Mayo isn't run by dummies. They know a reform bill dog turd when they see it. They are wisely positioning themselves to opt out of Medicare as the political climate dictates. We should all follow their lead.

When my practice gets full, Medicaid will be the 1st thing I cut. Medicare will not be far behind.

I did my interrnship there, and have the utmost regard for the institution. Hats off to them. Too bad they didn't do this 6 months ago.

Obama has held out the Mayo as a trend setter, and much to his chagrine, they will be widely emulated.

now if the Cleveland clinic would just do the same and make it 2 for 2

I can easily see how the government could eliminate this from becoming a national trend. Simply require medicare and medicaid participation or you won't be granted a license to practice. I wonder if this is in the health care bill?

Sermo Doc 6--it's not in the bill...yet.

Flightdoc, I don't think the feds would be able to dictate what state licensing boards can do. Not that they wouldn't try!

THe Dems will tie licensure and anything else they can to try and control us. They may not win, but they will try. Batten down the hatches.

"Flightdoc, I don't think the feds would be able to dictate what state licensing boards can do. Not that they wouldn't try! " I agree and will go down in my rowboat with all flags flying if it comes to pass.

BTW, this is post #3 on this topic.

I hope that Senator Kent Conrad from N. Dakota will see this. He is the one who stated last week that we will all accept more Medicare cuts because it means we will have 30,000, 000 more patients to see under the new bill. This will not be the case when we all start leaving Medicare in droves.

Amazing how this sort of story does not make the mainstream news. Thank goodness for the Wall St. Journal, running daily editorials about the disaster that will ensue if the pending legislation is passed. As they stated today, the American public is more rational and educated than Congress gives them credit for...the Dems can kiss their majority goodbye in November.

One Obama Hellcare Sandwich, hold the Mayo.

One way that CMS can ensure that you cannot drop Medicare is to only allow participating physicians to order tests / write covered prescriptions.

This is a huge deal . . . hopefully more will follow suit.

This is great.
We have not accepted Medicaid in a long time

And the Feds could very well force us to accept medicare or not be able to get our licenses

I work in a practice that's over 40 years old. Medicare is now our biggest payor. We couldn't afford dropping Medicare. Although at this point, we're considering rejecting any new patients with Medicare. The ones we have who grow old and switch to Medicare will not be turned away. We can't lose that loyalty. Referrals from family and friends still brings in more business than advertising, community outreach, and professional referrals combined.

if medicare is now your biggest payor, it must not be doing that much good in bringing in paying referrals Sermo Doc 16.

So, if the government will request that only doctors who are enrolled in Medicare order their labs and tests, there will become two types of doctos: the doctors who go for the volume and can order the tests but have no time to come up with a good plan; and the outside doctors who will come up with the gameplan. Not very efficient, but not surprising.

Clearly the system is completely broken. Not only is the Medicare fee schedule too low, it comes with policing and enforcement by Gestapo-type officials. Who would want to be a part of it?

However, I agree with flightdoc, Sermo Doc 15, and others: if physicians refuse to participate, I anticipate that there will be a move to force us to agree to accept Medicare/Medicaid patients as a requirement for holding a medical license. This Mayo story will be interesting to follow.

MD, the one thing you should not forget, is that as much as it would be nice, to have Mayo be an advocate and a leader in this war agains physicians, is that Mayo will first and foremost look out ONLY for itself. Any benefit that accrues to us, as unaligned physicians, is only accidental from their viewpoint.

It is my understanding that Mayo Jacksonville has not accepted Medicare for years.

Dude, quit lying. The actual headline is as follows (emphasis mine) :"Mayo Clinic in Arizona to Stop Treating SOME Medicare Patients". If you read the article, all they are doing is no longer seeing Medicare PRIMARY CARE patients in GLENDALE, AZ. This doesn't even effect the other Medicare pts at other sites, or those receiving specialty care. We all know the payment structure for Medicare is skewed towards proceduralist and specialty care over primary care. Obama's efforts aim to eventually help raise/improve primary care reimbursement.

radio get a clue obama wants to enslave us and then replace us with midlevels. maybe he will make you the czar of stupidity

oh well that explains it so much better radio. I'll pass that along to my neighbor who was ranting to me yesterday that this change is going to cost him $4-7,000 a year, being one of those pesky PRIMARY CARE patients that doesn't need specialty care. oopsie.

Don't get me wrong Radio. I just "luuuuuvv" what the Mayo is doing. I still can't wait for Team Obama(One Big Ass Mistake, America) and what they have to say on the Mayo acting like a business.

Probably team Obama won't say anything about it - just try to keep it quiet. I wonder if we will see anythng about this on MSNBC - I doubt it.

Sermo Doc 20, that's even worse. Mayo was touted by the Administration for its efficient brand of integrated care. The nay sayer said it was all about patient selection. Turns out the nay sayers are right. Lets here it for the Medical Home (high end specialty care need not be concerned).

Reform is a joke and so is the present bill, its all business as usual . . .

Reform is not a joke
Good reform that is

I doubt that the Feds can force Medicare participation for licensure as it is State regulated. States haven't even tried Medicaid participation requirements for licensure. This would be worse much worse. Neither would be a smart move given the worsening physician shortage. And, as has been noted before, participation doesn't mean there is room on your schedule.

I am only 36 years old and have been out of residency for 7 years. I am already thinking ahead and considering 1. How long do I want to practice? and 2. What else could I turn to outside of medicine? I canot imagine how many physicians in their 40s and 50s are doing the same.

You can try and force doctors to take patients for licensure, but in the end, you cannot force them to be doctors. If you start dictating from the federal level what patients we must see and what level we will be paid, physicians will simply find something else to do. As a group we are, in general, smart, hard working and driven. Its not like many doctors are doing this because they have no other options or have no other usable skills. ANd younger people looking at this will simply choose another profression.

Welcome to the beginning of the PA and nurse practitioner driven health care.

Mayo Clinic doesn't take Medicare at ANY of their locations: Arizona, Florida, or Minnesota.

www.mayoclinic.org

On the birght side, if no physicans/hospitals accept Medicare it will take longer for it to go bankrupt. Thank God the Scooter store and Liberty Medical are still fully funded ;- O

My personal opinion currently is LET THEM MAKE WHATEVER SYSTEM THEY DAMN WELL PLEASE. Because in the end, doctors are smart people and will vote with their feet. If they make a system that's stupid and ridiculous to work under, we'll just stop accepting it. And the moment they FORCE me to accept their insurance plan in order to practice, then I will go find something else to do. 'Cause I'm a smart guy--there's other stuff I can do that'll earn me a fair dollar. If we don't like it, we accept cash at the door, and let the patients hunt for their reimbursement. I'll continue to be a compassionate physician, but unfortunately, compassion won't feed my kids or put them through school.

I practice in Arizona, and the Mayo announcement is no big surprise. Healthcare dollars are very tight in this state. Even though the cost of living is relatively low, encouraging physicians to move to a state with summer temps in the 116 range requires a good deal of financial enticement. I've been looking for a physician for years, and the price is too high.

There's no use stopping that juggernaut of political healthcare. However, you and I are all able to step aside, can't we? So let them get their momentum up.

Radiohaul makes a point that has two edges--one, that this is only a small portion of MEDICARE, but two, this is the portion primary care docs around the country are treating, and if MAYO in AZ cannot justify this based on their losses (they cannot make it up sufficiently on other patients), then how are the rest of us going to survive?

Also note that this is based on losses prior to the new healthcare or hellcare proposals, so it speaks more to how the government has mismanaged its existing programs and not so much to the overall argument on Obama-care or Pelosi-care.

Feds may not be able to hold state licensure as hostage but could require MC participation to get a DEA number, which would put a crimp in a lot of practices. I could see seniors and AARP putting pressure on individual state legislators, however.

This part of the article was strange:

Robert Berenson, a fellow at the Urban Institute's Health Policy Center in Washington, D.C., said physicians' claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients' primary care.

"Some primary care doctors don't have to see Medicare patients because there is an unlimited demand for their services," Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, "then Medicare does indeed look like a poor payer," he said.

