians to provide such care.
Then let society's lawyers take care of them. We'll see how well their subpoenas cure their illnesses. And what their tort laws add to the average life expectancy.
This whole decade reimbursements have basically been frozen, despite a 30% increase in practice costs. A frozen reimbursement is equivalent to a 3% cut, and more if there is inflation. We have practiced in a dual environment. We have socialistic wage controls on the income side but a capitalistic exposure to costs. We can't freeze employee salaries, rents, utilities, supplies, etc. for 10 years. We need cash available to maintain and update equipment. We need a minimum 3% yearly increase or more to make up for the last decade. If our fees are frozen by Medicare they will also be frozen by Managed Care plans. The result will be the collapse of the Medical Practice. Doctors will not be able to survive, period. The Government is trying to balance the budget on our backs. Because we are prohibited from organizing to negotiate increases, we are abused and have no recourse. We are the low hanging fruit. We cannot accept the role as "whipping boy" any longer.
It would take an effort as explained by Webdoc, with massive resignations from Medicare or from medical practice totally, to demonstrate just how bad we need some reform; that said, the public option is NOT viable (lets face it -- they can't even coordinate flu vaccination this year), the SGR needs to be eliminated, the patient needs to understand, hence, get involved with the economics, rather than turf everything to the payors, and finally, wow, we need tort reform on a national basis.
I really do see many people, including us who have private clinics, to opt out of Medicare and Medicaid in order to cover our overhead expenses. Without comprehensive analysis of the reform proposals, we will NOT have the high-grade medical care available when I'm old and gray, let alone for my grandchildren.
WASHINGTON (Wednesday, October 21, 2009) - Senator Patrick Leahy (D-Vt.) Wednesday joined with Senate Majority Leader Harry Reid (D-Nev.) and Senator Charles Schumer (D-N.Y.) to announce that he will offer the Health Insurance Industry Antitrust Enforcement Act as an amendment to health insurance reform legislation. The bill, which Leahy first introduced in September, promotes competition in the health insurance and medical malpractice insurance industries that will benefit consumers. Providing antitrust exemptions for insurance companies has been anticompetitive and damaging to the American family and the American economy. leahy.senate.gov
Personally I believe what you are seeing happening is the WALMARTization of medicine in this country. Recent stats show single office private practice declining by 2% a year over the last 20 years. Recent #s also show 60 to 75 percent of new internist going into hospitalist medicine. My opinion is directly or indirectly the govt is forcing our hand into joining hospital run medicine or mega groups for efficiencies of scale and cost. If you keep lowering the bar ie reimbursements only stupid people like myself would stay in practice for autonomy and although govt says we are not forcing you out of private practice, the numbers speak for themselves. Join the Walmart model or perish. Is that what govt is indirectly forcing. Once hospitals run the business model, don't you think they will lower doctor pay or hire NPs or PAs and water down quality. There is a reason most here are DISGUSTED with the whole GAME! That is truly what it is a game that is lopsided in favor of corporate interests ie pharma, insurance and lawyers.
They say the people get the govt they deserve, well they will soon get the lack of care govt will create. There is a saying in communist Russia, they pretend to pay us so we pretend to work. Coming soon to a hospital near you!
If I called Senator Coburn's ofice and identified myself as being from a state other than Oklahoma his staff would politiely listen to my opinion but would not register it. All Congressional offices want your zip code because they couldn't care less about the voters outside their district or state. Yet, Senator Coburn solicits opinions from a coummunity that is idealogical similar to him but most off which are not from Oklahoma. But he does waht to feel better when he votes against the interest of most of his fellow physicians.
Repeal the SGR. Suck up the debt. Start over with a better const containment system.
Anyone who thinks any Congressman, Republican or Democrat, would vote to freeze Medicare payments to physicans doesn't understand how Congress works. Repeal of SGR is not linked to a pay freeze. The curent SGR is an automatic, yearly pay cut which is always overridden. A farse.
No wonder America is tuning out this health care debate! We would rather watch a crazy balloon in Colorado than discuss important health care policy. How can anyone make sense of this?
My thoughts - when Medicare was started in the late '60's. Doctors were against it. Now our seniors are dependent on it and there is no way it is going away any time soon. Health care costs are dramatically higher than they were in the past. We are a compassionate country and thank God we do not stand by idly while people, particularly seniors, children, pregnant women, and the sick and frail suffer and die.
If the private sector can equitably provide decent quality health care for the poor and the most vulnerable in society then that would be great. But since this is not likely to happen, the government health care is the best option. We are already subsidizing and paying this health care bill for uncompensated care. It is time to quit the charades and make a public option available for everyone who cannot afford their own health care. This can and should be paid for through realistic taxes and perhaps excise taxes on gambling, tobacco, alcohol, and luxury items. Health care cost control should be rewarded to physician or hospital or pharma initiatives that demonstrate excellence in more cost effective, high quality health care that can be widely implemented. Furthermore, efforts to control health care liability costs and curb defensive medicine and promote tort reform MUST be included in any realistic measure of health care reform for physicians support.
Senator, the SGR formula is hugely flawed! I am not sure S 1776 is the answer , but I am disturbed about the lack of any specific plans for improving health care access and quality coming from your Sermo letter to physicians. As a physician/politician I would expect more.
Sermo Doc 95, the unspoken etiquette rules in the house and senate offices are that they are supposed to listen politely to people who are not from their districts and then refer you to your own representative or senator. This is the way it works and always has.
While the nation is drowning in red ink, the legislature is arguing about rearranging the deck chairs on the Titanic. There is no cost containment in any of these bill worth a dime! If you insure more people, you are going to have more cost.. duhh! If all these currently uninsured, become insured, oh just look at the colonoscopies, PSA's, MMG's stress tests etc... The cost will BLOW your minds and the budget... Even by having a pure public option and erasing the parasitic insurance companies who are sucking the marrow out of the country (with their lawyer co-parasites) there still is not enough money to satisfy the voracious demand for health care!
Tort reform, elimination of futile care, balance billing and transparent charges.. all these need to be implemented FIRST before adding any more "insured lives."
All studies that look at this show that we are essentially killing off the uninsured by less vaccines, preventive care, diabetic and hypertensive control etc... Stopping this "kill off" and replacing it with any semblance of medical care will blow the budget out of the water if cost containment is not addressed.... S 1776 is just a waste of our time!
Medicare/medicaid is a tiny percentage of my income, so I don't really care personally, but the writing is on the wall if draconian cost containment is not implemented not just in health care, but across the federal and state systems, the United States of America as we know it will be gone.
The first attack is going to be on the 401K's. Just watch.. when the deficit balloons, all those politicians are going to look at those juicy, ripe retirement accounts and pounce like a pirhana on a fattened calf!!
1) We need to establish P4P (pay for performance) for Congress. Since the legislators have not devoted time and energy to fix the flawed formula, therefore jeopardizing access to care for seniors, then the Congress should have a pay cut.
2) The Congress always waits for 3 am Saturday on mid December, and the LAST thing they do before going for Xmas break is to cancel the now 20% cut scheduled for Jan. One year they were so lazy or unconcerned that they let the cut pass and on Feb of the following year they had to cancel the cut retroactively to Jan 1st.
3) If Congress can't find $250 billion now to care for the current Medicare patients, how can they threaten to have National Healthcare i.e. Medicare for ALL???? The money will have to come from the taxes or from somewhere. From the same place that the money for defense comes. So don't punish doctors just because the money is "not there".
Physicians and Senators need to recognize that doctors are not as stupid as we seem to be somtimes-or maybe we really are. We are expected to be grateful for not getting our pay cut for 10 years when what is needed is a pay increase. A durable medical equipment vendor will make more money from a single back brace or other orthotic devices than an internist will make seeing 15 complicated medical patients in a whole day. Medicare does not pay a primary care physician to do an EKG, so the doctor gets a cardiology consult instead. Instead of an extra 50 bucks for an EKG to re-assure the patient and pick up an occasional significant diagnosis, doctors say screw it and send the patient for a workup at the cardiologist which sometimes costs tens of thousands of dollars. Doctors don't practice what's good for the patient anymore. They practice what's covered or they only do what will be paid for. Too often necessary things are not "covered " so unnecessary things get ordered. Any "across the board" change will be unreasonable or inadequate. Meaningful reform must consider incentives to urge physicians to want to see new medicare patients. To accomplish this, logic dictates that reimbursements for some services will have to increase and reimbursements for others will have to decrease. An across the board decrease will not help anything. Not increasing reimbursement for primary care will derail anything that comes out of congress, like it or not. As it is, and even moreso as it will be no doubt, from a business point of view, a primary care physician is pretty unintelligent if he or she continues to see medicare patients in a private practice setting. Care of our seniors will continue to be delegated to PA's, nurse practitioners and physicians who work for non-profit organizations. Don't insult the intelligence of doctors by expecting a pay freeze to make us happy.
I have read through all of this and agree with Dr Armstrong and his supporters. I left residency 11 years ago hoping I could really help patients and their families and earn a decent income. I am far from rich, but don't mind where I am now. We went to school for most of our youth to become physicians. I think we deserve more respect and earnings than we do. Medicare IS the Titanic. No matter what changes are made, it will sink soon.
SGR or no SGR, I can't see how Medicare payments can continue in our current system of monopolizing insurance companies, defensive medicine, and the overwhelming demands of the public for the "best" health care without rationing.
If Medicare payments sink, which they will sooner or later, I will be forced to end services to seniors and the disabled on Medicare. I will have to fire most of the staff, and I will see fewer patients, but at least give them more of my time. I will likely have to move out of my location, which has mostly lower income patients on Medicare or commercial insurance from their jobs. My patient population of over 2500 will have to find a willing nurse practitioner at a minute clinic to see.
Perhaps I will be happier in that situation. It will be me and one medical assistant and maybe one receptionist. I can see 15 patients a day and give them all the time they want, and I can go home at a reasonable time and be with my family. I will earn less, but die happier.
Medicare is the Titantic but it is also the flagship of the fleet. Where is goes, so too the private insurers follow suite. I think it is ridiculous that the public is led to believe that we are paid what we are charge much less what we are truly worth. Let us not forget that basis of reimbursement is medicare.
I disagree with Dr. Jesse, why would this balance have to be budget neutral for physicians but not for everybody else. Any significant change will drastically alter what we know now. I don't think anyone can predict with will occur based on simple or complex changes for better or worse. It is this "butterfly effect" that we theorize about. The reality is that currently, medical equipment/supply companies, hospitals, and insurance companies will fare better based on language already written in the two bills proposed. There is no such language for phyisicians. All physicians deserve increased pay/reimbursement, not just some. That increase needs to be substantial to offset the losses for he last 6-8 years to simply break even. People, and politicians have little sympathy in this regard. As long as the care is given, and we are required by hospitals to see medicare/medicaid patients [in most by laws], this destroys the cause. Even if you opt out of medicare, does that mean an ER patient with medicare/medicaid does not need to be seen if you are on call? I would theorize the answer is no. Therefore the patients that you refuse to see in the office, will be seen in the ER instead..... you lose again.
We are so regulated and critiqued, that all avenues have been reviewed and loop holes will likley be closed for most physicians. Again, this begs the question, why is it that physicians are the only ones that cannot unionize? The worst nightmare of Speaker Pelosi, King Obama, Medicare/medicaid, and private insurers...........physician unions that would make a single unified voice be heard, and level the playing field. I suppose I answered my own question.
Medicare payments should be indexed to inflation; this would help sustain the viability of medical care. Tort reform should be addressed. The deficit should be fixed. This would mean finding the finances to support government programs such as Medicare. It is doubtful that fraud and abuse by providers are major sources of government waste. Rather, get rid of private industry's participation in Medicare. The biggest fraud and abuse is being done by the Federal government as it continues to allow the private insurance industry to get rich off of taxpayers by allowing them to sell Medicare plans, such as Medicare Advantage. The government's own figures show that private industry can not provide care as efficiently as government Medicare operations. Mediare Advantage plans should be dumped so the American taxpayer is paying for our own care, not to line the pockets of the insurance industry. Put a halt to the adage of Will Rogers, Jr. that 'we have the best government money can buy'; stop, to paraphrase Obama, business as usual. How about voitng in term limits for Congress?!
Check out my latest MDNG article, a call for action, published 1 month ago:
"Announcing the HIT 1115 Project"
In the article I'm making a call for all physicians to go nonpar or to opt out of Medicare altogether, en masse, between 11/15/2009 and 12/31/2009, the period where we are allowed to change our participation status.
I like your blog Al, and agree completely. All physicians need to opt-out. Ask anyone that has already done so and they will tell you how liberating it was.
If everyone did this, quality would go up just due to the mere fact that we would have more time, less paperwork and fewer idiotic rules to comply with. P4P, PQRI, ePrescribing, bullet points, RAC audits, ICD-9, E&M codes, mandated EMR, perpetually suppressed reimbursement-- nonsense.
I favor a permanent repeal of the SGR as it is madness. Whether that is S 1776 or another bill is not as important to me. The bottom line is that our Nat'l debt and deficits are now our major problem. Now is not the time to add any huge govt programs. Look at the jolly time Massachusetts is having with "universal" health care.
Ways to start are so simple. 1). Allow individuals and small business owners to band together in large groups to buy insurance from national pools. 2). Make 10, 15, 20, or 30 year policies instead of 1 year policies. This will greatly help the "pre-exisiting" illness problem. Give people choices and control over those policies. For example, a healthy 20-year-old may need only a catastrophic plan. A healthy 25-year-old woman may need a plan with OB coverage, etc. Also allow expanded HSAs so that people have to shop around and spend some of their HSA money. 3). Allow MDs to treat indigent patients and then deduct the value of the service from their income, i.e. give us a tax credit to see the uninsured. 4). Adopt the Indiana model for tort reform. Though this one would never fly as the trial lawyers control the Democratic party. 5). Expand funding for Community Health clinics and staff them like HMOs staff urgent care centers. Then advertise. This would help keep the uninsured out of ERs.
Just some common sense ideas that we should use as a start. This sure beats a massive govt takeover, in my humble opinion.
