dagblog - Comments for "Patients’ Costs Skyrocket; Specialists’ Incomes Soar"

Yes, sorry, I plead the flu.

Peter Schwartz — Tue, 21 Jan 2014 17:54:41 +0000

Yes, sorry, I plead the flu.

P.S. From Brookings

artappraiser — Tue, 21 Jan 2014 09:52:24 +0000

P.S. From Brookings Institution, January 14, 2014, "Medicare Physician Payment Reform: Will 2014 Be the Fix for SGR?" Congress has shown some will and plans to start working on reforming the system this year, transitioning to "alternative payment models" not related to volume or intensity. To receive full payment in the alternative payment arrangement, physicians would have to meet meaningful measures of quality of care. But the devil is in the details, which haven't really been straightened out. And whether they will actually do any of it or backtrack on a lot of it when difficulties arise (or certain lobbies scream bloody murder) remains in question.

BTW, there's more on other possible Congressional changes to Medicare by March 31 @ The National Journal:

Congress Braves First Steps in Medicare Reform
Seniors beware: Congress is considering changes to what Medicare will pay for, and what's coming out of your pocket.
By Clara Ritger, Jan. 20, 2014

If the quoted text is not

artappraiser — Tue, 21 Jan 2014 06:31:40 +0000

In reply to Why is Medicare "the heart of

If the quoted text is not self-explanatory as to that, I really don't know how to help you understand it. To sum it up, but it's really all there: The Medicare panel as described sets the prices paid by Medicare which everyone else in our system uses to bargain, and the Medicare panel values procedures by specialists relatively high and time spent by primary care practioniers relatively low.

That there is a power fight involved when these decisions are made for Medicare just makes it clearer how important they are, how they just don't affect the Medicare market but the entire health care system.

They are the source of the standard where these kind of procedures are highly paid and profitable and primary care time not highly paid and not just an unprofitable use of a doctor's time, but even in some cases a losing proposition.

Further in the article and elsewhere you can read of lobbying of Congress for this kind of result (within Medicare, because it sets the standards) as well for the same reasons.

Edit to add: this article is not at all about insurers lowballing payment of doctors as a whole, it is about Medicare encouraging certain treatments and discouraging others by doctors, by virtue of what it is paying for what, way high in some cases, especially for the time involved, way low in others.

Why is Medicare "the heart of

Peter Schwartz — Sun, 19 Jan 2014 23:41:48 +0000

In reply to Medicare's approach with

Why is Medicare "the heart of the problem"?

Private insurers should have an incentive to pay doctors as little as they can?

And my insurer isn't (yet) competing with Medicare for my business?

Medicare's approach with

artappraiser — Sun, 19 Jan 2014 05:02:25 +0000

In reply to Patients’ Costs Skyrocket; Specialists’ Incomes Soar

Medicare's approach with payment preference for procedures over time with patients is at the heart of the problem:

Medicare’s valuation of physicians’ services is based on a complex algorithm that is intended to take into account the time and skill required to perform a medical task, with an adjustment made for a specialty’s malpractice rates. Many insurers follow Medicare’s lead, often paying anywhere from 80 percent to 200 percent of the Medicare fee. But “time and skill” are easier to quantify for procedures than continuing patient management. And, experts say, Medicare has not reduced payments for many procedures that now take far less time than when they were invented, because of improvements in efficiency or technology.

But renegotiating payments involves a highly contentious process that plays out behind closed doors at the American Medical Association’s Relative Value Scale Update Committee, which consists of doctors representing 26 medical disciplines who advise Medicare. In dermatology trade journals, Dr. Coldiron, who has served on the committee, describes it like this: “Everybody sits around a table and tries to strip money away from another specialty.” It’s like “26 sharks in a tank with nothing to eat but each other.”

Primary care doctors — who make up only 12 percent of physicians in practice — say they have little clout, with at most five representatives on the panel. “That committee keeps the perverse incentives in place,” said Brian Crownover, a family physician from Boise, Idaho [.....]

Critics say the robust revenues from doing procedures has led to overuse —[....]

But in some cases dollars from procedures keep practices afloat, because insurers pay so little for time with patients [....]