Clearly, now with the new bill being amalgamated from both chambers of Congress, we NOW have a crisis in evolution. Physicians will now be not participating in government sponsored programs, and patients will be forced to find alternative places for care. Things seem to be getting worse and not better.

yeah i've been working on my exit strategy for a while, since i don't want to deal with cosmetic patients half my day. it's tough to replace a good income though.

we'll be dropping Medicaid soon. i am the only person in two counties who takes it. the patients just don't show up.

if any cuts in Medicare go through we'll stop taking new Medicare, and then three months later just quit scheduling any Medicare appointments if they don't fix it.

health care reform is a must. the current system is ridiculous. the trick is to get the government to stop overspending on drugs and go after real fraud. why should the biggest purchaser of drugs in the world pay the highest prices? why should we have to put up with attack audits?

i agree that a quick vote with our feet, should the 20% cut go through, is the immediate and best strategy. the politicians will hear the AARP loud and clear.

I still think that the "Mom and Pop" business plan of physicians (solo/small groups) vs. the big business model of places like Mayo, Cleveland Clinic is a twisted offshoot of the American approach to any type of commerce, which is why neither approach works very well.
We are not purveyors of soda or breakfast cereals, and "brand loyalty "should not be a medical practice goal. We should act like the elite cadre of highly trained professionals that we are, unionize, and make our needs known through collective bargaining.
My OBG colleagues in Canada are happy to have such a system to interface on their collective behalf with the federal healthcare bureaucracy, and the vast majority of them are happy to make a comfortable living, working 36-40 hours per week, knowing that they will be paid for every single patient that they see --no ifs ands or buts.

I have a neurosurgeon friend who visited neurosurgeons in Russa 20 years ago and the saying there back tehn was
They pretend to pay us
And we pretend to work.
Hummmm... Hummmmm.... Hummmm

We have gone a step ahead of Russians. We pay those who pretend to work!

God bless Mayo..............ten years ago I accompanied one of my dearest friends who needed a liver transplant to Mayo (still alive and doing very well!!!!!).........I trained at one of the large UC Hospitals, but was awestruck by the level of care............."like a a Swiss watch," I tried to tell my friend, who had nothing to compare it with..............lol

However it was abundantly clear that one of the reasons Mayo could be so successful was that their patient population was/is so homogeneous...............employed well insured patients, sprinkled with many many international multimillionaire patients who endowed wings of the hospital, and departments!! No sign of Medicaid or illegal immigrants.............wow.........The support staff were well educated, had incredible work ethic, and all spoke correct English, with "no attitude"...............LOL... I was SOOOOO envious of the docs....sigh........................

So when I heard Obama and his crew touting Mayo as the example for cost control and high quality medicine......................I had a great laugh.....................well, YEAH, if you can get rid of Medicaid, limit Medicare, refuse all illegal aliens, and employ loyal intelligent well trained support staff, you too can have some degree of cost control and quality control. They really shot themselves in the foot with this one.........Morons............guess no one really looked at Mayo up north to figure out why the system "works"............typical mental midgets......................well, now that I have vented, have a nice day...................

Mayo should be ashamed. I'll send no more patients to any of their over-reputed facilities.

I have sent a request to all major news organizations asking why they have not covered the Mayo clinic opting out for primary care, 21% pending pay cut and Medicare January 1 payment freeze. We'll see if anyone has a response. As far as Mayo is concerned, their Rochester location is non-par, not opt-out. However, they submit all in-state patients as participating. Only filing non-par for out of state patients. Wonder how they get away with that. In Florida, I see a load of out of state patients half the year and would love to charge them extra for the hassle.

Sermo Doc 31 Internal Medicine Posted Jan 04, 2010 at 2:29 PM
This part of the article was strange:

Robert Berenson, a fellow at the Urban Institute's Health Policy Center in Washington, D.C., said physicians' claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients' primary care.

"Some primary care doctors don't have to see Medicare patients because there is an unlimited demand for their services," Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, "then Medicare does indeed look like a poor payer," he said.

LOLOL....Yeah Sermo Doc 31....................its not so strange when what this fool really means is that we should be happy to see twice as many patients to earn what one could earn with half as many insured patients......................either that, or he is truly logic challenged in how he covers this issue...................either choice is unappetizing................

I heard a news report out of Boston a few days ago that the state run health care plan is now requiring doctors to see patients covered by it's failed system. I am in agreement that we should all stop seeing Medicare and Medicaid but, I'll bet Obama will have the Congress pass legislation to require us to accept goverment plan patients to keep our medical licenses. They only way to change is to elect a rational congress and oust the current administration.

Tip of the iceberg. Let them pass this, and I drop Medicare. Fee for service. Break your leg? Bone sticking through the skin? YOU NEED ME OR ONE LIKE ME!! Barney Frank can't and won't help you. Let the bastards learn that the system doesn't work without DOCTORS. Bring it on; MAKE MY DAY! We're going to be sitting around a campfire bartering away our services a year from now, so what is the use of all of this posturing bullshit?

Hypothetical Question: How would all of our lives change if the majority of physicians across the country opted out of ALL insurance contracts? Like starting right now? Sort of like hitting a "re-set" button, back to the good old days (before I started practice) when insurance companies actually wanted physicians in their plans and paid them well to make them a provider and keep them as a provider. Of course, back then, money went toward paying physicians, rather than paying health insurance company executives.

Sermo Doc 38

No reason at all for Mayo to be ashamed.......Mayo is an incredible institution..................I have been exposed to top drawer med schools, and residencies, but had never seen how a hospital should work until Mayo. Truly a joy for patients and docs alike. Why? Because they are smart enough to not let themselves be bulldozed by the typical burdens of most medical centers............. unlike California, the patient population is largely employed, speaks English, and has insurance. A whole different culture of responsibility............they do not accept federal money, and run their own show. Yes, that means that the patients need to have insurance, and they serve very few medicaid patients......unlike many hospitals......... so what. If I ever need cutting edge surgery, no offense, but if humanly possible, I will get myself to Mayo.

The fact that Obama and his ship of fools could not figure out why Mayo was/is so successful, and adjust their 2000 page Health Care Reform, just shows us how totally out of touch they are......................

Don't bash a system that works, just because the rest of us don't have the same hospital system................

medicare is the 'get into heaven good deed' for the next life since it doesn't do much for this life. i like the vote with the feet. it is obvious that no one listened to the other end of the body as it tried to talk its way though the healthcare reform. since the tongue didn't work maybe the feet will.
i feel bad for the patients, but doctors need to be reimbursed for their knowledge and training, and high level of thinking skills...not to mention surgical skills, etc.
good luck to all.

It will start getting national attention once hospitals that drop Medicare start turning away ER patients that can't pay. After all, these hospitals are no longer bound by EMTALA if they don't take Medicare money.

This is just the first domino to fall.

Good for Mayo Phoenix.

Would be more impressed if this occurred systemwide.

FWIW with RAC on top of cut reimbursements, Medicare-accepting specialists will be a rare commodity.

Obamacare will work...
The mayo clinic says so....
follow the link

sure now and the sun will rise in the west, and never set;
there will be enough of everything for all and it will be free;
peace will come from talking...

and if that's not enough, I have an ocean beach front house for you in the middle of the Grand Canyon.
I just need a little help getting it fixed up... :)

maybe I'm just a little cynical,

but I don't think so.


Bob

www.bloomberg.com

I would appreciate a fuller account of the circumstances of and reasoning behind the decision by Mayo

Personally, I cannot afford not to take Medicare. Here in NJ the national carriers have all followed the local Blues affiliate and have dropped payments 20% (ore more) below Medicare for small practices, for a number of years now, if they pay at all. The local BCBS is very cozy with the state government, providing elected officials (or is offals) with a premier medical plan. Ten years ago the NJ Legislature capped (below Medicare) what automobile insurers had to pay for mostly primary care services rendered after an accident. I have asked the AAFP to come to this state to help with the problem but have gotten no response.