Al, always good to see your clear and refreshing thinking here! I would urge everyone who can to follow Al's lead. Go to his site and read about what he has been doing and continues to do...smart!
' Instead, we should be eliminating the estimated $300 billion of waste, fraud, and abuse each year in the federal government'. I am tired of hearing this you dont need any new rules to get rid of fraud . stop the bull....
You too Al! I liked your 7th point more than any other.
3rd party payment is unethical. It corrupts. It corrupted everyone involved. Medicare is the mother of 3rd party payment system. Nation is very grateful to the congress for passing unfunded mandates and other shackles. We need more poison to the system. Medicare needs to collapse before we bring in financial discipline in picture.
Excellent posts from all, but it outlines why we have difficulty showing a united front on these issues. I think Dr. Coburn should be thanked that he asked. I doubt other congressman or even congressman MD's would. Lots of heat on that ball with a curve at the end. The frustration here is obvious, but the next step is not. I sent money to Coburn and I do to all the MD's I know of in congress that are sane, because I want some say. Its all we can really do as is evidenced in these posts.
I am ashamed to say that I wrote my Senators in support of this bill. I did it without knowing about the 10 year freeze on reimbursement. Once again, Senator Coburn has done an exemplary job in his role as a U.S. Senator.
Any discussion regarding health care REFORM is a complete waste of time if Tort reform is not considered. I apologize for this brief response however its all smoke and mirrors and I have had enough. As a busy physician that pride himself in quality and care I cannot continue this charade with greedy trial attornies. I am forced to practice defensive not evidence based medicine -Does anyone truely believe that ordering unneccessary tests (defensive medicine) is not enormously expensive. The current medicallegal climate is out of control.
Defeat S 1776...or amend it so that Docs are paid at least in accord with COLA and then freeze all Congressional income and perks at the present level for at least a decade!
It'll take that long to get the crooks out of their PALACE!
Current news, senate, actions are redirecting attention at physicians as the cause. I like how one states that doctors don't want their pay cut 25%.This is very different from the reality of revenue in practice - If your overhead is getting close to 75% for non procedural practices, then a 25% cut = the doors close, the doc makes no money. Patients go home. Boo hoo.
Well after we are all shoo'd out of our clinics, we'll probably jump at the Giesinger, Kaiser gulags and sweat mills just to keep our kids in college. (And I was so poor I was had financial aide - now with my sons tuition, my student loans, and the business loan to start my practice i'm living on less than my mailman.).
A life of crime is starting to sound better these days.
Um... just a dumb question. Has anyone figured out a fiscally responsible, non gulag/Geisinger option (I'm not accepting new patients from them by the way).
I am always amazed when the media brings out a bunch of docs....and Obama supplies them with white coats...what we can't afford them any more?
Then this Senator who says " I care " gets on this forum and wonders why the answers don't fit into his neat perspective of the world.....No he isn't in Kansas any more.
Like so many others I am outraged that our profession has been dealt such a nasty hand...I had good intentions when I became a physician and 27 years later still do.
But like so many have stated before me, ( unlike those who work for a corporation or hospital ) I have no bargaining power and have watched my reimburesments drop while my overhead continues to skyrocket.....this is my last year in private practice...and with 5 stents in my chest I do not need the stress of yet another year wondering how to pay for my health insurance ( nondeductible ) and my malpractice and overhead...I am %$^$#%^ broke!!!!
So Senator whatever solution Washington comes up with will not help me nor does it care....but I am sure there are many other docs in the same shape.....
Good luck taking care of you senior citizens and I hope they vote the whole bunch of you out of office..
My understanding is that this quarter trillion dollars that would be added to the deficit is already there, it just hasn't been added yet. Every year for the last 5-10 years Congress has postponed this problem by not cutting reimbursement. By not fixing the SGR, the cost of doing that just roles forward to the next year where the percent we will be cut continues to rise to pay for not getting cuts in the previous years. They have been building this huge debt and now we are supposed to feel guilty for adding a quarter trillion to the deficit because they refused to act. Any attempt to get rid of the SGR will require them to deal with this debt that they have been ignoring for years as if it would just go away. I think the best thing that could happen would be for the 20.5% cut in Medicare reimbursement to go through. Physicians would drop Medicare in droves and Congress would then have to face the electorate and fix the problem.
Doctors have been so marginalized that we are now totally off the page in Congress!!
We all were helpful years ago, but now we're helpless to control our own destiny!
1. no company paid health care insurance. all health care insurance is bought at the insurance store.
2. no refusal for pre conditions.
3. patient / physican contracts that the insurance companies have to honor upto the amount set by the insurance coverage.
4. allow physicians to take personal deductions on their income taxes for non payment of fees.
5. medicare can give each recipient a credit card that has so much money on it each year. such as $25,000 for hospitalization,$ 200/month for medications, and etc. then the recipient can spend that money as the patient and the doctor sees fit. that is all you get each year. patient / physician contracts become very important.
my 2 cents on health care reform -- thanks for listening
Senate Judiciary Chairman Unable to Explain Where Congress Gets Authority for Individual Insurance Mandate.
(CNSNews.com) – Senate Judiciary Chairman Patrick Leahy (D-Vt.) could not explain what part of the Constitution grants Congress the power to force every American to buy health insurance – as all of the health care overhaul bills currently do. “Why would you say there is no authority? I mean, there’s no question there’s authority, nobody questions that,” Leahy told CNSNews.com.
So, if the Chair of the Senate Judiciary Committee hasn't any clue and Obama, the alleged "Professor" of Constitutional Law doesn't know, doesn't it seem likely that Congress has no right to impose any insurance mandate under the Constitution?
I love doing what I am doing...but can barely survive. And I am not talking about vacations, big homes, jewlery, expensie restaurants.
I mean, just survive. i earn enough to pay salaries, insurance, utilities, supplies, etc. There is ZERO left for me to take home. Thank God for my social security.
It is ridiculous. No one would be so dedicated, work so hard for no salary.
I can't charge for the hours on the phone in the evening, answering calls, prescription refills etc.
And now, I am being urged to further into debt for EMRs.
And, Time has an articel stating we earn too much.
This is madness.
Agree with Ramstrong and my brother and sisters in the profession.
Thank you for responding so quickly yesterday with your thoughts and feedback on S. 1776. As you probably know, the vote to proceed with considering the bill did not pass. You can find a list of how Senators voted, here: www.senate.gov .
Because the bill did not pass, Congressional action will be required before the end of the year to prevent physicians from experiencing a cut in reimbursements from Medicare. As I mentioned in my initial post, I strongly support a permanent fix to the SGR and will not allow such a pay reduction. Congress will likely pass a one or two year patch separate from a major health reform bill, but I believe SGR "reform" should be part of health reform.
The debate moved quickly yesterday, but I found your responses helpful and informative. I look forward to continuing to share them with my colleagues. As always, I look forward to engaging with you in upcoming weeks as the health reform debate moves forward. Thanks for all you do to as America's physicians who deliver critical care to our nation's seniors and others.
Total horse-shit. Thank you for wasting my valuable time.
Fellow physicians, opt-out now or wallow in your own stupidity. Senator Coburn is the only remote voice you have in D.C., and he has demonstrated that he has neither the clout nor the temerity to influence his political comrades.
Be a lemming or a wolverine. Choose now, or your destiny is assured.
The solution is simple. Allow the SGR to reduce medicare payment as scheduled. Eventually all docs will quit seeing medicare patients and billing medicare. With no patients being seen, medicare will become profitable and solvent.
I am interested in how much of a "pay cut" others are willing to endure for the good of the nation. Physician reimbursement may need to be linked to the salaries and benefits of senators and members of congress. Maybe lawyers who do work for the government would be willing to take reductions in their fees over the next decade.
It is ashamed that we resort to sarcasm and cynicism, but how many of us sincerely believe that our government will do the right thing when it comes to health care "reform". Everyone agrees that our tort system adds billions to the cost of health care but nothing is done about it.
Why?
Will there be any meaningful reform or politics as usual?
If anyone thinks that WE will accept any cut - beit an actual cut or a cut because we get a FREEZE in reimbursement with no COLA increases - they can go $#@ themselves.
Sorry to be so blunt. You go and try to not give a cost of living increase to any other government worker and they will be protesting in the streets; time we got some balls and did the same.
Repeal the freakin SGR and replace it with cost of living increases yearly - period.
How can the Congress call "doctor's fix" a measure that will freeze our pay for 10 years with not COLA??? That does not fix anything, so are they stupid or are we??
Propose that to any other profession and see what happens.
Also, the answer "there is no money" can be applied to ANY bill proposed by Congress, so it's just a lame excuse to say: doctors go f*** yourselves, sorry...
Ignorance is excusable. Stupidity is a different issue.
"Stupid" is making the wrong decision when all the information to make the right decision is readily available.
It sounds like some of our colleagues that are in favor of a public option and the government taking more control are beginning a long painful journey. Perhaps they are just ignorant.
Please share this information to help all physicians become better educated.
#1
online.wsj.com
Mainers Vote Overwhelmingly to Repeal Dirigo Health Tax
From Kelly William Cobb on Thursday, November 6, 2008 12:00 PM
Below is ATR's press release celebrating the repeal of a multi-million dollar tax hike on soda, alcohol, and insurance in Maine.
On November 4, Mainers voted by a near 65-35 margin to pass Question 1, repealing a $77 million tax on soft drinks, beer, wine, and health insurance claims. The tax, passed by the state legislature earlier this year, was slated to raise money for Dirigo Health, the state's government-run health insurance program.
If Question 1 had failed, the tax hike would have added 24-cents to a six-pack of soda, 7-cents to a bottle of wine, and 16-cents to a six-pack of beer in Maine. The taxes would have also placed a 1.8% fee on all insurance claims. The Center for Fiscal Accountability and Americans for Tax Reform have calculated that after accounting for various excise taxes, corporate income taxes, and other federal, state and local taxes, consumers across the country already spend 37.6% of the cost of soda and 56.2% of the cost of beer paying for government taxes and fees.
"The overwhelming turnout of Maine voters to pass Question 1 and repeal the Dirigo tax is a huge victory for consumers and a crushing defeat for Governor Baldacci and the Democrat state legislature that tried to pile $77 million in new taxes onto Maine residents," said Grover Norquist, president of Americans for Tax Reform.
When launched in 2005, the Dirigo Health insurance program was projected to cover nearly 128,000 Maine residents by 2009; however, the program is currently covering less than 12,000 individuals. To increase funding, the Democrat-controlled state legislature passed the Dirigo tax hike last spring with little public knowledge or discussion. Following a citizen petition by the Fed Up With Taxes coalition, the tax was put on hold pending the results of the November 4 vote.
"The passage of Question 1 is not just a clear message that taxes on Maine consumers are too high, but also a referendum on the state's Dirigo health program," added Norquist. "Mainers realize that the state's attempt at big-government health insurance has failed miserably and they are simply not willing to foot the bill for it. Governor Baldacci and state lawmakers should take note that higher taxes for the purpose of state-run health insurance simply does not fly in the Pine Tree State."
Unfortunately, I am now compelled to investigated opting out of medicare due to the pressures imposed by the current medicare system, both from a reimbursement as well as regulatory standpoint. The anticipated cuts in consult fees taken with the failure to update our rates (and possibly cut them) makes it hard for me to stay ahead of overhead. I am sorry, both for me and the seniors who may suffer.
We have not met, but most of us community docs have acquired the impression that Washington just doesn't care about us. Rather, we feel like part of a formula, manipulated to suit a bottom line that doesn't account for the heart and soul we've invested in the care of our patients. I'd be happy to discuss this in person if you wish.
I actually think we should let it happen.Let them cut medicare by 21.5%.This will really bring things to a head.We all stop being medicare participants at that point and its cash up front for medicare patients to be seen.They can deal with medicare to get their meager reimbursment.The ppeople will be outraged at the govt .Ive been telling patients about this and they are outraged to hear this is happening.I think it will really drive positive change on our part .We are lame as a group.But if something this drastic occurs and we do what I said collectively it will shake things up drastically.
While legislators have all the time on the world to do their business, doctors are busy healing lives. I believe this has been our achilles heel- while we work, everybody else is busy thinking of ways of how to further squeeze money out of us "rich docs". Of course no one understands "overhead".
I just want to know how it came to pass that "automatically", cuts are ingrained yearly into Health care, specifically, Medicare? And that yearly, it has to be painstakingly repelled back? What distorted thinking went into that? (I know- just a rhetorical question...)
I say, bring on the cuts, let primary care die a natural death, and we'll see what happens with this armaggedon.
3rd party pay system is inherently unethical and breeds corruption, which invites regulation and administration.
To take back control of our profession, we must push back all non-physicians including the congress. Only way to do that is to make them irrelevant by refusing to accept payment from them.
Just say no to 3rd party payment.
If you are going to live a lower middle class life (as indirectly mandated by Govt) anyway, why not to go cash-only and avoid the pains and hassles of 3rd party system?
Did you ever wonder why it is that Congress can vote themselves a pay raise using taxpayer money, but there is no National Referendum for the People to decide if they deserve it???????
Freeze Congressional pay and perks for 10 years...
this will provide MORE THAN ENOUGH COLA for Doctors!
If there are funds left over, they can be used to fund Medicare!
While I am very concerned about the national deficit, we as a country are spending very much more than this on our international "adventures" with questionable benefit to the U.S. security. SGR is flawed fundamentally as a head-in-the-sand method to control costs. With increasing numbers of seniors and increasing medical technology, it cannot continue. The cost is going up, and the physicians cannot be the ones to "eat" the difference. As a 54 yo medical oncologist, I am increasingly frustrated and have backed out of private practice medicine to a hospital-employed position because of issues like these. A guaranteed decrease in pay each year will lead many physicians to back out of medicare completely, which is only marginally profitable as it stands. As a nation, we need to step up to the plate and do what is necessary to ensure our medical care. Evidence-based medicine should be reimbursed fairly. Thanks for your efforts!
Rather than engaging in rants, why not just do what is asked for and answer. Is a ten year freeze fair, no. Is it fiscally sound for doctors or the government, no. Why not get a short term freeze in place to sunset when the healthcare bills actually are enacted. Inflation is currently 0%, the bills proposed are supposed to begin in 3-4 years. Staunch the bleeding now and triage. Make a freeze hold for as long as we are under the current system. We should insure everyone the same, phase out Medicare and put everyone on the same field. Would seem the fairest to all for now.
