Balls and Walnuts
more than you ever wanted to know
Hosed frog.
Frog on Hose by Brenda Anderson
I’m not a greedy person. If I were greedy, I would jump at those headhunter offers from the deep South, offering guaranteed incomes over $500K; or I would have become a facial cosmetic surgeon, something I very well could have done, except I didn’t care much for the patient population. Because some things are important, you know? Like living in one of the most beautiful areas of the country, living in a place where my family is happy, even if the majority of my patients are Medicare or Medicaid.
But this is depressing:
Potential Medicare reimbursement cuts worry doctors
By LIZ FREEMAN
December has rolled around and doctors nationwide are in limbo, as they have been this time of year for the past six years.
They are left to speculate whether Congress will act in time, before the year’s end, to halt Medicare reimbursement cuts slated to take effect Jan. 1. For the most part, Congress has done last-minute reprieves and frozen cuts in prior years.
Doctors face the prospects of a 10.1 percent reimbursement loss next year on average depending on specialty, with no regard to increasing practice expenses. If the cut goes through, more physicians are expected to follow in the shoes of others fed up with the reimbursement system and say enough is enough.
It’s depressing because I’ve cut damn near all of the fat out of my practice already, and I have ratcheted up my patient load to the point that I’m already rushing through the day and feeling like road kill by the end of it. But what else can I do? My overhead costs get higher every year, insurance reimbursements get lower every year, so my only defense is to see more patients, work harder and smarter and cut what little fat is left to cut.
That article goes on to discuss the AMA’s bright idea — legislation that would allow us docs to bill over the Medicare rate and recoup money from our patients. Yeah, that’s right, the fixed income folks. Sure, some of them can afford it, but some can’t. Guess that would give me more opportunities to play Mr. Nice Guy, eh?
But the really depressing part is the primary care angle. We’re already strapped in this region; many of my patients can’t find a primary care provider. If this thing goes through as planned, it will be even harder for patients (the elderly and the disabled, that is) to find primary care.
And, yes, it’s depressing that I might have to squeeze more patients in, which in turn would mean cutting back on time spent per patient, or cutting back on services (like cleaning ear wax, which can be time consuming and reimburses poorly).
On my ENT mailing list, a lot of the older docs are saying this will push them into retirement. One guy said he already works gratis — everything he makes goes into his overhead. This, I suspect, is a fellow who hasn’t cut his overhead as well as I have. The older generation of doc, they’re used to having a nurse, an audiologist, maybe a few other ancillary staff. I have a staff of two. No audiologist, no nurse. Ours is a tidy ship, but of course that means I have already restricted services.
Bear in mind that Medicare reimbursements have already fallen 20% since 2001, and that when Medicare cuts their payments, private insurers soon follow.
It feels like I’m treading water, and I’ve never been very good with that.
D.
Something’s gotta give at some point. You (as a nation) are cutting healthcare funding for those that can least afford it. It’s crazy. It’s like somebody is trying to drive you (Doug) out of providing medicare coverage and into mainstream medical practice.
I pay $1400 per year for our little family, the same as everybody else pays for a family. I get seen when I need to be seen. I can’t be refused coverage because of a pre-existing condition. My coverage isn’t tied to an employer.
Everybody’s medicare here. And specialists of any stripe make a decent living. It’s not as good as in the US, but you only have to pay $1400 a year for healthcare. Same as everybody else.
Curious: what if you’re too poor to afford the $1400?
People who make less than $20,000 year pay nothing. It goes up, people who make 28,000 pay 80%, and over that, they pay the full shot.
A single person making 21,000 year pays 10.80 a month. A single person making 29,000 per year pays 54.00 per month.
Sounds good to me.
I’m all in favor of single payer. It would be worth any personal hit to my income to see all the Blues go out of business (and all the other evil SOBs).
There is an interesting article in the December issue of The Atlantic about the perserve economics of medicine in the U.S. I’ve also liked the most of The New Yorker articles on medicine. My uneducated opinion is that government (not my favorite solution – as a member of it, I know how perverse and inefficient it can be) or at least legislation needs to tackle big issues such as who gets what services and who pays. It’s hard as a health care consumer to make rational decisions (look at how some people get sucked into quack remedies in their desperation). When I had typhoid, the doctor in the U.S. had no clue and kept sending me for various tests (chest X-ray?), but as a person with a 104 degree fever, incredible fatigue, and bowel problems, I wasn’t really in a position to argue with him. Turns out he wasn’t covered by the PPO, so the bills were immense. For another problem, I tried to found out what the cost would be before doing a procedure – nope, no one would tell me. Now contrast this with the pay-as-you-go fertility industry. No problem getting rate sheets! At least as an infertile consumer all sorts of information is available, so one can make a good decision. Sorry for the diatribe.
I still wonder if Karen’s fertility docs were on the level. We were quoted a “three in ten-thousand” chance of conceiving the old-fashioned way — this, by no fewer than three different docs. (One ob-gyn, to her credit, told Karen, “You’re not necessarily infertile, you know.”) It’s a big money business, as you well know. I wonder if anyone said Damn! when we managed to do it the easy way?
Oooh fertility docs! There’s a lot of variation and definitely some people who oversell. My first appointment was with a doc, who told me that we’d have no problems with IVF (required due to tubal blockages) and not to worry about multiples since I was big enough to carry them. When I get only good news, I’m convinced something is missing. Then we go to another doc and she gives us a balanced presentation, shows us their success rates, explains what can happen, etc. The clinic also has a guarantee program, so you pay a chunck of cash up front and then get four tries to have a healthy baby. If you get lucky on the first try, they make money and you don’t have to go through lots of stressful, unpleasant, grueling treatments. If you don’t manage after four tries plus whatever frozen embryos are in the freezer, then you get your cash back and can enter the horrorshow that I hear is trying to adopt. I’ve had lots of friends do the infertility thing (yes, my friends are old in the OB world – they called me a geriatric mother! This at 38!) and it seems that having a good fit with the doc and the clinic’s philosophy is key. I’ve had a couple friends get pregnant when they were told they wouldn’t and then vice versa. As my husband says, with medicine the research always shows “Some do, some don’t.” I believe his PhD thesis was a bit more elaborate than that…
I’m flashing on George Bernard Shaw’s “The Doctor’s Dilemma” — great play about docs making big money operating on a nonexistent organ, the nuciform sac. All disease stems from the nuciform sac, which MUST be removed! And nearly everyone has one! Great biz for the surgeon.
Cynical? Much.