How Outdated Data Distorts Doctors' Pay 336
Hugh Pickens DOT Com writes "Peter Whoriskey and Dan Keating report at the Washington Post that Medicare annually pays $69.6 billion for physician services according to an arcane and little-known price list, known as the Relative Value Update over which doctors themselves exercise considerable and less-than-totally-transparent influence. A 31-member committee of the American Medical Association (AMA) recommends what Medicare should pay for some 10,000 procedures — with the fees based in part on how long it takes to complete each one. But this time-and-motion study often fails to take full account of changing technology and other factors affecting physician productivity, so anomalies result. For example, if the AMA time estimates are correct, then 41 percent of gastroenterologists were typically performing 12 hours or more of procedures in a day, which is longer than the typical outpatient surgery center is open and and one gastroenterologist in the Post story would have to work 26 hours, according to the committee time estimates, to accomplish what he gets done in a typical workday. Here's how it works: Medicare pays for a 15-minute colonoscopy as if it took 75 minutes resulting in a median salary for a gastroenterologist of $481,000. It is possible that in 1992, critics allow, when the price list was first developed, a colonoscopy actually took something close to 75 minute when doctors had to hunch over an eyepiece similar to that of a microscope for a look. But technology has advanced and now the images are processed and displayed on a large screen in high-definition video. Responding to criticism that the nation's method of valuing medical procedures misprices payments, a bipartisan group of legislators has drafted a bill that would reshape the way the nation pays doctors. The bill would require Medicare officials to collect data such as how much time doctors spend doing procedures and reducing the doctor payment for overvalued services. 'What started as an advisory group has taken on a life of its own,' says Tom Scully, who was Medicare chief during the George W. Bush Administration. 'The idea that $100 billion in federal spending is based on fixed prices that go through an industry trade association in a process that is not open to the public is pretty wild.'"
Praise Legacy Data (Score:2, Funny)
Sad, racist H8ah
Or sweep it from chin
For cleanshaven win!
Burma Shave
Re:Praise Legacy Data (Score:4, Interesting)
Get out the pitchforks and torches, antisocialists.
What is interesting to me is that private hospitals negotiate rates with medicare and insurers, but basically set their own rates for the uninsured. My limited knowledge on the topic is merely based upon the few articles that have achieved my attention, but medicare rates are apparently the most reality-based, since the federal government gets to collect and analyze more of the pertinent data than anyone else. The private insurers have some strength in numbers/volume, and have their own data, and get to negotiate a bit. The uninsured are basically screwed, and are asked to pay many times what is charged to the insured or medicaid patients.
Google chargemaster, if you are interested.
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You don't need to google anything. Just talk to someone who doesn't have any or good health insurance.
Re:Praise Legacy Data (Score:4, Informative)
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I know a number of people who have encountered cash prices less than half what the insurer would be billed
Irrelevant, since what the insurer gets billed and what they pay have little to do with each other. People who think they're getting a great deal may still be paying more than the insurer would.
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I had a facility bill my insurance for over $30k for a procedure that took less than one hour. Insurance paid about $600.00. The facility tried to get me to pay the balance, offered me a "deal" to pay just 1/3, alleging that I owed the amount because while the physician was in-network they were not. I didn't pay them anything and now the statute of limitations has expired to collect on the bill. The system is designed to screw over anyone who is accustomed to paying full retail price, religious people w
Re:Praise Legacy Data (Score:4, Insightful)
I don't think $451,000 is unreasonable pay for someone who has to look up diseased arses all day to help prevent their owners dying a horrible death - with the prospect of being sued into oblivion if you make a mistake? Sure it's s lot of money, and definitely on the high side, but I think I'd still rather be a programmer earning less than 1/4 of that compared to doing that job. You thik the goatse guy is bad? I reckon a day in the office looking over a proctologist's shoulder would make it look like kittens.
The tens of millions paid for company executives in charge of companies that take a nose dive and have to be bailed out by taxes? Now that's unreasonable.
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Get out the pitchforks and torches, antisocialists.
What is interesting to me is that private hospitals negotiate rates with medicare and insurers, but basically set their own rates for the uninsured. My limited knowledge on the topic is merely based upon the few articles that have achieved my attention, but medicare rates are apparently the most reality-based, since the federal government gets to collect and analyze more of the pertinent data than anyone else. The private insurers have some strength in numbers/volume, and have their own data, and get to negotiate a bit. The uninsured are basically screwed, and are asked to pay many times what is charged to the insured or medicaid patients.
Google chargemaster, if you are interested.
My understanding is that the doctors have no choice but to jack the rates up on the uninsured. The insurance companies force it. They want a discount over what uninsured patients pay. If they do not get the discount they want, they do not add the provider to their network. My source for this information? A doctor I see on a routine basis. I needed a piece of medical equipment that my doctor carried. My co-pay, with insurance, was over $500. When the doctor saw the co-pay, he sold it to me for his cos
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That's pretty much correct. It's generally acknowledged that Medicare and Medicaid pay the least, private insurers pay more and individual patients pay the most. But now the other shoe drops and it appears that Medicare and Medicaid are being cheated, private insurers are being cheated much more and individual patients are being robbed at scalpel-point.
