Is Obamacare Pushing Private Practice Doctors Over The Cliff? (independent, insurance, abortion)
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I can speak to this with some experience. I have been in clinical and hospital management for 33+ years. Have several Cardiologist/GP/ personal friends.
The MD's are afraid of the medicare cutbacks that are coming because of Obamacare. The 30%+ reduction in fees for medicare patients has been on the table for a few years now and has been "kicked down the road" through congress; it will now come to fruition.
Medicare makes up the majority of MD income with private insurance and self-pay a smaller portion.
Several MD's I know will cut back on Medicare patients because the fees are already lower than most private insurance/ self-pay patients.
Many MD's are now selling their practices to hospitals. This is making sense to most. The hospital buys the practice for X dollars and hires the MD to be on staff. The negotiations to which I have been privy are working quite well for the physicians. Most are getting salaries which are very close to their previous income and they are losing the headache of running a business with staff, billing and overhead costs. I know of 4 MD's which have done this already this year in anticipation of the cutbacks. It makes sense for them.
Downside is that the hospitals cant absorb all of the physician practice employees because of duplication of services....lots of layoffs so far.
Many think this is the future for a lot of private practices strictly due to medicare reimbursement cuts.
The downside for us is that hospitals can charge more from medicare for testing etc. than MD's can in a private office. e.g. A physician may get $400 for both the technical and professional component of an Echocardiogram done in their office....hospital gets $1200 for the same test. This is why hospitals are in competition to buy MD private practices...there is even a sort of "bidding war" going on in the town I live in between 2 hospitals.
The government seems to be pushing things back to the hospital setting through reimbursement policies to some degree.
Also, just an FYI....the number of Nurse Practioners and Physician Assistants is growing very rapidly. It wont be long until these are the people you will primarily see when you go to the hospital/doctors office. I have nothing against NRP's or PA's but I like to see the MD when I'm sick.
Things are going to change rather quickly in the way health care is delivered, who you will get to see for a problem and the wait times for care. Whether this is good or not remains to be seen.
Not to mention real world what is happening to us. With Obama care coming my employer is setting us up for it, and it aint nuthen nice. Way higher premiums, sad coverage, much higher deductables. Anyone besides me looked at there health care electives for 2013, and they promise 2014 is gona be wayyyy worse.
Course if u never had insurance and don't work thangs are gona be great, no deductable, no co-pay and full coverage
You do realize that health care in Australia is universal. Even the largest private health system is government-owned.
So? Do you think all universal health care plans are created equal? She's looking at the quality of life doctors have not whether or not the country has universal health care. Places like Norway have it too and a great quality of life for doctors. They pay for many of their programs with oil revenues.
I haven't done the research. Dd is doing it. Her take, right now, is that she will have a better quality of life in Austrailia than here. That does not mean their program is perfect. It just means the quality of life for doctors is better (here we hate people like doctors who we count among the "filthy rich" and try to take what they have earned. Maybe they don't do that there...maybe they only sue doctors when they actually make a mistake instead of every time they don't get the outcome they wanted and then sometimes when they do because it's easy money and juries hate the "filthy rich" and pity the poor.). THis has nothing to do with universal health care. It has to do with whether or not doctors are allowed to make a decent living and whether or not they are going to have to abide by the decisions of death panels (sorry to offend but I'm calling a spade a spade. Not a pretty black flower with a stem on the bottom.) and allow patients who can't pay to die. She doesn't want to look patients in the eye and tell them they have to choose between bankruptcy and death. She also wants a return on her investment in the form of a decent standard of living that reflects the effort she will put in to get that medical license. If her dad and I move with her, we'll bring our 401K and what dh inherits from his father's estate so we'll have something to start ourselves off with.
Obviously, more research will have to be done before a decision of what country we're looking to move to is made. It may not end up being Austrailia. Maybe we'll find that life is even better somewhere else. We'll have to look at the whole package. All I know now is that it's looking like we will not retire to America and dd will not practice medicine here. I'm sure there are countries that would welcome a medical doctor, and her engineer/IT specialist parents (who both plan on working until they die. Dh because he loves what he does and me because I just can't see sitting home all day. That could get boring in a hurry.) Given our level of education, I'm sure we can move elsewhere. Of course this is all a few years off.
Last edited by Ivorytickler; 11-11-2012 at 08:14 AM..
So? Do you think all universal health care plans are created equal? She's looking at the quality of life doctors have not whether or not the country has universal health care. Places like Norway have it too and a great quality of life for doctors. They pay for many of their programs with oil revenues.
