Medicare Plans to Cut Specialists' Payments

[Taurus]

Medicare Plans to Cut Specialists' Payments

By JANE ZHANG

WASHINGTON -- The Obama administration said Wednesday that it plans to cut Medicare payments for imaging services and specialists, and will use the savings to increase payments to physicians providing primary care.

Under the proposal, Medicare would put specialists' payments for evaluating and managing illnesses on par with those of primary-care physicians starting in January.

That, combined with other changes, would boost payments to internists, family physicians, general practitioners and geriatric specialists by 6% to 8% next year, said the Centers for Medicare and Medicaid Services, the agency that manages Medicare, the federal insurance program for the elderly and disabled.

Payments to cardiologists would be trimmed by 11% overall, but certain procedures they perform would see steeper reductions. Alfred Bove, president of the American College of Cardiology, figured that cardiologists would receive 42% less for an echocardiogram and 24% less for a cardiac catheterization.

Radiologists would see an estimated cut of 20% for imaging services using expensive equipment such as MRI and CT scans, said Bibb Allen, chairman of the commission on economics at the American College of Radiology. That would be in addition to the cuts imposed on radiologists under a 2005 law, he said.

The proposal, open for public comment until Aug. 31 and expected to be completed by Nov. 1, comes as the Obama administration seeks to boost the number of primary-care doctors to meet the needs of an aging population and care for the newly insured if legislation to overhaul the nation's health-care system is enacted.

The administration is already spending $500 million in stimulus funds to train more primary-care physicians and repay the student loans of primary-care doctors who work in underserved areas.

Legislation being debated in the House and the Senate also includes provisions intended to increase the number of primary-care physicians.

Ted Epperly, president of the American Academy of Family Physicians, said the Medicare proposal would help reduce the income gap among doctors -- specialists make two to five times as much as primary-care physicians -- and attract more medical students to primary care. He called the change "long overdue."

Groups representing cardiologists, radiologists and other specialists said they will lobby lawmakers to stop the cuts. Dr. Bove warned that "cutting back like this certainly threatens the successes we have had over the years with reducing heart disease."

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[psychforme]

 

[dynx]

Yep!
divide and conquer!
The family physician spokes person is a *****. What does he think? Obama is looking out for him? The programs for loan forgiveness are out there allready, nobody wants to do FP in bum-f*ck south dakota. The article said nothing specific about where they are going to increase FP pay. Pay per office visit? Per patient? What? The cuts on the other hand...42% less for an echo...sound like they've put some thought into that. Lets just let Obama make the cuts first then we'll talk about where we increase pay...trust me, he'll get to it im sure. And if he doesn't? The FPs are gonna piss and moan like a bunch of impotent *****s and all the "specialists" they thumbed thier noses at when this plan was proposed are NOT going to lobby with them for the pay increase they were told was coming.

 

[radslooking]

Yep!
divide and conquer!
The family physician spokes person is a *****. What does he think? Obama is looking out for him? The programs for loan forgiveness are out there allready, nobody wants to do FP in bum-f*ck south dakota. The article said nothing specific about where they are going to increase FP pay. Pay per office visit? Per patient? What? The cuts on the other hand...42% less for an echo...sound like they've put some thought into that. Lets just let Obama make the cuts first then we'll talk about where we increase pay...trust me, he'll get to it im sure. And if he doesn't? The FPs are gonna piss and moan like a bunch of impotent *****s and all the "specialists" they thumbed thier noses at when this plan was proposed are NOT going to lobby with them for the pay increase they were told was coming.

reducing the pay disparity is going to happen one way or another. if you have another way of solving the problem let us know.

there's no objective reason why a specialist should get paid 3x-5x what a PCP is. There just isn't.

 

[lowbudget]

The article said nothing specific about where they are going to increase FP pay. Pay per office visit? Per patient? What? The cuts on the other hand...42% less for an echo...sound like they've put some thought into that.

1. Move physician-administered drugs from Part B to Part D to avoid those drugs being calculated into SGR. (I guess they're referring to chemo.)
2. Eliminate consultation codes
3. Increase payment for Welcome to Medicare physical
4. Increase payment to those with higher malpractice costs
5. Add cardio & pulm rehab services & CKD education into coverage
6. Reduce payment for advanced imaging
7. Require technical component of image generation to be accredited
8. Bonus for e-prescribing
9. Add more measures for PQRI

http://www.cms.hhs.gov/apps/media/p...ge=&showAll=&pYear=&year=&desc=&cboOrder=date

 

[Taurus]

It's not just cards or rads. It's every non-PCP who will get hit. Cards, GI, rads, ortho, neurosurg, ENT, etc. At least the pain gets spread around.

