Last edited Sat Aug 16, 2014, 05:36 PM - Edit history (1)

they aren't much different from insurance companies. Part of our problem here is that providers are greedy too. They have worked against payment reform so that if they do more tests, more diagnostic procedures, etc., they make a lot more money (and we pay more in coverage, rather through insurance premiums or taxes).

They are only part of problem-- vendors, administrative people, insurers, and everyone else have their greedy hands in the health system. Even patients aren't always willing to compromise for the system'a good. They do in Canada.

When you get your paycheck, do you settle for 30% of what you are owed? Do you spend X amount of time for each paycheck detailing in triplicate what service you provided for your boss? Or maybe hire someone to do your paycheck billing for you?

And do you pay job malpractice insurance?

Healthcare providers deserve to be paid, same as everyone else.

We could have had a system by which it would be Single Payer Universal HC for all, without the Big Insurers skimming the doctors' wages away from them.

I really fail to see how you can miss the gist of the article - the Big Insurers all get their protection monies, while the doctors are being stiffed.

That is a relatively small cost of doing business and making up for the fact that some docs should not be in practice, and in most places you can practice without it, if you are stupid enough.

As to billing in triplicate, if they invest in decent billing staff that knows how to code claims and learn what "medical necessity" means, that won't happen. If you know someone that has to file in triplicate, I'll show you how to get paid the first time. It's not that hard, unless you are just slapping a bunch of codes on a claim, providing questionable services, etc.

Most of the plans today pay at or above Medicare, and a decent primary care doctor can easily make $150,000 - 200,000 without having to take call, etc. And many make considerably more. Specialists make even more. Today, most docs can sell their practice to hospitals and no run the risk of running a medical practice.

Cut the insurers out, and a doc might get paid 10% more per service. More likely, without any checks on what they do, docs will run unnecessary tests, perform unnecessary procedures, etc. Cost will go up.

I'm all for single payer, but docs will get Medicare rates at best, probably less. They can do that now.

The only "poor" doctors I've me, choose to be (working part-time, selflessly provide free services, are crazy, exhibit low-quality care, etc.) or have other issues.

With all that said, I think Medicare rates are a good benchmark for fair reimbursement. I doubt Canada pays more. Problem is, a lot of docs want to have expensive cars, two or three homes, make enough in one year to retire, etc. They should be well paid. But most are in the top 1% - 5% of income, and most are Republicans.

And they don't get Medicare rates when a high deductible is involved and the patient doesn't pay up
Insurance zero patient zero
Hard to repo an echo or X-ray

Plus, Medicare's Part B deductible is not that much.

Echos cost very little to run, and are over-utilized nowadays. They get paid if run for the proper reason. Heck, under Medicare you get paid when you file a claim, even if you didn't do one (although, you might get caught in a post-payment review for fraud).

Average salary of hospital employed OBGYNafter malpractice and other expenses, is $270,000. Hospital employed OBGYNs have coverage, little risk, hospital staff to run the administrative aspects of practice (which can be a headache if you are too cheap to hire trained staff), etc. Complaints aren't really justified.

Now if a doc wants to run his own practice, life can be a little tougher. But that is his/her choice. They still do well, and really shouldn't complain and lie by saying they are going to move to Canada where the will get paid more.

Like $250,000 or more in debt to become a doctor with a specialty. That's a lot to pay off when your earnings are so low due to insurance thievery.

Let's assume that is too much for them. Most docs will start out at least in the $150,000 - $200,000 range (they'll make a salary more than most DUers during residency).

Let's say it's $150,000, or $100,000 after taxes. I think they could easily pay $25 - $35,000 per year toward their debt and still have a nice lifestyle. Of course, within a few years, their income will go up and they can pay more.