I haven't done the research. Dd is doing it. Her take, right now, is that whe will have a better quality of life in Austrailia than here. That does not mean their program is perfect. It just means the quality of life for doctors is better (here we hate people like doctors who we count among the "filthy rich" and try to take what they have earned. Maybe they don't do that there.). THis has nothing to do with universal health care. It has to do with whether or not doctors are allowed to make a decent living and whether or not they are going to have to abide by the decisions of death panels (sorry to offend but I'm calling a spade a spade. Not a pretty black flower with a stem on the bottom.) and allow patients who can't pay to die. She doesn't want to look patients in the eye and tell them they have to choose between bankruptcy and death. She also wants a return on her investment in the form of a decent standard of living that reflects the effort she will put in to get that medical license.
So why do you conservatives fight tooth and nail to prevent a universal healthcare system here if it's so much better? A lot of doctors say that without Medicare their practice would fold. Medicare is a form of socialized medicine right? So if we socialize the whole thing wouldn't that allow these doctors to stay in business and everyone have access to the care they need?
This is why my dd wants to move to Austrialia when she gets her medical license. She's been investigating the quality of life for doctors in different countries. So far, Austrailia seems to be ahead. She ruled out Canada right away. I knew she would. My doctor and her husband moved from Canada because they could earn a better living here. Now I think that is going away.
Your daughter is in what, high school? Maybe she'll learn a little more about this as she actually pursues this medical degree.
Quote:
Originally Posted by Ivorytickler
So? Do you think all universal health care plans are created equal? She's looking at the quality of life doctors have not whether or not the country has universal health care. Places like Norway have it too and a great quality of life for doctors. They pay for many of their programs with oil revenues.
I haven't done the research. Dd is doing it. Her take, right now, is that she will have a better quality of life in Austrailia than here. That does not mean their program is perfect. It just means the quality of life for doctors is better (here we hate people like doctors who we count among the "filthy rich" and try to take what they have earned. Maybe they don't do that there.). THis has nothing to do with universal health care. It has to do with whether or not doctors are allowed to make a decent living and whether or not they are going to have to abide by the decisions of death panels (sorry to offend but I'm calling a spade a spade. Not a pretty black flower with a stem on the bottom.) and allow patients who can't pay to die. She doesn't want to look patients in the eye and tell them they have to choose between bankruptcy and death. She also wants a return on her investment in the form of a decent standard of living that reflects the effort she will put in to get that medical license. If her dad and I move with her, we'll bring our 401K and what dh inherits from his father's estate so we'll have something to start ourselves off with.
Obviously, more research will have to be done before a decision of what country we're looking to move to is made. It may not end up being Austrailia. Maybe we'll find that life is even better somewhere else. We'll have to look at the whole package. All I know now is that it's looking like we will not retire to America and dd will not practice medicine here. I'm sure there are countries that would welcome a medical doctor, and her engineer/IT specialist parents (who both plan on working until they die. Dh because he loves what he does and me because I just can't see sitting home all day. That could get boring in a hurry.) Given our level of education, I'm sure we can move elsewhere. Of course this is all a few years off.
I think a 17 year old needs to get a little older, and learn a few things before she makes her plans for the future. You and DH better do some research, too, on retiring in Australia. It may not be the Shangri-la you seem to think. You probably won't be able to work in Australia, unless you become citizens.
As much as you don't want to believe it, there are no death panels in the ACA.
So why do you conservatives fight tooth and nail to prevent a universal healthcare system here if it's so much better? A lot of doctors say that without Medicare their practice would fold. Medicare is a form of socialized medicine right? So if we socialize the whole thing wouldn't that allow these doctors to stay in business and everyone have access to the care they need?
Where I live to find any doctor that will accept Medicaid you need to travel 64 miles one way, 128 miles round trip.
Not a single doctor in my county, or any surrounding counties for that matter, accepts Medicaid.
Most doctors are not accepting new Medicare patients either.
Imagine, you get what you pay for. What a concept!
But now as a defeated repukkkikan I am shifting my support from the failed policies of the repukkkikan party to Obama's democrats.
In fact i will go one up, we should not cut spending by increase it at all levels except defense. Consiider the combined government spending at all levels is now a measly $20,195.20 per person ($80,780.80 for a family of four) it is obvious it has to increase!
I know, I know, defense spending. If only we could rid ourselves of defense spending rainbows would spring up all around, we would balance the budget and find time to sit around the camp fire in the old woods singing "Kumbaya" together.
If we take defense spending of $2,847.70 per person (that's $11,390.8 for a family of four), which represents 14.1% of all government expenditures, we would have money for free medical, condoms for all, transgender operations for anyone who wanted it and we could double the budget to the Save the Whales Foundation!