This is LONG overdue and the data should definitely be shared with private insurers and everybody else.
We also need price transparency. Hospitals and doct
Re:Praise Legacy Data (Score:5, Interesting)
Some of the factors involved:
1. anti-trust laws and specific legislation prevent hospitals and doctors for sharing price information (aka Sherman Anti Trust Act [wikipedia.org])
2. The government demands a discount from hospitals for services.
3. The insurance companies, not to be outdone by Uncle Sam, also demand discounts. (8th paragraph [nytimes.com])
4. Different geographic locations have different pricing indexes.
5. Local competition, despite #1 above, can influence prices
6. Different patients have wildly varying medical histories and co-morbidities.
7. Most complex cases (esp surgery and other procedural based care) fall into a class of billing called the DRG (diagnostic related group), which is kind of a set rate for a package of care....so if I take out your gallbladder and you leave in 1 day or 3, the hospital gets paid the same (see side note below)
Taken all together, the hospital is basically free to charge what ever they want....not that they ever get it.
Most insurance companies pay a "regionally adjusted payment", and that's what gets paid....with a few exceptions. Those without insurance, usually get some kind of compassionate coverage from Medicaid (state funded, not Medicare). Those who do not are often eligible for charity care where part or all of the bill is reduced. So why not just bill the uninsured a lower upfront cost? Rule #2. Uncle Sammy wants his discount
The interesting side story....patients who have an exceptionally difficult problem can fall into a group called the outliers (imaginative name, but better I suppose than the untouchables....). These are pts who fall outside of the DRG....as such the hospital may submit a bill for outlier payment. This is typically $0.10 on the dollar of hospital billing. Well that sucks for the hospital....but a less-than-scrupulous Mega-Health-Care-Corp came up with the idea of inflating their outlier billing to be 10x what they had been billing.....the end result is $ for $ reimbursement. This was all well and good for them, for a couple of years....then Uncle Sammy caught on.....10 years later and they still haven't gotten rid of the shit smell after the government came down on them and beat the living shit out of them financially and punitively.
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And they should be hourly rates, set according to the education and certification of the Dr. Also, equipment should be charged at an hourly rate.
The opacity of actual costs is probably the most significant driver of increased costs.
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Re:Praise Legacy Data (Score:4, Insightful)
I see it as the hospital trying to cover some of the bills on which they never collect.
Technology costs? (Score:3, Insightful)
So, it appears the article only talks about the time spent by the physician. I'm curious if the costs of the tools/technologies of these procedures have gone up, and how the doctors get paid for those (potentially) increased costs?
Re:Technology costs? (Score:4, Insightful)
So, it appears the article only talks about the time spent by the physician. I'm curious if the costs of the tools/technologies of these procedures have gone up, and how the doctors get paid for those (potentially) increased costs?
Well, that's another part of the problem, I would say. If one cost isn't getting addressed/monitored, and the way to try and offset it is to have another cost kept arbitrarily high in a way that does not reflect reality, then you're going to lose visibility into the real economics of it all and get undesired effects. Add in the fact that a trade association representing the vendors (in this case) is a major driver in the price determination process and the lack of transparency, and you increase the likelihood of undesired effects even further, and practically guarantee that anyone who looks upon the result will question it.
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We all know that medical procedures require no setup, cleanup, assistance, explanation, or double checking, and of course are only done by one single doctor and no staff. Biling and coding, technology costs and training, facility costs.... those don't count either.
Clock in, surgery, clock out.
Re:Technology costs? (Score:4, Insightful)
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But medicare and medicaid don't' take into account anything BUT the payment tables.
YOUR bill is itemized, the government's bill isn't.
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Oversimplification (Score:5, Informative)
We are talking specifically about how much time the doctor is working on the case of the patient.
The average time a doctor spends on a single patient isn't even close to the entire story. Bit of background: I'm an industrial engineer and also a cost accountant. I have degrees in both and have worked in healthcare doing six sigma projects, time studies and cost analysis.
1) Procedure times are NOT normally distributed. Not all cases are identical and some take considerably longer than the average. These longer cases typically are much more expensive. On a weighted cost basis the average cost will be higher than you would expect if you make the mistake of assuming a normal distribution.
2) You have to account for the time of the doctor PLUS the time of all the support staff. The time a doctor spends on a procedure frequently is not the biggest cost driver. My wife is a doctor. For the work she does her average time per case is about 10 minutes. For every minute she spends on a patient there is about 3-5 minutes of support staff time - sometimes more. On some cases she might spend an entire hour or more plus have to consult with other doctors for a particularly difficult diagnosis.
3) The value of a doctor's time isn't just driven by the average time for a procedure times some arbitrary hourly rate. What makes a doctor (particularly a surgeon) valuable is the value of his time when something unexpected happens. Patient goes into arrest on the operating table for instance. At that point the value of the doctor's time grows exponentially. If everything was just routine all the time, you could use nurse Now granted you can normalize the value of their time with enough study but the number you will get is going to be higher than if everything was routine and identical.