Here's some facts on student loans:

https://www.aamc.org/download/152968/data/debtfactcard.pdf
https://www.aamc.org/advocacy/meded/79048/student_loan_repayment.html


Here's some info on salaries, debunking the Canada pays better:
http://www.motherjones.com/kevin-drum/2013/02/charts-day-doctor-pay-america-and-other-countries


Again, I think physicians should be paid very well, and they are. But, it is not as bleak as some would have us believe. I think most people would invest $200,000 or so for annual earnings of $150,000 - $350,000 per year. The smart ones will discharge their loans by public service. The others, don't really have a lot of room to complain.

Is about how the money that the patients are owing is already collected by the damn insurers. It is not as though gypping the physicians will result in some sort of savings for the public.

In attacking doctors, you are supporting the Big Insurers.

Your stance on this seems a bit delusional. Period.

How can you attack doctors for their greed, when they have to cope with a system, as Ilsa details, that insists on a huge recapture of their earnings on account of student loans? Why are you not attacking the damn BANKERS, who ar impoverishing students across the country. of course, the bankers own Congress, so hopes of getting anything to help withthe student laon situation is nigh impossible.

Secondly there is extremely high malpractice insurance many doctors have to shell out.

Personally, I was a home health aide for close to 20 years.. Way back in the early and mid-1990's, many decent doctors were shutting out new patients as they were not getting re-imbursed properly through MediCare.

Now we have a new law on the Book, the ACA, and it will short change doctors, as there are few if any provisions that help wrest the monies the Big Insurers receive and have that go over to the doctors who have earned it.

the docs you know.

Under ACA, insurance companies must pay out 80% of the premiums they take in. Of that 20%, they have to pay for claims processing, credentialing providers, coordinating care, the risk of taking on a sick population, etc.

So, at best, there is another 10% or so that could go to paying providers, expect without claims processing that focuses on medical necessity, fraud, etc., that would all be eaten up by unscrupulous providers overutilizing services that put another nickel in their pocket.

Other than that, I don't think you understand insurance reimbursement, so I won't waste time trying to explain it to you.

Nor do you understand that someone making $200,000 per year has very little room to gripe when people are suffering.

decisions of where to work, along with career opportunities from working the rural vs city "beat".

One friend of the family went the Army route to get his MD. It's a good fit for him. Another carries a load of debt, and his spouse is an engineer at a large firm. They want to live together and not have their work split too far. But they'd never leave the US.

On edit: an accountant friend was telling me that his dr friends that are family, general, and pediatricians, really aren't "hauling it in". They have a decent salary and hope for a good bonus at year end, but that doesn't always materialize. The ones who have pretty good living standards have spouses pulling in good salaries. But this is anecdotal information.

Heck, go work in an inner-city area to discharge debt and live in the suburbs.

Pediatricians do get the short in of the stick. But, then, most see almost nothing but sore throats and runny noses for $125,000 per years. If patient is really ill, they are sent directly to a specialist. They should do better, however.

Plus, let's talk about the medical societies that docs use to lobby to limit the number of doctors that are trained each year, limit what physician assistants and nurse practitioners can do, etc. Heck, if they stopped protecting their turf, we'd be a lot better off.

...certainly do not see "nothing but" runny noses and sore throats. Far from it. The scope of pediatric care covers birth thru college. On a daily basis we may walk into an exam room and be expected by parents and patients to be able to answer questions about dermatology, neurology, nutrition, orthopedics, allergy/immunology/asthma, sleep problems, infectious diseases, cardiology, gynecology, behavior/psychology - all in the same day.

There are days I yearn for "just" an ear infection or strep throat case.

My main point is peds do have room to complain, especially if they are treating a lot of Medicaid patients. But, they also choose that specialty. Glad they do. Bet you aren't contemplating moving to Canada.

...were to win the White House, I could be seriously tempted to head north if they would have me.

...in our practice. I work with 9 docs, most of whom are fellow liberals as best I can tell. Some I know are, for sure. I wouldn't dream of asking those I'm not sure about. One has a great picture of her and her husband taken with President Obama - she has a grin a mile wide on her face.

vein. You are lucky.

