Comments on: Medicare Costs and the Income Trap http://scienceprogress.org/2008/11/medicare-costs-and-the-income-trap/ Tue, 13 Sep 2011 13:59:48 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: JustaDoc http://scienceprogress.org/2008/11/medicare-costs-and-the-income-trap/comment-page-1/#comment-4077 JustaDoc Wed, 21 Jan 2009 03:54:41 +0000 http://www.scienceprogress.org/2008/11/medicare-costs-and-the-income-trap/#comment-4077 This article ignores completely the influence of patient demands on increasing health care costs. When someone hears a squeaking sound under the hood of their car, they don't go to the garage and demand that the mechanic inspect and swap out everything that squeaks. Instead, they ask the mechanic to look to see what most likely is squeaking and go from there. As a physician, I am asked daily to inspect from bumper to bumper and replace the engine for good measure. If I don't comply, the angry customer (who used to be called a patient) may file a complaint and call me a "bad doctor." Physician salaries should be addressed, but only after a couple dozen other high-cost wrinkles are ironed out. By the way, I'm a primary care physician in training looking at stagnant/declining income future. But for the system (i.e. for public health) primary care is where money is best spent. Feel free to continue to cut my reimbursement as a reward for a lifetime of dedication to a subject you feel important enough to merit a modicum of your time. This article ignores completely the influence of patient demands on increasing health care costs. When someone hears a squeaking sound under the hood of their car, they don’t go to the garage and demand that the mechanic inspect and swap out everything that squeaks. Instead, they ask the mechanic to look to see what most likely is squeaking and go from there.

As a physician, I am asked daily to inspect from bumper to bumper and replace the engine for good measure. If I don’t comply, the angry customer (who used to be called a patient) may file a complaint and call me a “bad doctor.” Physician salaries should be addressed, but only after a couple dozen other high-cost wrinkles are ironed out.

By the way, I’m a primary care physician in training looking at stagnant/declining income future. But for the system (i.e. for public health) primary care is where money is best spent.

Feel free to continue to cut my reimbursement as a reward for a lifetime of dedication to a subject you feel important enough to merit a modicum of your time.

]]> By: Mary Arneson http://scienceprogress.org/2008/11/medicare-costs-and-the-income-trap/comment-page-1/#comment-3720 Mary Arneson Sun, 07 Dec 2008 15:46:27 +0000 http://www.scienceprogress.org/2008/11/medicare-costs-and-the-income-trap/#comment-3720 One thing that would help is reining in the incomes of the people physicians compare themselves with -- health care executives, financial services managers, attorneys, etc. If you see someone in a cushy office making many times as much money while doing much less real work, it's hard to accept a pay cut. One thing that would help is reining in the incomes of the people physicians compare themselves with — health care executives, financial services managers, attorneys, etc. If you see someone in a cushy office making many times as much money while doing much less real work, it’s hard to accept a pay cut.

]]> By: Merrill Goozner http://scienceprogress.org/2008/11/medicare-costs-and-the-income-trap/comment-page-1/#comment-3585 Merrill Goozner Wed, 26 Nov 2008 21:17:39 +0000 http://www.scienceprogress.org/2008/11/medicare-costs-and-the-income-trap/#comment-3585 It is well understood that PCPs are underpaid vis-a-vis oncologists and other specialists because of the AMA's RBRVS. But isn't just price. Physician income is determined by price times volume in our fee-for-service system. So PCPs squeeze more and more patients in shorter and shorter visits into their harried days (driving many from the profession); while specialists cram more and more procedures and images into their lucrative days, and drive away in Porsches. There have been many proposals to increase for PCPs while holding specialists' relative pay constant (above zero, but below inflation). But specialists have gotten around these efforts by increasing volume. To fully follow Dr. Ubel's prescription, we would have to get both PCPs and specialists into salaried positions within group practices that can implement evidence-based medicine rather than volume-based medicine; hold the specialists pay at slightly above zero (but less than inflation so that the spread will decrease over time); and then reimburse the group practices based on quality standards. Over time, this would bend the cost curve down while improving the health care system. But it's no quick fix for either the disparity in physician income, the outsized pay of specialists, or the current poor performance of the system. It's merely the only hope we have of reforming the system without running into the buzzsaw of opposition correctly predicted by Dr. Ubel. It is well understood that PCPs are underpaid vis-a-vis oncologists and other specialists because of the AMA’s RBRVS. But isn’t just price. Physician income is determined by price times volume in our fee-for-service system. So PCPs squeeze more and more patients in shorter and shorter visits into their harried days (driving many from the profession); while specialists cram more and more procedures and images into their lucrative days, and drive away in Porsches.

There have been many proposals to increase for PCPs while holding specialists’ relative pay constant (above zero, but below inflation). But specialists have gotten around these efforts by increasing volume. To fully follow Dr. Ubel’s prescription, we would have to get both PCPs and specialists into salaried positions within group practices that can implement evidence-based medicine rather than volume-based medicine; hold the specialists pay at slightly above zero (but less than inflation so that the spread will decrease over time); and then reimburse the group practices based on quality standards. Over time, this would bend the cost curve down while improving the health care system. But it’s no quick fix for either the disparity in physician income, the outsized pay of specialists, or the current poor performance of the system. It’s merely the only hope we have of reforming the system without running into the buzzsaw of opposition correctly predicted by Dr. Ubel.

]]> By: Joyce Dillenberger http://scienceprogress.org/2008/11/medicare-costs-and-the-income-trap/comment-page-1/#comment-3582 Joyce Dillenberger Wed, 26 Nov 2008 19:09:52 +0000 http://www.scienceprogress.org/2008/11/medicare-costs-and-the-income-trap/#comment-3582 I think you miss the point to some degree. Physicians' incomes should not be expected to diminish; their office and personnel costs certainly do NOT go down. The present Medicare model balances the costs on the backs of the providers, which is not fair either to the providers or to the patients. I am not a physician but I have seen our PCP struggle to pay his staff, keep abreast of insurance requirements (hello, that's where a LOT of medical costs go: to insurance and pharmaceutical middlemen) and still provide services for we the patients who need them. We need to completely overhaul how health care is delivered in this country. Other countries successfully provide both health care and reasonable physician salaries, so why don't we??? I think you miss the point to some degree. Physicians’ incomes should not be expected to diminish; their office and personnel costs certainly do NOT go down. The present Medicare model balances the costs on the backs of the providers, which is not fair either to the providers or to the patients. I am not a physician but I have seen our PCP struggle to pay his staff, keep abreast of insurance requirements (hello, that’s where a LOT of medical costs go: to insurance and pharmaceutical middlemen) and still provide services for we the patients who need them. We need to completely overhaul how health care is delivered in this country. Other countries successfully provide both health care and reasonable physician salaries, so why don’t we???

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