 

[Winged Scapula]

It's not just cards or rads. It's every non-PCP who will get hit. Cards, GI, rads, ortho, neurosurg, ENT, etc. At least the pain gets spread around.

Income redistribution would be fine if all specialists made "2-5 times" what PCPs do. Not all of us do.

Be prepared to see even fewer people go into General Surgery when the overall reimbursement and reimbursement for image guided procedures (which are our biggest money makers - I make more for an US guided biopsy than I do for a modified radical mastectomy) is so low that no one is willing to do the training to make the same amount they could as an FP.

There's already a shortage of general surgeons; this isn't going to help.

Rising Cost of Malpractice
+ Rising Capital Costs
+ Increasing Litigation
+ Rising Office Supply/Staff Costs
+ Rising Medical Education Costs
+ Decreasing Reimbursement
__________________________
= Hope you can find a specialist when you need one.

 

[SOUNDMAN]

Then what would one propose a specialist get paid in comparison to a PCP? A specialist who put in the extra time in residency/fellowship, financial hardship, and sacrifice to become a specialist. Now what about surgeons who are doing some very techinically complicated procedures/operations, shouldn't they be reimbursed more than that diabetes/htn/hyperlipidemia follow up? They are inherently taking a bigger risk just doing their job compared to a PCP.

Let's face it not ALL doctors are equal, and we need to quit pretending that. Do I think PCP's should be paid more, absolutely. Should it be based on performance etc, yes. Should surgeons and specialists be paid more than PCP's, yes!.

Should specialists, i.e. NOT surgeons (cardiologists, GI, pulm, radiologists etc) be earning 3-5X more than PCP's I don't know I guess it depends on the amount of procedures they do.

 

[radslooking]

Income redistribution would be fine if all specialists made "2-5 times" what PCPs do. Not all of us do.

Be prepared to see even fewer people go into General Surgery when the overall reimbursement and reimbursement for image guided procedures (which are our biggest money makers - I make more for an US guided biopsy than I do for a modified radical mastectomy) is so low that no one is willing to do the training to make the same amount they could as an FP.

There's already a shortage of general surgeons; this isn't going to help.

Rising Cost of Malpractice
+ Rising Capital Costs
+ Increasing Litigation
+ Rising Office Supply/Staff Costs
+ Rising Medical Education Costs
+ Decreasing Reimbursement
__________________________
= Hope you can find a specialist when you need one.

that is insane.

changing the malpractice milleu would do a lot to help. doctors are doing the best they can under stressful circumstances...surgical/medical specialists moreso than PCP's. You shouldn't have to walk on eggshells to do your job. They need to fix that. Obama has been a complete wimp on this issue.

 

[radslooking]

Then what would one propose a specialist get paid in comparison to a PCP? A specialist who put in the extra time in residency/fellowship, financial hardship, and sacrifice to become a specialist. Now what about surgeons who are doing some very techinically complicated procedures/operations, shouldn't they be reimbursed more than that diabetes/htn/hyperlipidemia follow up? They are inherently taking a bigger risk just doing their job compared to a PCP.

Let's face it not ALL doctors are equal, and we need to quit pretending that. Do I think PCP's should be paid more, absolutely. Should it be based on performance etc, yes. Should surgeons and specialists be paid more than PCP's, yes!.

Should specialists, i.e. NOT surgeons (cardiologists, GI, pulm, radiologists etc) be earning 3-5X more than PCP's I don't know I guess it depends on the amount of procedures they do.

The answer to that question is "NO". More, yes. not that much more. Somebody has coordinate the care for these complicated patients. If it was as simple as starting a blood pressure pill or tweaking that, then maybe they don't deserve it. But it's far more complicated than that.

 

[medicinesux]

Haven't been around these parts for awhile since I have been feverishly working on my Ark. You can all laugh at me all you want but I think it is coming along pretty well. She is turning out to be quite the beauty!....can't wait till she shines with a good coating after I finish the interior designing on the inside. Me thinks I need to start hauling some serious ***** and ship out sooner since this mother of all storms may be upon us sooner than I thought

 

[Taurus]

The official document describing the changes can be found at:

http://www.federalregister.gov/OFRUpload/OFRData/2009-15835_PI.pdf

Look on page 716. It lists the impact of the cuts on the various specialties.

