Your income is now public record

[oncology2020]

In spite of protestation, the data show glaring instances of abuse. We should not defend the indefensible just because we are doctors.

please elaborate...how from the article i posted are any of those doctors themselves abusing the system?

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[turtle1966]

please elaborate...how from the article i posted are any of those doctors themselves abusing the system?

How does your "selective quote of physicians" from the main article prove anything? My point was that one should not blindly conclude that there were no abuses from your post. I felt that AAD or AAO could have written it.

This disclosure was prompted because WSJ had done an expose of certain abusers; WSJ had discovered them based on a similar non-public database. From that experience, WSJ pushed for a public disclosure the data and prevailed. This is likely to be the first iteration of many to come, and likely more informative.

I have mixed feelings about this disclosure. As I understand it, this database is accusing no one of abuse or fraud. Many states and cities make public FULL wages of ALL public servants, therefore, this disclosure is not out of the norm.

I have seen abuses and abusers, so I can not accept (blindly) that a doctor would serve as a multi-million dollar conduit for pharmaceutical industry, entirely out of altruism.

Simply put, the salient point of this database is the standard deviation or scatter of income, those outrageous outliers without obvious justifications.

I thought that RVS had fixed dollar figure for physicians' labor within a narrow range. So, do some of us have more than 24 hours a day?, or RVS is imperfect? or there is .......

 

[oncology2020]

How does your "selective quote of physicians" from the main article prove anything? My point was that one should not blindly conclude that there were no abuses from your post. I felt that AAD or AAO could have written it.

This disclosure was prompted because WSJ had done an expose of certain abusers; WSJ had discovered them based on a similar non-public database. From that experience, WSJ pushed for a public disclosure the data and prevailed. This is likely to be the first iteration of many to come, and likely more informative.

I have mixed feelings about this disclosure. As I understand it, this database is accusing no one of abuse or fraud. Many states and cities make public FULL wages of ALL public servants, therefore, this disclosure is not out of the norm.

I have seen abuses and abusers, so I can not accept (blindly) that a doctor would serve as a multi-million dollar conduit for pharmaceutical industry, entirely out of altruism.

Simply put, the salient point of this database is the standard deviation or scatter of income, those outrageous outliers without obvious justifications.

I thought that RVS had fixed dollar figure for physicians' labor within a narrow range. So, do some of us have more than 24 hours a day?, or RVS is imperfect? or there is .......

Of course there are abuses, no one is denying that, but this disclosure is extremely misleading that's the point that you seem to be missing. It's hurting the doctors, majority of who are NOT abusing the system. If the government and media really cared about preventing abuse they would have called out the people actually committing fraud rather than throwing out data without providing any context or explanation of what those numbers mean. Do you not find it weird that there was absolutely no context provided behind these inflated numbers? The average person will think that all doctors make multi-million dollars a year, creating public outrage that guess what will also end up hurting whatever field you are in also. We are in a time where government and media are trying to generate public outrage against doctors to create the foundation for drastic cuts across the board. You really think by cutting the income of specialists they'll divert that money to primary care? It'll be drastic cuts across the board. Very naive to think otherwise. There are abusers, it is the duty of the government to go after them and audit them and hold them accountable. This disclosure does nothing to address that.

Another point that you seem to be missing is that these numbers do NOT represent incomes or take home salary. That actually would have been much more meaningful to see who actually is abusing the system.

Your comment about "a doctor would serve as a multi-million dollar conduit for pharmaceutical industry, entirely out of altruism" demonstrates that you don't know how the clinics of some specialists work. Below is a comment from an optho clarifying that point.

