Category: Physicians

Where are the “Open Payments” from Government?

doctor-xray-2Well, now we know how much pharmaceutical companies and medical-device makers pay doctors for consulting and similar services. Paul Keckley aptly summarizes last week’s data dump from the Centers for Medicare & Medicare Services (CMS):

  • In the last five months of 2013, drug manufacturers made 4.4 million payments totaling $3.5B to 546,000 physicians and 1,360 teaching hospitals to encourage acceptance and use of their drugs/devices: $1.49B for research, $1.02B for ownership interests, $380M for speaking/consulting fees, $302M for royalties/licensing, $93M for meals, $74M for travel, and $128M for “other.”

Half of Doctors Give Obamacare D or F

Confident DoctorsThe Physicians Foundation and Merritt Hawkins (a physician recruiting firm) have just published their biennial physicians’ survey. The survey interviews over twenty thousand physicians in all fifty states and multiple specialties:

  • Only 19 percent say they have time to see more patients.
  • 44 percent plan to take steps to reduce services or find non-clinical employment.
  • Only 35 percent describe themselves as “independent practice owners,” down from 62 percent in 2008.
  • 53 percent describe themselves as hospital or medical-group employees, up from 38 percent in 2008.

Physicians’ Political Contributions Switched from Republican to Democrat in Twenty Years

One of the most interesting things about health politics and policy is that those mostly responsible for driving health costs — physicians — are the least concentrated interest group. If we want to know what the research-based pharmaceutical industry, the generic drug industry, the health insurers, the hospitals, or the medical-device makers want, we know where to go to find a fairly unified answer.

Physicians have no unified voice. The closest thing to a professional association for all physicians should be the American Medical Association, but it is not. It is a business that profits from a government-sanctioned monopoly on billing codes.

Paying Doctors for Performance Does Not Work

Aaron Caroll, in the New York Times:

doctor-xray-2“Pay for performance” is one of those slogans that seem to upset no one. To most people it’s a no-brainer that we should pay for quality and not quantity.

In Britain, a program was begun over a decade ago that would pay general practitioners up to 25 percent of their income in bonuses if they met certain benchmarks in the management of chronic diseases. The program made no difference at all in physician practice or patient outcomes, and this was with a much larger financial incentive than most programs in the United States offer.

Who’s Your Doctor?

Over at Forbes, Bruce Japsen reports that the Affordable Care Act is boosting demand for primary care providers. As we’ve said before, Obamacare does nothing to boost physician supply. The millions of newly insured will increase their demand for medical care — and someone has to provide it. This has caused a Gold Rush of sorts among medical practices and hospitals scrambling for primary care providers.

Physician staffing firm, MerrittHawkins reports primary care providers — family physicians and internists tops the list. The number of requests for nurse practitioners and physicians’ assistants it’s been ask to recruits is up more than three times (i.e. 320 %). Advance practice nurses and physicians’ assistants didn’t even make the top 20 of most recruited medical practitioners three years ago. Here’s the current list.

In many cases, increased use of nurse practitioners and physician assistants can provide high quality care at reduced costs. I have long advocated increasing these professionals’ scope of practice as an important part of innovation in delivering medical care. On the other hand, this should happen as a consequence of increased consumer-direction of healthcare spending, not as a response to increased government control, as imposed by Obamacare.

More Reasons Why Doctors Do Not Participate in Medicaid

doctor-xray-2This blog has many entries discussing how few doctors participate in Medicaid, the joint state-federal healthcare program for low-income people that ObamaCare expands. One reason is that fees are too low to induce doctors to participate. But even if doctors are willing to accept low fees, they find that Medicaid is the worst payer in their practices:

  • Medicaid programs have the highest number of days to collect payment (days accounts receivable): All payer average = 26 days; Medicaid average = 44 days.
  • Medicaid programs have the highest denial rate: All Payer average = 6.8%; Medicaid average = 18.5%.
  • Medicaid programs have the lowest transparency in electronic explanation of payment and adjudication of claims (electronic remittance advice): All Payer average = 95%, Medicaid average = 89.4%.

Primary-Care Physicians Earn Only 20 Percent of What They Charge

If $180,000.00 is 20% of the total reimbursement, then a PCP brings in $900,000.00 a year. Therein lays the misconception that doctors are overpaid, but remember: the doctor does not pocket that total. At a patient load of 7,200 patients that is $125.00 for a 15 minute appointment. This is great pay. But remember also that 80% of that total goes to pay the staff salaries and benefits, rent, utilities, as well as such government mandated programs like Electronic Medical Records and all other costs needed to keep a business running. (The InsureBlog)

Are Doctors Really Better Than Nurses?

Confident DoctorsSimply put: the preponderance of empirical evidence indicates that, compared to physicians, NPs provide as good — if not better — quality of care. As I’ve written previously, patients are often more satisfied with NP care — and sometimes even prefer it.

The Institute of Medicine is unambiguously clear about this:

No studies suggest that APRNs [Advanced Practice Registered Nurse] are less able than physicians to deliver care that is safe, effective, and efficient or that care is better in states with more restrictive scope of practice regulations for APRNs.

More.

How Doctors Get Paid

One doctor reports:

Confident DoctorsI can freeze a couple of warts in less than a minute and send a bill to a patient’s commercial insurance for much more money than for a fifteen minute visit to change their blood pressure medication.

I can see a Medicaid or Medicare patient for five minutes or forty-five, and up until now, because I work for a Federally Qualified Health Center, the payment we actually receive is the same.

I can chat briefly with a patient who comes in for a dressing change done by my nurse, quickly make sure the wound and the dressing look okay and charge for an office visit. But I cannot bill anything for spending a half hour on the phone with a distraught patient who just developed terrible side effects from his new medication and whose X-ray results suggest he needs more testing…

Most people are aware these days that procedures are reimbursed at a higher rate than “cognitive work”, but many patients are shocked to hear that doctors essentially cannot bill for any work that isn’t done face to face with a patient. This fact, not technophobia, is probably the biggest reason why doctors and patients aren’t emailing, for example.

 

How Well Do We Match Medical Student’s with Residencies?

Amy Ho at Forbes writes:

StethoscopeThis year, 5.6% of US allopathic (MD) seniors did not match, and 22.3% of U.S. osteopathic (DO) seniors did not match. On the whole, 25.0% of applicants in the NRMP Match did not match — with a 25% unemployment rate, how successful is the Match, really?

This system is highly wasteful. It incurs massive costs for hospitals and students through the interview process, precludes contract negotiations that could optimize value for both parties and results in depressed wages for young physicians. Additionally, it incurs significant opportunity cost in trading interviews for educational senior year curricula, causes undue duress for applicants and their families and contributes to decreased quality of care in physicians unsatisfied with results of the Match.

Full piece worth reading.