A hospital fee, minus the hospital

Link. [bostonglobe.com]

Quote : The federal Medicare program, which covers 47 million people and is under pressure to cut costs, is taking a look at the practice. An independent agency that advises Congress concluded last year that the charging of facility fees at hospital-owned medical practices is costing Medicare millions of dollars a year. For a 15-minute office visit, for example, the federal health insurance program paid $44 more at a hospital-owned office in 2011 than at an independent office. Medicare patients pay more too: Their share of the bill for this standard visit was $11 more when they went to a hospital-owned office. The facility fee can cause an even larger difference for some procedures, the Medicare Payment Advisory Commission found. Laser eye surgery, for instance, costs Medicare 90 percent more — $738 — in a hospital-owned facility than in an independent doctor’s office.

I am posting this as an example of why hospitals purchasing or hiring Physician practices is very bad. i am certain people here will claim this is some kind of "failure of capitalism" bs, but i ask you to consider the opposite.... this is another failure of government regulation and laws. its easy to say that the facility fee should just be made illegal, but the problem is that medicare (CMS) WILLINGLY pays more to a hospital based doctor than a non-hospital based doctor... yes, you read that correctly. this is pushing physicians and hospitals to both want to work together and its costing everyone more money (with no real benefit to the patient or system). Whats worse is that the upcoming ACO's are accellerating these relationships. this is the opposite of free market capitalism as there is no incentive for the physician to compete against the hospital or other docs (with a lower cost alternative), in fact its the exact opposite.. manipulated market forces are pushing the 2 to merge as it is more profitable for both to do so. ultimately these systems get so large that there is no real local competition.

why are we supporting these large hospital run ACO's with extra payments with no real benefits?

SigX, just forget trying to educate people on American healthcare. I think it's a losing battle. I'm sure you've been on Sermo and read the last post about possibly unionizing so CMS can't bully us.

There's probably less than 0.2% percent of voting Americans that know what an ACO is. You're can't expect them to know what bundling and the deprivatization of physicians will result in. Only when the shit hits the fan will people wake up.

I'm good for the next 30 years while I still have my mental faculties I can take of my family and friends, but sadly I fear what medicine will be like in 30 years when I need help.

Like many on Sermo I'm moving on to another career and enjoying my family, just trying to forget the cluster that modern day medicine has become. Ignorance is bliss

yeah, i saw this on sermo as well. wanted to see what people would say here. I cant leave medicine (even if i wanted too) my student and business loans have me still in the hole. gonna have to work 60-70 hour weeks for about 5 years to get anywhere with those loans. hoping my income does not drop by too much in the next 5 years (wishfull thinking, i know).

Just be glad that the AMA has blocked any effort to promote mass immigration of Doctors from India with H1-B visas, like has been done to keep the salaries of engineers down.

Really helps that medicine is a human interaction profession, too.

What do private insurers pay to those same doctors and facilities when the same work is performed?

Quote from 124nic8 : Just be glad that the AMA has blocked any effort to promote mass immigration of Doctors from India with H1-B visas, like has been done to keep the salaries of engineers down. Really helps that medicine is a human interaction profession, too.

training in india is far inferior or so the indian docs i know claim.

Quote from Rebound : What do private insurers pay to those same doctors and facilities when the same work is performed?

i am not entirely sure to be honest. i know that my practice has to negotiate yearly for some services but i think that some are just "multiples" of medicare.

anyway, would love to hear your opinion of the article and paying hospitals (purposefully) more for the same services. so you support this?

Quote from Rebound : What do private insurers pay to those same doctors and facilities when the same work is performed?

i have a better answer. i know the COO of a local hospital. Only medicare (not sure about medicaid, did not ask) gives the facility fee (which jacks up the cost). private insurance negotiates a total fee per visit based on coding (pay more for the visit but no facility fee). She had the same opinion as me... shocked that the gov has continues to allow this.

Quote from SigX : Link. [bostonglobe.com] I am posting this as an example of why hospitals purchasing or hiring Physician practices is very bad. i am certain people here will claim this is some kind of "failure of capitalism" bs, but i ask you to consider the opposite.... this is another failure of government regulation and laws. its easy to say that the facility fee should just be made illegal, but the problem is that medicare (CMS) WILLINGLY pays more to a hospital based doctor than a non-hospital based doctor... yes, you read that correctly. this is pushing physicians and hospitals to both want to work together and its costing everyone more money (with no real benefit to the patient or system). Whats worse is that the upcoming ACO's are accellerating these relationships. this is the opposite of free market capitalism as there is no incentive for the physician to compete against the hospital or other docs (with a lower cost alternative), in fact its the exact opposite.. manipulated market forces are pushing the 2 to merge as it is more profitable for both to do so. ultimately these systems get so large that there is no real local competition. why are we supporting these large hospital run ACO's with extra payments with no real benefits?

Sorry man, the healthcare industry knew this was coming and that the current model was unsustainable. Instead of coming together and coming up with a solution they kept lobbying for more bailouts.