"Before everyone condemns physicians, as an ophthalmologist it needs to be clarified drug costs are included as physician payment. The drug Lucentis costs $1950 [for me to purchase for my office to administer to patients within office], I am paid 4% over that price to buy it, store it and provide to the pt. I do not get $2000 for the drug. The drug companies somehow got the drug cost included in physician payments. This will skew what ophthalmologists make as it is not a true full payment to us. Medicare allows $125 for the physician service to inject that medication in a person's eye. The 4% over drug invoice is to cover our carrying costs for a drug. If you think 4% pays my staff time, drug management issues you are not considering whats involved. "

If a doctor owns a clinic, he/she needs to purchase drugs from pharmaceutical companies to administer within office. No one is serving as a conduit for pharmaceutical companies but because the database includes these numbers it makes it seem as though the $2000 that the doctor had to buy the drug and get reimbursed for is actually what he is taking home when that is far from the truth. The $2000 actually went to the pharmaceutical company when buying the drug, while the doctor gets $125 for administering it/storing it but the database includes the $2000 in the name of the physician making it seem as though the physician took home the full $2000. If a doctor has a 1000 patients and each received the $2000 drug you can imagine that doctors numbers will be severely inflated, when in reality it is the pharmaceutical company that is benefitting from it but doctors are the ones getting the sole blame. That is why the oncologists who are purchasing expensive chemotherapy for in-clinic administration have their numbers severely inflated in that database--that money is not what they're taking home. A point that you seem to be missing, so imagine what the average person thinks.

Despite what they want you to believe, physician salary is not the major issue. Insurance companies, medical device companies and pharmaceutical companies are the ones driving up medical costs with expensive technology and drug costs, making billions of dollars in PROFIT, but they have very powerful lobbyists in DC so all doctors end up being the scapegoats.

 

[turtle1966]

Of course there are abuses, no one is denying that, but this disclosure is extremely misleading that's the point that you seem to be missing.

Thanks for your informative post. I think Board like this serves to present both sides. At least my post gave voice to some, and opened the door for an informed person like you to present the facts.

The disclosure was a legal disposition, therefore, it can not be reversed, except by a higher Court. It was not meant to be fair, therefore, there are flaws that should be corrected. However, I would like to point out:

1-WSJ, NYT and other media outlets went out their way to emphasize over and over that the "main finding" was that a few doctors were receiving lion's share of payments AND not that doctors were making a lot.

2-public Q saw there were many many more doctors making very little, so this blunts somewhat your argument.

3-doctors can present their facts and pressure Medicare to correct reporting errors in the future.​

I have mixed feeling about the disclosure, however, as a tax payer, I see no lasting injustice, since the doctors will have means of pressuring Medicare to improve the methodology.

Despite what they want you to believe, physician salary is not the major issue. Insurance companies, medical device companies and pharmaceutical companies are the ones driving up medical costs with expensive technology and drug costs, making billions of dollars in PROFIT, but they have very powerful lobbyists in DC so all doctors end up being the scapegoats.

The cause(s) of high medical cost, I am told, is (are) very complex; however, as a doctor, I tend to agree with you.

 

[yaah]

The "true costs" of medical care are subject to interpretation, opinion, and are fungible.

Nearly every specialty or service can claim, quite correctly, that bills for their services only account for "a small fraction of medicare expenditures". And then they can conversely lump things together and say that another area accounts for far more. In the past weeks since these data were released, I have seen the following things online or elsewhere that say that such and such specialty only accounts for a "small fraction" of spending and therefore doesn't deserve further cuts (and actually deserves more money because they are saving money from other more spendthrift areas):

Labs
Hospital admissions
Primary care office visits
Ophthalmology injections
Da Vinci robot use
Orthopedic hardware
In office labs
In office radiology
$1000 hepatitis C pills
Screening tests like mammogram, colonoscopy, etc
Pap smears
Emergency room visits
Urgent care visits

(I am not kidding by the way, I actually read something about how cost-saving orthopedic hardware, da vinci robots, and ER visits were).

I have also seen articles on each of the above that claim that the specific target above is the source of excess spending that could be targeted.

So we are way, way far away from a cure for the medical cost problem. It seems like many people are settling on two main drivers of cost (three if you count self-referral, although that isn't a main driver of cost, it's just a relatively small excess): Drug prescriptions and hospital admissions. Reduce these and healthcare spending will become more controllable. But these two areas not coincidentally have the highest paid and most extensive lobbying organizations. It is starting to turn into a turf battle where other specialties are becoming the enemy, at least for specialty organizations. This is part of the reason why so many doctors are moving to an employed model.