What will happen? New Jersey will lose more primary physcians (and it is already on the bottom of the list in the Dartmouth Atlas), the legislators will once again villify physiscians as they have in the past, and encourage the insurers to punish us with even lower payments.

Simple, and makes perfect sense to poiiticians.

Or I can move to AZ. Anyone looking for a new associate out there?

In our community the only PCPs taking new Medicare patients are those the hospital has hired for that purpose. None of the privates take them. The last internist who did had to close her practice and make her living doing Locum Tenens work as she was only making $35,000 per annum. Primary care for Medicare patients is going to become purely a hospital subsidized situation, unless Medicare cuts hospital reimbursements to the point that they don't want any Medicare patients, in which case no one will take care of them.

Doesn't Massachusetts require docs to take their Medicaid as a condition for a license?

Megadittoes there, Sermo Doc 41. Couldn't agree more. Like Ole Lodgkins said in The Outlaw Josey Wales ,"Hell's coming to breakfast". The pompous idiots really think that we will roll over and take it rectally. When we can't feed our families or educate our kids, then we don't pay taxes or provide anymore care where we lose money on every case. Licensure? A state issue, NOT federal. DEA license? Before the DEA, states licensed practioners individually with regard to prescribing. In North Carolina, it was called the BNDD- Bureau of Narcotics and Dangerous Drugs. Worked just fine. I live in a state that is, thank God, considering succession and sovereignty (Tennessee). Oklahoma has already passed it and Texas is not far behind. We don't need the damned government, but they sure as hell need us. Traitors; every damned one of them!

To even consider droping Medicare is a luxury. The area I practice in is dominated by two major carriers that pay 60% of Medicare. I would starve without Medicare. Prepare to tighten your belts my friends, If you are unhappy with Medicare payments just wait for what is in store.

I could easily see the federal gov't requiring Medicare participation by linking it to your DEA # and the states would soon follow with linking Medicaid participation to your state medical license. Read your private payor contracts more carefully, MANY require medicaid/Medicare partcipation in order to allow your enrollment. This is how many private insurance companies ensure their enrolled docs aren't in trouble with the Feds.
I forsee this to be a problem. We'll see soon

I really think that this announcement is just the tip of the iceberg. Mayo has always tried to ballance the percentage of private pay (predominantly international), private insurance, and medicare/medicaid patients. in order to meet their financial goals. They currently can manupulate these percentages for their larger clinics through admission policies. However, this becomes more difficult with their smaller clinics, especially in areas where there are large numbers of Medicare patients.

As the baby boomers more toward Medicare elgibility, their larger clinics will share in the problems that have emerged in their regional practices.

EMR's, cost containment, value based reimbursement and Obama-speak cannot and will not correct the payment inequties inherent in Medicare reimbursement.

Just think the polit-idiots wanted to enact a 21% reduction in physician reimbursement, while costs associated with medical practice continue to increase. But in a Christmas-Holiday gesture they postphoned for a couple of months.

The gov't could very easily require Medicare participation without actually making it mandatory. All they would have to do is state that only medicare providers can order tests or write prescriptions for Medicare patients.

If they force me to take medicare or medicaid as a requirement for licensure, I will quit. I'm only early 40's, but I've got all my debt paid off and I can find enough work to survive, or I may just move overseas. I will never be a slave to our government. I'm quite sure the majority of my colleagues 10+ years older than I am would do the same, and the young docs don't want to work more than 40 hours a week anyway.

Good luck getting those patients seen, comrade Obama.

The Feds forced states to adopt 18 year-old drinking age by linking highway funds to
compliance. Only the naive think they can't force states to make licensure contingent on participation in Medicare or Medicaid or whatever plan ever comes out of Obamacare. As for me, I gave up the practice of medicine at 57. In another era, I would have worked to 75.

I have heard the Cleveland Clinic in Ohio, perhaps the Mayo is similar, does not take uninsured patients at the present time so how can they be a model for us to admire and try to reach! This farce is being played out, unfortunately the right of having health care continues to be a myth.

It is for the privileged few who either have unlimited wealth and do not need insurance or those with jobs that provide health insurance (HI) . I have always had to pay my own HI ever since leaving residency, now 22 years and counting. Over the years I have decreased my coverage because I just can't afford it!!!

Unless things change course 180 degrees we will have a 2 tier system nationally. Those of means will pay cash. Those in the "insurance realm" will wait and hunt for a provider willing to accept what they offer. This is the de facto socialist model of health care delivery. Unfortunately, the drones in DC and much of the public confuses health insurance for health care.

if we have any guts we would all stop seeing medicare patients and force a reasonable re-imbursement for us

I am not surprised. Many of the primary care physicians and now multiple specialists are not accepting Medicare in Chicago.

Does this surprise anyone at all? Sermo Doc 1 said it best. My 2 cents worth (no pun intended), Osler, Charcot, Cushing, et al must be rolling over in their graves based on this new health care deform turd-bill and it's "add-on" compromise. My personal ethic now is to refer lawyers and politicians to others. I cannot simply sleep at night knowing that these knuckleheads will write backstabbing idiotic "healthcare" legislation, yet ask for help when they are sick. Agree with someone above, I am looking for a new line of work. I could never, conscientiously, recommend anyone ever go into what is being called medicine today...I could not look anyone in the eye and say "oh yeah, go for medicine". Medicine is being systematically destroyed, taken apart bill-by-bill, and, we are passively letting it happen. (rolling over as someone above said). Agree, you are quite naive if you think they cannot link anything to this bill. Why do you think they did it behind locked doors at 2 AM?

I agree with Sermo Doc 49--Medicare is clearly one of our better payers. Our 2 biggest plans--BC/BS and United pay ~ 60-70% of Medicare. The issue isn't one gvs multiple payers--it's our ability to be paid a reasonable fee for our services.

I wouldn't get out of bed for 60-70% of Medicare! I can stay at home and lose money.

GREAT for MAYO Arizona!! hope more follow.. the truth needs to come out that more delayed payments and idiots denying in gov med than ever now..
Mayo JAX stopped ACCEPTING ASSIGNMENT to Medicare years ago but they would file your insurance .. not sure what they do now.

truth is that Medicare is now in its FAMINE STAGE since it ran out of money in 1990 as predicted by the INsurance COMMISSION in 1965 when Pres Johnson LIED to congress and cut Premium and Copy to one FIFTH of what they KNEW was NECESSARY

ALSO CRITICAL for us DOCS to understand that as the gov throws around this stupid numbers on the future costs.. REMEMBER THEY are NOT Factoring in the SKY HI INTEREST RATES environmen we are HEADING INTO with the INSANE SPENDING and PRINTING money and FED BUYING BAD DEBTS THAT THEY CAUSED !!!!!!

so costs will sky rocket

ANYONE worked the VA when there were CUT BACKS AND NO FUNDS? I HAVE... and we were told to tell VETS that "this is NO LONGER THE TREATMENT OF CHOICE" WHEN IT WAS....ie to LIE LIKE THE GOV"T

I hope ours never FALL SO FAR DOWN!!

key to me it so STOP ALLOWING SCHOOLS TO PROFIT OFF TURNING OUT MORE DEBT SLAVED JUNIOR DOCS!!!!!!!!!!!

Here is the link to Mayo Clinic Rochester Medicare FAQs

www.mayoclinic.org

So what, AMA is still strongly supporting Obama.
If they think that making less money and working longer and harder is good for me, then it must be so.

//sarcasm

Having trained at Mayo Rochester I know that Mayo runs a pretty tight ship and if they cannot make a living with Medicare it will be very tough for the rest.
It is obvious that Obama wants to punish older people (who have Medicare).
Seniors were the only population group that did not have a majority vote for him.
They will pay the price with Medicare cuts. Just your usual political payback!

Didn't Herman Hospital-Memorial system in Houston opt out recently?

The title is misleading!

The article states Mayo Arizona will stop treating Medicare patients, What Mayo Arizona is doing is stopping accepting Medicare as third party payment.

It did state Mayo will continue treating Medicare patients for CASH.

If we did that, we would have to wait two years. Will Mayo have to wait?

