Physicians

PHYSICIANS: Barry Bonds and the AMA’s still got management where they want them

Dilbertlie
The irony is quite staggering. On the same day that Barry Bonds gets the San Francisco Giants to bid against themselves–appalling the local baseball columnists–and give him $16m for one season in his tarnished chase of Hank Aaron, the Congress after a lot of high falooting talk, cancels the fee cut for Medicare Part B and gives a tiny P4P boost. Obviously like Bonds and the Giants management, the AMA still has Congress where it wants it — even though Bond’s numbers for the last two years have not exactly been worth $6m a year let alone $16m, and the cost to Medicare of Part B physician services has gone up despite previous fee cuts, while all the wonks agree that access to physicians for Medicare patients is not a problem (or at least not one affected by across the board fee increases or decreases).

Still let’s not look to baseball teams or Congress for rational decisions, especially with other people’s money. And I won’t even comment on the potential abolition of the limit to which people can put tax-free money in HSAs, other than to note that as they can be used for any spending after age 65 Congress may have just created the biggest tax avoidance scheme of all time!

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NishaTom LeithMedical TourismTheLastPsychiatristjd Recent comment authors
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Nisha
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Womenbrands is a free service on women issues and interest. We provide help and information on various issues related with women and thier problems i.e Fashion, dating, relationship, divorce, breat cancer, beauty etc.

jd
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jd

Tom,
Good points. I had neglected to consider that Matt might be talking about the share of physician fees rather than the share of total medical expenditures. If that’s what he meant, then he’s much closer to right, though the average is somewhere around half of what he proposed. 15% might be right for Ob/gyn.
Even granting 15% of physician fees, that translates into at most 5% of total medical expenditures. 7% of physician fees translates into around 2% of total expenditures.

Tom Leith
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Tom Leith

> that’s the number i’ve heard
> before from a couple doctors.
Well, not all doctors are equally well-informed about the business aspects of medicine. MedMal premiums vary by specialty. Surgeons pay more. If the couple doctors you heard from were obgyns especially in a “litigationally-risky” area like East St. Louis they might pay 15% of their total billing in MedMal premiums. But MedMal premiums don’t come close to 15% of the sum of doctors’ gross incomes, much less 15% of total medical spending.

Matt S.
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Matt S.

Perhaps I was not clear enough in my first post. I said: “Feel free to comment if you don’t agree.” i’m not fighting you here, jd.
i said i wasn’t talking about causes. excellent. you don’t agree. that’s the number i’ve heard before from a couple doctors. you think it’s wrong and controversial. gotcha.

jd
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jd

Matt, Our claims about facts do not agree, that’s why I assumed you must be talking about causes when claiming 15% contribution from malpractice. In fact the total for all malpractice awards and premiums is less than 2% of all healthcare dollars. It is not 15%. There simply are no facts to support your claim for 15%. When people do make claims for 15% contribution from malpractice, what they mean is that some portion of the costs for other segments (drugs, hospital, physician fees) is generated by defensive medicine. This is a causal claim. It is also highly suspect, however.… Read more »

Matt S.
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Matt S.

JD, i’m looking at overall money by sector for all the categories i listed from the _coverage_ perspective only. i.e., where i think reimbursement dollars are spent by payers. i separated out malpractice only because it was topical. had i omitted it, all of that money would have rolled up into the doc bucket, because it’s all one pie – where reimbursement dollars are spent – so the percents can be added. my apologies..should have been more specific. the causes aren’t at issue – there’s little i can do about whether it’s flu season or not. i just want to… Read more »

jd
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jd

Matt S., You didn’t address my main point: it is not appropriate to compare estimates of the share of total cost that measure where the dollars go with those that try to identify the causes directing the money into the various components. Is that distinction clear? There are so vastly many different causes (medical causes, economic causes, social causes) that these estimates will sum to a number far higher than 100%. So talking about percent contributions of causes, though widely done, is quite misleading unless you are very careful about exactly what you are claiming in terms of counterfactuals and… Read more »

Matt S.
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Matt S.

Thanks for the feedback jd. Where do you get your figures? I think if you take my malpractice number (which does take into account the defensive medicine portion) and re-allocate it to the doc group, we’re very close…which is pretty great, actually!
Gwest: I think your argument is a separate issue, and your India argument is, well, um, yeah. I completely disagree. But the outsourcing thing is a highly controversial, off-topic aside, so I’m not touching that.
thanks for the props, pgbMD!
as for Mr. Holt, he’s pretty much spot-on.
licensure studies, anyone?
http://healthcare-economist.com/category
/supply-of-medical-services/licensure/

Medical Tourism
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Medical Tourism

spam comments are automatically deleted, moron …
– J

TheLastPsychiatrist
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I actually wrote about this back in April. I know it says “Healthcare Savings” Account, but that’s just packaging. HSAs are really IRAs. The logic is that most medical expenses occur in later life; and whether you save money in an IRA or an HSA, when you turn 65 and need it, the doctor isn’t going to care which account it came from, so why should you? Let me respond to Gadfly, who certainly voices the criticism of many others: I full acknowledge this does almost nothing to solve the problem of expensive healthcare and an aging population. However, I… Read more »

jd
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jd

Matt S., Your percents are a bit off. Hospital expenses are now about 45% Physician expenses are now about 30% Drug costs are now 12-15% (the higher number includes over the counter) Medical equipment costs are 5-10%. Malpractice premiums/claims are only about 1%! Some analyses claim that defensive medicine triggered by malpractice fears generates up to 15% of expenses, but this kind of charge is about causes of expenses, not where they go. Only 1% of the medical dollar goes to pay malpractice premiums/claims. When you start talking about underlying causes, it is kind of b.s. to talk about percent… Read more »

Gadfly
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Thank you for keeping your eye on the tax shelter ball. That’s all we need – more gazillionaires avoiding taxes as if the gap between the top one percent everyone else weren’t already excruciating.

pgbMD
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pgbMD

“the big, 400lb gorilla in the room is the hospital.”
“physicians, focus on the hospital. find a way to move business out of the hospital”
excellent. medicare and the insurers already know this. patients like it and much of the care is moving away from the hospitals (ie IMRT, etc, etc).

Gwest
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Gwest

My only comment to the posting from Matt S. is that almost every other profession in the US makes more than their counterparts in other countries. Look at the highly skilled, highly educated workers in India that are taking our jobs because they make barely minimum wage. I think you have unfairly singled physicians out as a profession here. I know the AMA is not 100% behind P4P, but many physicians and healthcare leaders feel it is the right way to go. Lets pay the providers with proven better results and quality outcomes and not reward the marginal providers for… Read more »

Matthew Holt
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It may of course be that Scott R has moved the market and faced down Congress on his own…. 🙂 My point is not that doctors should be forced into begging in the street. And in no way is the current system of physican payment (or any of Medicare’s payment schemes) defensible. No one is going to pretend either that the other players on the Part A and Part D side are in any way not milking it and probably are doing so more than the physicians. However, the facts are that physician costs as a component of Part B… Read more »