Some fields benefit while others get hit.

The worst hit are:
rad onc (-19%)
nuc med (-13%)
cards (-11%)
rads (-11%)
IR (-10%)

1 TOTAL $ 77,744 0% 1% 0% 1%
2 ALLERGY/IMMUNOLOGY $ 171 0% 0% -2% -3%
3 ANESTHESIOLOGY $ 1,713 0% 5% 1% 6%
4 CARDIAC SURGERY $ 371 -1% -1% 3% -2%
5 CARDIOLOGY $ 7,179 0% -10% -1% -11%
6 COLON AND RECTAL SURGERY $ 129 -1% 5% 1% 5%
7 CRITICAL CARE $ 221 0% 3% 1% 3%
8 DERMATOLOGY $ 2,504 0% 2% 0% 3%
9 EMERGENCY MEDICINE $ 2,395 0% 2% 0% 2%
10 ENDOCRINOLOGY $ 370 -1% 3% 0% 3%
11 FAMILY PRACTICE $ 5,055 2% 5% 1% 8%
12 GASTROENTEROLOGY $ 1,779 -1% 1% 0% 0%
13 GENERAL PRACTICE $ 719 1% 5% 0% 6%
14 GENERAL SURGERY $ 2,213 -1% 4% 1% 4%
15 GERIATRICS $ 167 1% 6% 1% 8%
16 HAND SURGERY $ 89 -1% 4% 0% 3%
17 HEMATOLOGY/ONCOLOGY $ 1,888 0% -5% -1% -6%
18 INFECTIOUS DISEASE $ 549 -1% 4% 1% 3%
19 INTERNAL MEDICINE $ 10,061 1% 4% 1% 6%
20 INTERVENTIONAL PAIN MANAGEMENT. $ 352 -1% 7% 0% 6%
21 INTERVENTIONAL RADIOLOGY $ 227 0% -10% 0% -10%
22 NEPHROLOGY $ 1,789 0% 1% 1% 2%
23 NEUROLOGY $ 1,417 -2% 6% 0% 3%
24 NEUROSURGERY $ 586 -1% 3% 1% 2%
25 NUCLEAR MEDICINE $ 72 0% -12% -2% -13%
26 OBSTETRICS/GYNECOLOGY $ 615 0% 1% 0% 1%
27 OPHTHALMOLOGY $ 4,736 0% 11% 0% 11%
28 ORTHOPEDIC SURGERY $ 3,257 0% 4% 0% 3%
29 OTOLARNGOLOGY $ 926 -1% 3% -1% 1%
30 PATHOLOGY $ 985 0% -1% 0% 0%
31 PEDIATRICS $ 64 1% 4% 0% 4%
32 PHYSICAL MEDICINE $ 816 0% 7% 0% 7%
33 PLASTIC SURGERY $ 278 -1% 5% 1% 5%
34 PSYCHIATRY $ 1,071 0% 2% 1% 3%
35 PULMONARY DISEASE $ 1,753 -1% 3% 1% 3%
36 RADIATION ONCOLOGY $ 1,799 0% -17% -1% -19%
37 RADIOLOGY $ 5,254 0% -10% -1% -11%
38 RHEUMATOLOGY $ 494 0% 0% 0% -1%
39 THORACIC SURGERY $ 389 -1% 0% 3% 2%
40 UROLOGY $ 1,989 0% -6% 0% -7%
41 VASCULAR SURGERY $ 685 -1% -1% 0% -1%
42 AUDIOLOGIST $ 35 0% -4% -7% -10%
43 CHIROPRACTOR*** $ 700 0% 4% 1% 5%
44 CLINICAL PSYCHOLOGIST $ 533 0% -7% 0% -7%
45 CLINICAL SOCIAL WORKER $ 353 0% -6% 1% -6%
46 NURSE ANESTHETIST $ 772 0% 2% 0% 2%
47 NURSE PRACTITIONER $ 1,004 1% 5% 1% 7%
48 OPTOMETRY $ 834 1% 11% 0% 12%
49 ORAL/MAXILLOFACIAL SURGERY $ 35 -1% 3% -1% 1%
50 PHYSICAL/OCCUPATIONAL THERAPY $ 1,857 0% 10% 0% 10%
51 PHYSICIAN ASSISTANT $ 749 0% 4% 0% 5%
52 PODIATRY $ 1,656 1% 7% -1% 6%
53 DIAGNOSTIC TESTING FACILITY $ 1,044 0% -19% -5% -24%
54 INDEPENDENT LABORATORY $ 960 0% -4% -1% -5%
55 PORTABLE X-RAY SUPPLIER $ 85 0% -8% -2% -11%​