I did not see whether or not Mayo would give the patient a claim form to submit to Medicare for personal reimbursement.

What is an annual "administrative fee"?

If it were not for non-Medicare patients, I could not continue seeing Medicare patients either.

Obama is wrong. We don't need "Mayo type care" in most communities because we are now able to do pretty well ourselves.

What we need is adequate reimbursement!

Internal Medicine.

Mayo accepts medicare in all of their locations for patients, EXCEPT Mayo Arrowhead, which is a primary care office in the Phoenix area. This is a pilot for two years, as well, I believe, a political statement to the Obama administration on healthcare reform. Because no NEW medicare patients had been allowed in primary care in Arizona for the last few years, there are medicare patients who are happily opting in to the program to be able to see a Mayo physician for primary care and coordinate with their specialists.

Yes medicare patients can be seen for payment. Medicare does not allow patients to submit bills for payment. The annual administrative fee is $250.

Let's not be disingenuous about Medicare and Medicaid. They give only partial reimbursements because they are government programs being asked to reimburse private market costs. It is analogous to trying to run a restaurant where top quality food is prepared but to only be paid in food stamps. Costs for technology and medications have been driven up insanely by the unregulated corporate influence on medicine. The problem is that it is the middle man - the doctor or hospital - that takes the actual screwing because they are the ones who already laid out for the materials or the work done and are then not getting paid in return. In a single payor system the costs are held down at the distribution end - before the service is rendered. Medicare for everyone would set costs at a reasonable level up front instead of forcing providers to engage in a payment lottery. The doctors I know in Europe (England, Greece, Germany) live quite well and cannot understand why American doctors tolerate being
victims of this "one-two punch": costs that are too high because they are privately-determined just like any other profit-driven business and payments that are therefore too low because they are governmental.

Please see the letter I sent to President of AMA:

Dr. James Rohack
President, AMA
                                    January 4, 2010
Dear Dr. Rohack,
With all due respect, I know you believe that you and the AMA are doing the right thing for American Medicine by supporting the proposed Congressional legislation, but most physicians and patients in this country disagree. I'm happy to see that Mayo/Glendale gets it (see link below), and perhaps it's time for ALL SELF RESPECTING MEDICAL PRACTITIONERS in this country to get it too! The ONLY way to raise quality and reduce cost is to restore a free marketplace in medicine (Yes sacs of potatoes or carrots if necessary). Any attempt by Congress to enforce the reductions in compensation mandated by SGR when this flawed legislation fails will be met by massive efflux from Medicare resulting in its collapse. Not a bad way to restore the free market. Time will tell, I guess.
Paul Scheinberg, MD, FCCP
Atlanta, GA

Mayo Clinic in Arizona to Stop Treating Some Medicare Patients
www.bloomberg.com

We, as doctors, were selected out based on our test taking skills, butt kissing skills, and purported desire to help people no matter what we got paid. We have a reputation for being poor business people and herd like cats. Collectively, doctors are ineffective at making a significant impact on reinbursement and tort reform because we cannot act collectively and I doubt we ever will. The Mayo has overcome these issues better than any one group in the nation. Consequently, they are in demand and have the luxury of turning away those who dont pay well. The rest of the brillient doctors are left to fight for the scraps and hope there is enough to go around.

This is very interesting.Keep your eyes on Massachusetts which now has a bill ,pending tying licensure to accepting the worst of the states ins,Commonwealth Bronze.If you take any existing ins then you will have to take this one by law if it goes thru.There is no negotiating rates either,they will be abysmal.I applaud the Mayo Clinic and I think I will apply for a Job there.These guys running this place can see whats coming and they are proactive.With 21.5% cut coming now and 40% cut in2014 what else could we do but drop out.But I bet the feds try to tie licensure to acceptance of their crap.

Radio,dream on,Obama and his admin has targeted us ,you are in his sights.

Sermo Doc 61 Ob wants to punish physicians not patients .Although all of will suffer under his admin.Vote republican,no matter who the candidate is.

Mass requires acceptance of medicare fee with no balance billing for licensure and there is a bill pending to require acceptance of a new state payer that will be for small businesses.
There are no free market considerations in MA and you can look here to see your future. Thanks Teddy Kennedy. Let's see if they treat the lawyers the same way. Who can get by w/o legal advice these days? What about the grocers? Don't we all need food?

I chose option #6 because #1 + #2 , or, respectively, the Liberal Left powers-that-be [Big Oh/Kennedy-McNamara Harvard-Brookings Institute--NY Times] NEVER will get it but nonetheless there's-a-light-at the end of the tunnel because their ship-of-state is hitting the rocky shoals of reality! Amongst their own camp murmurs of discontent are heard (e.g. I believe NYT quoted & profiled Vermont Senator Bernie Sanders) regarding apparent abandonment of the so-called public option, insinuating the possibility of 'NO' votes on Left in the Senate.

>Sermo Doc 46 01/04/2010, 3pm=Agreed, more info needed & ASAP.

>radiorahul 01/04/2010, 10:54am=Yeah OK, the Mayo action may be local in scope but who's to say that it isn't a stalking horse for similar changes on a bigger scale?

>ridinggirl 01/04/210, 2:37pm=Nothing here to add or detract from Mayo's prestigious reputation but it was interesting to point out that the NYT (again) reported that Mayo's perceived cost advantages had to do with favorable differential regional cost-of-living factors (e.g. Mid-West less expensive than NE with Brezhnev USSR-NYS or Taxachussetts).

>flightdoc07 & migrainemaven, 01/02/2010, 2-3pm=The Federal Gov't (since FDR) has found one way or the other to override US Constitutional boundaries or firewalls (judicial 'review'/activism, deficit/megadeficit spending/borrowing, executive orders overriding Congressional perogatives, Congressional micromanagment of executive functions, etc.) on behalf of the Liberal Left agenda. Impressment of MDs into Medicare & Medicaid might be fought only, I think, on 13th Amendment grounds (not States Rights grounds, the latter long since vitiated by Earl Warren & co.)

>orthodoct 01/04/2010, 3pm: Please, forget about secession from the Union. Even President of the Confederate States of American, the Honorable Jefferson Davis (in retirement) did not recommend that such an action be considered in the future &, indeed, the last sentence in his memoire read something like "The Arch of the States in Perpetuo Est" (pardon any typographical errors).

Sermo Doc 38 ....are you for real.Are you looking forward to a 40% cut inreimb set for 2014.

If they try to deny me a DEA, I will just laugh. I already run a more or less nonnarcotic headache practice. Minor loss.

If they tie M'Care/M'caid to licensure, then I will stay home and figure out something else to do. No reason to incur liability while losing money!

Hey--Sermo Doc 67. It's not going to take 4 years for a 40% cut in reimbursement. That'll be coming your way long before then. :-(

My 2 cents on tying insurance acceptance to state licensure. First, I don't think the Feds will be able to make this legislation directly. They will have to force the state med boards to do it by refusing to transfer public funds if they don't. Second, I think physicians have a better chance at organizing / unionizing at the state level and controlling the response to blackmail, so this may not be an all-bad thing. Third, as far as tying DEA numbers to accepting medicare / medicaid, I suspect this would be open to legal challenge. However a work-around we could use is to agree to participate in said programs, and then utilize fair and transparent scheduling practices to minimize our financial exposure.

Senator Conrad does not know what he is talking about. The extra patients do not justify the medicare cuts. Most primary doctors already work non stop 12 hours a day. Not sure if this is true but some have said that many doctors are requesting the paper work to opt out of medicare just in case that becomes an imperative.

If everyone is going to treat us (medical practice) like a business, we must treat it like a business. If a contract does not pay enough we should not sign it. If we are in a contract that doesn't pay what we need to run our business we should get out.

FIRST of all, we do not want more patients- Conrad et al do not seem to understand that we do not make widgets every person you accept into your practice is a life you are responsible for. It is a life that you have to be available for- there is a reason we have lower life expectancy and a higher divorce rate.
SECOND- what the hell took us so long- we have been limping along being co dependent on a failed system. Why don't we require them to pay off our student loans before we will take medi caid or care? Let them try to put us into slavery- they better have a whole bunch of NPs and PAs and CRNAs WE'RE NOT GONNA TAKE IT -NO WE AIN'T GONNA TAKE IT we're not going to take it anymore!!!