The engineer has her own student loan debt to repay, also. Yes, they are still much better off than most. But I can understand why he would want the extra education, work, residency, etc to "pay off". Especially if a Computer Science degree and a job with Google, sooner, was comparable in pay.

Health care, paying for it, careers in it, etc, are all still a complicated mess, apparently.

Instead we got a system that guarantees Big Insurers their protection monies, and those insurers, just like Obama's buddies on Wall Street, face few penalties no matter what they do.

Meanwhile numerous requirements are in place that to be part of the ACA a person has to report continually to the government on such things as whether they are or aren't pregnant, whether that pregnancy ended through abortion, miscarriage, still birth or a child, etc. (I hope we don't come to find out that those personal records are reported to the anti-abortion crowd.)

The onus in Obamacare is to the individual, not to the Big Insurance Corporation.

Already, people in Marin County Calif are finding out that although they signed up to be covered by Big Insurer "Anthem," that they were "tricked" by Anthem into what their coverage would be about. Specifically they were fooled regarding which physicians were part of the "Anthem" program.

The photos of doctors displayed on the Anthem California Covered web page depicted actual doctors that Marinites know and like.

Only it turns out that NONE of the those doctors actually are part of that program. They didn't like or trust Anthem, and they also did not provide their photos to Anthem. I would call that fraud on the part of "Anthem" plain and simple. So is the Obama administration going to go after Anthem? Will state regulators in California go after them? (If John Garamendi (D) was still the state Insurance Commissioner, these Anthem folks would be in trouble big time, but he is now in Congress.)

We had "reform" in 2009, but it wasn't really reform. It was simply an insistence that the public be forced to pay protection monies to big insurers.

Same reason so few treat Medicaid patients. They can do better seeing other patients and many don't want poor people in their waiting room. As one told me one time when I suggested he might supplement his income by taking Medicaid, "heck, if I do that, they'll flood my office." Well, yes doc, they would and you'd make more money, which is what you said you wanted to do. So get over your hatred of poor folks.

I'm sorry, I still say there is a lot of provider greed in the system to go along with insurance company greed, and unreasonable expectation of some patients under the system that is forced upon us by the right wing mentality on such things.

looked into moving to Canada and New Zealand. Canada wouldn't take us--
since he was in his 50's and they didn't want us so close to retirement--
and New Zealand had just started the process of privatizing their
previously single payer system, so we passed on that option.

We ended up staying in the US. I sure wish Canada had wanted us at the time.

period when I first started having a headache whenever I had to help an elderly person find a doctor wh would accept MediCare. Before that time, doctors who accepted MediCare were plentiful as Congress had not yet chopped payments down.


Also, malpractice fees were going through the roof. And also, regular insurers were refusing to offer the most basic coverage for life threatening situations, so decent doctors were becoming upset by how they were hamstrung in treating their patients.

I remember one radio broadcast on KPFA about a young boy, fully insured, who
needed a $ 10,000 treatment to save his leg. But the Big Insurer found some loophole to avoid paying for saving the leg. (He might have kept the leg, but it would never work right without that treatment, and the treatment had to be offered then, not down the line.)

-Laelth

Most care providers in Canada outside of large provincially operated hospitals are private practices, it's just that those private practices and clinics bill the province for the services. But most Canadians also have supplementary medical benefits that cover things the provincial systems don't.

She said she came to Canada because she just didn't have the skill or energy to run the business side of her practice or the stomach for debt collection. Debts that were either too small to bother or so large that the patient was already well on the road to a medical bankruptcy.

ok so 1 or 2 did not pay their $120 bill if the were self pay or they didn't pay their 20% copay before.

