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  1.    #21  
    Quote Originally Posted by clemgrad85 View Post
    Yo...davidra...not going to win this one. I am referring to in-network visits where the physicians have tried to charge the discount back to the patient. They picked the wrong patient to do that to on me. I don't remember the exact numbers....but if the original charge was say....$250, the agreed upon reimbursement was $180, and they billed me for the $70 discount (they had received their $180). Many patients just pay this amount, and they cuss their insurance plan for not paying. When I called them (doctor) on this, they quickly back tracked, said it was an error, and said I didn't have to pay it. I've also had this happen with clients and I've told them to call their provider, tell them they aren't responsible for the discount, and this usually solves the issue. I guess I don't blame the physicians from trying to get more money, but certainly seems sneaky to me. Of course, it could be just a "horribly organized" office as you say....but....it does happen more than you think.

    And yes....I understand the out-of-network issues and being more than "normal and customary". Not referring to that issue.
    Like I said...I would not be surprised 1. if a lot of people DON'T understand about out-of-network charges. I know of one person who wasn't told her specialty visit would have to be paid for in part by her, and she was part of a physician-owned PPO. 2. many of these mistakes are mistakes because of horribly organized offices. I have great insurance, and they screw up mine all the time, necessitating multiple calls and interactions. 3. if in fact there are practices that try and take advantage of individuals who don't understand their plans. I just am not aware of this, and I am very aware of the multiple mistakes in billings due to inadequately trained personnel.
  2.    #22  
    Quote Originally Posted by sweaner View Post
    I am a physician participating in Medicare. We are again on the verge of having our payment cut 21%.

    Venture to guess what happens to my salary if payment is cut 21%? Answer to follow.
    I wouldn't worry too much if I were you, as congress has generally corrected this quickly. Of course, the republicans are doing their best to see you don't get adequate reimbursement. You might consider that next time you vote if you happened to vote republican the last time.

    March 26, 2010 A 21.2% Medicare pay cut will take effect April 1 after the Senate today failed to pass a bill extending the effective date to May 1 before lawmakers recessed for 2 weeks.
    The Senate was poised to vote on the Democrat-sponsored legislation this week, but Sen. Tom Coburn, MD (R-OK), put a procedural block on it, saying Democrats were engaged in a harmful exercise in deficit spending. Sen. Coburn said they should find a way to pay for the bill, which also would have extended expired unemployment compensation benefits, subsidies for health insurance premiums for the out-of-work under the COBRA program, and various tax breaks.
    The 21.2% reduction in reimbursement taking effect on April Fool's Day does not necessarily mean that physicians will experience the Medicare meltdown everyone has dreaded. When Congress goes back to work on April 12, Senate Democrats will try to pass the 1-month extension again and make it retroactive to April 1. The Centers for Medicare and Medicaid Services has announced that it will freeze payments on physician Medicare claims for the first 10 business days of April and then pay the full amount as if the reduction never occurred once the 1-month extension passes in the Senate.
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    #23  
    Quote Originally Posted by davidra View Post
    I wouldn't worry too much if I were you, as congress has generally corrected this quickly. Of course, the republicans are doing their best to see you don't get adequate reimbursement. You might consider that next time you vote if you happened to vote republican the last time.
    What?!? Republicans want to be able to pay for Medicare? How irresponsible! We all know money grows on trees. Chinese trees.
  4. #24  
    Quote Originally Posted by davidra View Post
    I wouldn't worry too much if I were you, as congress has generally corrected this quickly. Of course, the republicans are doing their best to see you don't get adequate reimbursement. You might consider that next time you vote if you happened to vote republican the last time.
    It wasn't even the republican party, it was ONE Senator that had the balls to stand up for direct violation of the paygo bill the Dems passed. The senator was simply upholding a principle, despite it being an unpopular move, and that act is commendable.
  5.    #25  
    Quote Originally Posted by groovy View Post
    What?!? Republicans want to be able to pay for Medicare? How irresponsible! We all know money grows on trees. Chinese trees.
    Fine. Take a stand. Do you favor cutting Medicare reimbursement to doctors by 20%? If so, the force be with you. Any bets on what Medicare recipients think about that? I realize that you and the rest of your party don't really care what Medicare recipients think, since they are sucking on the teat of socialism, but then again, they vote.
  6.    #26  
    Primary care and health care reform

    Health overhaul likely to strain doctor shortage
    By LAURAN NEERGAARD (AP) – 15 hours ago

    WASHINGTON — Better beat the crowd and find a doctor.