This pivotal article explicitly documents how the coercive economic power of government monopsonies (i.e. single buyers or so-called "buyer monopolies") like Medicare and Medicaid ultimately will adversely affect physician practices, the patients they serve and the premiums paid for employer-based, private health plan coverage of 157 million other Americans who are not yet elderly or poor.

"Nationwide, doctors made about 20 percent less for treating Medicare patients than they did caring for privately insured patients in 2007, a payment gap that has remained stable during the last decade, according to a March report by the Medicare Payment Advisory Commission, a panel that advises Congress on Medicare issues.

At the end of 2008, Medicare covered an estimated 45 million Americans and Medicaid 58.7 million (in FY 2006) according to the Centers for Medicare & Medicaid Services, the agency in charge of the programs. While 92 percent of U.S. family doctors participate in Medicare, only 73 percent of those are accepting new patients under the program, said Heim of the national physicians' group, citing surveys by the Leawood, Kansas-based organization.

This story highlights the perilous state of the mostly small service businesses of American physicians, 87% of whom are practicing solo or in single specialty groups of less than 10.

In the face of these unprecedented developments affecting one of the largest and best multispecialty group practice brands in America, it would be interesting to see any rational response from those physicians who are still irrationally advocating for Congress to establish a THIRD government monopsony, in the form of the "public option", expanding Medicare for ages 55-64 or even the "U.S. single payer" fantasy.

Having read the Bloomberg article I have a ? Are they really charging (and obviously NOT getting reimbursed) $1500 for one P.E. and 3 visits per year? That is multiples of anything I've ever seen (let alone charged myself before I retired) for such office visits. A little clarification is in order.
djeretIMdoc

Sermo Doc 25,massachusetts has a bill pending right now tying licensure to acceptance of state ins.

Dear Sermo Doc 69:

The succession idea is not mine. The goal is aimed more at sovereignty than succession, but that is the next step. This began in Montana regarding firearms registration and has expanded to the point where states no longer feel as if they should be loyal to A federal government that no longer represents them. For example, why should my state (TN) help fund Ben Nelson's (NE) or Mary Landrieu's (LA) medicaid programs? This legislation has PASSED in one form or another in OK and is pending or at least being discussed at the state house level, to the best of my knowledge, in TN, NC, SC, TX, AL to mention a few. I could be wrong, but the internet has been abuzz about this for the past month. The bottom line is that if we, as the providers, don't support their program, then it will die. Doctors AND patients are fed up with what is going on in this country, and I am afraid that civil war is coming. This treasonous Congress who feels that they are gods who can do whatever they please TO their constituents instead or FOR their constituents truly have awakened a sleeping tiger---the "silent" majority. If you don't think that the citizens of this country are preparing for war, go try to buy a box of ammunition. It is flying off the shelves faster than the industry can make it and I know, on good authority, that the makers of firearms and ammunition are working 24/7 because this is their time to "make hay' before the government tries to restrict ammunition purchases. A gun is only a poor club if you don't have ammunition for it. This is why the Founding Fathers of this country had the foresight to include a Second Amendment to the Constitution so that the citizens of this country could overthrow a tyrannical government. How much worse can it get?

When hard working people have a choice of feeding their families or paying taxes, then taxes won't get paid. Chaos is soon to follow. If you haven't noticed, people are SCARED and elderly patients will tell you that they have never been so scared in their lives.

I am a Christian PATRIOT father of three who works hard to do what is right. According to Janet Napolitano, that makes me a Right Wing Extremist. I wear the badge proudly.

Now, as a sage cardiac surgeon told me many years ago, "We are the only ones who can do our jobs and ours is an apprentice program. Therein lies our strength".

WE HAVE THE STICK. IT'S PAST TIME TO SWING IT TO PROTECT OUR PROFESSION, OUR FAMILIES, AND FIRST OF ALL, OUR PATIENTS. WE ARE THE ONLY ONES THAT STILL CAN. LET'S SHOW THIS CONGRESS AND PRESIDENT THAT WE HAVE NOT ONLY KNOWLEDGE AND SKILLS BUT ALSO
BALLS!

Thinking some more about what leverage the Feds have to force Mayo to accept Medicare patients, it occurs to me that the govt could threaten to withold federal funding for graduate medical education and NIH research dollars. That would probably elicit a response.

I thought Obama said if you like your plan you can keep it and if you like your doc you can keep him/her. Intellectually dishonest to continuously repeat these poll-tested phrases last year - haven't heard them for the past six months since Obama finally realized they were untrue.

Has it dawned on you yet that our President is a pathological liar?
Incredible - And I hope you have many friends who will appreciate it ..............
www.theospark.net

Is the tide turning? Are the forces causing a shift towards a new equilibrium?

Interestingly, being a non-american living in this country, I saw the whole country drink the darn coolaid. The Obamawave swept everyone off their feet. Eagerbeavers wanting to call themselves liberals saw an opportunity to prove themselves by electing Obama.

I have a domestic situation, where my wife, who is a pediatrician, was a supporter and admirer of Obama. I saw the writing on the wall. I tried to educate her to little benefit.

Now she detests what obama has brought to the table, as her bubble has burst. Each tax increase that hit us, I remind her that voters like her put us here.

I also saw the writing on the wall for American healthcare about 6-7 years ago, and decided to put myself through an MBA while working full-time as a specialty surgeon and managing a full family. Many were cynical about my decision.

I went into real-estate and in one year, with about one month's work increased my net worth by an amount equivalent to my annual salary. That opened my eyes. I realized one does not need to work the way physicians do to live well. No one needs to committ fraud either. You just have to be determined to work smart and change your DNA as the situation demands.

When I meet my colleagues who are still muddling through their misery without a plan B, I pity them for their short-sightedness and unwillingness to change or standup for themselves.

I do not hesitate one bit to give up my specialty surgical practice today. I have found much lucrative alternatives. The deadbeat public which does not take accountability for their health and their actions can get people like Barney Frank, Pelosi and Obama to be their doctors.

so it is time that we do things collectively. is there a way for Sermo to form a national organization that we can pay money into that will truly represent us.

OK ,
let's stop the silliness.
There is no place else in the world where what we are now doing will be tolerated.
There is no place else to go.
That's why doctors and Engineers from all over the world come here.
We are bitching to each other, because no one else will listen.
Food , Shelter, take precedence over medical care.
But we are the most tractable part of the equation.
We will always do "what's right".
Control us, and the lawyers ( politicians; same curse word) run free.
All other groups from corporate execs to the illegal aliens lick their boots, and now the AMA does also.
No PC here.
I am a retired Naval Officer. I am Triple boarded. I worked my butt off to get here.
I took an oath to "... support and defend the Constitution of The United States against all enemies foreign and domestic..." and so did every member of congress, every judge, and the VP and President.
Those who violate that oath are treasonous, or too stupid to understand what they pledged.. In either case they are unfit for office.
It is necessary that we, the educated, not fall prey to the criminals.
It is not Medicare or medicaid, it is an unlawful taking.
The Constitution and the Bill of Rights do not grant rights.
The rights existed before the documents
The first 10 Amendments are misnamed: They are a Bill of Restraints on the Government.
The government is what we allow it to be.
Restore Values. Unelect those who do not represent us.
Not only Atlas, but the American people will shrug.
Be prepared.
Or be overcome.

Bravo fellow physicians. This has always been the answer. Do not participate. I stopped participating in Medicare 10 years ago and continue to do well without hassle or guilt. All of us should stop taking the insurance. The patients can still come and pay cash. so you are not refusing care We are boycotting the insurance not the patients.

opting out early and capturing the patients that value and prioritize their health is the only way to maintain your practice and your self-esteem. Larger groups, like Mayo, will have two business models, one that they limit their volume and risk that is gated (public) and one that is available to private pay and private insurances with more immediate access. As private institutions develop, the cost may actually decrease to the private payers since cost shifting will not be a factor in cost determination.
You may soon see the show cased high profile physicians at large institutions soon opt out to scoop up the better reimbursements or simply refer the govt insureds to the less senior staff.

