Primary care still waiting on ACA Medicaid pay raise – amednews.com

If the states manage to screw this up, and prevent pay improvement for primary care, it could jeopardize the success of the ACA…

Washington Primary care physicians who qualify for higher Medicaid payments under the Affordable Care Act might not see these rate increases as quickly as anticipated this year.

The Medicaid program has had a long-standing reputation for paying doctors at rates far below what Medicare pays for the same services. The ACA aimed to address this problem by directing states to bump rates for primary care services provided by primary care doctors up to 100% of Medicare rates for calendar years 2013 and 2014. Because the final rule on the provision was issued in late 2012 with an effective date of Jan. 1, many family doctors were hoping to see an immediate boost in their claims payments. However, “there could be a lag of several months even from now” for the enhanced Medicaid rates to take effect, said Jeffrey Cain, MD, president of the American Academy of Family Physicians.

Some physician organizations are concerned that states are missing the opportunity to prop up primary care because they aren’t moving quickly enough to pay these higher fees.

Several administrative steps are needed first at the state and federal levels, said Neil Kirschner, senior associate of regulatory and insurer affairs for the American College of Physicians. States have until March 31 to modify their Medicaid plans accordingly and submit those changes to the federal government, which then has an additional 90 days to approve the plans. “It’s unclear how many states have done that,” he said.

In recent letters to the National Governors Assn. and the National Assn. of Medicaid Directors, the American Medical Association and other organizations representing primary care doctors called on states to enact the pay bump expeditiously and engage in active communication with physicians to notify them about the timing of the pay increase.

With the ACA provision in effect for only two years, any implementation delays will make it harder for the government to collect data to see if patient access is improving by raising Medicaid payments, Kirschner said. The longer states take, the longer physicians must wait for these enhanced payments, which could affect decisions whether to take new Medicaid patients, he said.

Primary care still waiting on ACA Medicaid pay raise – amednews.com

What influences specialty choice?

The income gap between primary care and subspecialists has an impressively negative impact on choice of primary care specialties and of practicing in rural or underserved settings. At the high end of the range, radiologist and orthopedic surgeon incomes are nearly three times that of a primary care physician. Over a 35-40 year career, this payment disparity produces a $3.5 million gap in return on investment between primary care physicians and the midpoint of income for subspecialist physicians.

Phillips RL Jr, et al.; Robert Graham Center. Specialty and geographic distribution of the physician workforce: what influences medical student and resident choices? March 2009. http://www.graham-center.org/online/graham/home/publications/monographs-books/2009/rgcmo-specialty-geographic.html.

Do Medicare And Medicaid Payment Rates Really Threaten Physicians with Bankruptcy? – Health Affairs Blog

Orthopedists. A 2011 survey revealed that orthopedists enjoy a median salary of $514,000. This is the net physician income after office overhead has been paid. Overhead costs averaged 46.3 percent for orthopedic surgeons in 2000 and accounted for 45 percent of revenue in 2012. (This is slightly better than the 50 percent overhead that my practice averages.) Therefore, the gross practice revenue per orthopedist currently is just over $934,000 with an average overhead cost of $420,000. According to data provided by the American Academy of Orthopaedic Surgeons, orthopedic patients by payer are as follows: Medicare/Medicaid—31 percent; the uninsured—17 percent; commercial insurance—34 percent; and other sources, such as worker’s compensation—18 percent. Essentially, half of the average orthopedist’s payment sources are commercial insurance of some type, one third are Medicare or Medicaid, and one sixth is self-pay; this last category—patients paying for their own care—typically contributes only a small amount to practice revenue.

We can test the claim that physicians lose money on their treatment of Medicare patients or make only $8 an hour treating such patients by substituting Medicare reimbursement for the commercial reimbursements to a doctor’s practice. Would orthopedists truly make $8 an hour or would their practices be bankrupt if all payers used Medicare’s reimbursement schedule? Remember, this is the articulated position of much of the orthopedic community and a common defense against reimbursement reductions.

According to a comprehensive analysis by the consulting firm, Milliman, in 2008, on average, commercial insurance paid 130 percent of Medicare’s reimbursement, or, seen a different way, Medicare paid 78 cents for every dollar of commercial reimbursement for physicians’ work. If we reduce the $467,000 in commercial insurance payments to a typical orthopedist’s practice by 22 percent to reflect lower Medicare payments, we obtain $364,000. Adding this back to the Medicare/Medicaid and self-pay portion of practice incomes yields a new gross revenue figure of $831,000. This would be the average orthopedist’s practice income if Medicare’s pay scale were universally used.

Taking out $420,000 in overhead, we see that an orthopedist surviving solely on Medicare reimbursements would receive $411,000 in take-home pay, or approximately $100,000 less than we actually enjoy with the current mix of insurance payers. While I agree that this is a steep reduction, it is abundantly clear that such reimbursement would by no means bankrupt a practice or yield an hourly wage anywhere close to $8 per hour. Therefore, such statements are gross hyperbole.

Do Medicare And Medicaid Payment Rates Really Threaten Physicians with Bankruptcy? – Health Affairs Blog

Medicare SGR sticker shock adds urgency to pay reform campaign – amednews.com

Medicare SGR sticker shock adds urgency to pay reform campaign

The price tag of a one-year Medicare payment patch rises to $25 billion as calls continue for a permanent measure to overhaul the program’s pay system.