    Primary care physicians already are in short supply in parts of the country, and the landmark health overhaul that will bring them millions more newly insured patients in the next few years promises extra strain.

    The new law goes beyond offering coverage to the uninsured, with steps to improve the quality of care for the average person and help keep us well instead of today's seek-care-after-you're-sick culture. To benefit, you'll need a regular health provider.

    Yet recently published reports predict a shortfall of roughly 40,000 primary care doctors over the next decade, a field losing out to the better pay, better hours and higher profile of many other specialties. Provisions in the new law aim to start reversing that tide, from bonus payments for certain physicians to expanded community health centers that will pick up some of the slack.

    A growing movement to change how primary care is practiced may do more to help with the influx. Instead of the traditional 10-minutes-with-the-doc-style office, a "medical home" would enhance access with a doctor-led team of nurses, physician assistants and disease educators working together; these teams could see more people while giving extra attention to those who need it most.
    A good description of the medical home, which hopefully will be the way medicine is practiced in the future.
  7. #27  
    Quote Originally Posted by davidra View Post
    I wouldn't worry too much if I were you, as congress has generally corrected this quickly. Of course, the republicans are doing their best to see you don't get adequate reimbursement. You might consider that next time you vote if you happened to vote republican the last time.
    Yes....but isn't a part of the health care bill numbers that went to CBO involving cuts in Medicare reimbursement? I'm asking the question. So, if Medicare reimbursement cuts don't occur, then the CBO numbers are instantly thrown off, correct?
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  8. #28  
    I heard an interesting take on things yesterday where some are saying that those that can afford it will go to physician groups that don't work with insurance. My wife's doctor did this recently, where he charges a fee....I think it was $1500 for the year....and this gave you access to the doctor throughout the year (like a "retainer" fee?) and a full physical. My wife ended up changing physicians and not doing it, but I know some people did. So, you might end up with those who can afford it going that route and perhaps getting better attention. In other words, they will pay the physicians more to get the extra attention. Davidra, I'm sure you've heard of these practices....what are your thoughts on this from the medical side? Do you see more doctors going to these types of practices?

    I also see insurance companies coming out with more medical supplement plans....much like Medicare Supplement plans, but plans to go with regular health care. Folks that can afford those will get them. It's going to be interesting to see how all this shakes out.
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  9.    #29  
    Quote Originally Posted by clemgrad85 View Post
    I heard an interesting take on things yesterday where some are saying that those that can afford it will go to physician groups that don't work with insurance. My wife's doctor did this recently, where he charges a fee....I think it was $1500 for the year....and this gave you access to the doctor throughout the year (like a "retainer" fee?) and a full physical. My wife ended up changing physicians and not doing it, but I know some people did. So, you might end up with those who can afford it going that route and perhaps getting better attention. In other words, they will pay the physicians more to get the extra attention. Davidra, I'm sure you've heard of these practices....what are your thoughts on this from the medical side? Do you see more doctors going to these types of practices?

    I also see insurance companies coming out with more medical supplement plans....much like Medicare Supplement plans, but plans to go with regular health care. Folks that can afford those will get them. It's going to be interesting to see how all this shakes out.
    Sure...concierge or boutique medicine are some common terms for it. Here's a pretty complete description of the positives and negatives from the doc's standpoint. From the patient's standpoint, it's important to realize that these practices are usually primary care practices....if you are sent to any specialist, or admitted to the hospital, all bets are off if you don't have additional insurance.