To Sermo Doc 75- patients pay per visit, starting at $175, I believe the average visit is somewhere in the $250 dollar range. They are no ties to a certain number of visits per year. Plus there is an administrative fee of $250 per year to cover phone calls, paperwork, refills, etc. It was either try this pilot or close primary care because they were losing so much money on Medicare patients in primary care.

Forcing medicare on us as a licensure requirement reeks of pure Socialism. We all signed up to practice freely in a democratic country. Fine, we all organize and strike and see how long that lasts. OF course, morally I wouldn't and couldn't as my unionizing would mean someone will die unnecessarily. They can gladly take the DEA away. that will solve the huge diversion problems instantly if the druggies can't doctor shop because the docs can no longer write schedule drugs. I'm sure Vicodin and Lortab unions would step in. What a mess. We've let lawyers practice medicine with hideous consequences.

Cash only, guys, cash only. It works.

As time goes on, the opting out, cash only idea becomes ever more compelling. And clearly it would work - especially if we ALL did it at once. Of course, therein lies the problem. Physicians have never been able to agree to do anything together. I blame that on our lack of leadership and representation. We need an organization that truly represents the best interests of all of us - rather than representing its own agendas.
If we had such an organization - and the word officially came from that body that we can opt out en masse, then it might happen. Otherwise, we would have to spread the message by word of mouth. When you are asking people to make such big changes, and take such big chances, they need some assurances. Of course, it is probably illegal for me to even mention it.

when the final health bill is passed, every mD in america should close their practice for one week and march on Washington . it is not a strike, it is an educational week in order to educate the public what happens when you push us too far.. we should all engage in work slowdowns to limit access as well - make patients wait longer for nonemergencies and eventually we will have a say .... make tort reform a non negotiable prerequsite to participation in the new plan...
Enough is enough!!!!

Intelligent people with a conscience can not unite.

It is inherently against their nature. Presence of both these elements is a contraindication to unity. Because of their intelligence, they can see through things better than others and they are used to thinking, analyzing and making their own decision. Only if a significant mass of intelligent people decides to ignore its decision, they can be united.

So, doctors are not going to unite.
We will have to take individual action.
Dont wait for others to come and join you. There is no time to wait. We dont have any widely accepted direction. 3rd parties have corrupted/enslaved/influenced many of us.

Unfortunately, as we stand today, it seems only action that will work is Gandhi style peaceful non-cooperation.
They (non-physicians) will keep taking us for granted as long as we let them.

Final Bill may be signed by the end of month, before state of the union address:

www.bloomberg.com

I can't tell if the pick of the week is driven by a political agenda. Hold on a second. . . okay, now that I've pulled my head out of my ass it's all starting to clear up. Obama, congress, the former administration. . . none of them have even come close to understanding this issue, but this has just turned into a big anti-Obama fest.

We are also bashing the AMA for their cowardly collaboration with BO. They would make the Vichy government proud.
I have more respect for BO because everyone knew where he stands. I despise the AMA for being a spineless, self-serving Trojan horse that BO can use to shove this crap down our throats.

I sent out queries to all the major news media yesterday asking why they weren't covering the Mayo clinic news, 21% pay cut and physican pay freeze on January 1. Not surprising, I only got a response from Fox News, but they only printed a tiny blurb from Bloomberg. www.foxnews.com
Bret Bair will be doing stories all week on the health care bill on Special Report.

10 years in private practice...no medicaid pts. for 9 years ( never got paid correctly) and no new medicare pts.for 5 years -( about 1% of the practice). still, can't wait to retire - 10 years to go if I'm lucky !

Checkout the American Association of Physicians and Surgeons website (http://www.aapsonline.org) for directions/means/support to opt out yourself.

First let's be clear. They are not accepting Medicare assignment. Medicare patients may still be seen at Mayo, pay for services and get reimbursement from Medicare. My group experimented with this in the past. They will not continue it because it will create more collection hassles and some patients have pocketed the Medicare check and stiffed the doctors.

Sermo Doc 91,

You are incorrect. The have "opted out" at their Arizona facility. When patients see an opted out doctor, patients cannot submit for reimbursement and they need to individually contract with their doctor. Their main campus is "non-par", in which case they can submit for reimbursement and the payment goes to the patient, which as you stated can be a collection hassle.

The first worst thing that happened to American healthcare was Medicare.
LBJ's little gift. Remeber how little they said it would cost?
So now they want to add Version 2: (Ob)Omnicare

The second worst thing that happened was the guy who signed onto the first managed care plan. If I could find him I would choke him with the fomite necktie I no longer wear and wrap the body up in my germ laden out of date white coat.

If every physician in the country dropped all insurances, we would be making the first step to liberation and adequate reimbursement for serivces.
Remember when the contract was between the partient and the insurance carrier and the patient had to pay the differential on the fees?

Forgot to add: It's time to Unionize and to hell with Anti trust labor laws.
Never seemed to bother the Teamsters

One of the OBs in the docs lounge this am was saying that, if a patient wants a procedure not covered by medicare (he mentioned mammogram or pap) and is willing to pay for it and the doc does it and lets the patient pay, the doc gets fined. Didn't seem to make sense to me so I am sure it is true.

My favorite (and chilling) quote form the article:
"Robert Berenson, a fellow at the Urban Institute's Health Policy Center in Washington, D.C., said physicians' claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients' primary care.

"Some primary care doctors don't have to see Medicare patients because there is an unlimited demand for their services," Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, "then Medicare does indeed look like a poor payer," he said. "

So... their plan will be to
A) Flood the market with providers and
B) Hope that private insurers follow the CMS death spiral in payments, making Medicare look "less bad."

Earlier this year, the Wall Street Journal ran a piece titled "Obamas War on Specialists." I now realize how wrong that article was.

This administration has painted a bright target on every physicians' back.

A start in the right direction would be to make Congress, the President, and all other government employees be covered by the exact plan as Medicare. No better, no worse. Fair is fair (well, it used to be).

As I understand it, all the FEDS have to do is to tell the STATES that if they wish to receive any FEDERAL dollars, they will change their individual medical practices laws to require STATE licensure be tied to accepting MEDICARE, MEDICAID, TRICARE and such. I assume the PRESIDENT could issue a PRESIDENTIAL ORDER to FEDERALIZE all physicians if so desired and if it were determined to be a national emergency should physicians decide not to participate. Any thoughts? SCARY!

Thanks to Sermo Doc 13 for the clarification

Congratulations to the Mayo Clinic. Many of us have tried to go along with CMS in the spirit of cooperation. However, our cooperation has been perceived as capitulation by the Feds. I am not surprised to find that they have continually tried to exert more authority. Starting to shrug.......

Sermo Doc 96:

I suspect that that will be the next angle. Legislation similar to that was mentioned in Georgia a year or two ago but never went anywhere. I think it will play out like this:

The state will say that the license to practice medicine is a privilege granted to the physician (similar to a driver's license). In order to receive a license to practice medicine, the physician will HAVE to agree to accept medicare/caid. This will prevent the argument that an individual is being forced to take medicare/caid by simply replying that it is the physcians CHOICE to practice medicine as opposed to earning a living doing something else.

The same goes for tort-reform states. As soon as these states realize the amount of money they will forego, they will soon toss physicians under the bus. Since there won't be any tort reform states to move to, physicians will likely stay put where they are instead of protesting with their feet! Win-Win for the state.

There are a couple of physicians here in the area that are on a cash only basis. Their fees are less, they both run their office with one LPN, one receptionist and one physician. Collection rate is almost 100% for both of them. Both are doing very well. I have considered doing the same. If you want to get reimbursed by your ins. record copies and receipts are provided, you send them in yourself, but you pay upfront.
I have thought about having an urgent care type setup like this with hours from 1pm to 8 pm. with one or two partners.

this is not Obama care but based on previous Medicare benefits,
If this is like my hospitals the $840M is based on difference between charges and medicare allowable
not a real loss

Sermo Doc 67 and ann sermo:

do you have the name, etc of the bill tying massachusetts commonwealth care to physician licensure or more details? i cannot find mention of it anywhere else but would be very interested to know who is sponsoring it.