4) Time studies of procedure times are expensive and relatively difficult to perform. I've done a lot of time studies personally and trying to get an industry average for each and every procedure is far more difficult and expensive than most people realize. While there is no excuse for using outdated or wrong information, it is important to realize that maintaining an accurate and authoritative listing of expected procedure times is not a trivial exercise.
Re:Oversimplification (Score:4, Informative)
The time and money that I've spent in training has value. The specific skills I have as a result of that time and money are significant, and useful to many people. I'm happy to use my skills to help people - it has intrinsic reward. However, the current climate requires that I do so 10 hours a day, plus nights, plus weekends, always with a smile, every 15 minutes, and job satisfaction has mostly gone the way of the dodo.
4 years of college. 4 years of medical school. 3 years of residency training. 3 years of cardiology fellowship training (gastroenterology, the example from the article, is also a 3 year fellowship). College & med school leave most of us with >$200k of debt. Residency and fellowship pay essentially minimum wage when you account for the insane hours, all the while collecting interest on our college and med school debt. I didn't have kids until I was in my late 30's because we didn't think it was fair to raise them without seeing their father.
We all have this same conversation when discussing the issue of money in medicine. In the beginning, there was a binary relationship - patient, doctor. The doctor provided services, the patient provided cash. These facts haven't changed, except now the care provided is better, the patient spends much more, the doctor gets paid much less, and everyone else in the system siphons away the money without the hours or the liability we incur.
In any event, you're not paying for 15 minutes of colonoscopy time, you're paying for the 14 years of training necessary for the doctor to do the colonoscopy.
Not to mention the cost of the colonoscope and its upkeep, the techs, the sedatives and management of their associated risks, the endoscopy suite constructed and maintained to restrictive code standards, cleaning of the endoscopy suite between each case, archiving and storage of the images, time to interpret and create a report from the colonoscopy, conversations with the patient, the patient's family, the patient's primary physician, time lost from providing other services (office and hospital visits - people are always clamoring for more availability), the enormous billing apparatus, a significant cut to the insurance company, maintenance of certification & credentialing (which requires many hours a year away from the office in a hotel conference room watching Powerpoint slides, at great expense), etc.
What's it worth to you?
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Have you ever been to a hospital for any sort of procedure? The bill is broken down into about a billion items (including a line item for stuff like over the counter grade ibuprofen that you would expect to be free). They also happily charge anything you say or is said to you as a "consultation". All of that stuff is accounted for in addition to the fee for the procedure itself.
Re:Technology costs? (Score:4, Informative)
Even the AMA says the times are distorted, but they emphasize that the relative times are pretty good. Meaning, for the most part, a procedure that takes twice as long as another is accurately recorded as so in the data. Medicare is generally not covering providers' costs, to the point where most unsubsidized hospitals in poor areas have closed and doctors have to limit the number of Medicare patients they take. It's pretty clear that, in aggregate, doctors aren't fleecing the system. As such, the absolute numbers are pretty much meaningless and it's the relative numbers that count. If a certain type of doctor feels screwed out of some money because they don't think the ratios are correct, then let them take it up with the AMA - why would we want to get involved?
Full disclosure: my wife is a doc.
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Medicare is generally not covering providers' costs.
Like the aforementioned gastroenterologist making $460k/yr?
The whole healthcare system is incredibly messed up. You get pockets of near-bankruptcy mixed with pockets of largesse.
Perhaps the solution is to just reduce reimbursements every year until the medical school acceptance rate is 90%?
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- $460k/yr
How much of that goes to malpractice?
How much of that goes to med school loans, undergraduate loans, etc? CHEAP Med school in the US starts at $250k without interest.
Disclosure: Fiance is a doc.
Re:Technology costs? (Score:5, Insightful)
If you engage in a bunch of communist nonsense to devalue the work of doctors, people will stop becoming doctors for the money.
Fixed that for you. As a side effect, medical schools will have to decide between re-purposing themselves to underwater basket weaving or, just maybe, not costing a quarter of a mil.
This applies to anything. The cost of overhead doesn't pay itself.
I'm a miserable, cynical bastard at the best of times, but this ridiculous idea that money is the only reason anyone does anything is just sad.
All things aren't created equal. People who advocate that capitalism must apply to the care and ease of human suffering should be subject to having their organs harvested.
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If you engage in a bunch of communist nonsense to devalue the work of doctors, people will stop becoming doctors for the money.
Yeah, my father is a professor at a medical school and he's been watching the decline of the quality of student for a while. While the students do well enough in the classes and are all extremely competitive, he says that he sees fewer students every year that have a real passion for medicine. The thing that really seems to pique their interest is any discussion of how much money they'll be making.
It seems to me that an interest in medicine, let alone a real passion for it, is not even remotely a qualificat
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Like the aforementioned gastroenterologist making $460k/yr?