 

[Pinkertinkle]

Wow they're really dinging the imaging. How exactly are they increasing the reimb for anything when table 40 shows a good 10-40% cut for every code in 2010?

 

[medsRus]

This is LONG overdue... Imaging fees have gone out of control. Now, there needs to be tighter control on ordering imaging studies.

 

[Faebinder]

This is LONG overdue... Imaging fees have gone out of control. Now, there needs to be tighter control on ordering imaging studies.

What does imaging fees have to do with reimburisement for a radiologist? Do you think the $3000 fee tag is paid to the radiologist or the hospital?

The problem here is that people are not distinguishing the huge difference between the reimburisement of physicians and what the hospital charges.

A lap cholecystectomy in theory costs a raw of $35,000 for which the surgeon (regardless of experience) is given $750 and the anesthesist (regardless of level of education and skills involved) is given $750. Who pocketed all the money and how is given the surgeon or the anesthesist $650 each saving you the consumer? What about the other $33,500 that no one is talking about?

 

[Winged Scapula]

What does imaging fees have to do with reimburisement for a radiologist? Do you think the $3000 fee tag is paid to the radiologist or the hospital?

The problem here is that people are not distinguishing the huge difference between the reimburisement of physicians and what the hospital charges.

A lap cholecystectomy in theory costs a raw of $35,000 for which the surgeon (regardless of experience) is given $750 and the anesthesist (regardless of level of education and skills involved) is given $750. Who pocketed all the money and how is given the surgeon or the anesthesist $650 each saving you the consumer? What about the other $33,500 that no one is talking about?

When patients complain about the cost, I make it a point to show them where the costs are.

Excisional Biopsy of the Breast

Surgeon Fee (Medicare Allowable): $362 (which includes a global period of 90 days where all related care is free)

Facility Fee: $2400 (varies)

OR time; $47/minute (varies)

Opening the OR/Set-Up Fee: $1300

Anesthesiologist: $1000

Pre-Op/PACU/Medications/Supplies: I have no idea

but all in all, the charges come out to be around $10,000 of which I make
very little.

What you haven't recognized is that insurance companies don't pay hospitals what they hospitals bill. So while the hospital may bill $35,000 for the lap chole, they will get less than 25% for it from the insurer. When I had surgery, the surgeon waived his fee as did the anesthesiologist but BC/BS paid less than 25% of the hospital charges for an emergency surgery.

 

[Hernandez]

Should specialists, i.e. NOT surgeons (cardiologists, GI, pulm, radiologists etc) be earning 3-5X more than PCP's I don't know I guess it depends on the amount of procedures they do.

Why should the benchmark of income be amount of procedures performed?

 

[radslooking]

Why should the benchmark of income be amount of procedures performed?

my personal belief is it should have some bearing, but not all. I think you'd do better to have a base salary with some modest increase for number of procedures. Otherwise you've got people scratching and clawing over each other to do procedures.

 

[SOUNDMAN]

If I am a better surgeon than you, and more people come to me because I am better, and thus I do more Total Knees/radical mastectomies/whatever than you bet I should be paid more than you. I don't see why that is hard to understand, maybe I'm missing something.

Secondly, we need to discriminate between those physicians that may be hired by a hospital and those having their own practice/group practice. The compensation for them is usually different.

If hired by a hospital, most do the base salary plus some sort of performance compensation from my experience. This is where things have gotten hairy, b/c hospitals are trying to have all these specialists present so they bring in the patients so then the HOSPITAL gets the reimbursement for the procedure/surgery/hospital stay etc. So they may lose money on one end by paying the physicians they've hired, but make up for it in the "extra" revenue that those physicians bring in, but the physician never sees. You'll never get a hospital to tell you what it's "actual" costs are, which is probably part of the problem. They'll tell you what they "charge" for it, but not the actual breakeven cost. Maybe all hospitals should become not-for-profit? Chew on that for a bit.

