Category: Physicians

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.

Doctors Push Back on Release of Data

doctor-xray-2Doctors reacted swiftly and indignantly to Wednesday’s release of government records revealing unprecedented details about Medicare payments to physicians…The top 10 doctors alone received a combined $121.4 million for Medicare Part B payments in 2012…In interviews, many of the doctors said they were just passing through the payment to drug companies. Some said they were unfairly singled out even though they were billing for an entire practice. And still others disputed the accuracy of Medicare data. (Washington Post)

What Happens After Surgeons Take a Break?

We find that a surgeon’s additional day away from the operating room raised patients’ inpatient mortality risk by up to 0.067 percentage points (2.4% relative effect) but reduced total hospitalization costs by up to 0.59 percentage points…Our findings are consistent with the hypothesis that after returning from temporal breaks surgeons may be less likely to recognize and address life-threatening complications, in turn reducing resource use. (NBER Working Paper)

How We Handle Bad Doctors

Adoctor-bribe-convicted colleague called [Christopher Duntsch] a sociopath and a “clear and present danger” to patients.  Another doctor compared him to a serial killer…

While at Baylor Plano, Duntsch was accused of maiming several patients and causing the death of another. One patient — his roommate and closest friend — claimed that Duntsch operated on him after a night of using cocaine, which Duntsch denied. The roommate emerged from the surgery a quadriplegic.

Yet when Duntsch departed Baylor Plano in 2012, the hospital stated that his record was officially clean. (Dallas Morning News)

Update on Doctor Pay Fix

  • CBO says a fix will cost $153 billion over the next ten years.
  • Rs and Ds have agreed on a fix, but they haven’t found a way to pay for it.
  • But if they don’t do something doctors are about to get a double digit pay cut under Medicare.
  • Under the deal, 9% of doctor fees will be based on conformance to quality indicators by 2021. But since we know that P4P doesn’t work, it’s not clear why they are going through the motions.

The plan. Sarah Kliff commentary.