You are cherry picking a specialty. The average family practice doc starts at $120k or so and might top out near $200k if they are lucky. Pediatricians make less than that. That GI doc took extra years of residency, probably a fellowship, and has higher liability insurance. You can offer them less, and watch as Medicare patients wait in huge queues to get a endoscopy. In Canada, they make about the same amount, and they have socialized health care.
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Out of curiosity, what is the cost for malpractice insurance in Canada? The doctors may actually net more there. Sadly, the giant ACA had nothing, as far as I know, to reduce that cost to doctors which only gets passed to us.
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My wife is a doc, so we've thought a lot about malpractice.
My opinion is that the doctors are at fault in large part. They could _easily_ band together and kill these lawsuits, but they have a very individualist spirit that harms them greatly. All it would take to kill the worst malpractice suits is for the AMA and local medical boards to start yanking licenses of docs found to be making unreasonable testimony. Many (most?) of the docs testifying are being paid by the plaintiff and do this as a substantial
Re:Technology costs? (Score:4, Informative)
Malpractice coverage is mostly provided by the Canadian Medical Protective Association. It's not really malpractice insurance like in the states, but they deal with providing legal services and paying settlements. Rather than premiums, they charge a annual membership fee, which is dependant on specialty and location (Doctors in Ontario and Quebec get different fees than the rest of Canada) and is massively variable. An office-practice family doctor in the RoC would pay $1,344/year, whereas an OB/GYN who does deliveries in Ontario is looking at $49,416/year.
You can look at their fee schedule here [cmpa-acpm.ca].
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Rural areas have to pay outsized salaries because, under normal circumstances, no one in their right mind would live in Roswell. The average starting salary is still around $120k, outliers included. In some crowded markets, pediatrics had dipped below $100k. I know a few docs that abandoned pediatrics in mid training because they weren't going to be able to make their loan payments after residency without stretching them to 20 years. At that point, why in the world are you wasting so much of your life on al
Re:Technology costs? (Score:5, Informative)
It's pretty clear that, in aggregate, doctors aren't fleecing the system
I disagree. First, doctors are horrible at finance. Few trouble to manage their own money effectively. It's common for a doctor to be pulling down 6 figure pay, and yet be broke because he blows all his money on expensive cars, big houses, and trophy wives. They are even worse with their patients' money, going through that like the proverbial drunken sailor. They'll happily order unnecessary $2000 scans, "just in case", and to cover their asses and to get some use out of the really expensive equipment the practice should not have bought in the first place. They prescribe expensive brand name medication when a generic is available, and oft times is superior. An example is prescribing Crestor, instead of simvastatin or lovastatin. Even a generic may be the wrong approach, if patients have not tried other measures first, such as improving their diets and exercising. I realize there is a great deal of pressure on doctors from both Big Pharma and patients. We're really sold on the idea of magic pills that fix all our medical problems. Doesn't help that Big Pharma works the public over with all these ads. "Ask your doctor about ..." But rather than go with the flow, especially since it's more profitable, doctors have a duty to push back.
My own personal experience with this was thanks to an automobile accident. Had my parents with me, and they were both injured. My mother finished her hospitalization in a private place, where she had been sent for rehab. On the day they released her, they shoved a wheelchair at us, and shoved a form under her nose for her to sign. The form said that she promised to pay for the wheelchair herself should her insurance refuse. She didn't need the wheelchair, but at that time we were still just a little too credulous and inexperienced with medical profiteering. I protested that we could get a wheelchair from a friend who no longer needed his, but was ignored. I asked how much their wheelchair cost, and was told not to worry about it because insurance would cover it! I pointed out that the form they were insisting she sign suggested that there was a possibility insurance would not cover it, and so I ought to know what it cost. They replied that they didn't know but it was sure to be reasonable. Uh huh. Turned out that damned wheelchair cost $825, 4 to 6 times what it should have cost. That was hardly the only instance of profiteering.
You should read Bitter Pill [time.com] (paywalled), and How Dentists Rip Us Off [go2dental.com] (pdf) if you are truly ignorant of the reckless and cavalier attitude the medical community has towards costs.
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The same way you and I pay for the tools/technologies that we use. We write them off on our income taxes, amortize them over a period of time, etc.
I don't know if you're old enough to remember when doctors actually lived in the communities they service, solidly in the middle class. They might have lived in the nicest house in the neighborhood, but they
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Only recently has medicine been seen as some sort of path to the top 1%.
I don't know where you get your data. A typical new family medicine doc gets a decent low $100,000s salary [aol.com] and has enormous debts and malpractice insurance to pay off. A pediatrician gets even less. True, there are specialties where they make a lot of money, but this is not typical. A $2500/month payment on student loans puts a pretty big dent in your take-home, and you enter the work force in your 30s, so everyone else has an 8 or 10 year head start. The hours suck, and unless you are in something like rad
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First of all - werd. To just about all of this.
Secondly I want to add that it's not as if there is some other definitive source that the government can use to determine the appropriate reimbursement rate for procedures. Hospitals have something called a "chargemaster list," but the prices on those lists vary wildly from hospital to hospital. And most hospitals, when quizzed as to why the prices seem so out of whack, argue that it doesn't matter because consumers "rarely" ever pay those prices.