I think that this episode with S 1776 should open the eyes of any physician who supports a public option.
Many Republican Senators support the repeal of SGR. But they refused to vote for this bill because of political reasons. Your livelihood is just another political bargaining chip.
Medicare is a "public option". If you don't think a public option will become the only option, check out how many health insurance policies are available to people over the age of 65. Unless they are still working and have insurance through work, there is no private insurance.
And your fees in the future will be set for the public option as they are now for Medicare, by a ridiculous formula that does not keep up with your expenses. Something like SGR which, despite being dysfunctional enough to destroy primary care, is not going to be changed until the political winds shift. SGR is now 12 years old. It was immediately seen to be flawed when it passed. Yet the political will has never been found to repeal it.
BTW, for those who opposed S 1776 because it added $247 billion to the deficit over 10 years. Do you realize that right now the US Treasury is borrowing $260 billion EVERY TWO WEEKS just to keep the government doors open? In other words, at the current rate of borrowing, S 1776 would have increased the deficit by 0.3%.
PS: THERE IS NO TEN-YEAR FREEZE IN THE BILL, THAT IS A MYTH STARTED BY THE OPPONENTS. The words are not in the bill. The bill is only half a page long, read it.
WSJ OPINION: OCTOBER 22, 2009, 6:18 P.M. ET.
Obama's Doctor Shortage
All of the president's "fixes" will just create new problems.
By ALLYSIA FINLEY
"In his campaign for health-care reform, President Obama has repeatedly harped about a primary care doctor shortage. "The status quo is we don't have enough primary care physicians," President Obama said in an ABC interview in July. The president promises that his health-care reform proposal will address the problem of a primary care physician shortage---and he's right. He will make it worse.
Mr. Obama wants to provide insurance for an additional 30 million Americans, but recent experience in Massachusetts shows that universal coverage will result in an even greater physician shortage and longer waiting times for patients.
Because Massachusetts' Commonwealth system served as the model for the universal coverage Mr. Obama wants to implement nationwide, a few results of its health-care experiment are worth noting. A 2008 Physician Workforce Study by the Massachusetts Medical Society found that the percentage of residents having difficulty getting care rose to 24% from 16% between 2007 and 2008. Since 2006 when the Commonwealth system was implemented, internal medicine and family practice went from having labor market conditions that were considered "soft" or unstressed to being the only two specialties with labor market conditions classified as "severe" or experiencing the highest possible degree of stress..."
Who would go into any job knowing you can't get a raise for 10 years??!!!
My Urgent Care doesn't accept Medicare. I see plenty of low paying patients in the ER.
Is there any doubt that the reimbursement on the Government Health Care Plan is going to be lower then Medicare! So spend a TRILLION dollars to insure everyone, then spend the next 2 years trying to find doctors to accept them.
Sermo Doc 50, S.1776 was used as a bribe by Harry Reid et al...period. The SGR should have and could have been repealed long ago. 13 Democrats voted with the Republicans against cloture. There was no 10 year freeze in the bill. This was pure politics and it backfired. The AMA, ACS and others who were at the meeting last Friday look like fools. And Harry Reid is running around saying he was misled by the AMA that 27 Republicans would support it. This is a circus and should be an embarrassment for all involved. I hope physicians were paying attention. This is tremendously important for our profession and for America.
And, I agree about the debt. We need some common sense here...not more smoke and mirror BS.
Its real simple- pay less, adn less medicare patients will be accepted. Unless of course the insurance companies link their reimbursements to medicare. How about you reduce the payment, but let me balance bill?? That way you save the govt money, people have more invested in their own care (instead of it being "free"), and the docs can maintain their practice.
Agree with Sermo Doc 1 and AStember. Most physicians will be forced to stop taking any more Medicare patients or will opt out if possible. Since what all physicians do for the US population as a whole is just as or more important than what anyone in government does, why not make the yearly increase in Medicare reimbursement to physicians the same percentage increase received by Senators, Representatives and Judges? Just tie it to that increase, get rid of the flawed SGR, and congress won't have to change any laws before the end of the year.
We have 69 days until January 1, 2010 and the 21.5% Medicare cut.
So, Senator Coburn, what is Plan B?
After fighting this for so many years, I would almost like to see the cut be implemented and then get stymied by the partisan political games so a fix can't go in. Then, when the primary care doctors start dropping Medicare patients it will be woe to any incumbent facing reelection in 2010.
That won't happen, Medicare will get fixed for one year and the price tag for fixing the SGR in the future will go up.
But I humbly predict here and now that the temporary fix for 2010 will turn out to be exactly what S 1776 would have done, 0% update.
But the SGR will survive to reappear like Freddy Krueger.
HELLO! Medicare rates have been below cost of providing service for years now. We need drastic reimbursement increases just to stay in business and the Congress is still discussing reimbursement cuts. I no longer take any managed care as I can no longer afford to be a philanthropist. Sadly and embarrassingly, the only hope we have is for all of us to stop signing managed care contracts and go back to straight fee for service (and we determine the fees). GW Bush and the Republicans promised us malpractice reform 9 years ago, but were too busy funding Iran and Afghanistan to keep their promise. The trial lawyers are back in control now!
I am a U.S. citizen first and foremost, and I want this country to survive into the next century and beyond. I don't care about Medicare reimbursements. Medicare should end. It is Medicare that is broken. At the very least, the retirement age should be increased to 69, and naturalized citizens should have stricter criteria before receiving Medicare. I am not sure if non-citizens (legal resident aliens) can receive Medicare, but if so this should end as well. If this is not enough to get Medicare in the black, then either restrict what Medicare covers and seniors will have to come up with alternatives, or eventually restrict what Medicare covers so that us young folk could start planning wisely for retirement to include a healthcare policy. I am sure that the private sector will come up with some kind of investment-plan-type insurance, such as longterm-disability insurance or longterm-care insurance etc... I care more that my son and my son's grandchildren have a great country many years from now than what kind of reimbursements I get with Medicare. Currently, I am employed by a hospital network and we do not have any restrictions on what kind of patient types we see, but we keep a close watch and monitor our statistics and profits. Whatever happens, if I ever go off on my own, I guarantee you that I will definitely start restricting how many Medicare patients I see, just like Medicaid. That's just life. If you don't plan and have crap insurance, then you will have inferior choices. I resent the never-ending redistribution of wealth.... where those who perservere, work hard, plan for the future, prepare for the rainy day, behave responsibly, and make wise choices have to pay for the ones that do not. Remember the story of the three little pigs? The pig that built the brick house CHOSE to help the other two. No government should force (steal the wealth of) its good citizens to right the perceived wrongs --the slings and arrows of life. Read the Federalist Papers, especially Thomas Jefferson, to understand what this country is supposed to be about. I could not care less about Medicare. On my own time, because I choose to do so, I will partake in charity service... but of course with the ridiculousness of the tort laws I am currently not inclined to do this solely on my own (sadly). Here in SC there are charity orgnaizations but I am not yet familiar with the malpractice coverage they have. A sad reality that has changed our nation into automatons instead of good honest hardworking and generous people, what America is supposed to be and has been. I hope American is not a "has been."
Thank you "Sermo Doc 50". You are so obviously well read and informed. I learned more from reading your short post than from watching CSPAN or attempting to read the House healthcare bill. I will copy here a very important point that you made just to emphasize its importance:
"BTW, for those who opposed S 1776 because it added $247 billion to the deficit over 10 years. Do you realize that right now the US Treasury is borrowing $260 billion EVERY TWO WEEKS just to keep the government doors open? In other words, at the current rate of borrowing, S 1776 would have increased the deficit by 0.3%. "
I would be against S1776. No change in 10 years is too big a rate cut. The AMA's President cited H 3200 as supportable because it did away with the SGR. Have they had second thoughts? The suggestion that we vote to let the 21% cut next year happen has validity.
I agree with all comments. The docs deserve a raise .I haven't seen even a cost of of living raise since I'm in practice. for 16 yrs.My overhead rises every year as well as all purchased services both professionally and personally. the govt will force its hand if the public option looks anything like charity hospital or the VA system. Healthcare for all of us has a most dismal future.Let all elected officals take a 21% pay cut.let nancy pelosi and cronies sell their jets on ebay. Let's level the playing field.
Sermo Doc 133, I agree with you wholeheartedly. Medicare will not continue the way it is, SGR or no SGR. Medicare has to change drastically or it will not survive. It is probably too late. I am planning my future by anticipating no social security or Medicare when I'm old. I know it won't be there anyway. We can debate over a dying horse 'til we turn blue. The way to save Medicare, if we want to save it, is not by cutting doctors' fees, but by making very fundamental changes, including raising the beneficiary age.
in the era of fake O'Bama/Pelosi/Reid play money, can anyone really keep a straight face when discussing "pay as you go" and 10 year projections. Get real!! budget neutrality: what budget?? Let's just print some mo' O'Bama money!!
Sermo Doc 137 Primary Care As a (former Dutch) solo practitioner I'm flabbergasted by the government people who in the name of health care reform speak with "forked tongue".I have been in practice for almost 35 years and enjoyed the first 25-30 years very much. However, the Medicare problem, the cutbacks, the threat of the government coming after you for miscoding etc. and also elderly people have more medical problems which necessitates more time. Since the overhead has grown so substantially over the past years I had to drop Medicare patients. Now Mr. Obama comes with a plan: healthcare for all Americans. On paper it sounds great, but the harsh reality is we don't have the money for it. I'm afraid that Washington just wants to print a few trillion more dollars so that in the next 5-10 years we'll be the United States of China. And also with a government option it looks like more and more Medicare-like medicine.So hopefully by the time that they will try to get this absurdity through Congress I'll be retired. In most businesses where something does not work, they do an analysis to see what works and where the problems are located. Then you look at the costs of a complete overhaul or just try to fix the "broken" parts at great cost savings. Washington, please consider our tax money not your "Las Vegas gambling Money" and completely bankrupt our proud and precious country!!!
So tru, Sermo Doc 137. (About being the USC- and I don't mean the University). Here's another reality check, the "overall picture". Healthcare is just the very tip of the iceberg, and I don't believe Sen. Coburn is at liberty to discuss this...
We are in a recession- yet you see govt spending left and right- with a shrinking workforce. Where does govt get the funding? Where else?- A credit line straight from China. China bought out at least 1/3 of our debt. Just like credit card companies, China is earning off of our debt. How? Pure and simple- read various editorials being hushed-hushed by the national networks...China is the world's #1 oil consumer. We're #2. China, being communist, is sanctioned/prohibited by the U.N. from overstepping its boundaries (read: being "present" elsewhere). The U.S. is in the middle east in the guise of "security". There is truth to that- 911 and all...but, there is more to it. We secure the oilfields, and get a fair share. That "fair share" stops there- China gets a huge chunk of it, as it does with the Alaska pipeline. Did you ever wonder why the U.S. only gets about 10-20% of alaskan oil? Now you know. China has also bought out our workforce. How can our labor force compete with a communist labor force?? Now you also realize why everything pretty much is "Made in China".
At this point i say bring on the %21.5 cut.This will stimulate change I believe in a hurry.Physicians will adapt by being nonparticipating providers.Collect from the patient ,your whole fee.Let them deal with the pittance from medicare.The public will be outraged at the govt.They will become instantly enlightened when no one takes medicare anymore.Positive change will occur.More people will assault washington.
Physicians & Republicans wake up! We need a public option for the 40plus million uninsured citizens. E ven that will not let us catchup with the rest of the world!! Look at the statistics!!??!!Let's not postpone change for the US Chamber!!
Sermo Doc 36 makes sense, too. I would accept Medicare patients if they paid themselves and dealt with Medicare themselves. They can leave if they think my prices are too high. Fair competition will be the way to stay a doctor.
We are not allowed to unionize or strike. Does everyone getting together to decide to go cash only count as unionizing or striking, as long as we did not get together to discuss a fee schedule? What are they going to do about it anyway? This profession is already strained by numbers...it's not like when Reagan sent air traffic controller across picket lines...who are they going to send? Where would they send them? They can't just take over my office with government employed docs who don't even exist. Going cash only would get the nation's attention. Something would happen fast. Yes, patients might have a hard time, but this model is unsustainable. It would be no different from what uninsured patients experience....they get seen anyway, taken care of, billed, and those who can't pay just don't pay (like I'm sure the 2 uninsured patients I currently have in the hospital will do). But I imagine it would be a short lived revolt of sorts, and Congress would emergently have to do something. I didn't realize until recently that the SGR law does not apply to reimbursement to hospitals or private insurers who participate in Medicare Advantage...it only affects physicians. No surprise, since we have the weakest lobby, but very infuriating. Small businessmen getting screwed by the government.
The government should not pretend to "provide" medical coverage on the backs of physicians.
Physicians have lost their constitutional right to free enterprise. This is a civil rights issue as one segment of society is forced to serve the rest.
The 13th Amendment to the constitution states: no involuntary servitude, .... shall exist within the United States, ....
The 14th Amendment states: No State shall deprive any person of life, liberty, or property.
Correcting MCR fraud would solve some of the problem. Allowing doctors to balance bill the patient would help as well. Some doctors may choose not to balance bill but others who believe they have superior service can balance bill. The patient can make their own decision based on quality of service and affordability. Patient's paid 40-50 cents on the dollar in the 1960's for medical care and now they only pay 13 cents. Medicine is getting much more expensive (especially with the advances in technology) and many patients have high expectations with the latest most expensive tests and procedures but many of the same patients are not willing to pay any of the bill. There is a compromise somewhere between government, private insurers, hospitals, private doctors AND patients-we just have to find it. If the government keeps hitting doctors they will leave. Why work 80 -90 hours a week, be away from your family, be available nearly 24 hours a day, go to school for 8 years, be a slave as a resident for 3-7 years at below minimum wage, experience high levels of stress, plan our own retirement (as well as our employees) , worry about losing everything to a disgruntled patient in a lawsuit, forced to work for free through on call emergencies, deal with unfair state and federal laws on medical business opportunities for private physicians, and then get slapped in the face with static reimbursement rates while our employees want raises and expenses sore? Doctors are some of the most intellegent people in this country and have proven that we can run businesses. Threaten them too much more and you'll see them use their intelligence in other businesses.