If You are in a private practice or a group practice, you might get a base salary for awhile but afterwards it's pretty much eat what you can kill, and the busier you are the better you are going to be doing, but that's fair, if I want to work 100 hours a week, while Dr. Joe doesn't then he shouldn't be compensated the same as I do.

 

[Hernandez]

my personal belief is it should have some bearing, but not all.

And what about specialties like IM, Psych, FP, Peds, etc which can have none to few procedures.

If I am a better surgeon than you, and more people come to me because I am better, and thus I do more Total Knees/radical mastectomies/whatever than you bet I should be paid more than you. I don't see why that is hard to understand, maybe I'm missing something.

I don't disagree with this, but the mental work of being a PCP or other mental specialties should not just be written off because they don't do procedures,

There should be some consideration to how long the post-grad training is for specialties in their pay, but the overly-simple metric of procedures performed to base what income should be is overly surgeon-centric and negates the very real work IM/FM and medicine sub-specialties do perform

 

[asmallchild]

I can somehow wrap my mind around cardiologists and radiologists getting their payments cut into (especially since I'm starting out on a cardiac unit and get to see how much extraneous imaging is going on right now)

I wonder why radiation oncologists were put under the spotlight?

 

[Winged Scapula]

I can somehow wrap my mind around cardiologists and radiologists getting their payments cut into (especially since I'm starting out on a cardiac unit and get to see how much extraneous imaging is going on right now)

I wonder why radiation oncologists were put under the spotlight?

Have you ever SEEN what they get reimbursed? Believe me, its quite lucrative or are least it is for my friends and colleagues doing it.

 

[Gibbles]

Yep!
divide and conquer!
The family physician spokes person is a *****. What does he think? Obama is looking out for him? The programs for loan forgiveness are out there allready, nobody wants to do FP in bum-f*ck south dakota. The article said nothing specific about where they are going to increase FP pay.

I hate to say it, but I think you have the wrong idea about FPs that practice in rural areas. The type of medicine that they practice means that they are usually on call every 3-5 days (or even more if they are the only doc in town) without subspecialist help whenever they decide to write an order for it.

In fact, I'd take a rural doc that has practiced for 2-3 years over any given doc that has practiced in a hospital system for a decade or more when we're talking about ingenuity.

I know at least 4-5 recent medical school graduates that would love to practice family medicine in rural South Dakota, because you have the opportunity to learn A LOT about medicine instead of constantly having your knowledge base crippled as an academic internist or family practice doc, because you have to rely on subspecialists to get pretty much anything done and you don't have the same free roam with EGD/Colons, bronchs, or pretty much any invasive procedure.

 

[sirus_virus]

I guess they finally figured the best way to get cuts to go through is by injecting some divide amongst physicians. Give some a raise and cut the others; I dont expect to see any AMA ads on tv resisting this move.

 

[asmallchild]

Have you ever SEEN what they get reimbursed? Believe me, its quite lucrative or are least it is for my friends and colleagues doing it.

Never realized it was that a big a target. We didn't even have a radonc department at my school

That being said, this is just Medicare restructuring right? Or do the private insurance companies base their rates off of Medicare's?

 

[Taurus]

That being said, this is just Medicare restructuring right? Or do the private insurance companies base their rates off of Medicare's?

Private insurance typically parallels Medicare. They may reimburse slightly higher, but if Medicare reduces pay then they typically follow suit. Why would private insurance want to reimburse significantly higher? That's money out of their pockets. That's why this country has a pseudo-national healthcare system controlled by Medicare.

 

[asmallchild]

Private insurance typically parallels Medicare. They may reimburse slightly higher, but if Medicare reduces pay then they typically follow suit. Why would private insurance want to reimburse significantly higher? That's money out of their pockets. That's why this country has a pseudo-national healthcare system controlled by Medicare.

It's both amazing (and pathetic) that I've been able to get through medical school without the grasp of these simple concepts

 

[MOHS_01]

It's both amazing (and pathetic) that I've been able to get through medical school without the grasp of these simple concepts

That is because they won't let people like me address the students on these subject matters...... they tightly censor what you are afforded the opportunity to learn.

 

[Taurus]

That is because they won't let people like me address the students on these subject matters...... they tightly censor what you are afforded the opportunity to learn.