It was only a matter of time before the government had to step in, and it's gonna suck, but I don't have much sympathy anymore.

Quote from 808Lurker : Sorry man, the healthcare industry knew this was coming and that the current model was unsustainable. Instead of coming together and coming up with a solution they kept lobbying for more bailouts. It was only a matter of time before the government had to step in, and it's gonna suck, but I don't have much sympathy anymore.

so we're adding more people to the healthcare rolls while at the same time decreasing incentives to become a Dr. and/or remain in the profession.

Quote from Dr. J : so we're adding more people to the healthcare rolls while at the same time decreasing incentives to become a Dr. and/or remain in the profession.

So does this mean they can't take Wednesdays off every week to golf anymore?

One big change I have noticed in the last 30 years is that when I was a kid I always went to the Dr's and saw the Dr. He/She would take my blood pressure, my heart rate, make me stick my tongue out and say "ahhhhhhh", etc.. These days all that stuff is handled by a nurse (of some sort) and then the Dr. comes in. Heck, even some times I don't even see a Dr. and are prescribed medications.

On one hand I can see why meeting with a Dr. is better but I would say that 90% of the time I go to the doctor it's for some simple reason that someone with considerably less training can handle. You don't need to go to school for 8 years for example to tell me that I have the friggin flu that everyone else has. Personally, I'm for continuing that practice. There are definitely places where a highly trained doctor is necessary but at the same time there are other places where they are overkill. I think a nice balance between the two is needed.

Quote from Dr. J : so we're adding more people to the healthcare rolls while at the same time decreasing incentives to become a Dr. and/or remain in the profession.

Let me just say, Medicare was near it's end, they needed to start cutting costs. The problem is they kept cutting reimbursements and every year congress would cut an additional bill to keep them the same. The system is broken and has been, it needs to change.

Instead of leading the charge for meaningful reform that would increase incentives for doctors and result in cost savings that could make the program last. The healthcare industry has done nothing to help itself, they just keep lobbying and whining for more "exclusivity", less intervention, more tax payer money and screwing anyone they can. Healthcare in this country is broken, either help with the solution or GTFO.

Heck if enough doctors quit, maybe that will be enough incentive to open up more visa's and then the healthcare industry gets to see what's its like to have their job outsourced like more of this country has.

FYI This is the same stance I take with california unions (and a bunch of other ones), you know the system is broken, by whining and ignoring the problem you take yourself out of being part of the solution, and it sucks when you lose your pension later.

Quote from 808Lurker : Let me just say, Medicare was near it's end, they needed to start cutting costs. The problem is they kept cutting reimbursements and every year congress would cut an additional bill to keep them the same. The system is broken and has been, it needs to change. Instead of leading the charge for meaningful reform that would increase incentives for doctors and result in cost savings that could make the program last. The healthcare industry has done nothing to help itself, they just keep lobbying and whining for more "exclusivity", less intervention, more tax payer money and screwing anyone they can. Healthcare in this country is broken, either help with the solution or GTFO. Heck if enough doctors quit, maybe that will be enough incentive to open up more visa's and then the healthcare industry gets to see what's its like to have their job outsourced like more of this country has. FYI This is the same stance I take with california unions (and a bunch of other ones), you know the system is broken, by whining and ignoring the problem you take yourself out of being part of the solution, and it sucks when you lose your pension later.

I understand you are frustrated with the system but you seem to be railing against physician income only. as if that is the only (or maybe biggest?) problem. if this is what you think I am afraid you missing so many other ways to achieve meaningful reform. the problem list is long and part of the problem (as usual) is the gov itself. look above... see how medicare is throwing money down the drain.... and its not doctors that are cashing in, it is hospitals and hospital admins. but keep railing on docs....

Quote from LivninSC : So does this mean they can't take Wednesdays off every week to golf anymore? One big change I have noticed in the last 30 years is that when I was a kid I always went to the Dr's and saw the Dr. He/She would take my blood pressure, my heart rate, make me stick my tongue out and say "ahhhhhhh", etc.. These days all that stuff is handled by a nurse (of some sort) and then the Dr. comes in. Heck, even some times I don't even see a Dr. and are prescribed medications. On one hand I can see why meeting with a Dr. is better but I would say that 90% of the time I go to the doctor it's for some simple reason that someone with considerably less training can handle. You don't need to go to school for 8 years for example to tell me that I have the friggin flu that everyone else has. Personally, I'm for continuing that practice. There are definitely places where a highly trained doctor is necessary but at the same time there are other places where they are overkill. I think a nice balance between the two is needed.

what your asking for is reasonable except that this is what nurse practitioners have been doing for years. fast forward to NOW where NPs no longer want to work "under" doctors. they want to be seen as "equals" despite years less of training... in addition, they want EQUAL PAY. so, the days of seeing a "midlevel" provider are dwindling quickly as NP fight for equal pay and no supervision. They are even going to call themselves DOCTORS!!!!! lol.

(I know that somebody is going t come along any moment and call me a liar. please, before you do this, do some research.)