It does not take much to know the inflation factor will gallop at 5% for the next 10 years with all the massive deficit spending. Remember Jimmy Cater years.The cut wiil be above 50% over the next decade as all the over heads will sky rocket. The Micigan 3% tax on GROSS reveues is just a starter. The medicare will make fees global fees, it will not pay for all the medications, devices and supplies in futures. Why only physicians are selectively targeted for this plunder while the wall street and trial lawyers are showered with millions of dollars. No one is going to practice any business at loss. Soon majorty of physicians may not accept low paying insurances like medicare and medicaid and others there by reducing medical access to many. Have you seen any lawyer take up a case without 5 to 10 thousand dollars retainer fee except a medical malpractice case which is bonanza for the lawyer thanks to Obama and likes who do not want Tort reform as a payback for their millions of dollars, political contributions.
This bill would only make Emergency Departments even more overcrowded and underfunded. The Medicare patient population is the fastest growing demographic in emergency medicine, and stopping reasonable increases in payment would force many of these patients into the ED for primary care, and only increase emergent exacerbations of chronic illness. This will eventually bankrupt hospitals and limit all Americans' access to emergency care. Why not do something simple and logical, like make a bill that increases Medicare payments on an annual basis equal to the amount of CPI inflation.
Thank you for engaging the Sermo Community. In New York State we have already been cut 20% for medicare/medicaid patients because we cannot bill medicaid or the patient for the 20%. Any further cuts would be catastrophic. Perhaps congress should force my landlord, insurance company, phone company, electric utility, office suppliers, equipment suppliers to give my practice a 20% discount too. You get my drift. The situation as it stands is not sustainable, and your colleagues in congress need to know this. No "reform" is possible without doctors, and we will soon be a vanishing breed. Oh and one more thing, can we please have a union?
There HAS to be tort reform. There HAS to be fiscal responsibility. I am not sure that we will see the first and pretty sure we will never see the second come out of Washington.
Thank you for reading this, Senator Coburn. I hope you don't think I'm upset with you personally by saying this. Without the physicians, the whole stack of cards falls down. Look at it this way:
-Medicare cuts lead to few doctors seeing Medicare patients. Medicare patients write their congressmen, storm the white house, and talk about their plights on the major news networks. Government forces doctors to see Medicare patients. Doctors write their congressmen, storm the white house, and talk about their plights on major news networks. This is due to violations of Constitutional amendments. The congressmen lose millions of votes and get kicked out.
I still do not believe that Coburn personally reads the responses on these threads. Some staffer may read them, write a summary like, "Nope, the docs don't like that idea either.", and he comes up with another political bogus suggestion.
How about this? Actually introducing a bill composed of ideas that have been promulgated on this board. Then, let's see how that flies.
Sermo Doc 146,
This Posting has existed for quite a while and nothing of significance has been done in Congress by Sen Coburn or others. Do you get the feeling that perhaps Doctors are being ignored? :-)
As we now know, the bill didn't pass.
While many may be concerned about the political ramifications, and others about the cost, my concern is purely practical.
MY PRIVATE PRACTICE in FAMILY MEDICINE, the primary care people that all sides in the debate agree are the least paid, most in shortage, and which virtually no US medical student wants to go into (<2% of this years med students chose primary care specialties), WILL GO BROKE AND CEASE TO EXIST WITH ANY PAY CUTS, let alone 21.5% !!!
So, blocking paycuts to physicians will cost over 200 Billion over ten years? I say, so be it, who do the expert pundits think will be around to care for all these people, for no pay, when all the doctors go broke???
As for those who see paying doctors fairly as only possible with offsets--
NOT EVERY GRANDMA NEEDS A $4000 SCOOTER PROVIDED BY MEDICARE.
ORTHPEDIC DEVICE MANUFACTURORS DONT NEED $10,000 PER HIP, they and their sales force are some of the highest paid people in the medical system, and these days are mostly glorified delivery people.
A LONG LIST OF DUBIOUS TEST DEVICES are sold daily to some less than scrupulous folks (doctors, unfortunately) who run unnescsessary tests that provide little value to the patient care, but are "BILLABLE WITH THIS OR THAT ICD9 CODE" ACCORDING TO THE SALESPEOPLE.
The doctors who use evidence based medicine, and a modicum of common sense, who provide high quality cost effective care, are pushed out of the market.
STOP THE FRAUD, and you can have your OFFSET enough to fairly pay for the truly nesessary medical care.
Where were the physicians when the SGR was created in 1997? Were we all sleeping then?
Every idea/option needs to be evaluated and debated on its own merit, a political quid pro quo approach of S. 1776 is simply wrong.
Another sin of the so-called "doctor fix" is designed to move $247 billion off the cost of ObamaCare, making it look more affordable. This is not something obvious to many.
Congressional Budget Office, nonpartisan though they may be, their track record of predicting Medicare and Medicaid costs over the decades were dismal at best. What can convince us that they got it right this time?
Sermo Doc 148,
Unfortunately, we've been practicing Medicine as it shoud be done all along, but we somehow missed the implications of a Govt. takeover in 1965 when Medicare was passed and the Govt. started its' takeover of our Practices!
I would agree with Drs. Ford and Armstrong. As a pediatrician, I don't face Medicare but Medicaid reimbursement is already not on par with Medicare. So I will cut my panel of those patients. I also worry that private insurers would take a cue from the Gov't and lower fees as well. If we freeze time for Doctors let's do the same for all professions
I am a psychiatrist working in an underserved part of the country.. Our specialty already takes a 20% cut, apparently because we are only 80% of a physician. I see people with Medicare because I like the people and the work. If my rates are cut any furthur it will be at or even below my office costs. I am not a non-profit corporation.
In light of the treasonous rape of the Middle Class by Wall St. as enabled by Greenspan, Summers, Geithner, Paulson, and a cast of cons worthy of pinstripes at the least, as well as their enabling whores in Congress, I suggest one solution - something the French tried in their revolution some years ago.
Sharpen the guillotine! I think Congress and many of our best and brightest on Wall St. deserve to anticipate the Rapture and be enabled along their journey to Eternity! And let's throw in the heads of health insurance companies as well.
This entire debate is based upon fraudulent premises. I reject any legislation of my profession at the hands of a fraudulent legislature that is bought and paid for like cheap crack whores! That, Tommy,, is what I think of you and your cohorts in both political parties. Give my best to Satan when you reach your destination!
For those that support the public option and then criticize the reimbursement of medicare/medicaid-- Do you realize how counter-intuitive it is to support yet another system that will be run and reimburse us in exactly the same manner?!! The situation will only become worse.
We haven't seen "worse" yet, but it's coming soon from your Democratically elected Leader and his BOdopes in Congress!
If our Reps and Senators are not listening to us, what impact are we having??
Our only real impact is in our Office when we see individual Patients and tell them if you don't call/speak/write your Reps. in Congress, your Medical Care will be the worst ever that you can imagine!!!
It used to be that physicians get paid by the patient, then the physician gave the patient the EOB so he or she did send it to Medicare or to the insurance company to get reimbursed. Some clever guys got doctors into changing this way of doing business and then the Stupid doctor (us) took the job to do it for the poor patient in benefict of the insurance companies and medicare which then could screw us up directly. The patient is the one paying the insurance company for a promise of service and coverage; we should get out of the this idiotic game and leave the patient and the insurer, be the government or the private sector to deal with their issues. We should collect for our services as we price them based on our Hard work; it is time for the American public to know whta is the fundamental problem the physician face when reimbursments are down and expenses are out. Only then patients will value the idea to really step in and demand our governemt to do the right thing and really make Our private insurers be responsible, sensible and efficient and demand that the government itself be thet way too.
Coburn is an extreme social conservative who is the king of toothless partisan resolutions in Congress. I am chagrined that this site has chosen him to whip people up into an emotional frenzy.
Yes, we all agree that the SGR is a flawed computational system to decide on physician payment in the Medicare program. But, repeal of the SGR should NOT be used as a bribe to extract physician cooperation for a badly flawed plan.
As you well know, there are fiscally responsible ways forward. Unfortunately, the democrats and the President are not listening. My hope is that we can move forward constructively with legislation that deals with the root problems without adding trillions of dollars to the national debt, without establishing a whole new level of federal bureaucracy and without strapping our struggling states with more unfunded mandates.
I urge you to help defeat S.1776 and the current health care reform proposals.
Thank you!
Richard A. Armstrong MD FACS
Please help to defeat this bill. I fear that there will be few Medicare participating providers by the time I reach 65!
Costs increase at at least 5% per year....Congress must be reasonable. No tort reform. No regulatory relief. New mandates for electronic records and prescribing. New mandates for reporting information to the government. New penalties for practicing medicine appropriately for subspecialists. Bureacrats reducing payment schedules on a whim.
We need a balanced billing amendment to the Medicare program which permits us to individualize bills to each Medicare recipient. We collect on average less than 90% of the Medicare pay scale, which is 80% of the cost (not the charge) for the care. If Congress can't get this simple concept down, we just have to refuse all Medicare. Your wealthy supporters who are getting physician and government subsidized care are certainly going to be unhappy.
What if non Medicare patients are paid under reform at about Medicare rates? It will be impossible to survive in practice and doctor shortages will skyrocket.
Handing most of the money to hospitals is a horrible idea. They don't know the first thing about practicing medicine, limit physician and patient access to new equipment and will hoard most of the dollars under non fee for service schemes like APGs. A reward for the incredible inefficiency of most hospitals.
Medicine is practiced one patient at a time. Thankfully, we physicians fulfill our duties to patients in spite of every roadblock to efficiency regulation throws at us.
The payment for the Healthcare reform bill currently before us will bring predictable financial disaster on us all in the foreseeable future. So say the economists.
The payment for medical services rendered under medicare's formula has been under the cost of providing that service for some time. Almost all of us continue to see medicare age patients, out of a sense of duty and professional obligation, and those in charge have taken advantage of our collective good will. Now that many of us are finally treating this as a business decison, like most real businesses, you do not continue to provide goods and services at a loss, and expect to survive. You exit the business, and this is exactly what has been happening over the last 5 years, as phsicians have responded to market forces, and stopped accepting new medicare patients, and stopped participating in medicare altogether. This bill does nothing to change this trend.
E. Rawson Griffin III MD FAAFP
LOL. Seriously? You're suddenly all against repealing SGR because the Democrats are behind it and it would help them keep the reform coalition together? Want me to go back and find the threads when we were fighting to keep those SGR cuts from going into effect last year and the year before that and the year before that?
Remember 3/4 of us physicians want health reform with a public option according to the NEJM survey, and even if I spot you a twenty point MOE, you STILL are in the minority!
And 8 of the 10 largest physicians organizations support HR 3200 which includes SGR repeal and a public option.
But y'all keep it up.
Very strong words from a generally restrained publication, but sadly, they are true.
The editorial also rips the AMA for being "a cheap date" and states "Mr. (sic) Rohack seems prepared to trade away his members for a sack of magic beans."
As Sermo Doc 1 stated above, eliminating (or, in actuality, putting off) the SGR should not be a quid pro quo for support for an otherwise hopelessly flawed plan.
I will reiterate, once again, that the only solution that makes sense is to take steps to return the costs of medicine to the table that rests between the patient and his or her physician. At present, insurers negotiate with employers to price policies, and "negotiate" with providers to price payments, giving them full control of the entire economic process, and removing both the patient and the individual physician from any discussion of the costs of care.
John Mackey's solution at Whole Earth Foods fixes one end of the problem. By using HSAs, his company puts first dollar payment considerations into the hands of the patient, and the success of his approach is real and quantifiable. By leaving insurers free to dictate provider payments, however, Whole Earth's plan solves only half the problem.
Responsibility for patient payments to physicians and other providers must be returned to the patient - they must take on the responsibility for filing claims for their reimbursement, as they do now with great efficiency in the auto and home repair industries. Restrictions on how physicians price their services must be drastically altered by allowing physicians to reduce rates as they see fit. Lower costs for the poor will happen - that was the norm in the era before Medicare. Require physicians to post pricing for their most frequent treatments and procedures and consumerism will help drive prices down without heavy handed government policies - it's working now in plastic surgery and other fields unencumbered by current regulations. Shift insurance purchase tax advantages away from employers and offer them to patients instead - insurers will reduce their administrative burdens in order to compete for consumers, rather than increase them in order to please employer negotiators. Fixing med-mal to eliminate defensive medicine would complete the process, but should probably be addressed separately due to its own overwhelming complexity.
As for the SGR, it is a farce of epic proportions, and given the distrust most physicians (and Americans) have for long term federal government promises, neither a one year nor a ten year abatement will cause doctors to be any less wary of the system, or any more likely to continue participating in it. The 800 pounder in the room isn't a gorilla this time - it's an elephant. And it has a memory. Independent of anything proposed above, the SGR has got to go away, and do so permanently.
the medical profession agrees that our healthcare system is broken and needs to be fixed. however it should not be on the backs of physicians.
we need to address tort reform and take healthcare away from wall street whose only interest is double digit profits
Thank you for your action towards stopping the government irresponsibility.
My position is that there are a lot of empty promises being made - promises that do not make any financial sense - promises that are counter to the basic principles that have made this nation great.
In brief:
- The government needs to get out of debt.
- The government needs to provide SOME basic regulatory framework, but otherwise stay out the way. The economy will grow if WE THE PEOPLE are given incentives to succeed instead of incentives to quit. The government needs to keep its foot off our throats, let us breath and create jobs for those who want to work.
- Specifically regarding physicians - same principles plus an increased emphasis on staying out of the way of medical providers taking care of people. We have too much bureaucratic oversight as it is. I am personally tired of insurance companies and the government dictating how physicians and patients interact with each other.