It truly is sad that medical schools don't spend any time talking about practice issues like how to run a practice, DNP's, etc. They only talk about "helping others" or "research, research, research". This is why doctors always seem to get the shaft. We do this to ourselves.

My gf is a dentist and tells me that dental schools drill that stuff into you. It's no surprise then that dentistry for the most part is immune from govt control. They realized long ago not to accept Medicare and make it mostly cash-based.

 

[Impressions]

Do you think that is going to change very much? How much are these cuts going to impact the average rad onc attending salary?

Have you ever SEEN what they get reimbursed? Believe me, its quite lucrative or are least it is for my friends and colleagues doing it.

 

[docB]

It's both amazing (and pathetic) that I've been able to get through medical school without the grasp of these simple concepts

That is because they won't let people like me address the students on these subject matters...... they tightly censor what you are afforded the opportunity to learn.

I agree that this is a problem with medical education. I don't know if this is on purpose or due to the fact that the preclinical years, which would be the time when med students have time for such discussions, are taught by PhDs for the most part. They could do some lectures on writing grants but it probably wouldn't be too helpful. Preclinical would also have the disadvantage of being so far out of context that the students wouldn't get it.

 

[radslooking]

Have you ever SEEN what they get reimbursed? Believe me, its quite lucrative or are least it is for my friends and colleagues doing it.

yeah, they get paid a ton. 20% aint gonna put many of them in the poor house.

 

[radslooking]

That is because they won't let people like me address the students on these subject matters...... they tightly censor what you are afforded the opportunity to learn.

I dont ever agree with hiding the reality from people. Which is precisely what our medical schools have been doing. To the detriment to the country as a whole. If you don't understand something, you can't fix it.

 

[radslooking]

Private insurance typically parallels Medicare. They may reimburse slightly higher, but if Medicare reduces pay then they typically follow suit. Why would private insurance want to reimburse significantly higher? That's money out of their pockets. That's why this country has a pseudo-national healthcare system controlled by Medicare.

True. People dont' understand what they mean when they say socialized. We already have a somewhat socialized system. It's just poorly implemented.

 

[radslooking]

When patients complain about the cost, I make it a point to show them where the costs are.

Excisional Biopsy of the Breast

Surgeon Fee (Medicare Allowable): $362 (which includes a global period of 90 days where all related care is free)

Facility Fee: $2400 (varies)

OR time; $47/minute (varies)

Opening the OR/Set-Up Fee: $1300

Anesthesiologist: $1000

Pre-Op/PACU/Medications/Supplies: I have no idea

but all in all, the charges come out to be around $10,000 of which I make
very little.

What you haven't recognized is that insurance companies don't pay hospitals what they hospitals bill. So while the hospital may bill $35,000 for the lap chole, they will get less than 25% for it from the insurer. When I had surgery, the surgeon waived his fee as did the anesthesiologist but BC/BS paid less than 25% of the hospital charges for an emergency surgery.

How in the world can an anesthesiologist earn triple what you do for actually doing the procedure. What a mind f.......

 

[radslooking]

I agree that this is a problem with medical education. I don't know if this is on purpose or due to the fact that the preclinical years, which would be the time when med students have time for such discussions, are taught by PhDs for the most part. They could do some lectures on writing grants but it probably wouldn't be too helpful. Preclinical would also have the disadvantage of being so far out of context that the students wouldn't get it.

oh it's on purpose. I had an attg in residency who thought it was heresy to discuss prices becuase he wanted you to learn "best medicine". What a dope. You can't ignore financial realities. That's what got us into this mess.

 

[radslooking]

I guess they finally figured the best way to get cuts to go through is by injecting some divide amongst physicians. Give some a raise and cut the others; I dont expect to see any AMA ads on tv resisting this move.

I think only about a quarter of physicians belong to the AMA. Its reach and relevancy, while not negligible, is somewhat limited.

 

[radslooking]

And what about specialties like IM, Psych, FP, Peds, etc which can have none to few procedures.



I don't disagree with this, but the mental work of being a PCP or other mental specialties should not just be written off because they don't do procedures,

There should be some consideration to how long the post-grad training is for specialties in their pay, but the overly-simple metric of procedures performed to base what income should be is overly surgeon-centric and negates the very real work IM/FM and medicine sub-specialties do perform

im sure you already know this, but patients can be counted just like procedures can. Unfortunately, the complexity of patients varies more than most procedures, and generally are more poorly reimbursible. "Well, she asked me 15 questions!" is a common occurrence, but rarely garners you any more pay. A surgery with complications will at least most of the time have a modifier that will reimburse better. Patients, not so much.

