Doctors bail out on their practices

Discussion in 'Too Hot for Swamp Gas' started by PSGator66, Jul 16, 2013.

  1. wgbgator
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    wgbgator Sub-optimal Poster Premium Member

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    Regulations arent created only by the government. All markets are regulated, by self-regulation, their own organizations/associations or outside entities. If regulations don't create honest caring people, that's an even better reason for non-interested parties to be creating the regulation, rather than the people with a stake in the endeavor.
  2. austingtr
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    austingtr VIP Member

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    You will never get it.
  3. wgbgator
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    wgbgator Sub-optimal Poster Premium Member

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    You're right, I will never get that idea that regulations are only the product of governments, and they would be non-existent without them.
  4. leogator
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    leogator Well-Known Member

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    She's right, the AMA does not regulate at all!
  5. austingtr
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    austingtr VIP Member

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    exactly
  6. mastoidbone
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    mastoidbone VIP Member

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    I am not here to argue hospital good wiil----but if you want to work at many surgery center you need to have privileges at a local hospital---for various reasons. To do that you can not opt out of medicare.

    My point is that there are rules and pressures and community expectations that a doc will take medicare---not so easy for most docs to do.

    Medicare pays me a GROSS of $80 an hour-----a baby sitter takes home $15 an hour where I live. 80 gross an hour---after expenses is less then a sitter takes home......yet I do it.
  7. austingtr
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    austingtr VIP Member

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    Yes medicare pays very low, and yet we do it as public service. However, in the future, if things get to the point where you cannot do the best for your patients because of government regulations, he will drop it. I can see a scenario in which some people will have to reject their medicare/SS because of decisions made in Washington regarding what gets covered and what doesn't. In this climate you cannot be reactive you have to be proactive. You position yourself to do what you think is right. You cannot accept medicare, and perform non covered procedures on a patient. That is illegal, even if they are willing to pay out of pocket.


    If you want to read more on this subject
  8. NorthCaptivaGator
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    NorthCaptivaGator Well-Known Member

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    You do Medicare "as a public service"? What a crock, Medicare may not pay well but they are certainly not asking you to work for free. In fact Medicare pays for many services better than private insurance does. Many a doctor has become very rich treating patients "as a public service". Don't try to make it sound otherwise. The facts are not in your favor.
  9. austingtr
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    austingtr VIP Member

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    Reading medicare mammography is a public service. As a matter of FACT you lose money providing that service. Same for many bread and butter billing. Ask a cardiovascular surgeon how much do they pay him to do by-pass surgery. Find out how much does a pacemaker pay.
    Probably when is all said and done, less than a plumber when he comes to my house.

    Yes there are profitable medicare reimbursements. They are procedures that in a national scheme of things are rare. Because if they are common they are a public service. The time that requires to treat an 78 y.o. isn't the time that takes to treat a 55 y.o. with private insurance with the same condition.

    And what "facts" are you referring to? These days NOBODY gets rich by treating medicare patients- unless you are selling them scooters, strips, and expensive canes.
  10. austingtr
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    austingtr VIP Member

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    And medicare doesn't pay better than many private insurances. That is a false statement. Again, thanks to the business of lobbying, yes, they pay better for scooters, diabetic supplies, canes, etc.
  11. egator1245
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    egator1245 Premium Member

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    You sound like a KNOW-NOTHING, envy-riden, angry Obama-loving liberal. Name a service that Medicare pays a doctor better than private insurance. The fact is that medicare pay for doctors has decreased significantly since the 1990's while the cost of living and expenses have increased significantly. Also name any profession or job (especially union or government) where pay has decreased over that time period. A crock? That is BS and an insult.
  12. mastoidbone
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    mastoidbone VIP Member

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    On average----medicare pays 78% of private fees.

    In my field it is 28% of average----meaning----i would make more babysitting then providing anesthesia to geriatric population....
  13. NorthCaptivaGator
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    NorthCaptivaGator Well-Known Member

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    Yes, Medicare pays 78% of private fees because they only pay 80% of any given service, the patient is responsible for the remaining 20%, an amount usually covered by a supplementary insurance . Again, many a doctor has made a very good living treating only Medicare patients, this cannot be denied, to do so is by no means a "public service".
    Taking Medicaid, on the other hand can be classified as a public service because it reimburses far less than cost of providing the treatment
  14. NorthCaptivaGator
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    NorthCaptivaGator Well-Known Member

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    Medicare pays a doctor far better than many HMO plans for a multitude of services - try finding a primary care doc in a heavy HMO region that accepts CIGNA or AETNA or UHC, they would rather see Medicare patients. Believe me, I am no fan of Medicare but in comparison to all but the very expensive private options they pay at least the same amount with fewer BS denials and pre-approvals I live this every day, no envy, no anger, just facts
  15. QGator2414
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    QGator2414 VIP Member

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    Do you even understand that you confirmed Mastoid's point that Medicare pays far less than private insurers?
  16. NorthCaptivaGator
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    NorthCaptivaGator Well-Known Member

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    Yes, which is why the first word in my reply was yes
  17. QGator2414
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    QGator2414 VIP Member

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    Just making sure you understand Medicare on average pays far less to doctors vs private insurance. Just because it covers 80% of that far less amount and the patient pays the other 20% themselves or through supplemental insurance does not change the fact doctors receive far less from Medicare on average...
  18. QGator2414
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    QGator2414 VIP Member

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    And if you are an anesthetist then you really get screwed on Medicare...
  19. mastoidbone
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    mastoidbone VIP Member

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    yes---the problem is govt is on average a poorly run entity.
    In early 1990s when medicare reorganized its payment system it messed up.

    Anesthesia was ONLY specialty paid based primarily on time spent with patient as opposed to diagnosis or procedure. This simple task confused our brilliant government and when calculating the formula they screwed up---vastly undervaluing anesthesia time component. The result is---that while most doctor payments were cut by 5-10%---anesthesia was cut by 80%----resulting in medicare paying us less then min wage. While some like FP saw increases.

    After 20 years---they still have not fixed the problem---despite admitting they have made a mistake.

    The result on americans was significant----the year prior to the rule change----over 1000 american medical school graduates applied to anesthesia residency----the year after the number was less then 100.

    This resulted in significant anesthesia shortages and many cases delayed or cancelled. Eventually there was a response by hospitals having to pay stipends to anesthesia providers----the poorer hospitals which serve the poor were hardest hit.

    To this day, medicare has been unable to fix the problem.....which was a MAJOR reason a single payer was defeated----many opponents pointed out to anesthesia problem if medicare rates were mandated for all.

    http://www.gao.gov/new.items/d07463.pdf
  20. mastoidbone
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    mastoidbone VIP Member

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    To explain---medicare decided to pay anesthesia services $19 a unit. This is of course your gross. Each unit was 15 min of time. There were also 3-7 units paid for each case based in complexity.

    In a typical 12 hour day spent in hospital--there is also a great deal of time waiting on nurses and surgeons---so in 12 hours 6-7 are usually spent in OR. So a good day would mean about 40 units typically. Or $800 gross for 12 hours of time at work.

    After overhead--malpractice CME, license fees, staff overhead, etc---your pre-tax net might be $500. So $45 an hour---which is less then a HS graduate in a GM factory would earn.

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