Steven Brill
Taking it up the colonoscopy (Score:2)
Sorry no information in this comment I'm just throwing out there that in my opinion since insurance companies are increasingly becoming the payors for services rather than individuals it seems stories like this are becoming more prevalent. I mean, and I stand to be corrected it seems that the medicare system now has a "watchdog/whistleblower" vis a vis the insurance companies. It appears to me insurance companies don't like to pay the costs it used to be OK for the average joe to mortgage their house/ruin
So what. Doctors SHOULD be paid more. (Score:5, Interesting)
You know I am sick and tired of everyone blaming doctors for the cost of healthcare in the US. When in fact, doctors salaries are a miniscule portion of US healthcare, especially compared to drugs and device costs and hospital CEO pay! Doctors should be paid MORE. Yes I said it, more! What other profession do you study at least 12 years before you make a decent salary, take on at least $250k in school loans, and work 12 hour days for your entire career?
Yes doctors make good money but it's far less than other folks in the US make who are far less deserving. How about addressing the seriously disgusting salaries on wall street? Should a computer nerd working in Morgan's computer risk group really be making $500k which is FAR more than the majority of doctors? What about the asshole investment bankers making millions at Goldman figuring out new ways to screw every US citizen out of a couple of pennies. Meanwhile the doctor is someone who makes you feel better and often will save your life.
p.s. I am not a doctor. I just work with a lot of them and see how hard a life they have nowadays.
Re:So what. Doctors SHOULD be paid more. (Score:4)
I work in the healthcare IT field (formerly at an IT vendor). The reality is -- health care organizations are becoming IT shops. And that's expensive. Big iron servers, expensive SAN storage, workstations in every clinic office / nursing unit, and certified trained staff to run it all... It adds up.
There's definitely some research that suggests it results in better care -- warnings for med interactions, doing the right procedure on the right patient, etc. But it's really being driven in the name of compliance (and CYA). Document & audit trail EVERYTHING, so you can justify the charges if Medicare comes knocking for an audit. Or in case there's a lawsuit. It's complicated, and expensive. And Medicare (and the insurance companies) just make it more complicated & expensive by increasing complexity of the billing rules.
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I'm also in IT in a healthcare facility. Our department has exploded in the last five years and IT staff has gone from one person ten years ago to nine people now. Likewise, our server rooms were getting packed to capacity before we started migrating everything possible to VMs within the past year. It's amazing the record keeping we're required to keep (by the state) for auditing... backup jobs, server updates, software updates, etc. I spend an average of five to ten hours each week just documenting crap th
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The reality is also that all that IT contributes little to day-to-day healthcare.
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Then why do nurses and doctors bitch so much if the servers have so much as a hiccup? They spend more time on various software programs than they do with actual patients.
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Then why do nurses and doctors bitch so much if the servers have so much as a hiccup? They spend more time on various software programs than they do with actual patients.
Just because they don't like being held up by being unable to do the things they are required to do with those systems, does NOT mean those things contribute in any way at all the care of patients.
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Hey, hey, you, get back in line. We need you to express jealousy of another's wages as some form of moral righteousness, not try to reason why one person might be paid more than another. ;-)
You're arguing about how people value each other's work, and that's an entirely subjective phenomenon. And let's be honest, programmers are getting paid poorly these days, with other fields (doctors, lawyers, engineers, etc.) coming under the knife. They want the doctors to be replaced with nurses to cut costs...and the
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Re:So what. Doctors SHOULD be paid more. (Score:4, Insightful)
Lawyers study as long as Doctors, get as many loans, and make less. Most Law School grads make under $50k. Vets are worse. It's harder to get into vet school then MedSchool, the coursework is harder (you have to know medical care for multiple organisms), the loans just as bad, and $50k is a really good salary for a Vet. Hell do you think ANY humanities PhD is ever gonna pay off his student loans?
I would have a lot more sympathy for American Doctors if their foreign counterparts didn't make do with a much less pay. Luxembourg is an incredibly expensive country to live in, yet their Doctors make 30% less then our doctors. Yeah we overpay our MBAs, and MPHs, but it's very hard for me to sympathize with a guy who does the exact same job as a Doctor from Winnipeg for $40,000 more and complains he isn't paid enough.
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Lawyers study as long as Doctors, get as many loans, and make less. Most Law School grads make under $50k. Vets are worse. It's harder to get into vet school then MedSchool, the coursework is harder (you have to know medical care for multiple organisms), the loans just as bad, and $50k is a really good salary for a Vet. Hell do you think ANY humanities PhD is ever gonna pay off his student loans?
I would have a lot more sympathy for American Doctors if their foreign counterparts didn't make do with a much less pay. Luxembourg is an incredibly expensive country to live in, yet their Doctors make 30% less then our doctors. Yeah we overpay our MBAs, and MPHs, but it's very hard for me to sympathize with a guy who does the exact same job as a Doctor from Winnipeg for $40,000 more and complains he isn't paid enough.