- If Medicare and Medicaid patients had to pay at the time of service and be reimbursed by the government that would help prevent a lot of unnecessary visits. They know they don't have to pay anything so they have no restraints on going to the doctor's office or hospital when many times it is unnecessary. The doctor's office should not have to administrate Medicare and Medicaid. Medicare and Medicaid payments should be between the government and the person. Medical care should be between the doctor and the patient. The means of payment/reimbursement should be separated. This one simple change in the system would greatly help curtail cost, both for the government and for the medical offices. If you want to decrease medical cost then decreased the cost of doing "medical business."
Just a few thoughts...
Sincerely,
Marty
With all due respect, the caliber of people we have on BOTH sides of the aisle in congress is embarassing, and certainly not up to the standard of the founding fathers.
Republicans held down increased re-inbursement for years in the name of controlling costs, which allowed third-party payers to follow suit, and now they want to portray themselves as the cavalry arriving in the nick of time, to rescue physicians? Please! Everybody is dirty and dishonest here.
We have all said it before. You cannot be serious about controlling costs, and therefore look at re-imbursement, until you do real work on tort reform and eliminate the costs of defensive medicine.Without that, everything else is nibbling around the edges, and will not work in the long run.
Also, I agree with clinped that Sen. Coburn is definitely not the person I would pick to be in charge of getting us out of the health care mess we are in as a nation and as physicians.
There are a few very active posters who want the system to collapse,but my concern is what happens to our patients and our practices if this occurs.
Does the Sen support balance billing,and will he advance legislation to do this?
Will he work to force private insurers to act like insurance companies and not the profiteering rackets they have become?
Finally:Yes its not "paid for" but neither is the war in Iraq. May be we should cancel that also.
www.bubbaworld.com/coburn.html
With that information at hand, S. 1776 is a ridiculous solution to a overwhelming problem.
I do think we all agree that something must be done to change the course. The problem is that all proposals have an agenda and hidden messages that will ultimately only hurt the situation. Polishing a poison apple doesn't make it any less dangerous to eat.
To simply freeze reimbursement is not only unacceptable, but would be a pay reduction. Anyone ever heard of cost of living increases, particularly when our inflation is where it is, and only going higher.
The solution is to put the responsibility back in the patients hands. As a patient we all have to be culpable for our care and the costs. The "free care" option is neither free nor care.
SGR should have been discarded when Bush and the Republicans controlled all three branches of government a few years ago. But it wasn't. That was a complete mistake.
If there is strong bipartisan support to repeal the SGR, then DO IT!
It makes no sense to fix Medicare payments for the next ten years. As earlier posts pointed out, all of our overhead costs are paid for out of physician fees. The result would be physicians opting out of the system, substantial job losses for educated people (nurses, etc. who also vote!), and a net loss to many communities of an important resource and economic engine.
Washington promised many years ago to take care of our seniors. Millions are relying on that promise now. It is too late for them to make other plans. When you took office, you in essence agreed to maintain that responsibility. Live up to that promise now!
I chose S 1776. Otherwise, I stop treating Medicare patients.
The 10 year freeze on fees included in the bill is somewhat of a red herring. It is analogous to the reductions in fees included in the SGR legislation 10 years ago. Future members of congress will patch that as needed.
Tort reform is a good idea, but adding it to this measure is wrong. It is too easy to screw it up - for example to set it up so that it pre-empts state measures that work, like MICRA in California.
As someone mentioned above--Balance Billing and direct contracting with patients is the only way out of this mess. Our nation cannot continue to balance the elderly healthcare budget on the backs of younger taxpayers and the doctors who provide the care. All of us have Medicare patients who have the means to pay a substantial amount more than the pittance that Medicare approves for their visit--in fact, they would WILLINGLY pay, if allowed to.
To deny a competent patient the right to contract with their own physician with mutually agreeable terms is a travesty of justice.
As a small internal medicine practice in rural Georgia, we stopped accepting new Medicare patients two years ago. We plan to opt out in 2010.
Balance billing is the answer.
Why is it assumed that if we are not part of the discussion/decision making process, that we will be there to clean it up when it's done.
I'm beginning to like the idea of "Concierge Obstetrician/Gynecologist".......it has a nice ring to it.
did you know that the WellPoint CEO scored a $400,000,000 bonus this year???
why is the AMA asking us to support a bill that gives us a pay freeze for 10 years?
pay freeze for 10 years = tens of thousands of physicians dropping out of medicare
I for one am more seriously considering quitting medicine and starting that winery I have always dreamed about.....................
The Republican party had years under the last administration to fix the SGR, the national debt, tort reform and a million other issues. Similarly, the Clinton administration and Democrats had the same opportunity and failed to do so (although at least the US was enjoying a budget surplus by the end of Clinton's term)
Is S1776 ideal? Of course not. There is not a single bill in Congressional history that is without its detractors. Should doctors have to bear the burden of a 21% cut in Medicare reimbursement because the economy is in the toilet thanks to a myriad of other greedy people? Again, no. But if this is the vehicle for change at the present time, then I support it.
Washington will only get the message when "healthcare blackouts" start happening across the nation: physicians en masse must call in sick for weeks at a time. Crippling the entire healthcare system is the only means we have to be heard. This approach kills two birds with one stone: Washington and Wall Street.
alamodoc, Thanks for the link to bubbaworld. That kind of hits the nail on the head concerning this senator.
I agree with Sermo Doc 16. I and most other physicians support health care reform with a public option.
Also, I agree with clinped that Sen. Coburn is definitely not the person I would pick to be in charge of getting us out of the health care mess we are in as a nation and as physicians
Also, I feel Congress should be looking at other cost cutting options than just decreasing what they pay overworked physicians!
This is a legislative scam...pure and simple. NO ONE in Washington is honestly addressing the real problems! Wake up doctors! The rug is being pulled out from under you and if you don't realize it...you lose!
The bill is only 18 lines long, read it below!
Nowhere does S 1776 freeze the conversion factor update for ten years!
What S. 1776 does is eliminate the SGR as the basis for calculating 2010 and subsequent years' changes in the RBRVS conversion factor. Because SGR will no longer be the basis, and trying to pass a new complex formula is impossible in such a short time, the placeholder number "0 percent" is used.
Here is the text of the entire bill:
---------------------------------------------------
A BILL
To amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Medicare Physician Fairness Act of 2009'.
SEC. 2. MEDICARE PHYSICIAN FEE SCHEDULE UPDATE FOR YEARS BEGINNING WITH 2010.
(a) Update- Section 1848(d) of the Social Security Act (42 U.S.C. 1395w-4(d)) is amended by adding at the end the following new paragraph:
`(10) UPDATE FOR 2010 AND SUBSEQUENT YEARS- The update to the single conversion factor established in paragraph (1)(C) for 2010 and each subsequent year shall be 0 percent.'.
(b) Conforming Sunset of Sustainable Growth Rate- Section 1848(f)(1)(B) of the Social Security Act (42 U.S.C. 1395w-4(f)(1)(B)) is amended by inserting `(ending with 2008)' after `each succeeding year'.
Calendar No. 178
------------------------------------------------------
The $247 Billion budget effect comes from eliminating the calculated ten years of savings that results from keeping the SGR and cutting Medicare physician fees by 40% over that time under current law.
Which is better, a 40% cut or a 0% change for one year? Using CBO logic this bill increases physician fees by 40% over the next ten years. And physicians are against it?
Do physicians think the issue of physician pay will never come up again until 2019?
Hospitals, labs, surgicenters all are NOT subject to SGR and have all done better than physicians since 2002. Yes, we can do better, but we can't do better Right Now.
We've been fighting SGR for 12 years, with a battle every year, and now here is a bill to kill it and doctors are saying, "it's not good enough"?
You take your victories where you find them, and then pick up your sword and wade back into the war.
Obviously, I support S 1776.
1. Ultimately, medical decisions need to be made by doctors and their patients.
2. No legislation should become law without serious tort reform.
3. Insurance can be made more affordable by allowing competition drive down costs.
4. Transform the reimbursement and billing systems that are strangling physician's practices.
5. End the unfair censuring of doctors without due-process.
As you can see these 5 principles represent the word U.N.I.T.E. That is what the physicians of the www.millionmedmarch.com will be doing to protect our patients on Nov 21st. Politician's have intruded into the practice of medicine one too many times and it ends today. It is time for politicians to start listening to their doctor's.
Fraternally,
Darren J. Sommer DO, MPH, FACOI
Please do not support this bill
This is the only reason that S.1776 was introduced now. He wants us to all fall in line for the health reform bill that is being crafted in secret that no one has seen. Falling for this ploy is just plain dumb.
"This bill repeals, but does not replace the SGR. Instead, this bill freezes physician Medicare reimbursement rates with a 0% increase over the next decade. There is no guarantee of anything further and it does not address what happens after the ten years are up."
The Senator has obviously not read the bill....... Or is being intentionally disingenuous.
Count ME Disgusted with such sloppiness.
Watching incomes drop yearly wih increasing overheads would drive many business owners to change their business model. We unfortunately are physicians who have taken an oath to heal and provide high quality care.
Our office is on the brink of dropping out of Medicare, we will balance bill these patients and let them collect their money from Medicare. They can fight their appeals and denials. We are sick of it. A public option will be " Medicare for the rest of us".
This bill is a joke. It is window dressing on a much bigger problem.
Tort reform is a must, cost of living raises is a must, allowing patients to take responsibilty for their own care is a must. Allowing seniors access to their physicians expertise without insurance industry of government control is a must.
Where is our bail out money, Mr. OBAMA!!!!!
We have had enough!!!!!!!
Or do you think that politicians never back out of a deal after they get what they want?
PUBLIC OPTION.
WE (the majority) DO NOT WANT SOCIALIZED MEDICINE.
The founding fathers nor the constitution suggest even the slightest hint of the idea that the government should provide or administer public healthcare.
These socialistic ideologies need to give way to common sense and the principles that our nation was founded upon. Socialized medicine has never been, nor should ever be considered.
"Most physicians support a public option" is Dem talking points, NYTimes hogwash. Other polls of real physicians, not the phonies at the WH photo op - yes thats us out here in "Bubbaland", are 2/3rds against.
Medicare with no raises for 10 years, plus a public option whose express goal is to have every man, woman and child, legal or illegal, eventually on a government run medicare fee schedule, is 10 year slide towards indentured servitude.
Keep your drivers licenses current you all will be driving cabs for pocket change like the eastern european MDs . . .
However, IT IS STUPID TO CALL FOR A PUBLIC OPTION because we want reform with our current system. A public option is not the solution. ONLY L wing liberal idealogs would think more government involvement is the answer to our problem.
I think we need a public option. If I'm a left wing liberal idealogue, then what pray tell are you?
In real dollar terms, medicare reimbursement has not kept pace with inflation. Adding a 21% pay cut may be what it takes to cause the program to unravel as practices shun medicare patients because its payment are less than costs. The same thing might happen with a 10 year freeze on payment increases.
The message being sent to medicare recipients that the government has so little commitment to paying for their health care that it is unwilling to pay enough to pay to ensure that medical practices can see them without incurring a deficit.
All of us should get out of all the ins.plans and bill the pt for our services. lets see costs will come down!! I wont need an authorisation or numerous billing collectors to chase down the deadbeats. I would add to Dr. Blue's comments...Fed govt should ask medicare pts to pay a copay...hopefully they will stop wasting my and their time in our medical offices..doc shopping? or ck out a new doc in town? etc.etc.
So Dr. Coburn the message is explicit:::: Fix tort reform....Looser pays + peers in same speciality decide the validty of the complain+ have special courts for malpractise like they have for Workers comp..Something to chew on. Wish u the best..
It is certainly not to get the government more involved. Why would anyone want more of what we have with Mediare and Medicaid?
Are you suggesting that you want our system to be more of the nature of Medicare and Medicaid?
If the government wants and needs to pay less for health care, then The People need to pay more. Otherwise health care providers will 1) adopt business models that exclude patients who won't balance pay, or 2) take their brains into other fields entirely.
Mr. Senator, the answer is catastrophic insurance policies combined with MSA.
Health care finance in the US is "broken" because it is a socialist system grafted onto a capitalist economy. Socialism = somebody else pays for what you consume.
The only way to fix Medicare is to introduce proven, well-established, practical, and logical market forces. Patients need to have a stake in what their doctors are charging and what tests are run. They must have a stake in how their premiums and their government spends their (and all taxpayers') money. Without this control, no amount of laws, orders, regulations, rules, or other tricks will be able to control government expenditure on Medicare. Here are a few simple ideas:
1. No direct reimbursement to physicians. (Patients will "see" and "feel" the bill each time they come to the doctor's office. It will help control costs by forcing patients to see what their charges are.
2. A mandatory co-pay that each patient must pay according to their income level which will help: a) offset the costs b) will remind patients of their responsibility in their healthcare costs.
I also believe that Americans are yearning for a national "Catastrophic Health Insurance Plan" paid for by general taxes and covering everyone. this program will serve as the backbone of the healthcare system. It should cover only those illnesses that are life-threatening. Just as we all pay for roads and public schools and the police, we should pay for and be covered for these life-changing illnesses such as major trauma or cancers. This system again must include some measure of responsibility and involvement by the patient.
I truly feel we are headed for a mass exodus from Medicare/Medicaid by physicians. The lines of rising overhead/declining reimbursement are converging, and being offset less and less by well insured patients due to the economy. We are tired of subsidizing Medicare/Medicaid by accepting horrible reimbursement (on top of already paying into the system more via higher taxable incomes).
As for tort reform...an Ophtho friend just shared a nice story. They see premature babies to do exams in the NICU to evaluate for retinopathy of prematurity (which if untreated can lead to blindness). The exam means a special trip for them to the hospital, and is a more difficult exam than your average eye exam. To perform this exam, they pay $10,000 PER PHYSICIAN in additional malpractice insurance because of the risk of lawsuits. Medicaid (a high percentage of the preemies are Medicaid) pays about $35 for this special exam. Of course, this means they are LOSING MONEY to provide this service. Logically, they are having to talk with the hospital about making other arrangements as they can no longer afford to do this.
The system is broken on the physicians' side as well as that of the patient. We need relief!
Nonethless I'm intrigued by landesbw's explanation that the S. 1776 may be the better half of a bad situation--anyone to counterpoint (constructively) landebw's critique.