Therefore, you get paid a base rate with some extra based on the number of patients you see. With some allowance made for complexity of patients, which is difficult to measure, but possible.

 

[Winged Scapula]

How in the world can an anesthesiologist earn triple what you do for actually doing the procedure. What a mind f.......

They do a very valuable and skilled job and I don't begrudge them any of what they make. I wouldn't be able to do what I do without them. I am more appalled about the hospital charges.

 

[radslooking]

They do a very valuable and skilled job and I don't begrudge them any of what they make. I wouldn't be able to do what I do without them. I am more appalled about the hospital charges.

that's very noble of you. but certainly, its still weird.

 

[Winged Scapula]

A surgery with complications will at least most of the time have a modifier that will reimburse better.

There is a modifer - 22 for complex procedures, however, just because you code for it doesn't mean that you'll get paid for it.

Intra-op or post-op complications are not rembursed at a higher rate. There is no modifier for "complications", only for "complex" procedures. If you have to go back to the OR, you can bill for that.

Here are the modifiers: http://www.id.regence.com/physician/billing/modifiers/

 

[lowbudget]

That is because they won't let people like me address the students on these subject matters...... they tightly censor what you are afforded the opportunity to learn.

Agreed, although I'm not sure if medical school is the best forum for these topics. Most doctors teaching doctors are just as uninformed about these issues. Besides, even if you talk about and focus on it (like we did in residency), many times it falls of deaf ears because students/residents aren't interested in hearing it.

What I want to know is... what the hell is everyone doing during UNDERGRAD?!! I mean, I'm not the sharpest pencil in the can, but hell even I learned about the basics of how the health care system works in undergrad. I'm surprised people don't study the health care system BEFORE they choose medical school...

 

[lowbudget]

How in the world can an anesthesiologist earn triple what you do for actually doing the procedure. What a mind f.......

Anesthesiology market is much different from the surgery market in that anesthesiology is almost always dominated by a handful of large groups in town that sign exclusive contracts with hospital systems.

How many solo practicing anesthesiologists do you know who are out there? Maybe guys who do pain? But otherwise...?

With that comes monopolistic pricing...

(Very similar to radiology, pathology, emergency medicine and certain super-subspecialty who lock down a market; but with these there tends to be a little bit more competition than anesthesiology.)

 

[Winged Scapula]

Agreed, although I'm not sure if medical school is the best forum for these topics. Most doctors teaching doctors are just as uninformed about these issues.

Exactly. Most academic faculty don't know the first thing about billing and reimbursement, other than what box to check on the clinic sheet. They don't know how much they get paid for each code, whether or not they actually DO get paid, what the contracted reimbursement is. They are NOT the best ones to do the teaching.

FYI: they also don't know much about job hunting, interviewing either outside of the academic arena.

 

[Impressions]

The question is will that technical component even affect the payment (which I thought was the professional component) of a Rad Onc attendings salary? What do they make on average? I have heard such a giant range but it seems very difficult to tell what they actually make.

 

[Taurus]

I wouldn't feel bad for the radiologists. Their demise has been falsely predicted many times. The Deficit Reduction Act (DRA) of 2005 cut imaging reimbursements by as much as 30%, yet the average radiologist salary only decreased by 1%. Radiologists are a very clever group and they will figure a way to keep up their salaries. Maybe work more hours or something or improve productivity through technology.

I'm not sure how patient-centric fields like rad onc and cardiology will fare with these cuts though. It may hit them harder than rads.

I also expect that those fields that escaped cuts this time around will get it next time. Obama is intent on shifting money from specialties to primary care. For example, 40-50% pay cut for Moh's surgery in derm last year. It's a zero sum game. There's no money coming into the system. It's just shuffling of the chairs on the deck. So I wouldn't breathe a sigh of relief just yet.

DRA has affected radiologists' salaries, study finds
By Kate Madden Yee
AuntMinnie.com staff writer
June 4, 2009

The Deficit Reduction Act (DRA) of 2005 has negatively affected radiologists' salaries, although the severity of the law's impact varies across the U.S., according to results from a study published in this month's Journal of the American College of Radiology.