I disagree as your facts appear to be incorrect.
1. Lawyers have 3 years of school and no residency. Doctors have 4 year schooling, 4 years of residency, and more residency if they specialize. Cardiologists often don't finish training until their mid-30s. I don't follow how you say they study "as long"? They aren't even close to similar.
2. You're not comparing properly. In Canada med schools are far less than the US ones. About 1/3 less according to the article. Thus, the society subsidizes some of the
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Good points, but I think you meant to say Canadian med schools are about 1/3 the cost of American ones (39% actually), not 1/3 less. That makes your point even more strongly. Specifically $15k/yr vs. $38k/yr. Wow.
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You do realize that residents get paid? And they get paid MORE then most bunny lawyers, all vets, or humanities PhDs? And that very few PhDs make it through in three years?
So your Doctor has the same amount of schooling our vet or humanities PhD does, then he makes $40-60k for four years, during which time our vet and humanities PhD is making $40-50k. So he's probably made $20k more during his residency then our vets and humanities PhDs. Law-school is three years, but many bunny lawyers do not get legal job
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Everybody makes these arguments: "we should be paying more for drugs, they save so much money on doctors", "we should be paying more for CEOs, they can save so much money", etc. The problem is: nobody knows how much any of these "should" be paid, an
Re:So what. Doctors SHOULD be paid more. (Score:5, Interesting)
Doctors should be paid MORE. Yes I said it, more!
Depends on the doctor. Primaries aren't getting rich, but some specialists are. That explains why we have too many specialists and not enough primaries. I don't buy that most specialties are all that much more difficult than being a primary. As per the article median gastroenterologist income is $481k. IIRC that's 2.5x what a primary makes. Moreover, income often has little to do with the difficulty of a specialty. Radiologists are amongst the highest paid, not because it's so difficult, but because you can flip through scans pretty quickly and charge for each one. The actual scans are done by techs.
The ratio of specialist to primary pay is largely controlled by the AMA's "advisory" committee, so they are very much a part of this. The AMA has long had a pro-specialist bias.
How about addressing the seriously disgusting salaries on wall street?
Does getting ripped off by one group mean we shouldn't also worry about getting ripped off by another group?
Should a computer nerd working in Morgan's computer risk group really be making $500k which is FAR more than the majority of doctors?
It's not the computer nerds making $500k/yr.
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You know I am sick and tired of everyone blaming doctors for the cost of healthcare in the US. When in fact, doctors salaries are a miniscule portion of US healthcare, especially compared to drugs and device costs and hospital CEO pay!
Well, looking at this graph [aetna.com], which I'd say looks like most I've seen, for every dollar that gets spent on drugs, two dollars get spent on doctors. In most cases it is the drug that actually has the health benefit, and the doctor just figures out which one is the most appropriate one to prescribe. I'm not sure where this particular breakdown stuck devices - often they're treated as drugs (they're certainly regulated in a similar fashion).
Now, there are certainly plenty of ways to make drugs cheaper, but yo
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Whether they should make more or less isn't quite the issue at hand.
The real problem is that there's essentially no sane way to understand health care costs.
You say doctors work 12-hour days? Well, what if Medicare says some are billing for 26-hour days, and a hospital maybe says they're only spending 6 hours in surgery (that's a wild guess)? So, what's their hourly wage? How much of it goes to medicine, and how much of it is administrative busy-work? Can it
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Re:So what. Doctors SHOULD be paid more. (Score:4, Insightful)
Bullshit. The simple fact is that tort reform does not lower costs, look at Texas to see this. What it does do is mean that you can be crippled by a doctor, forever unable to work and get less than he makes in a year out of it.
If you want to make that kind of money you have to be willing to take some risk. Tort reform is simply the doctors privatizing the profits and socializing the losses when they fuck up. This is because once those meager limited payouts runout we as a society have another person to pay for on disability.
easy way to fix malpractice suits (Score:2)
Depending on how bad the problem was either put the doc up on assault charges or on murder charges.
of course you could also have a third party run a listing of how many "errors" doctors have made.
To be fair with this list show the National Average Local Average also.
of course any fines should be split 85%+ to the "victim" and the balance to The State.
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All of those would be good ideas, none of them limit how much I can recover when a doctor cripples me.
There is no reason for the people to pay for a person on disability when it results from malpractice. If they want that deal then doctors wages need to come way down.
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Huh? Did you even read my comment?
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No, I do not. If you read my comment the first sentence addresses this...
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ObamaCare fueled a huge wave of consolidation in the health care industry.
ObamaCare aka the Great Bogeyman. It's barely started to take effect and yet you're saying it "fueled a huge wave of consolidation in the health care industry" (note past tense). Next it'll be blamed for natural disasters.
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Specialist vs generalist is supply and demand. Specialists in any field cover a niche. If I have an issue with my Exchange server that no one on the IT team can figure out, I call in a specialist. He might charge twice what it would cost for the IT team to figure it out, but he can solve the problem much faster and give more confidence in his solution - which is exactly why he can charge more.