As to DrBlue (capitalist?) & Sermo Doc 29 (socialist?), as I've said many times before in Sermo at large: Socialized medicine? Anytime you want--as long as you take what must go with it, if such a system is to function cost-effectively & affordably in a large & diverse nation (like the USA or the former Soviet Union)--in contrast to compact, homogeneous, affluent, self-contained societies of Sweden or Switzerland--namely, rigorous & ubiquitous Soviet-style command-control of health services providership- supply & consumer-demand.
Hope that this helps (a little).
The following is a copy of an email I received from someone in the know who received this from someone else in the know. I can't cite the source as I don't know who it is but very reliable:
Minutes ago the Senate voted on a motion to invoke the cloture on the Motion to Proceed to S. 1776, a bill, by Senator Stabenow (D-MI), the SGR repeal bill. The vote failed, 47 to 53. There have been talks to amend the bill to transform it to a two-year or a 4 year patch possibly paid for by a "millionaire's" tax (congratulations) or pay it with "unused" TARP funds.
The to-be-merged Senate health care reform bill will likely contain at a minimum a one year SGR fix that is paid for. The House bill is also likely to contain a fix to the SGR, however, we are hearing that the original full SGR fix included in the House Tri-Committee bill is likely to be scaled back due to the cost. Therefore, if the House and Senate bills are conferenced, the issue will be subject to change but very likely will end up as a 1 year or 2 year fix. The AMA has stated they will actively oppose anything that does not repeal the underlying SGR formula. It will now be interesting to see what the AMA says about health care reform bill(s) that don't fix the SGR.
Agreeg SGR fix dont agree with price freeze. We cant even talk or unionize and we are getting the shaft.
Please bring some common sense to Wash for us. I could talk at lengh on how to fix this mess. Important Points
Tort reform- Get us our own court with court appt expert witnesses, make the loser pay for the winners lawyers, punish the ambulance chasers. Defensive medicine is rampant. I saw three patients in one week thathad anaphylaxis and the ER wanted to keep em overnight to be safe. I went in and discharged them saving almost 10 K. The only reason they were admitted was for CYA reasons
ICD-10- Do we want this expense?
EMR- Is it worth it to spend 50K/doc X 100,000 doctors=~ 50-100 billion dollars over 10 years for a not-ready-for-prime-time system? In a budget crunch your going to force me to become less productive? Show me the people who say they are more productive with hunt and click EMR and I will show you a rarity. I have yet to have a patient tell me they like their doctors nose in a laptop while they talked to them. Yesterday I saw 26 patients and they all had adequate time spent with me. Then I didnt go home on the computer to finish charting like my friend does with EMR.
Insurance- Make regulations nationally and allow inter-state competitiion between companies and we will see rates drop. Make Insurance companies standardarize in how they ask for information and make refusals. Give teeth to the Insurance overseeing agency to punish spurious decisions
End of Life- Old people often say to me Let us die ! I saw a 87 y.o. in the ICU with maggots coming out of his nasal septal necrotic ulcer! He had spent a month in ICU after a gallbladder surgey. He had Alzheimers and had not been self-aware for 10 yrs, not walking for 5 yrs and not eating with J-tube for 3 yrs and was in the hospital for 6 weeks. Why are we wasting our talent and money on this guy when the 40 yr old woman who lost her job and cant afford her cobra couldnt pay for her medications yesterday. Who is more deserving of charity? This makes no sense
Good luck. I donated to your reelection fund today. If doctors dont support doctors in Wash we are in trouble. Here is his web for donations
www.coburnforsenate.com
Please put your dollars where your mouth is.
Your post is way too politically influenced. You are trying to inflame us against Dems.
Please dont drag us in this bickering.
BTW, I did tell my Senator to vote against it.
Health care reform in this country doesn't need to proceed in this manner. Can you trust those in Washington to honor their word on this or any other issue? I'm not just talking about the party in power here. I'm talking about the process.
fees fall, we will see loss by attrition of early retirees, even with less than they dreamed of in their retirement plans. There will be little incentive for new trainees, and more reliance on nurse anesthetists and foreign grads. Of course, members of Congress will never have to worry .
The answer is quite simple- a gasoline tax. Canada , with its "utopian" health system, has a gasoline tax such that 35 % of the cost goes for taxes. The US rate is 20%.
This tax will help the environment, decrease our dependency on foreign oil and be a more equitable source of income. Those travelling on long vacations pay more.
The tax on trucks could be reduced.
And let's adopt the Canadian tort system while we are at it.
I think it's wrong that the best and worst physician in the US get paid the equally for the same procedure or office encounter type. Balance billing, however, would possibly increase costs (it might decrease it if patients seek less care) and seniors would not be able to afford the increased cost. Therefore I propose that physicians be allowed to balance bill a portion of their patients (say 50%, and possibly based on patient income). Those paying more might get longer visits scheduled. Yes, it' would be a two tier system, and politically might be a hard sell, but the lower level would still be good care, similar to how it is today. Already those with more money have access to better food, clothing and shelter, and can afford the higher copays of 2nd and 3rd tier medications. If patients did not like the higher charges, they could find another doctor. Presumably the higher quality doctors would be able to command the premium. It could also be variable. It might be an extra $10 per visit for one, or $100 for another depending on what the doctor wants to charge, and what the market might bear.
Like most others, I did not go into medicine for the money, yet I feel I deserve to get fairly reimbursed. My family suffers the long hours I put in, yet vacations, new cars and college educations strain my budget.
1) Check with my office staff, landlord, utility companies, suppliers etc to verify that none of them will expect a raise or increase their prices over the next ten years;
2) Check with my wife to make sure that our household budget will not need to increase at all over the next ten years;
3) Check with all of my patients to make sure that they don't mind me having less time to spend with them when they come to see me, so that I can squeeze more patients into my schedule in order to maintain a stable income, at least relative to expenses and inflation (if that is even possible!);
4) Check with other professionals - my accountant, lawyer, etc, to see if they anticipate earning the same amount of money (or less, adjusted for inflation and increased costs) every year for the next decade;
5) Check with my congresspeople and senators to find out if they will be receiving cost of living driven pay increases over the next decade;
6) Check with the drug companies to see if their prices are going to change over the next decade;
7) Check with some healthplan executives to see if their pay will increase at all over the next decade;
8) Call my health insurance company to see if my personal and family medical insurance premiums will be the same every year for the next decade...
I could go on, but I'm sure you get the idea!
Mike Ford, MD
Dr. Coburn: Thank you for all your work. I am in favor of a tort reform component to any legislation. But I fear that a 0% increase over 10 years is actually better than what our economy can support long term and that making a deal like that now would be the lesser of two evils.
1. TORT reform
2. Medicare/Medicaid fraud resolution which costs $$$$.
3. Novel idea: Increase the age of Medicare eligibility to to within 3 years average age of death for men and women. What was the average life expectancy in 1965, you'll see my point.
4. Open up the ability for citizens to buy insurance from ANY insurance company, anywhere in the US.
DID ANYONE READ MY PREVIOUS COMMENT???
S. 1776 is officially DEAD.
The continued oppression of physicians is a done deal; the mechanism is irrelevant. We should-- for once-- be smart enough to see the imminent destruction of our beloved profession. Physicians need to stop this madness and opt-out of Medicare and drop commercial insurers.
For God's sake people, save your patients. Save yourself.
WE ARE GOING TO HAVE TO OPEN A HORSE AND PONY SHOW OUT IN THE PARKING LOT. CHARGE THE PARENTS AN ADMISSION FEE TO KEEP AT LEAST ONE DOOR OPEN NEVER MIND BOTH DOORS.
S. 1776 IS the blackmail offer. The SGR was created by bureaucrats and CMS policy wonks, and was designed to effectively suppress physician reimbursement despite the enormous rise in practice overhead over the last eight years. The current offering is the same type of bait that Pharma and the insurance industry latched onto.
The promise: We won't make it worse (eliminate the SGR), but it will never get better (S. 1776). Don't you see that the current proposal of eliminating the SGR is linked to the future proposal of no increase in reimbursements, which is exactly what has been happening for the last 8 years!!
Feel free to be a lamb. Your destination is ensured...
Second, paying doctors $250 billion a year for services provided to society to keep people productive is money far better spent than any of the "handout" programs currently in existence and being proposed. Let's stop giving money to people for nothing in return, and use that money to pay people to provide a service or build something. Pay people to build roads and bridges. Pay teachers to teach students. Pay firefighters to save people's homes. Pay for scientists to develop new cures for diseases. Pay doctors to keep citizens healthy and working and providing for their families. Cut out the entitlement programs that provide nothing to society in return. That's how you pay for this.
Finally, medical liability reform seriously needs to be addressed, but that is another topic that should be addressed in another bill. One thing at a time here. Why do all bills have to be 1000 pages and address hundreds of issues, encouraging political bargaining and vote trading. Can't we debate one issue on its own merits until we reach a compromise that's best for the majority, and then move to the next issue?
We as doctors have painted ourselves into a political corner. I suggest we revolt, stop seeing government sponsored patients, illegal aliens, and al payments coming from bureaucratic dicision making.
If enough of physicians slow down, stop working, and see only private patients, it may make a difference with the AMA, AARP, Big Drugs, Big Labor, Big Attorney lobbies which all make our profession be a problem to work in.
Now certainly our subspecialty is in no position to opt out of Medicare. However, as reimbursements decrease and/or remain the same patient care will suffer directly. In order maintain cost flow we simply have to see more patients in a shorter period of time. Our other option is to hire physician extenders. This does not improve the quality medical care. I can't think of any provider that wants to work harder for less of a reimbursement and provide lower quality care.
there should be a set formula for cost of living, cost of running a practice increases every year and incentives for higher payment.
as an internist i can save more money for the system if reimbursements were higher and therefore compensate for the defecit spending. bottom line, reimburse me appropriately for the time i spend with pts, then i will take the time in effort to provide a higher quality care that can reduce costs by limiting testing, specialist referral etc that comes with having to feel rushed.
in summary, i agree wtih my colleges, s 1776 is a sellout and does not do our profession justice. we deserve better and should expect it.
Why should tort reform be linked to SGR repeal? Is it not possible that these measures can be passed individually? I think the Republicans will loose a fair amount of physician support on this Senate vote.
This does not matter to me - we have already stopped accepting new Medicare patients. The govt can keep their money and balance their budgets - not on my back!
I went into medicine to help people. My mother was ill for most of my childhood. She died a premature death at age 53 due to aftereffects of an untreated strep throat she suffered as a child in war torn Europe that led to rheumatic heart disease and destroyed her mitral valve. It was this daily exposure to my mother's illness as a young boy that led me, in the 4th grade, to solemnly vow that I would become a physician one day.
I graduated from medical school in 1981. My mother was proud of her son, the doctor, until the day she died a few years later.
While I went to medical school with altruistic goals, I have found over the ensuing years that the practice of medicine has, at its core, a subset of expectations and demands placed on physicians like no other endeavor. I still hold true to the 'old' version of the Hippocratic oath, not the newer 'politically correct' version.
I never had expectations of riches, fame or fortune by becoming a doctor. However, I never expected that I would have to take a vow of poverty either.
The practice of medicine is not the same that it once was. It is certainly not the medical field I envisioned when I entered medical school in 1977.
Physicians have been demonized, marginalized, sued, over-regulated, nickel and dimed by the insurance companies as well as Medicaid, locked out of medical staffs and insurance plans for want of board certification, etc. The list goes on and on.
I had hoped and wanted to practice medicine until my 60's. It is no longer my desire to do so. I feel unwanted and unappreciated on so many fronts that my burning desire to be a physician has dimmed to a dying ember. It saddens me.
I do not appreciate being used by either political party for its own ends. If you have the desire, I encourage you to read my four part "Thoughts of a physician" posted on Sermo just three months ago. It goes into more depth than I can here.
I have a mentally handicapped son who suffers from autism. I fear for his well being in this 'new America.' I also have two other 'typical' children. One has expressed a desire to become a physician. I have actively discourage this!
Come what may, I am expendable as is everyone else. I will leave the practice of medicine and do something, anything else, to feed, clothe and house my family. Maybe, just maybe, life will be worth living again.
It is with a distinctly bitter taste in my mouth that I state "I am not leaving medicine, rather, medicine left me."
We are philosophically on the same page. My criticism is with catering to politicians who only want to use you as a pawn to propagate their own personal interests. The AMA has succumbed to such flattery, contributing to the demise of practicing physicians. As individuals, we should not subject ourselves to the blatant, pathetic enticements that have ultimately undermined our professional stature.
As much as I can appreciate SOME voice in the present debate, I recognize that the lure is only Congressional grandstanding. In the end, we will lose because we cannot comprehend the political and financial forces pitted against us.
I'm tired of kissing an ass that will never recognize my personal and professional contribution to humanity.
Read the Declaration Of Independence and recognize that our nation was founded on the moral principle of INDIVIDUAL RIGHTS to life, liberty, property and the PURSUIT of happiness. It does not say an individual has the right to have others provide him with property or happiness. The government is required by the founding documents to use force to protect us from those who would harm us by using force that would prevent us from thinking and acting in our own selfish interest to create the values our lives and happiness require. Sadly government has become the most flagrant violator of our rights not our protector. Wake up and reverse course before our nation becomes a complete fascist dictatorship!
The AMA tried to sell this as a good thing, as the basis for the "hope" of better treatment in the upcoming reform bill. The senate saw through this attempted fiscal scam today, which is a good thing. Did you see Joe Lieberman's comments on the floor of the senate? Connecticut should be proud that they have him.
2. We'd get further in guaranteeing the highest quality of care for all by replacing the SGR with something logical, and removing geographic disparities in payment with one swoop.
Thanks to you for your communication and for soliciting input.
I QUIT.
I, like many other physicians am barely able to get through the month at current pathetic rates. This kind of cut makes it easy to decide what to do but painful and sad to realize that my skills are thought to be less valuable to society than the Sears repairman who checks out my washer as his fee is almost double mine.
Wont the Senate be surprised when millions of Medicare patients no longer have a physician willing to work for wages that are laughable. Don't expect to bring in many new physicians at these rates as the smart students already know NOT to go into medicine.