I believe every American worker should have a living wage of $40,000 whether he works or not. How's that for a starter?
All college should be free and, in fact, I suggest students attending should receive $1,200/month in stipends to encourage every to go to get those fabulous degrees such as "Gay bioethics now an academic program at Penn" state.
Just so mods know I am not... Penn State Newspaper...their words not mine.... well here, look for yourself.
Am I the that sees the problem as a spending addiction?
But I think we need to increase spending at all levels. We will call it "investment" and everyone knows investments are always good.
What GenY needs to experience is a 30% inflation rate so they learn what true misery is all about. Burn this sucker to the ground, don't fight Obama join Obama!
Again, I work in the insurance industry - this has been going on for YEARS - not weeks, not days - YEARS.
Medicare and Medicaid do not reimburse at the level of private insurance. SHOCKER!
Also, just an FYI....the number of Nurse Practioners and Physician Assistants is growing very rapidly. It wont be long until these are the people you will primarily see when you go to the hospital/doctors office. I have nothing against NRP's or PA's but I like to see the MD when I'm sick.
Things are going to change rather quickly in the way health care is delivered, who you will get to see for a problem and the wait times for care. Whether this is good or not remains to be seen.
My sister is a nurse in a hospital. She is getting pushed to take on more responsibilities.
She does NOT want to do this but it is being forced on them along with some quick training.
She's trying to get off the floor now and get into administration. She says this will only get worse.
I can speak to this with some experience. I have been in clinical and hospital management for 33+ years. Have several Cardiologist/GP/ personal friends.
The MD's are afraid of the medicare cutbacks that are coming because of Obamacare. The 30%+ reduction in fees for medicare patients has been on the table for a few years now and has been "kicked down the road" through congress; it will now come to fruition.
Medicare makes up the majority of MD income with private insurance and self-pay a smaller portion.
Several MD's I know will cut back on Medicare patients because the fees are already lower than most private insurance/ self-pay patients.
Many MD's are now selling their practices to hospitals. This is making sense to most. The hospital buys the practice for X dollars and hires the MD to be on staff. The negotiations to which I have been privy are working quite well for the physicians. Most are getting salaries which are very close to their previous income and they are losing the headache of running a business with staff, billing and overhead costs. I know of 4 MD's which have done this already this year in anticipation of the cutbacks. It makes sense for them.
Downside is that the hospitals cant absorb all of the physician practice employees because of duplication of services....lots of layoffs so far.
Many think this is the future for a lot of private practices strictly due to medicare reimbursement cuts.
The downside for us is that hospitals can charge more from medicare for testing etc. than MD's can in a private office. e.g. A physician may get $400 for both the technical and professional component of an Echocardiogram done in their office....hospital gets $1200 for the same test. This is why hospitals are in competition to buy MD private practices...there is even a sort of "bidding war" going on in the town I live in between 2 hospitals.
The government seems to be pushing things back to the hospital setting through reimbursement policies to some degree.
Also, just an FYI....the number of Nurse Practioners and Physician Assistants is growing very rapidly. It wont be long until these are the people you will primarily see when you go to the hospital/doctors office. I have nothing against NRP's or PA's but I like to see the MD when I'm sick.
Things are going to change rather quickly in the way health care is delivered, who you will get to see for a problem and the wait times for care. Whether this is good or not remains to be seen.
It's bad.
A hospitalist is just a hospital employee and doesn't know you from Adam.
Your own doctor knows your health history -- very often knows you over the years, knows your pain tolerance, your health habits, knows if you want lots of prescription drugs or prefer to be as chemically free as possible. Your own doctor was usually your best patient advocate - could call up administration and get things done for patients.
Now you're put under the care of a hospitalist who works for the hospital, is under the control of the administrators. When you leave the hospital (if you leave), the hospitalist will likely never see you again. They are paid by the hospital, not by the patient.
I know one guy who died at age 82 and the hospitalist put down on the death certificate that he died from heart problems caused by chronic smoker -- this man hated smoking, was dead set against cigarettes especially -- but the hospitalist just put down whatever, it's not like she knew the patient or gave a damn.
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THis has nothing to do with universal health care. It has to do with whether or not doctors are allowed to make a decent living and whether or not they are going to have to abide by the decisions of death panels (sorry to offend but I'm calling a spade a spade. Not a pretty black flower with a stem on the bottom.) and allow patients who can't pay to die. She doesn't want to look patients in the eye and tell them they have to choose between bankruptcy and death. She also wants a return on her investment in the form of a decent standard of living that reflects the effort she will put in to get that medical license. If her dad and I move with her, we'll bring our 401K and what dh inherits from his father's estate so we'll have something to start ourselves off with. 