    Should you consider concierge medicine?

    While I don't ordinarily think Wikipedia is worth much, this is a decent description as well:

    Concierge medicine
  10. #30  
    Quote Originally Posted by davidra View Post
    Sure...concierge or boutique medicine are some common terms for it. Here's a pretty complete description of the positives and negatives from the doc's standpoint. From the patient's standpoint, it's important to realize that these practices are usually primary care practices....if you are sent to any specialist, or admitted to the hospital, all bets are off if you don't have additional insurance.

    Should you consider concierge medicine?

    While I don't ordinarily think Wikipedia is worth much, this is a decent description as well:

    Concierge medicine
    Thanks....I'll take a look at it.
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  11. sweaner's Avatar
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    #31  
    Quote Originally Posted by davidra View Post
    I wouldn't worry too much if I were you, as congress has generally corrected this quickly. Of course, the republicans are doing their best to see you don't get adequate reimbursement. You might consider that next time you vote if you happened to vote republican the last time.
    I am not worried, just sick of dealing with the uncertainty. Yes, I voted Republican and will continue to do so.

    I am waiting for an answer to my original question. How much will our salary be cut if payment drops 21%.
  12.    #32  
    Quote Originally Posted by sweaner View Post
    I am not worried, just sick of dealing with the uncertainty. Yes, I voted Republican and will continue to do so.

    I am waiting for an answer to my original question. How much will our salary be cut if payment drops 21%.
    Do you consider all physicians to be salaried? If you're an employee of a plan, or in academics, one would expect that would depend on your employer. If your question is how much less will you earn in a private practice, I suppose that would depend on whether or not you're a pediatrician or a geriatrician, right? Or whether you decide to accept assignment or not?
  13. #33  
    Quote Originally Posted by zelgo View Post
    Your salary would be cut by 21% of the reimbursement you got from Medicare.

    However, if history is any judge, this cut won't happen. (It hasn't happened for the last 10 years that it's been up). If it happens, it will be very temporary and reimbursement will be retroactive.

    By the way, it was the the entire Republican Party that voted, en block, along with a few Democrats, that keeps the 21% cut in place so far...
    Trying to get an answer here....I honestly don't know the answer....weren't Medicare reimbursement cuts included in the CBO numbers? I believe those projections assume these cuts occur. So first, can someone confirm if they were a part of the assumptions....and second, if so, don't these cuts need to occur? In the articles that Groovy referenced, it appearted this was a big part of the concern that Congress followed through with the cuts that were outlined in the numbers sent to CBO.
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  14. sweaner's Avatar
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    #34  
    Quote Originally Posted by zelgo View Post
    Your salary would be cut by 21% of the reimbursement you got from Medicare.

    However, if history is any judge, this cut won't happen. (It hasn't happened for the last 10 years that it's been up). If it happens, it will be very temporary and reimbursement will be retroactive.

    By the way, it was the the entire Republican Party that voted, en block, along with a few Democrats, that keeps the 21% cut in place so far...
    WRONG! If you run a business you will know that expenses need to be taken into account. Expenses keep increasing, and need to be paid out of that payment.

    The answer for most physician practices, usually having expenses of 50%, is therefore 42%! How would anyone like that kind of a pay cut?
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    #35  
    Quote Originally Posted by davidra View Post
    Fine. Take a stand. Do you favor cutting Medicare reimbursement to doctors by 20%? If so, the force be with you. Any bets on what Medicare recipients think about that? I realize that you and the rest of your party don't really care what Medicare recipients think, since they are sucking on the teat of socialism, but then again, they vote.
    Yes, the party doctrine is that old people should "die quickly". That line is tired. You could address where, exactly, that money would come from. Especially since we're just getting into paying for the slacker... er... Boomer generation. The strains on the system are only going to get worse.
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    #36  
    Quote Originally Posted by davidra View Post
    I wouldn't worry too much if I were you, as congress has generally corrected this quickly. Of course, the republicans are doing their best to see you don't get adequate reimbursement. You might consider that next time you vote if you happened to vote republican the last time.
    Am I the only one that sees a problem here? The government now determines physician pay, and it's a partisan issue?
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  17.    #37  
    Quote Originally Posted by Micael View Post
    Am I the only one that sees a problem here? The government now determines physician pay, and it's a partisan issue?
    Let's get one thing very clear....doctors do NOT work for the government. The government pays some of them (even most of them) through Medicare, and states pay them through Medicaid. Nobody forces them to take any of this money. They can open boutique practices, or become pediatricians or obstetricians (almost none of whose patients are on Medicare).