My respect for Mayo went upl

I'm from the peoples Republic. Hold on to your seats for they'll do anything necessary to get us to do as they wish. Page 22 - Massachusetts Application for licensure....
Massachusetts General Laws Chapter 112, §2, and 243 CMR 2.04 (2) (k) require
that you complete the following statement:
I will not charge to or collect from a Medicare beneficiary more than the Medicare
"reasonable charge" for services, in compliance with Chapter 475 of the Acts of 1985.

www.massmedboard.org

Just the beginning.Soon,the avalanche:-)

I think any attempt to force private citizens to do work for Federal and State programs without an agreed contract by means of making it a condition of licensure should be fought legally all the way to the Supreme Court.
Physicians have the ultimate sanction of just refusing to work, or in the case of those from another country like me (Britain) of leaving. I kept that EU burgundy coloured passport just in case .. never thought I might need it.

"It lost $840 million last year on Medicare". That's a lot of money to lose. I love to do charity work, but normally charity work is voluntary and not done during my business hours, when I'm supposed to be making money for my family, when I'm supposed to be earning in order to pay my bills and invest wisely. The government has no right to force me into charity ---asking me to give my time during my work hours, and make me lose money in the process. Sorry, does not work. It's better to stop accepting Medicare during office hours, and just open up a free clinic with some colleagues for Medicare patients and whoever else wants to come in for free care.... but at least then it is voluntary and it is called what it is --doctors working for charity.

The solution is really simple: Only admit students to medical school who can prove that they are independently wealthy and don't need the money. They can devote themselves to curing the sick and the lame and not worry about money. That way Obama care will work.

Remember the missionary doctors? Why can't we have 300,000 of them.

If Obamacare is so good, why does Congress get an exemption from participating?

I hope there will be at least few doctors still in practice when I need medical care.

The current reform bill does not even pretend to solve overall funding problems. It is just a first step to help our country get its arms around the problem of medical care by at least assuring access to insurance for most of the people who actually want and need it. It does not get at the payment issues in any significant way. Nonetheless, I think it's a great step forward and I hope and pray that it actually passes.

Sermo Doc 108 - the "reforms" do not address a dysfunctional medical system that does not provide coherent medical care while being expensive and simultaneously driving providers out of business through low pay and may seek to rectify this by trying to force physicians to work at a loss. The whole legislation is a pile of contradictions that will fail if enacted. I would think you might be an employee physician, if you have a private practice you can't possibly believe it will survive rising costs and reimbursement cuts ?

Amen, Sermo Doc 103

I had a very awakening experience last week. I went back to Cleveland last week to visit my father. While I was there, I stopped in at my old residency program to see some old friends. When I graduated, we had one of the top residency programs in the Nation. We drew residents from some of the top programs in the Nation...Haravrd, Dartomouth, Yale, Stanford, etc. I was shocked upon my return to find that NOT ONE of the freshman class graduated from a US medical school! This radiical change has happened in only 7 years. God help us!

Interesting about the residence program and the FMG's. Same with the program I left 19 years ago, I think there are 2 grads from US medical schools in the 1st year class this year with 9 positions. Seems like we are not attracting primary care docs at least from US schools. I guess the shortage will continue. Not sure who the 47 million uninsured people who now will have insurance are going to see for primary care.

We are screwed. They cut out consult codes for medicare, they are starting to bundle services. How the hell are we supposed to pay our bills and still make a living. This is before obamacare even kicks in, and you know it is only going to get worse, once that nightmare goes into effect. What the hell are we supposed to do, work for free?

To Sermo Doc 103: I appreciate your insights and your thoughts. I AM an employed physician. But I have as much right to be concerned about are healthcare system as anyone else both as a doctor and as a patient. As you say yourself, our system is dysfunctional right now, prior to the passage of this bill. Why is that? Many people who are knowledgeable in economics feel that the problem is private practice itself, or at least the way we do private practice in the United States. The view from 30,000 feet is that we've got a system that is the most expensive in the world (16% of GDP as opposed to 8 to 10% GDP for most other developed countries) but which is mediocre overall, perhaps the 20th to 30th best healtcare system among developed nations. I realize that one cannot just flip a switch and suddenly adopt a system that is well adapted to other countries and simply install it in our country. We have different needs and expectations. Nonetheless, we can learn from other countries.

My greatest healthcare worries are related to my own health and that of my family and loved ones. The United States has a nice glitzy system that seems to work until a person gets really sick and can no longer keep a job or run a business. It happens to physicians as well. I have known a number of physicians who thought they were kings of the world. Then they got sick and found themselves without adequate insurance coverage and no way to get it. Their lives became catastrophic nightmares. Had they lived and worked in Europe they still would have had their illnesses but their savings and families would not have gone down the tube so radically. The current bill mainly addresses that kind of situation (partially). It does it at significant cost. It forces some people who do not want coverage to pay for it anyway. It takes some money from the Medicare funds. And it is probably not going save any money. But is does bring us closer to the goal that everyone who really wants insurance coverage can probably get it one way or the other regardless of pre-existing conditions. I think that is extremely important. It's a shame that in order to get just that much the bill had to be made so complex with so many trades and political deals. I think that this complexity is mainly due to the attempts of the conservatives who want to block it and keep our present bad system. What has come through is a watered down version of what was originally a better bill. But even the original proposals would have just been a beginning anyway.

We need a system with universal coverage. It does not necessarily have to be a "single payer system." Canada has mainly a single payer system and though I think the Canadian system is better than ours it is not the best. I think the French system probably is the best and surprisingly it has retained private practice. I like my life in the USA and would never move, but I wish I could work in such an environment. I also think that people are better off there as they get older because they are less frequently thrown to the wolves with an inadequate social safety net. But the French government plays a much stronger role there than it does here. Like it or not, I think it is necessary for the Federal government to play a much stronger role if we are to get a better healthcare system.

from a practical angle, people need to come to the US when young, prepare packing around 50 and leave for France at 55! Use the last 4-5 years of stay in the US to learn how to speak French properly..Growing old in the US is a nightmare. Panama, Costa Rica , India are great places to retire if you can communicate in local languages. In India you can get by with any language... ..No health care nonsense in India. You pay for affordable services in cash. No entitlement society like in France... I'm planning a work+retirement community in Bangalore and will be looking for clients! ( I'm serious)

Is it warm there Sermo Doc 36?

Sermo Doc 111: yes.It is beautiful, subtropical climate.

Sermo Doc 108 you want universal healthcare, great, pay for my med school loanes, pay my staff, my overhead and my malpractice. I will work 9-5 take a lunch and no call. It sounds good to me. The problem is we are getting all the bad of universal healthcare and none of the good. If we can not make a living, we can not keep our practice open. Who the hell is going to go into medicine in the future. Loanes, years of training, call, risk of picking up hiv, etc and barely be able to make a living. Does not sound great to me.

to Sermo Doc 36: I have a physician friend who is from India. When he needed a cardiac workup that was not covered by his insurance, he went back to India. Though he ended up getting it for free at his brother's clinic there, he told me that if he had needed to pay out of pocket it would have cost just a few thousand dollars to get the 128-slice CT of his coronaries plus the stenting for the blockages that were found. In the United States would have probably cost him 25 times as much. Yet his brother, the cardiac surgeon who does those procedures (he said the surgeons do the stents there), is apparently far from a poverty stricken person living in a mud hut. He said that a lot of doctors do very well there. Of course, I am sure there are a lot of people there without access to medical care at all, but it is interesting that doctors can make good livings without the extremely high costs that are built into our system. There is little malpractice cost there, but that can't be all the difference. As you suggest, another type of alternative to American high costs is medical tourism or even permanent or semi-permanent offshore retirement communities in other countries. Costa Rica is another nice place, closer to the US and quite active in medical tourism. Though I remain hopeful that American healthcare reform is going in the proper direction (in contrast, it seems, to most doctors on Sermo) I could see myself getting some of my own care offshore if things don't go right. It would be too hard and complex for me to attempt to practice, offshore though. I'll keep my modestly paid salaried job as long as I can and hope for the best.

