tag:blogger.com,1999:blog-9181810725696409953.post58914924507181919..comments2024-03-17T04:20:11.083-04:00Comments on The Population Health Blog: The Risk of a Physician Boycott of Medicare, Congress' Duty, Enterprise Risk Management & What MedPAC Should DoJaan Sidorovhttp://www.blogger.com/profile/05072456803925863874noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-9181810725696409953.post-28069569704888418312010-07-23T10:23:34.066-04:002010-07-23T10:23:34.066-04:00Karl is true to the name! And like many of the re...Karl is true to the name! And like many of the real Mr. Marx's past collaborators, it's clear he's spoiling for a fight.<br /><br />My point is that I'd like to "park" the issue of the adequacy of payment rates off to the side. It makes no difference how much is the "right" amount. My points are a) physicians - based on their perspective - COULD decide to boycott in all sorts of ways and b) if that happens, it could be very disruptive with a lot of social and political toxicities. That's when Congress will be put into the uncomfortable position. Would they follow Karl Marx's advice? Hopefully they'll act before it gets to that point.Jaan Sidorovhttps://www.blogger.com/profile/05072456803925863874noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-51139715312719135192010-07-23T10:18:15.714-04:002010-07-23T10:18:15.714-04:00Specialist physician "anonymous" makes a...Specialist physician "anonymous" makes a good point. Based on what (s)he's seen, the primary care physicians seem ill equipped to be the diagnostician-coordinators that they should be, and their failure to serve patients lies squarely with them. The market seems to know it, so what's wrong with letting them wither on the vine?<br /><br />I cannot disagree. In fact, it could be argued that the latest PCP wrinkle - the PCMH - should be allowed to succeed or fail based on its ability to deliver real value for the patients. <br /><br />Of course, there are MANY primary care physicians that fulfill their roles. Specialists may not be awaare of them because they're invisible: don't have to refer to them very much!Jaan Sidorovhttps://www.blogger.com/profile/05072456803925863874noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-42952036122533613272010-07-23T09:00:02.217-04:002010-07-23T09:00:02.217-04:00Physicians conveniently forget that they have almo...Physicians conveniently forget that they have almost a total monopoly on the provision of most healthcare services. They commonly style themselves as rugged independent entrepeneurs when their economic advantages derive largely from governmental power. But, by keeping the government monopolies somewhat fragmented via individual state licensure, it has been easy to avoid real reform and keep the different states and the Feds off balance by playing one off against the other. <br /><br />Medicare pays more than enough. Doctors, hospitals, pharmaceutical companies, insurance companies, and various healthcare executives are overpaid. Eurpopean countries pay roughly half of what we do and virtually every study on the subject shows they get better medical care. <br /><br />With respect to Medicare, doctors get training stipends from Medicare. How outrageous for them to even contemplate dropping out of the system. Let's give the intern, resident and fellow stipends as loans with a realistic rate of interest. If you want to drop out, at the very least, pay back the money you got for your education. <br /><br />It would be better to put all doctors on salary. Pay in excess of $100K yearly should be quite exceptional. Alternatives would be a single payer plan such as they have in Canada. To me, the best plans are in Europe in which they retain aspects of private practice and multiple payers but they have stricter regulations which prevent the bloated salaries that are sucking the life out of the American economy. The French pay about 1/2 of what we do and they get significantly better results, for example.<br /><br /><br />If doctors don't like it they can find some other country where they can do better.karl_marxhttps://www.blogger.com/profile/15297047365034933527noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-23817156947140980382010-07-22T12:20:12.270-04:002010-07-22T12:20:12.270-04:00I have practiced as a specialist for 30 years and ...I have practiced as a specialist for 30 years and I have some observations which may be contrary to popular opinion. Far from having a deficit of physicians,longstanding economic healthcare trends , the current economic crisis and personal observations suggest the opposite. In the 60's 70's and 80's, state legislatures could not fund and open medical schools faster with the presumed intention of preventing a presumably inevitable "doctor shortage" (which has not and never will materialize). Technology, sadly has made most "primary care" redundant. Most of my PCP colleague referrers (including their PAs and NPs )use Radiology and clinical serology services as the "physical exam". Obviously, aside from the perfunctory formulamatic H&P and Review of systems,management plan,etc., the Primary Care physician or his NP/PA is not in a position to establish a definitive diagnosis upon which to manage the given case without X-ray, CT, US or MRI. Unfortunately in our dysfunctional system, these folks and the surgeons control the patient. Some actually have the hubris to believe that their artificial placement in the practitioner caste system allows them special ability to acquire and overutilize the above technology(not incidentlally to their own finanacial advantage) without total awareness of appropriate application and timing. Of course there are artificial specious arguments for this behavior: "patient convenience", "lawsuit threats" etc. Declining reimbursements, unassuaged patient appetite for new technology,Insurer and governmental inability to provide consistent controls, have only increased overutilization and healthcare costs. So I say, let them quit (of course it will never happen as long as you analysts continue to incorrectly define the problem). Can the public be adequately(even better) served with fewer practitioners? Absolutely.