Why Pick on Doctors?
Medicare pays, on average in California, $18,000 for a total hip replacement ($16,336 to the hospital and $1,446 to the surgeon)…Cutting the surgeon’s fee by 27 percent [the SGR target] saves Medicare $390. While the numbers are higher in the commercial market, approximately the same ratio of payments exists; the bulk of the money goes to hospitals and device manufacturers.
Mark Smith at the Health Affairs Blog.
This raises some interesting questions. Doctors are the gatekeepers to care. Only a doctor can admit a patient to a hospital or order care that gets reimbursed by an insurance company or Medicare. But doctors’ fees are only a fraction of what the hospital receives for the service. Now, hospitals are buying physician practices in droves. For years, doctors were loath to work for anyone other than themselves. This is changing — maybe because of uncertainty; maybe because of complexity; maybe because the culture of medicine is changing — but doctors are now selling their practices to hospitals. When hospitals are able to finally gain leverage over the admitting physician, the income of both will likely rise. Physician services provided in a hospital outpatient setting pay better than the same service performed (in the same office) when the hospital doesn’t own the practice.
If doctors are the gatekeeper to hospital admissions and other forms of care, wouldn’t fee cuts that reduce physician income per task encourage doctors to perform more tasks? In the process of trying to perpetuate a target income, doctors could boost expenditures far more than is saved by cutting fees 27%. That is a theory I’ve heard before, although it’s not clear to me why a doctor willing to work longer hours wouldn’t do it to boost his income at any level. That logic suggests the way to save money is to pay doctors not to work. I think that’s something farm policy has perpetuated.
Well if the same the same procedure costs three times as much here as in any other country it must be better.
Sorry, I’m more focused on (and blown away by) the statistics in that IFHP report.
Interesting to notice that the large difference in payments between care providers, and hospitals. To me, it seems like $16k is a high price for a “glorified” 1 week hotel stay.
I dont necessarily agree with the part of the article that says “The time is right to make a grand bargain with physicians”. Why does it have to be one or the other? Why can’t it be both? Like Mark Smith said himself, physicians play a key role in the direction our health care system is headed…they get to make all major decisions regarding the type of care or treatment people are going to get…so why get on their bad side? why not simply work WITH them and make it easier for them to help others, while also getting their earned rewards for it?
I really like this quote from Mark Smith’s article:
“The main way in which competition is discouraged is through the complicated state-by-state “scope of practice” laws that strangle innovation in health care, slicing and dicing services into dozens of silos whose permissible practitioners are determined more by politics than by science or efficiency. So this is a perfect time to accept a “shortage” of physicians (as defined by their current practice patterns) and recruit physicians to the central task of making health care more affordable.”
Talking about physician burn out, exhaustion and unhappiness…
It almost seems this system’s goal is to discourage every medical practitioner out there..
Eventually high school drop-outs will be the only ones applying to medical schools. The smartest ones in the class are finally realizing that there is no future in medicine, Why sacrifice half of your life for a medical degree only to have limited earning potential?
Doctors are not the only personnel there are nurses and other hospital staff.
BTW I have twice had the experience of telling the doctors that we will pay directly and having them change the plan to much cheaper care.