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Specialist vs generalist is supply and demand.
If it was supply and demand the AMA wouldn't need a committee to set prices. This is about a guild, not a competitive market.
All kudos to the congressmen raising the issue (Score:2)
No incentive for accuracy (Score:3)
When the money comes from a Monoply box, there's no incentive for accuracy, only more money.
Maybe we could try capitalism & light regulati (Score:3)
The light regulation being complete price and quality transparency, with the prices for all procedures and outcome statistics easily available online. Put the prices for the 100 most common procedures on posters in large type every 200 feet in every hospital. Put a booklet in every hospital and clinic room. Even insured people frequently have a high co-pay. Think prices wouldn't drop?
Other prices would come down quickly if congress were to deregulate. Allow insurance and prescription drug purchases across state and international lines and prices would drop in a hurry.
Moreover, the whole "prescription" idea is a bit of a racket. If I want to buy a stronger zinc oxide cream for foot problems, I have to see a doctor and get a prescription. For foot cream with 5% zinc oxide. I mean, WTF? It's time to release all but the most dangerous drugs into the wild.
My 2 bitcoins.
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Health care has been heavily regulated for decades and costs have spiraled out of control. Obviously, regulation isn't working, and hence we should have less of it, not more. In different, the problem is overregulation.
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And you'd regulate the heck out of it. The more regulation you have the more costs you have. Pure and simple. Got to be a happy medium- and YOU aren't asking for that.
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Try a little different line there and you'd have it.
Private insurance typically pays out 30% of what Medicare pays out.
Medicare pays out 25-30% maximum in most cases with a few exceptions like powered wheelchairs for the disabled. They don't do dental. They don't do vision.
Tell me again that it's JUST the for-profit industry...
Balance (Score:2)
What about the opposite problem? Doctor performs a procedure in his office which includes the use of a $100 disposable device. Medicare pays him $35 for that procedure. Doctor either eats that difference, or chooses not to see Medicare patients.
This is a red herring. If they are looking to save money, look at the lawyers, insurance companies, and drug companies.
(I am not a doctor, nor do I play one on TV.)
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Then Medicare should instead provide the device. Let them buy those in bulk and give them to the dr for this procedure.
Tort reform does not lower cost, it only shifts the risk to the patient. Since with it a doctor can cripple you and payout less than you make in a decade. So we can rule out the lawyers. The insurance companies sure make good money, but they take a percentage so if procedures were cheaper they would make less. Drug companies are a problem, but the solution there is to stop them from adverti
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Actually, Medicare's out of touch with reality.
It's bureaucrats determining what is medically necessary and when they do how much they're willing to pay for it so that they can cover their own *sses and make their budgets look "good" so they can get more from Congress.
Supplying the device? I don't think so. It'd probably injure you. Honest.
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Considering how many doctors have tried to kill me, I don't see the risk really changing.
Some education on end of life spending would be nice too. I have seen many doctors spend what had to be tens of thousands to give people a couple more pain filled days of torture.
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And you think doctors don't already prescribe medication based on which pharmaceutical company buys them lunch?
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The pharma companies would not do it otherwise. Try to remember that this lunch comes from an attractive person of the sex you prefer. Who also controls if you get to go to that "educational" meeting in a nice tropical location.
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It's not just insurance companies, lawyers, and big pharma to blame. You fingered a solid part of the cause and then you go and blame insurance companies (which are part of the problem, but not the root cause...they typically only pay 30% over what Medicare pays- and typically, they'd have paid only $25, not $35- that's more the private insurance payout in most cases...)- go for one of the root causes. Big pharma just simply comes out of your pockets in most cases and not out of the doctor's hide. Not so
15 minutes triggers the BS detector (Score:4, Informative)
15 minutes for a colonscopy? Where do they get this number? Getting informed consent can take 15 minutes just by itself (and is something the doc has to do). 15 minutes sounds like the best-case scenario (e.g. a screening colonscopy on a healthy 50 year old with no findings) and a number to sensationalize the article. What is the distribution of times that the procedure takes? Maybe 75 minutes is actually a reasonable time to expect the procedure to take on average?
That the health care system in this country is screwed up is not at issue. The article wants to point out the ludicrousness of the reimbursement mechanisms in place. Putting in a context-free and unexplained statistic only weakens its argument.
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15 minutes for a colonscopy? Where do they get this number? Getting informed consent can take 15 minutes just by itself (and is something the doc has to do). 15 minutes sounds like the best-case scenario (e.g. a screening colonscopy on a healthy 50 year old with no findings) and a number to sensationalize the article. What is the distribution of times that the procedure takes? Maybe 75 minutes is actually a reasonable time to expect the procedure to take on average?
That the health care system in this country is screwed up is not at issue. The article wants to point out the ludicrousness of the reimbursement mechanisms in place. Putting in a context-free and unexplained statistic only weakens its argument.