If the Senators think the town hall meetings were emotional before, imagine 60,000,000 people not having any doctor to see, at all. Wow, that truly is health reform. Nice job.
Collective bargaining is the only means to protect ourselves against the powers that be. Interesting that the powers that be took the only real tool we have away, as that is illegal.
Interesting that all other parts of medicine [nursing, PA/CRNA/NP, Staff, and even administration] have the right to organize form a union, and protect themselves.
United we would stand, divided we are falling.
Physicians are the key to medicine, but are treated like the red-headed step child [no offense to red heads]. It blows my mind that we are discussing what we are. We have to defend our existence, defend and fight to be paid what we are worth, yet we all sit her on call tonight, at the whim of whomever needs us.
What would a legal consulation at night cost us if we needed it? I doubt that the gov't would state that after hours legal need is "part of their role and oath to uphold the laws of the land and our constitution".
Honestly!!! Freeze reimbursements? patch the SGR? avoid 21% cuts by January? Does any of that sound even remotely appealing or comforting at all? You cannot value medical expertise/skill/judgement with an equation/modifier or cofactor/coefficient. It doesn't work that way. How about valuating physicians for their contribution to daily life, health care, H1N1 vaccines [ha ha], Polio vaccines, Trauma care. It is amazing how valuable people think you are when they are dx with cancer, have perforated viscus, are incapacitated. No so much later, after you render services and then they get the bill. At that point, you really didn't do that much to help them, right?
Legislators need to wake up and be wary of devaluing something that they cannot quickly replace. We are all replacable, but not very quickly. How valuable were President Reagans surgeons? Dwight Eisenhower had Ulcerative colitis, do you think his physicians were of any value?
You see value is a subjective, market based product. Like housing, this product is worth what people are willing to pay to get it. "Free healthcare", or Medicare valuations will never allow that to mature, as it puts a false ceiling on that value [based on nothing that relates to what the true value is], which then becomes the reality for the average Joe or Jane to start from.....doomed before it ever begins.
Then let society's lawyers take care of them. We'll see how well their subpoenas cure their illnesses. And what their tort laws add to the average life expectancy.
I really do see many people, including us who have private clinics, to opt out of Medicare and Medicaid in order to cover our overhead expenses. Without comprehensive analysis of the reform proposals, we will NOT have the high-grade medical care available when I'm old and gray, let alone for my grandchildren.
Thank you for staying involved, Dr. Coburn!
leahy.senate.gov
They say the people get the govt they deserve, well they will soon get the lack of care govt will create. There is a saying in communist Russia, they pretend to pay us so we pretend to work. Coming soon to a hospital near you!
Repeal the SGR. Suck up the debt. Start over with a better const containment system.
Anyone who thinks any Congressman, Republican or Democrat, would vote to freeze Medicare payments to physicans doesn't understand how Congress works. Repeal of SGR is not linked to a pay freeze. The curent SGR is an automatic, yearly pay cut which is always overridden. A farse.
My thoughts - when Medicare was started in the late '60's. Doctors were against it. Now our seniors are dependent on it and there is no way it is going away any time soon. Health care costs are dramatically higher than they were in the past. We are a compassionate country and thank God we do not stand by idly while people, particularly seniors, children, pregnant women, and the sick and frail suffer and die.
If the private sector can equitably provide decent quality health care for the poor and the most vulnerable in society then that would be great. But since this is not likely to happen, the government health care is the best option. We are already subsidizing and paying this health care bill for uncompensated care. It is time to quit the charades and make a public option available for everyone who cannot afford their own health care. This can and should be paid for through realistic taxes and perhaps excise taxes on gambling, tobacco, alcohol, and luxury items. Health care cost control should be rewarded to physician or hospital or pharma initiatives that demonstrate excellence in more cost effective, high quality health care that can be widely implemented. Furthermore, efforts to control health care liability costs and curb defensive medicine and promote tort reform MUST be included in any realistic measure of health care reform for physicians support.
Senator, the SGR formula is hugely flawed! I am not sure S 1776 is the answer , but I am disturbed about the lack of any specific plans for improving health care access and quality coming from your Sermo letter to physicians. As a physician/politician I would expect more.
While the nation is drowning in red ink, the legislature is arguing about rearranging the deck chairs on the Titanic. There is no cost containment in any of these bill worth a dime! If you insure more people, you are going to have more cost.. duhh! If all these currently uninsured, become insured, oh just look at the colonoscopies, PSA's, MMG's stress tests etc... The cost will BLOW your minds and the budget... Even by having a pure public option and erasing the parasitic insurance companies who are sucking the marrow out of the country (with their lawyer co-parasites) there still is not enough money to satisfy the voracious demand for health care!
Tort reform, elimination of futile care, balance billing and transparent charges.. all these need to be implemented FIRST before adding any more "insured lives."
All studies that look at this show that we are essentially killing off the uninsured by less vaccines, preventive care, diabetic and hypertensive control etc... Stopping this "kill off" and replacing it with any semblance of medical care will blow the budget out of the water if cost containment is not addressed.... S 1776 is just a waste of our time!
Medicare/medicaid is a tiny percentage of my income, so I don't really care personally, but the writing is on the wall if draconian cost containment is not implemented not just in health care, but across the federal and state systems, the United States of America as we know it will be gone.
The first attack is going to be on the 401K's. Just watch.. when the deficit balloons, all those politicians are going to look at those juicy, ripe retirement accounts and pounce like a pirhana on a fattened calf!!
2) The Congress always waits for 3 am Saturday on mid December, and the LAST thing they do before going for Xmas break is to cancel the now 20% cut scheduled for Jan. One year they were so lazy or unconcerned that they let the cut pass and on Feb of the following year they had to cancel the cut retroactively to Jan 1st.
3) If Congress can't find $250 billion now to care for the current Medicare patients, how can they threaten to have National Healthcare i.e. Medicare for ALL???? The money will have to come from the taxes or from somewhere. From the same place that the money for defense comes. So don't punish doctors just because the money is "not there".
I left residency 11 years ago hoping I could really help patients and their families and earn a decent income. I am far from rich, but don't mind where I am now. We went to school for most of our youth to become physicians. I think we deserve more respect and earnings than we do. Medicare IS the Titanic. No matter what changes are made, it will sink soon.
SGR or no SGR, I can't see how Medicare payments can continue in our current system of monopolizing insurance companies, defensive medicine, and the overwhelming demands of the public for the "best" health care without rationing.
If Medicare payments sink, which they will sooner or later, I will be forced to end services to seniors and the disabled on Medicare. I will have to fire most of the staff, and I will see fewer patients, but at least give them more of my time. I will likely have to move out of my location, which has mostly lower income patients on Medicare or commercial insurance from their jobs. My patient population of over 2500 will have to find a willing nurse practitioner at a minute clinic to see.
Perhaps I will be happier in that situation. It will be me and one medical assistant and maybe one receptionist. I can see 15 patients a day and give them all the time they want, and I can go home at a reasonable time and be with my family. I will earn less, but die happier.
I disagree with Dr. Jesse, why would this balance have to be budget neutral for physicians but not for everybody else. Any significant change will drastically alter what we know now. I don't think anyone can predict with will occur based on simple or complex changes for better or worse. It is this "butterfly effect" that we theorize about. The reality is that currently, medical equipment/supply companies, hospitals, and insurance companies will fare better based on language already written in the two bills proposed. There is no such language for phyisicians. All physicians deserve increased pay/reimbursement, not just some. That increase needs to be substantial to offset the losses for he last 6-8 years to simply break even. People, and politicians have little sympathy in this regard. As long as the care is given, and we are required by hospitals to see medicare/medicaid patients [in most by laws], this destroys the cause. Even if you opt out of medicare, does that mean an ER patient with medicare/medicaid does not need to be seen if you are on call? I would theorize the answer is no. Therefore the patients that you refuse to see in the office, will be seen in the ER instead..... you lose again.
We are so regulated and critiqued, that all avenues have been reviewed and loop holes will likley be closed for most physicians. Again, this begs the question, why is it that physicians are the only ones that cannot unionize? The worst nightmare of Speaker Pelosi, King Obama, Medicare/medicaid, and private insurers...........physician unions that would make a single unified voice be heard, and level the playing field. I suppose I answered my own question.
You might consider tort reform!
"Announcing the HIT 1115 Project"
In the article I'm making a call for all physicians to go nonpar or to opt out of Medicare altogether, en masse, between 11/15/2009 and 12/31/2009, the period where we are allowed to change our participation status.
URL: www.hcplive.com
Now, with knowledge of these impending cuts, the call becomes more important than ever.
Al
If everyone did this, quality would go up just due to the mere fact that we would have more time, less paperwork and fewer idiotic rules to comply with. P4P, PQRI, ePrescribing, bullet points, RAC audits, ICD-9, E&M codes, mandated EMR, perpetually suppressed reimbursement-- nonsense.
Ways to start are so simple.
1). Allow individuals and small business owners to band together in large groups to buy insurance from national pools.
2). Make 10, 15, 20, or 30 year policies instead of 1 year policies. This will greatly help the "pre-exisiting" illness problem. Give people choices and control over those policies. For example, a healthy 20-year-old may need only a catastrophic plan. A healthy 25-year-old woman may need a plan with OB coverage, etc. Also allow expanded HSAs so that people have to shop around and spend some of their HSA money.
3). Allow MDs to treat indigent patients and then deduct the value of the service from their income, i.e. give us a tax credit to see the uninsured.
4). Adopt the Indiana model for tort reform. Though this one would never fly as the trial lawyers control the Democratic party.
5). Expand funding for Community Health clinics and staff them like HMOs staff urgent care centers. Then advertise. This would help keep the uninsured out of ERs.
Just some common sense ideas that we should use as a start. This sure beats a massive govt takeover, in my humble opinion.
I liked your 7th point more than any other.
3rd party payment is unethical. It corrupts. It corrupted everyone involved.
Medicare is the mother of 3rd party payment system.
Nation is very grateful to the congress for passing unfunded mandates and other shackles. We need more poison to the system. Medicare needs to collapse before we bring in financial discipline in picture.
How is that for keeping small town doctors doors open?
NO THANKS TO A PUBLIC OPTION AND SOCIALIZED MEDICINE !!!
It'll take that long to get the crooks out of their PALACE!
I want my $250 billion too. Go cry on someone else's shoulder about your budget shortfall.
Well after we are all shoo'd out of our clinics, we'll probably jump at the Giesinger, Kaiser gulags and sweat mills just to keep our kids in college. (And I was so poor I was had financial aide - now with my sons tuition, my student loans, and the business loan to start my practice i'm living on less than my mailman.).
A life of crime is starting to sound better these days.
Then this Senator who says " I care " gets on this forum and wonders why the answers don't fit into his neat perspective of the world.....No he isn't in Kansas any more.
Like so many others I am outraged that our profession has been dealt such a nasty hand...I had good intentions when I became a physician and 27 years later still do.
But like so many have stated before me, ( unlike those who work for a corporation or hospital ) I have no bargaining power and have watched my reimburesments drop while my overhead continues to skyrocket.....this is my last year in private practice...and with 5 stents in my chest I do not need the stress of yet another year wondering how to pay for my health insurance ( nondeductible ) and my malpractice and overhead...I am %$^$#%^ broke!!!!
So Senator whatever solution Washington comes up with will not help me nor does it care....but I am sure there are many other docs in the same shape.....
Good luck taking care of you senior citizens and I hope they vote the whole bunch of you out of office..
Dr. David Franzus
Internal Medicine
Doctors have been so marginalized that we are now totally off the page in Congress!!
We all were helpful years ago, but now we're helpless to control our own destiny!
1. no company paid health care insurance. all health care insurance is bought at the insurance store.
2. no refusal for pre conditions.
3. patient / physican contracts that the insurance companies have to honor upto the amount set by the insurance coverage.
4. allow physicians to take personal deductions on their income taxes for non payment of fees.
5. medicare can give each recipient a credit card that has so much money on it each year. such as $25,000 for hospitalization,$ 200/month for medications, and etc. then the recipient can spend that money as the patient and the doctor sees fit. that is all you get each year. patient / physician contracts become very important.
my 2 cents on health care reform -- thanks for listening
uh.... yes... maybe we should
Senate Judiciary Chairman Unable to Explain Where Congress Gets Authority for Individual Insurance Mandate.
(CNSNews.com) – Senate Judiciary Chairman Patrick Leahy (D-Vt.) could not explain what part of the Constitution grants Congress the power to force every American to buy health insurance – as all of the health care overhaul bills currently do. “Why would you say there is no authority? I mean, there’s no question there’s authority, nobody questions that,” Leahy told CNSNews.com.
So, if the Chair of the Senate Judiciary Committee hasn't any clue and Obama, the alleged "Professor" of Constitutional Law doesn't know, doesn't it seem likely that Congress has no right to impose any insurance mandate under the Constitution?
www.cnsnews.com
I mean, just survive. i earn enough to pay salaries, insurance, utilities, supplies, etc. There is ZERO left for me to take home. Thank God for my social security.
It is ridiculous. No one would be so dedicated, work so hard for no salary.
I can't charge for the hours on the phone in the evening, answering calls, prescription refills etc.
And now, I am being urged to further into debt for EMRs.
And, Time has an articel stating we earn too much.
This is madness.
Agree with Ramstrong and my brother and sisters in the profession.
Because the bill did not pass, Congressional action will be required before the end of the year to prevent physicians from experiencing a cut in reimbursements from Medicare. As I mentioned in my initial post, I strongly support a permanent fix to the SGR and will not allow such a pay reduction. Congress will likely pass a one or two year patch separate from a major health reform bill, but I believe SGR "reform" should be part of health reform.
The debate moved quickly yesterday, but I found your responses helpful and informative. I look forward to continuing to share them with my colleagues. As always, I look forward to engaging with you in upcoming weeks as the health reform debate moves forward. Thanks for all you do to as America's physicians who deliver critical care to our nation's seniors and others.
Tom Coburn, M.D.