James Moser, Ph.D., of the American College of Radiology (ACR) in Reston, VA, and Dr. Dawn Hastreiter of Washington University in St. Louis found that the DRA's provisions directly reduced radiologists' income by 1%, although the indirect effect was probably higher, because 55% of the radiologists who participated in the study noticed private payors adopting similar cuts (June 2009, Vol. 6:6, pp. 408-416).

The data were gathered in 2007 via a random-sample telephone survey of ACR radiologist members from Arkansas, California, Georgia, Iowa, Louisiana, Michigan, Montana, New Jersey, New York, North Dakota, Texas, and West Virginia. Responses totaled 601 out of 3,596 contacted, for a response rate of 20%.

Moser and Hastreiter found that the average portion of income derived from all Medicare and private-payor technical component sources was 18%. As Medicare represents an average of 27.5% of a radiologist's medical income, and the average Medicare technical component payment cut for imaging modalities is 18.5%, the average reduction in a radiologist's total income from DRA caps and cuts is about 1%.

However, the researchers added that the figure does not illuminate the potentially larger percentage cut for those radiologists whose incomes depend on technical component billing, who have large Medicare patient bases, or who perform a lot of imaging that has been affected by the DRA (such as MRI).

Radiologists most vulnerable to DRA reductions because of higher technical component incomes included those who:

* Owned imaging centers or were part of practices that owned imaging equipment
* Lived in the Northeast
* Were located in the suburbs of a large city
* Were not at academic or government practices
* Were 47 to 54 years old

Radiology practices dealt with the cuts in various ways, the most common being altering plans to acquire imaging equipment (particularly for modalities affected most by technical component cuts) and scaling back plans for future staff and office space. Moser and Hastreiter found that a practice's hours of operation and the types of imaging services offered were less likely to be affected by the DRA.

Finally, the survey data indicate that half of radiologists perform outside interpretations for imaging facilities that aren't directly part of their practices, with 40% of these cases possibly resulting in radiologists' not being reimbursed for the entire professional component. Moser and Hastreiter predicted that these types of contracts could also be affected by the antimarkup regulations that took effect in January of this year.​

 

[radslooking]

Before you make bold statements like that maybe you should actually do some fact checking. Radiation Oncologists, at this time, are not making siginificantly more than diagnostic radiologists and I know many radiologists who are making more than some of my rad onc colleagues. While our salaries are higher than that of a PCP, I don't see a problem with that since we spend 5 years to train vs. the 3 years for FP or IM without fellowship. Further, the level of complexity of radiation oncology is well beyond that of a general PCP.

The cuts for radiation oncology are primarily in the technical component due to a switch from 50% usage to 90% usage. Unfortunately, it appears that the government has lumped linear accelerators and radiation oncology equipment in with CT/MRI and both have taken a significant hit. It's a shame that there are people on this board who are happy to see specialists take a pay cut just so they can try to get a piece of it.

keep rationalizing why PCP's should get paid 1/2 to a 1/3 of what you do. 2 more years of residency? Yeah, that's definitely worth getting paid 3x what a pcp is. My fault!

I don't want to see anyone's pay cut. But they have to narrow the gap somehow. That's clear. That's if you want to have primary care at all. If you don't, well then enjoy your NP and PA.

 

[radslooking]

by the way, i do value rad oncs and the job they do. They work very hard. But in the current system they are overvalued relative to some of their other hardworking colleagues.

 

[asmallchild]

keep rationalizing why PCP's should get paid 1/2 to a 1/3 of what you do. 2 more years of residency? Yeah, that's definitely worth getting paid 3x what a pcp is. My fault!

I don't want to see anyone's pay cut. But they have to narrow the gap somehow. That's clear. That's if you want to have primary care at all. If you don't, well then enjoy your NP and PA.

I wonder if we'll see a swing towards primary care if the money is being redistributed in that arena.

After all, who would put themselves through a neurosurgery residency (or any grueling surgical residency for that matter) if their pay isn't significantly better than that of a PCP?

 

[Pir8DeacDoc]

I wonder if we'll see a swing towards primary care if the money is being redistributed in that arena.

After all, who would put themselves through a neurosurgery residency (or any grueling surgical residency for that matter) if their pay isn't significantly better than that of a PCP?

That is a very real reality. Why work yourself to the bone 70-90 hours/week and make the same as someone who works 9-5 for 3 years of residency?