Orthopedic Group in Philly lays down big bet for Romney

PhillyDeals: Small-business owners plan to delay hiring process until after election

Rothman for Romney

Doctors who staff the Philadelphia-based Rothman Institute chain of orthopedic clinics were, as a group, the “top contributors to Mitt Romney’s Republican campaign for the third quarter of 2012,” the Washington Post reports, citing Federal Election Commission data.

Contributions to a pro-Romney fund from 65 Rothman doctors on Sept. 17 totaled $751,000. The second-largest Romney-donor employer group for that period worked for private-equity investors Kohlberg Kravis Roberts, which gave $480,000.

Why do these bone men want to dump President Obama? Rothman spokesman Richard Cushman declined to comment when my colleague Harold Brubaker asked.

I know, I know! They have huge incomes and don’t want them to change one little bit.

Disparity in pay divides doctors – The Washington Post

A nice summary of pay disparity in medicine.

Recently, a medical student confided in me a thought that few in our profession would dare say aloud: “We may have come to medical school to help people, but we choose our specialty careers based on potential salaries.”

This in part explains why the most-prized residencies are in fields such as dermatology and radiology, whose procedures generate high fees. According to a physician survey by the Medical Group Management Association, the median income of specialists is nearly twice that of primary-care physicians — $384,000 vs. $212,000. The highest-paid gastroenterologists make about $846,000 a year; the highest-paid internists make about $352,000.

As in most professions, it has long been true in medicine that specialists earn more than generalists. They train longer and in many cases pay higher insurance rates, but these factors don’t fully explain the chasm. We’ve now reached a critical point where the income disparity is harming the general population.

JAMA- AIM | Physicians’ Opinions About Reforming ReimbursementResults of a National SurveyReforming Reimbursement

Physicians’ Opinions About Reforming Reimbursement Results of a National SurveyReforming Reimbursement

Results

The response rate was 48.5% (n = 1222). Four of 5 physicians (78.4%) indicated that under Medicare, some procedures are compensated too highly and others are compensated at rates insufficient to cover costs. Incentives were the most frequently supported reform option (49.1%), followed by shifting payments (41.6%) and bundling (17.2%). Shifting payments and bundling were more commonly supported by generalists than by other specialists. There was broad support for increasing pay for generalists (79.8%), but a proposal to offset the increase with a 3% reduction in specialist reimbursement was supported by only 39.1% of physicians.

Conclusions

Physicians are dissatisfied with Medicare reimbursement and show little consensus for major proposals to reform reimbursement. The successful adoption of payment reform proposals may require a better understanding of physicians’ concerns and their willingness to make tradeoffs.

Medicaid payments to primary-care doctors will rise under new regulation – The Washington Post

Medicaid payments to primary-care doctors will rise under new regulation – The Washington Post: Primary care doctors could get a pay raise next year for treating Medicaid patients, under a rule announced by the Obama administration Wednesday.

The proposed regulation implements a two-year pay increase included in the 2010 health-care law. The increase, effective in 2013 and 2014, brings primary care fees for Medicaid, which covers indigent patients, in line with those for Medicare, which insures the elderly and some disabled patients.

Although Medicaid is jointly funded by states and the federal government, the pay boost would be covered entirely with federal dollars totaling more than $11 billion over the two years it would be in effect.

Congress automatically appropriated those funds when it adopted the health-care law, so it will not need to act now.

However, the provision is among hundreds that could be instantly nullified if the Supreme Court decides to overturn the law in its entirety when it rules on the constitutional challenge. The court heard arguments on the case in March, and a decision is expected late next month.

The pay raise is one of several attempts in the law to address a fundamental challenge in U.S. health-care: Because primary care doctors focus on preventive care, they offer the best hope of curbing the nation’s health spending. Yet they are paid far less than specialists, contributing to a shortage of primary care doctors that is projected to grow with the aging of baby boomers, the retirement of physicians and an expected influx of more than 30 million Americans who will gain insurance through the health-care law beginning in 2014.

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Canadian doctors say fee cuts, pay inequalities will spur exodus | News | National Post

Canadian doctors say fee cuts, pay inequalities will spur exodus | News | National Post:

Despite repeated, expensive attempts to more logically divvy up fees, ophthalmologists earn almost 70% more on average than brain surgeons, who take in almost double the income of psychiatrists, according to Canadian Institute for Health Information (CIHI) figures.

“There are terrible inequities within medicine,” said Michael Rachlis, a Toronto physician and health policy analyst. “And this has really almost nothing to do with the actual value of services. It’s just that some services … often because of technological change, end up being relatively overpaid.”

Comparisons with other industrialized countries suggest that, on average, Canada is among the most generous in remunerating its doctors, though the U.S. continues to out-pay in some specialities. Statistics and recruitment agencies report a net migration of physicians into Canada lately.

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Physician Salaries Vary Widely Among Academics

Physician Salaries Vary Widely Among Academics:

Go West, academic urologist. You may earn more than $455,000 annually there, compared to $300,000 in the Midwest.

(If you are an academic dermatologist, the Midwest is the place to be, not the West, if you want optimum income.)

Whatever you do in academic circles, if you seek a very nice, comfortable salary, be a department chair and a specialist. Then again, if you are engaged in academia, it isn’t all about the money is it? There’s more money in private practice, of course, but we’ll get to that later.

There’s a wide variation in physician-related academic salaries, often dependent on geography and rank within academic settings, says the Academic Practice Compensation and Production Survey for Faculty and Management of 2012. The Medical Group Management Association report, based on 2011 data, contains information on more than 20,000 faculty physicians and non-physician providers categorized by specialty, and more than 2,000 managers.

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