    It's only bipartisan if the republicans can get democrats to rescind the Medicare correction. If not, yes, it's partisan.
  18.    #38  
    Quote Originally Posted by groovy View Post
    Yes, the party doctrine is that old people should "die quickly". That line is tired. You could address where, exactly, that money would come from. Especially since we're just getting into paying for the slacker... er... Boomer generation. The strains on the system are only going to get worse.
    Allow me to be totally honest. I don't know where the money will come from. Unlike some of you, I don't claim to be an expert in the macroeconomics of health care, even though I have some training in health policy. There are people that do have those skills, and I have worked with some of them. Frankly, holding myself out as an expert on the long-term funding of Medicare and national budgets would be ridiculous. And guess what? I don't think any of you have that expertise either. So when you expound upon what's going to happen in the future, I put exactly as much weight behind that as it deserves, which is about the weight I give to someone who knows nothing about the health care delivery system telling me how to practice.

    Certainly there are trends that suggest, obviously, that Medicare expenditures will increase as the population ages. That I can say with confidence. I am also positive that some way will be found to provide cost-effective care to everyone in the US, whether through a two-tiered system or what I think will end up happening in the end, a single-payor system with options for greater private coverage. I've been saying that for a long time. It's not just that I am in favor of a single-payor system. I would favor any system, private, public or a combination, that would provide appropriate care for all. It's just that from what I see, insurance companies are not going to be able to cut it in terms of controlling costs, and that will push the system toward single-payor.
  19.    #39  
    Quote Originally Posted by sweaner View Post
    WRONG! If you run a business you will know that expenses need to be taken into account. Expenses keep increasing, and need to be paid out of that payment.

    The answer for most physician practices, usually having expenses of 50%, is therefore 42%! How would anyone like that kind of a pay cut?
    Kind of depends on what you include in that overhead (which is probably pretty close to average). Do you have PA's? How many providers in your practice,and is it large enough to negotiate prices for supplies, etc.? What labs and procedures do you perform? How efficient is your office in terms of collections? And finally, in making this statement, aren't you assuming all your income is coming from the government? What percent of your business is Medicare?
  20. #40  
    Quote Originally Posted by zelgo View Post
    Where have you been for the last few decades?

    Medicare, Medicaid, and the Veteran's Administration all have government involvement. If you, as a doctor, choose to be part of any of these programs, you must accept what they will pay.

    One of the reasons that the federal government has been pushing so hard for reforms is that over 50% of healthcare funding in America is paid by the federal government. Costs are rising like crazy (mainly because doctors and hospitals are paid by the procedure, so, naturally, they do lots of procedures...). The federal government is trying to decrease the costs it has to pay.
    the problem is this reform doesn't decrease what government is paying, who do you think is going to pay for all those subsidized health insurance policies?

    Two reasonable ways to decrease healthcare costs:
    A) Give accountability for payment to the consumer, market forces will produce a sustainable expenditure on health care. (requires market rationing)

    B) Government control and the government dictating prices. Government sets expenditures at a sustainable level. (requires government rationing)

    -Either method requires the "evil" rationing. Current health care reform leaves insurance companies still in charge of determining a good deal of the costs, and has minimal attempt to ration care to a maintainable level. So with this route we will maintain a catastrophically unaffordable expenditure on health care until we eventually end up with fulfillment of option B, or a melt down.
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