Sermo Doc 108, just out of curiosity are you getting close to retirement. If so, you have a totally different perspective than the younger docs that are getting screwed. You put your kids through college and made a good living when docs were still getting paid fairly, perhaps a little too fairly.

Sermo Doc 108: You are viewing the problem from your own frame of reference. Getting elective care elsewhere is NOT a bad idea even if you have US health insurance, as the quality of people going into Medicine in the US is declining. Soon it will be only kids of ultrarich, who will be able to afford any education beyond high school. As others have pointed out, if you need socialized medicine, we will need the whole shebang...cradle to grave support system with extremely high taxes, free everything including college education and more importantly rapid execution of large numbers of plaintiff attorneys , which can be very messy (as they will even sue over their execution!). Direct and indirect taxes can amount to over 60% as in Europe.
I doubt Amercians would re-elect any democratic president in the next 12 years!( public memory is always short and the next best speech maker will be elected). Living as a retiree in France or Italy is Fun( retirees earn more than youngsters working). Living as a "working youngster"..no fun. No jobs there! I've been there and worked in many of these countries...

This looks like the beginning of the first physician "strike" in America. Talk is cheap until you're actually willing to do something or make a financial sacrifice to fight against a federal government takeover.

Very good article about this on the OP/ED page in today's Boston Globe by Jeff Jacoby. Can go to Bostonglobe.com to read it.

Sermo Doc 108 et al What we are dealing with is a fundamental contradiction between a private healthcare system and socialized one and the fact that government and others need to realize that private providers cannot provide healthcare in a socialized system where government sets prices that have no realistic linkage to the cost of providing the service - most of the comments here reflect that. So if they want us to provide care under government direction at the price they dictate they will have to employ us. As a former Brit (I kept the passport for emergency use if I have to leave) I worked for the NHS - if the US-NHS wants to pay me a salary, run the business, give me a pension fine, otherwise let me set my own prices and make Medicare a defined benefit and let me balance bill in a free market. FPs in Britain make about $160-$200K on current exchange rates, have no business risk, no malpractice costs, and get a generous inflation proofed government pension. I doubt there is a deliberate plan but US FPs may end up having to be government employees if private practice is not viable at the deemed reimbursement rate and we close down. You can't force people to work at a loss - they simply will walk away.
This also reminds me of what I saw in East Berlin as a young soldier in the Brit Army in West Berlin, the stores were empty, people unable to get anything other than very basic services because the government set prices and they were so low no one could be bothered to work unless forced / threatened. Being a German speaker I could ask those who dared speak to me why this was the case and they blamed the socialist government.

www.boston.com

a rehash of what we have discussed here, but appearing in print in belly of the beast as it were, takes it to another level.

Well cripes.... Th ER's gonna get even more busy....

to Sermo Doc 103: Adding in what you say to other information that I believe is accurate makes the case for government medicine stronger. I never dreamed that FP's in Britain made that much. British people have healthcare that is at least somewhat better overall than the US by most comparative surveys. Also, their healthcare consumes closer to 10% of their GNP rather than the 16% that we pay. So if the doctors get paid well, the healthcare is good, and the overall bill is low---what is wrong with that? I think our private healthcare system is devasting our country's overall strength and productivity. The real problem with Obama's current proposals may be that they are too modest. Many people would want a single payer system. But I think the present proposal is just a first step and probably is all that can be passed right now. And I actually like diversity myself and I hope there is a way to retain private practice. All the European countries are somewhat different from each other and we can be different too. But I don't think that we should maintain our current status as the most expensive healthcare system in the world with overall ratings about 16th to 23rd in the world. I acknowledge that we are probably the best in a few areas, but for what we are spending we should be the best across the board.

got my manifesto today in the mail!

search.barnesandnoble.com

One reason our system is so expensive is the medical liability insurance and the overall legal cost. If a surgeon pays $60,000 to $100,000 a year for med liab ins, after 20 years of practice that's $1.2M to $2M for a nice pension plus any earnings from a pension plan.

Somebody above talked about a heart surgeon in India making a nice living and not paying much liab insurance. My point is that here in the US the med liab cost has a great impact in our lives, careers, earnings and retirement.

I read most of the above comments regarding Medicare but has anybody taken the Medicare Part C and part D online "course" or questionnaire? To summarize it, it's a bunch of threatening garbage, a gun pointed to our heads regarding "fraud, waste and abuse". So those docs opting out of Medicare won't have to deal with all these threats, so that means less headaches also.

Is everyone aware that Mayo, Cleveland clinic, and the like (so-called high-value providers) are lobbying hard to have their Medicare reimbursents increased to a level above everyone elses?

WHen you know this, you have to wonder if this move (dropping medicare patients) may simply be a posturing threat to push through increased reimbursements for themselves at the expense of you and me.

I'm sure the people running Medicare are EXCITED! "YIPEE... We're well on our way to big savings!!" The less people utilize healthcare dollars, and the quicker they die, the more money the government saves.... sounds like they have a great plan!

Dear orthodoct (01/04/2010):
Thanx for your heartfelt response but with all due regard I don't think that 2nd Amendment issues or sectarianism are really very germane at this juncture in dealing with Obamacare issues. State sovereignity has been the target of specific & relentless deconstruction by Earl Warren & co., e.g. late 1970s attempts by some states to implement residency requirments for public assistance were stuck down as unconstitutional under 14th & 15th Amendments citing an individual right to travel interstate, including more $ from public assistance. The Lib-Left Establishment under its figurehead Obama is best challenged, at this time, on the autochthonous terrains of governance & economics, I would think (vide infra, regarding Sermo Doc 108 & RoyLBishop). At this point there is a House & Senate version of Obamacare, subject to reconciliation--neither have (as I understand it) the 'public option' & are loaded like Xmas trees with special interest legistlation. A North Dakota Democratic Senator has abandoned his bid re-election, suggesting jobs before health care (for the sake of the economy) & the Far Left is gritting its teeth (in partial frustation) over shortcomings in O'care. O'care may not yet come to pass before the end of this session of Congress.

Sermo Doc 108, RoyLBishop et al are really each saying the same thing but from different perspectives (I think) & are enunciating what I've said in Sermo before many times:
You want socialized medicine? Yeah, sure but then take all of what goes with it & that must mean either neo-Stalinism or Mussolinism. Either approach permits autocratic command-control of consumer-demand & provider-supply & either approach (if implemented) would be anathema to the Lib-Left, e.g. crushing autonomous unions (especially in health care), mooting the Trial Lawyers & their modus operandi, mega cartels (of buyers & suppliers), silencing 'Consumah Lobbies' (when ruthless rationing is thought necessary).

WAY TO GO MAYO.

Jacksonville has been NONPAR for years.
Scottsdale has opted out of Medicare. People will pay for quality. Take a lesson from this everyone.
Rochester is refusing out of state Medicaid.

DO LIKEWISE MY FRIENDS. IF YOU PROVIDE PEOPLE WITH GOOD CARE--THEY WILL PAY. STOP GETTING SCREWED BY MEDICARE/MEDICAID.


Sermo Doc 91--money up front.

Washing Post reported that in the new bill, Mayo will now get a massive increase in Medicare dollars moving forward.

No more leverage there.

where is the link to that report..? Sermo Doc 94

Sermo Doc 108 are you really comparing income and lifestyles " doctors can make good livings without the extremely high costs that are built into our system" with the USA? HAVE YOU SEEN THE AVERAGE PER CAPATA INCOME there? you could live like a king there on what my teenage son earns at a pizza joint. personal-house servents are cheap, employees are cheap, but the very wealthy Indian is not able to afford a very wealthy lifestyle here. costs of living are astronomically different!!

I'm with you, Sermo Doc 80! Bravo, Mayo clinic! Down with Ob-AMA!

What has been discussed here is the wsj editorial today.

online.wsj.com