JustADoc

I am a healthcare professional. I don’t let my doctors know because I just don’t. I like to see what they will do with the most basic of information I give them to gauge what they order and say to do.

http://www.npr.org/templates/transcript/transcript.php?storyId=124090475

“DAVID KESTENBAUM: Califano was President Lyndon Johnson’s adviser for domestic affairs. And the government was about to get into the health insurance business in a huge way – about to launch the largest health insurance plan we’ve ever had: Medicare. But the idea made doctors nervous, so LBJ, Califano and lawmakers made what seemed like a small concession. The government told doctors: We will pay you for every procedure you do. How much will we pay you? Whatever you think is right.

JOFFE-WALT: Califano shakes his head describing that call now. But he says, look, the government needed doctors to participate. If doctors didn’t accept Medicare, wouldn’t see patients covered by Medicare, the whole thing would fail.

. . .

Dr. LUCIAN LEAPE (Surgeon): We found out what the general fee for our service was and charged that or maybe added 10 percent, ’cause of course I’m better than average. And so it was an incentive for doctors to charge what they thought was reasonable for them, and then of course to increase it every year by, say, 5 or 10 percent.

KESTENBAUM: Medicare solution for how to pay doctors put into cement this idea of fee for service, paying doctors per procedure for every test, every scan. That sounds reasonable, but it served as a nudge to err on the safe side – to do more tests, to do that exploratory surgery.”

You caved for a few more dollars, but it turned out to be unsustainable and now you’re getting bit back.

And maybe the “defensive medicine” isn’t so defensive after all. It’s possible that it could be offensive!! It’d be interesting to see the comparison between what tests physicians were doing prior to the third party payor system and what they were doing shortly thereafter. Of course, you’d blame it all on lawsuits, but still it would be interesting.

All that being said, my prediction is you’ve let the public get too used to not paying out of pocket, so they’re not going to be willing to go back, and will prefer to nationalize you rather than have to start writing checks directly to you. Hopefully I’m wrong.

Although you’d seem a lot more honest in your anti-government rants if you didn’t keep asking the government to take over the jury system while getting out of the way of medicine.

Matt – in many respects we are already single payer. One of the hospitals where I work has only 1.5% of patients with commercial insurance. Most are either Medicare, Medicaid, or a smattering of worker’s comp cases.
The only problem is that 15% of the population has no access to medical care.

You’re right that this debate will come down to who the public vilifies more – government or physicians.

I’m betting you’re wrong about the outcome, though.

Both sides are digging in their heels and threatening disaster. Only one side will win.

The ace in the hole for the docs is that the government has two massive entitlement programs that it must keep afloat lest there becomes a civil revolt. Congress knows that. Medicare collapses like Medicaid has done and there will be a lot of incumbents looking for new jobs.
In order to keep those entitlement programs afloat, the government MUST have doctors to provide the services.

The cut in pay isn’t the only issue. Expenses are increasing. Paperwork is increasing. Regulatory oversight is increasing. EMTALA. HIPAA. JCAHO. Multiple payment rejections. EOBs in hieroglyphics requiring multiple 30 minute phone calls to CMS central. Government seeking reimbursement for “overpayment” to physicians.

A straight cut in pay is the old frog in the hot water analogy. The frog jumps out if you throw it into boiling water, but cooks to death if you slowly turn up the heat.

A lot of office physicians are pondering the following question, though: Is it really worth it to deal with all of the extra hassles, the extra liability for a patient with multiple risk factors for bad outcomes, the extra risk of government audits, AND a 21% pay cut to boot?

The next week or two will be a test to see whether Medicare needs doctors more than doctors need Medicare.

I’m betting that government will swerve first in this game of chicken, but I hope that it doesn’t.

The system and Congress need a good vetting.

But, Nurse K is spot on (proving once again, her beauty is only exceeded by her intellect). Docs, predictably, will whine and complain, stamp their feet, and surrender. The AMA already raised the white flag, with the terms of surrender being “a spot at the big people table so our voice can be heard”. So far their voice has been “would you like fries with your order and make it to go?”

So, all the AARPeurs and the medicaideurs will see is the medicare cuts, waiting lists and the ER..um…dur… ED becomes primary care. The Healthcare bill fails.

And then the real medicare reimbursement cuts begin.