But now with the high deductibles so many are really self pay until they satisfy their high deductibles
Now many do not pay their bills at all and the insurance processes the whole amount as patient deductible so no pay at all from a larger quantity of patients .
Oh the doctor has enough money is the meme and collection is hard on amounts under 1500 to offer payment plans through a third party
. Never mind staff supplies and rent it should be free anyway and I never thought I would use that high deductible insurance anyway I think is the reasoning for not paying and these are not low income folks who qualify for Medicaid
But they have to realize that too many now have the same attitude and crummy insurance for the doctor to absorb them all
That is why single payer Canada looks good. to them -the guarantee of some pay for services provided and they do not need an entire med educated staff to deal with insurance companies and non payers

Also this is pushing out independent doctors into hospital networks so might as well go into a single payer like Canada because the hospital networks are a bigger burn and their emphasis is on cost more than patient IMO

But they still think they are better off financially with the current system than having to take rates somewhere between Medicare and Medicaid.

I know some physicians support single- payer, but most do not.

Not network hospital pay so the doctors there are for the Canadian payment and individual practice with more input on care planning.
When as now most doctors are being forced out of private practice in the U S . , I wonder where 2nd possible differing opinions will ever come from esp. if they are all on the same or similar hospital rolls, where there are strict flows to adhere to regarding care, and the time they can spend with a patient is all bean counting


University med school hospitals maybe will remain an independent force in that regard?
Getting more corporate on both ends with the patient in the middle here in the USA .
I agree plenty got access with ACA but a Canadian plan would have worked better IMO.
Some doctors like politicians do go into it for one rea$on only. Most I have met do not and they do not have a lot of business experience , so they lose out when cost cutting /profit is not their bottom line and instead their priority is patient care and the payments start dropping like the article states.

Hospital doctor networks of course are more business focused than private practices in general
There are money fraud disasters in all fields and should be in check as this administration has made progress in that respect with Medicare .

So the government helps subsidize the high insurance premiums for people in the lower end of things.

But that family still might have to come up with a $ 5,000 deductible, and that deductible is not per family but for each individual.

Then to make matters much worse, if your doctor asks you to have some blood work, they may or may not send the test to a lab that is on your insurance network. And should the lab not be part of your insurer's network, not only do you pay that item, the cost of the item does not even count to your deductible!?!

May have to do a little checking on your own, of course if it is an emergency you may get stuck with the bill

But yeah it is the high deductibles creating non payers that appear to have insurance but really do not until they come up with5000$ over the premium payments and they did not expect chronic problems when they signed up.
Also insurance companies are really trying a multi of tactics not to pay, or pay less and less for less and less services so the combo platter of no pay is why doctors are looking north
With Canada it is not the westher !!

"Crime" of leaving the country, as they liked to visit friends and family, they did not move back to the USA.

but considered an acceptable consequence by the proponents.

migration to the new bread belt.

I was just lying on the couch thinking about Canada!

under single payer, there's no particular incentive to overbill. medicare or the canadian equivalent just pays the approved rate. there's no real chance of lucking out and getting more.

under america's wonderful partially uninsured construct (both before and after aca, though lessened under aca), it's open season on the uninsured, so providers are free to charge essentially whatever they feel like charging.

a few uninsured people actually can afford to pay the exorbitant charges (or get their parents to pay for it, as some of the uninsured are otherwise healthy 20-somethings who simply don't believe they'll need insurance) so hey, why not charge a whole bunch? most of the rest will not be able to pay so they'll bargain for something less, which the providers will often take once they're convinced you don't actually have the money.

in short, it costs providers nothing to try when they're dealing with the uninsured. the aca reduces the uninsured population, and therefore somewhat reduces this problem. however, providers still have no real incentive not to massively overcharge.

He was glad to get the $500, but still charged 50k for a 3 minute procedure, of doubtful efficacy. It is a greedy game.

He's going with three levels of service. Lowest is 1,800.00 a year, prepaid. For this you get all the coverage that he offers in that price bracket. Coverage does not include any specialist that is needed. He does have an in house lab.

Seems high to me but I can't get Obamacare. I'm a UAW retiree. The UAW pays for our medical and it sucks.

I smell hit piece.