U.S. Senator
Fellow physicians, opt-out now or wallow in your own stupidity. Senator Coburn is the only remote voice you have in D.C., and he has demonstrated that he has neither the clout nor the temerity to influence his political comrades.
Be a lemming or a wolverine. Choose now, or your destiny is assured.
God help us, Congress won't.
The government has had over a decade to "reform" the SGR. Why so long?
of the nation. Physician reimbursement may need to be linked to the salaries and
benefits of senators and members of congress. Maybe lawyers who do work for the
government would be willing to take reductions in their fees over the next decade.
It is ashamed that we resort to sarcasm and cynicism, but how many of us sincerely
believe that our government will do the right thing when it comes to health care
"reform". Everyone agrees that our tort system adds billions to the cost of health care but nothing is done about it.
Why?
Will there be any meaningful reform or politics as usual?
If anyone thinks that WE will accept any cut - beit an actual cut or a cut because we get a FREEZE in reimbursement with no COLA increases - they can go $#@ themselves.
Sorry to be so blunt. You go and try to not give a cost of living increase to any other government worker and they will be protesting in the streets; time we got some balls and did the same.
Repeal the freakin SGR and replace it with cost of living increases yearly - period.
Sermo Doc 120
Propose that to any other profession and see what happens.
Also, the answer "there is no money" can be applied to ANY bill proposed by Congress, so it's just a lame excuse to say: doctors go f*** yourselves, sorry...
"Stupid" is making the wrong decision when all the information to make the right decision is readily available.
It sounds like some of our colleagues that are in favor of a public option and the government taking more control are beginning a long painful journey. Perhaps they are just ignorant.
Please share this information to help all physicians become better educated.
#1
online.wsj.com
#2
www.atr.org
Mainers Vote Overwhelmingly to Repeal Dirigo Health Tax
From Kelly William Cobb on Thursday, November 6, 2008 12:00 PM
Below is ATR's press release celebrating the repeal of a multi-million dollar tax hike on soda, alcohol, and insurance in Maine.
On November 4, Mainers voted by a near 65-35 margin to pass Question 1, repealing a $77 million tax on soft drinks, beer, wine, and health insurance claims. The tax, passed by the state legislature earlier this year, was slated to raise money for Dirigo Health, the state's government-run health insurance program.
If Question 1 had failed, the tax hike would have added 24-cents to a six-pack of soda, 7-cents to a bottle of wine, and 16-cents to a six-pack of beer in Maine. The taxes would have also placed a 1.8% fee on all insurance claims. The Center for Fiscal Accountability and Americans for Tax Reform have calculated that after accounting for various excise taxes, corporate income taxes, and other federal, state and local taxes, consumers across the country already spend 37.6% of the cost of soda and 56.2% of the cost of beer paying for government taxes and fees.
"The overwhelming turnout of Maine voters to pass Question 1 and repeal the Dirigo tax is a huge victory for consumers and a crushing defeat for Governor Baldacci and the Democrat state legislature that tried to pile $77 million in new taxes onto Maine residents," said Grover Norquist, president of Americans for Tax Reform.
When launched in 2005, the Dirigo Health insurance program was projected to cover nearly 128,000 Maine residents by 2009; however, the program is currently covering less than 12,000 individuals. To increase funding, the Democrat-controlled state legislature passed the Dirigo tax hike last spring with little public knowledge or discussion. Following a citizen petition by the Fed Up With Taxes coalition, the tax was put on hold pending the results of the November 4 vote.
"The passage of Question 1 is not just a clear message that taxes on Maine consumers are too high, but also a referendum on the state's Dirigo health program," added Norquist. "Mainers realize that the state's attempt at big-government health insurance has failed miserably and they are simply not willing to foot the bill for it. Governor Baldacci and state lawmakers should take note that higher taxes for the purpose of state-run health insurance simply does not fly in the Pine Tree State."
Unfortunately, I am now compelled to investigated opting out of medicare due to the pressures imposed by the current medicare system, both from a reimbursement as well as regulatory standpoint. The anticipated cuts in consult fees taken with the failure to update our rates (and possibly cut them) makes it hard for me to stay ahead of overhead. I am sorry, both for me and the seniors who may suffer.
We have not met, but most of us community docs have acquired the impression that Washington just doesn't care about us. Rather, we feel like part of a formula, manipulated to suit a bottom line that doesn't account for the heart and soul we've invested in the care of our patients. I'd be happy to discuss this in person if you wish.
Regretfully,
-jrl
I just want to know how it came to pass that "automatically", cuts are ingrained yearly into Health care, specifically, Medicare? And that yearly, it has to be painstakingly repelled back? What distorted thinking went into that? (I know- just a rhetorical question...)
I say, bring on the cuts, let primary care die a natural death, and we'll see what happens with this armaggedon.
To take back control of our profession, we must push back all non-physicians including the congress. Only way to do that is to make them irrelevant by refusing to accept payment from them.
Just say no to 3rd party payment.
If you are going to live a lower middle class life (as indirectly mandated by Govt) anyway, why not to go cash-only and avoid the pains and hassles of 3rd party system?
These cuts are a blessing in disguise.
Did you ever wonder why it is that Congress can vote themselves a pay raise using taxpayer money, but there is no National Referendum for the People to decide if they deserve it???????
Freeze Congressional pay and perks for 10 years...
this will provide MORE THAN ENOUGH COLA for Doctors!
If there are funds left over, they can be used to fund Medicare!
Pay for Performance, not sitting on your butts!!
Many Republican Senators support the repeal of SGR. But they refused to vote for this bill because of political reasons. Your livelihood is just another political bargaining chip.
Medicare is a "public option". If you don't think a public option will become the only option, check out how many health insurance policies are available to people over the age of 65. Unless they are still working and have insurance through work, there is no private insurance.
And your fees in the future will be set for the public option as they are now for Medicare, by a ridiculous formula that does not keep up with your expenses. Something like SGR which, despite being dysfunctional enough to destroy primary care, is not going to be changed until the political winds shift. SGR is now 12 years old. It was immediately seen to be flawed when it passed. Yet the political will has never been found to repeal it.
BTW, for those who opposed S 1776 because it added $247 billion to the deficit over 10 years. Do you realize that right now the US Treasury is borrowing $260 billion EVERY TWO WEEKS just to keep the government doors open? In other words, at the current rate of borrowing, S 1776 would have increased the deficit by 0.3%.
PS: THERE IS NO TEN-YEAR FREEZE IN THE BILL, THAT IS A MYTH STARTED BY THE OPPONENTS. The words are not in the bill. The bill is only half a page long, read it.
Obama's Doctor Shortage
All of the president's "fixes" will just create new problems.
By ALLYSIA FINLEY
"In his campaign for health-care reform, President Obama has repeatedly harped about a primary care doctor shortage. "The status quo is we don't have enough primary care physicians," President Obama said in an ABC interview in July. The president promises that his health-care reform proposal will address the problem of a primary care physician shortage---and he's right. He will make it worse.
Mr. Obama wants to provide insurance for an additional 30 million Americans, but recent experience in Massachusetts shows that universal coverage will result in an even greater physician shortage and longer waiting times for patients.
Because Massachusetts' Commonwealth system served as the model for the universal coverage Mr. Obama wants to implement nationwide, a few results of its health-care experiment are worth noting. A 2008 Physician Workforce Study by the Massachusetts Medical Society found that the percentage of residents having difficulty getting care rose to 24% from 16% between 2007 and 2008. Since 2006 when the Commonwealth system was implemented, internal medicine and family practice went from having labor market conditions that were considered "soft" or unstressed to being the only two specialties with labor market conditions classified as "severe" or experiencing the highest possible degree of stress..."
More at:
online.wsj.com
LOL to us all.
My Urgent Care doesn't accept Medicare. I see plenty of low paying patients in the ER.
Is there any doubt that the reimbursement on the Government Health Care Plan is going to be lower then Medicare! So spend a TRILLION dollars to insure everyone, then spend the next 2 years trying to find doctors to accept them.
And, I agree about the debt. We need some common sense here...not more smoke and mirror BS.
So, Senator Coburn, what is Plan B?
After fighting this for so many years, I would almost like to see the cut be implemented and then get stymied by the partisan political games so a fix can't go in. Then, when the primary care doctors start dropping Medicare patients it will be woe to any incumbent facing reelection in 2010.
That won't happen, Medicare will get fixed for one year and the price tag for fixing the SGR in the future will go up.
But I humbly predict here and now that the temporary fix for 2010 will turn out to be exactly what S 1776 would have done, 0% update.
But the SGR will survive to reappear like Freddy Krueger.
"BTW, for those who opposed S 1776 because it added $247 billion to the deficit over 10 years. Do you realize that right now the US Treasury is borrowing $260 billion EVERY TWO WEEKS just to keep the government doors open? In other words, at the current rate of borrowing, S 1776 would have increased the deficit by 0.3%. "
Reduce Congress back to Colonial days with 1 Senator and 2 Reps from each state...that's 150 guys that can no longer ignore us!
Think of the cost savings and how we can reform everything or boot them out!
We are in a recession- yet you see govt spending left and right- with a shrinking workforce. Where does govt get the funding? Where else?- A credit line straight from China. China bought out at least 1/3 of our debt. Just like credit card companies, China is earning off of our debt. How? Pure and simple- read various editorials being hushed-hushed by the national networks...China is the world's #1 oil consumer. We're #2. China, being communist, is sanctioned/prohibited by the U.N. from overstepping its boundaries (read: being "present" elsewhere). The U.S. is in the middle east in the guise of "security". There is truth to that- 911 and all...but, there is more to it. We secure the oilfields, and get a fair share. That "fair share" stops there- China gets a huge chunk of it, as it does with the Alaska pipeline. Did you ever wonder why the U.S. only gets about 10-20% of alaskan oil? Now you know. China has also bought out our workforce. How can our labor force compete with a communist labor force?? Now you also realize why everything pretty much is "Made in China".
Ditto & touche! [pronounced too-shay].
Sincerely,
Sermo Doc 63
Better get our accupuncture skills up to date!
Physicians have lost their constitutional right to free enterprise. This is a civil rights issue as one segment of society is forced to serve the rest.
The 13th Amendment to the constitution states: no involuntary servitude, .... shall exist within the United States, ....
The 14th Amendment states: No State shall deprive any person of life, liberty, or property.
The situation as it stands is not sustainable, and your colleagues in congress need to know this. No "reform" is possible without doctors, and we will soon be a vanishing breed. Oh and one more thing, can we please have a union?
Look at it this way:
-Medicare cuts lead to few doctors seeing Medicare patients. Medicare patients write their congressmen, storm the white house, and talk about their plights on the major news networks. Government forces doctors to see Medicare patients. Doctors write their congressmen, storm the white house, and talk about their plights on major news networks. This is due to violations of Constitutional amendments. The congressmen lose millions of votes and get kicked out.
How about this? Actually introducing a bill composed of ideas that have been promulgated on this board. Then, let's see how that flies.
This Posting has existed for quite a while and nothing of significance has been done in Congress by Sen Coburn or others. Do you get the feeling that perhaps Doctors are being ignored? :-)
While many may be concerned about the political ramifications, and others about the cost, my concern is purely practical.
MY PRIVATE PRACTICE in FAMILY MEDICINE, the primary care people that all sides in the debate agree are the least paid, most in shortage, and which virtually no US medical student wants to go into (<2% of this years med students chose primary care specialties), WILL GO BROKE AND CEASE TO EXIST WITH ANY PAY CUTS, let alone 21.5% !!!
So, blocking paycuts to physicians will cost over 200 Billion over ten years? I say, so be it, who do the expert pundits think will be around to care for all these people, for no pay, when all the doctors go broke???
NOT EVERY GRANDMA NEEDS A $4000 SCOOTER PROVIDED BY MEDICARE.
ORTHPEDIC DEVICE MANUFACTURORS DONT NEED $10,000 PER HIP, they and their sales force are some of the highest paid people in the medical system, and these days are mostly glorified delivery people.
A LONG LIST OF DUBIOUS TEST DEVICES are sold daily to some less than scrupulous folks (doctors, unfortunately) who run unnescsessary tests that provide little value to the patient care, but are "BILLABLE WITH THIS OR THAT ICD9 CODE" ACCORDING TO THE SALESPEOPLE.
The doctors who use evidence based medicine, and a modicum of common sense, who provide high quality cost effective care, are pushed out of the market.
STOP THE FRAUD, and you can have your OFFSET enough to fairly pay for the truly nesessary medical care.
Every idea/option needs to be evaluated and debated on its own merit, a political quid pro quo approach of S. 1776 is simply wrong.
Another sin of the so-called "doctor fix" is designed to move $247 billion off the cost of ObamaCare, making it look more affordable. This is not something obvious to many.
Congressional Budget Office, nonpartisan though they may be, their track record of predicting Medicare and Medicaid costs over the decades were dismal at best. What can convince us that they got it right this time?
Unfortunately, we've been practicing Medicine as it shoud be done all along, but we somehow missed the implications of a Govt. takeover in 1965 when Medicare was passed and the Govt. started its' takeover of our Practices!
We were working, not sleeping!!!!!
Sharpen the guillotine! I think Congress and many of our best and brightest on Wall St. deserve to anticipate the Rapture and be enabled along their journey to Eternity! And let's throw in the heads of health insurance companies as well.
This entire debate is based upon fraudulent premises. I reject any legislation of my profession at the hands of a fraudulent legislature that is bought and paid for like cheap crack whores! That, Tommy,, is what I think of you and your cohorts in both political parties. Give my best to Satan when you reach your destination!
why are you begging?
why have you been brought to this situation that you are begging?
"DID ANYONE READ MY PREVIOUS COMMENT???
S. 1776 is officially DEAD"
I think most of us know it's dead. It doesn't stop us from expressing our exasperation with the broken healthcare system we have in this country.
If our Reps and Senators are not listening to us, what impact are we having??
Our only real impact is in our Office when we see individual Patients and tell them if you don't call/speak/write your Reps. in Congress, your Medical Care will be the worst ever that you can imagine!!!
I could go on a dozen different tangents here, but I'll refrain.
I'm convinced we have to see the worst before we will get better.
The new Socialist P(r)ogrom for Doctors has begun.