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-5216895853965582022010-07-12T05:58:29.139-04:002010-07-12T05:58:29.139-04:00Dr. Syn points out that physicians can "flex&...Dr. Syn points out that physicians can "flex" their Medicare availability. Will Medicare be able to detect this is happening?<br /><br />North Alabama suggests the phenomenon may be regional. What's anecdotally true in NYC may not be true in NC. It also appears that if Dr. Berwick were subjected to an MD vote instead of a Senate one, passage would not be assured....Jaan Sidorovhttps://www.blogger.com/profile/05072456803925863874noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-18928630337808100122010-07-12T01:18:47.516-04:002010-07-12T01:18:47.516-04:00I practice in North Alabama and speak to physician...I practice in North Alabama and speak to physicians across the southeast. In the last 2 weeks in Mississippi, Tennessee, Georgia and Alabama - states already with a relative shortage of Primary care physicians - over 90% of the PCPs that I have spoken with have ALREADY STOPPED seeing new Medicare patients. Contrary to maggieimahar - a 10% increase still is grossly inadequate to reverse the financial penalty of being a PCP.<br /> And I know of no practicing physician here supporting Dr Berwick.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-83886584270013712962010-07-09T15:47:33.972-04:002010-07-09T15:47:33.972-04:00Thank you for linking to HealthBeat,
but I didin&...Thank you for linking to HealthBeat, <br />but I didin't write the post suggesting that fears of doctors boycotting Medicare are overblowm.<br /><br />The post was written by my associate, Naomi Freundlich (She came up with the idea, wrote it without any help from me.) <br /><br />I doubt Naomi would characterize herself as a "liberal pundit." Formerly the Science Editor at Business Week, she's an excellent journalist and her posts tend to be fact-based. (I also wouldn't call myself a pundit--to me this suggests someone on TV who comes up with clever one-liners. But I am happy to be labled liberal/progressive.)<br /><br />Finally, I do agree with Naomi. The facts suggests that docs aren't moving away from Medicare in large nubmers.<br /><br /> For what it's worth, I have a relative in NYC on Medicare who has no trouble specialists, and not too much trouble finding a new primary care doc--though everyone is having a hard time finding primary care docs. This is not unique to Medicare patients. <br /><br />And the numbers support Naomi's argument.<br /><br />Of course, it could be "different this time" but those three words usually turn out to be wrong. And docs have been threatening to stop taking Medicare patients for years.<br /><br />More importantly, only quite young, very successful docs would actually be able to keep a practice going without Medicare patients. (Younger patients tend to prefer younger docs). <br /><br />More than 43 million Americans are on Medicare. Medicare patients account for over 22 percent of U.S. health expenditures . . <br /><br />And of course older people go to more specialists. The average age for a cancer diagnosis is 67, which means it would be particularly hard for oncologists, as well as cardiologist, orthopedic surgeon (who do all of those knee and hip implants) urologists or many other specialists to make it with Medicare customers.<br /><br />Middle-aged people will come in for testing adnd check-ups, but seniors are much more likely to need the big-ticket invasive procedures that keep a practgice afloat. <br /><br />Could docs begin turning down new Medicare patients? Sure--as long as the Medicare patients they have never die . . <br /><br />Finally, it would be odd if, after all of these years, primary care docs dropped Medicare, just when they are about to get significantly better payment (up 10%) plus many opportunities for bonsues.<br /><br />And by and large physicians are very enthusiastic about Berwick heading up Medicare.<br /><br />All in all, a strange time for a cascade of phyicians leaving Medicaremaggieimaharhttp://www.healthbeatblog.orgnoreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-54920369048451302092010-07-09T00:23:13.582-04:002010-07-09T00:23:13.582-04:00Physician practices will mostly relate to Medicare...Physician practices will mostly relate to Medicare by varying available capacity for Medicare patients. Many (no one knows how many) have been closed to new Medicare for months.<br /> <br />The four government betrayals this year are not encouraging to physicians in primary care. They can't bet their survivability on Medicare reimbursement. <br /><br />Medicare will have no way to know how much capacity for new patients they'll have until a few months after they don't have enough.<br />Physicians don't have to drop out of Medicare when they can just take new patients from other insured groups (or direct primary care without insurance involvement such as Qliance or Health Access Rhode Island) instead.Dr Synonymousnoreply@blogger.com