I just had an upper GI done yesterday. I was wheeled back at 9am and was back in recovery (and in and out of consciousness) by 9:30am. That was with them leaving a sensor in my throat to test for acid reflux. I wasn't fully sedated, they just medicated me to cause me to forget what was going on, and to not feel any pain during the procedure. I'm a bit resistant to the medication, which explains why I remember things starting at 9:30
You know the worst part? (Score:2)
The way private sector insurance companies determine prices is even more fucked up, because they always end up paying more then Medicare.
Granted frequently that's because hospitals flat-out refuse any proposal to pay less then Medicare offers, but you'd think if the private sector was actually good at setting health prices they'd have found a way to do so that was better-sounding then "pay whatever the government will pay, plus 20%, because that asshole plays hardball."
Who pays for the Technology? (Score:2)
While it is stated: "... technology has advanced and now the images are processed and displayed on a large screen in high-definition video.", the cost of the technology and the "overage" in cost per procedure goes hand in hand. It may now only take 15 minutes to preform what used to take 75 minutes, but if the doctors are only reimbursed for their time for the procedure, they would never be able to afford the technology which would put them back to 75 minute procedures.
This technology not only helps to pro
Wait... (Score:2)
Let me see if I understand this: A centralized, bureaucratic, government-run program is sclerotically unresponsive to the market, cost-inefficient, and ultimately impairs the ability of ...seriously?
- individuals to get the care they need
- professionals to get compensated to the degree due based on current practices, technology, understanding, etc.
- competitive forces to keep prices down.
That's unpossible. I'd ask my friend Adam Smith to comment, but I think he's banned from Slashdot.
The truth of the matter... (Score:2)
Is that Medicare pays approximately 25% of those so-called rack-rates. Private insurance typically pays 30% over the Medicare pay rates.
Overcharged? Perhaps. It's all this BS, though, that we're discussing right now (and Congress is mandating) that's causing it.
Want to actually make affordable healthcare? FIX THAT FIRST.
(Hint: It doesn't get fixed by bureaucracies like this and it doesn't get fixed by doing socialized medicine.)
Washington Post Accurate? (Score:2)
Having just had my first colonoscopy just last week, I can vouch that it took the doctor much longer than the Washington Post is claiming. I spoke with him before and after the procedure. Did it take 75 mins? Maybe slightly less if you consider that he wasn't with me the entire time, and I couldn't even confirm that it was him who did the procedure, since I was knocked out. How much time should the doctor spend talking to you, and reviewing the results, even if the specific procedure was 15 minutes?
Charge master BS needs to stop (Score:2)
Each hospital needs to have an price list that is easy to find and must show the all in price for doing X it's ok to show an rage but there will be limits on how big it can be.
Also any ER care must be an fixed price for all hospital in the same area
I'm not a gastroenterologist but I am (Score:5, Informative)
a dentist, and even I can tell you there's more to the story here. That 75 minute colonoscopy is probably an average. No one can predict exactly how long any given procedure will take on any specific patient. If a patient has no polyps, the procedure goes faster. If they find polyps and remove them (that's how colonoscopies prevent cancer) it takes longer. Patient anatomical variations and other medical complications can affect the time required.
I run into the same thing with my patients. A simple 15 minute restoration on a cooperative adult patient can turn into an hour long ordeal on an uncooperative 5 year old, but insurance pays the same for either one.
It doesn't matter. (Score:2)
If a 15 minute colonoscopy costs 2000 dollars, or a 75 minute colonoscopy costs 2000 dollars it's the same thing.
What these articles are really pushing is to lower the pay of doctors by 75 percent. I'm not going to argue for or against that, but it's the actual argument here. Can we as a society give doctors and surgeons a 75 percent haircut on salary and still expect the same level of service.
Also what profession exists that charges no base time and at a 15 minute interval? Most IT people I know charge
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Speak for yourself, I find this interesting.
On the other hand, if you _really_ would like to see other stories on /., feel free to submit stories yourself. After all, that is how /. works.
Thanks, /.
The other 99% of
Re: So What (Score:2)
If you are any smarter than the Americans, let's see an idea that could be written on a piece of paper and pass both houses within a few weeks. Because otherwise, there aren't many options other than violent overthrow, at which point it could be sa
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Nonsense. The public will loot the public treasury...after all, it is a form of the commons!
And in general, no one cares about the commons, until they are gone.
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Strictly speaking he doesn't have to. If something is inherently unfixable EVERYONE is too fucking stupid to fix it. It's kinda dickish to put it that way, but hey. It's slashdot.
If dickishness were banned my posts wouldn;t get a +1 from karma bonus.
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I have two barbers I like. One is an old guy who has been doing it forever. He does a good job, but only uses scissors and a comb so it takes about 30 minutes for him to cut my hair. He charges $18. The other guy is in his early 20's and has a nice selection of electric razors. The end result is just as good (maybe better), and takes less than 15 minutes. He charges $11.
The first guy is struggling because he's not willing to get the training or the tools to be more efficient, so he can't see as many people
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So you're ok with your taxes going to pay for 26 hours of work in an 8 hour day?
Efficiency is doing things faster AND/OR cheaper.
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My mechanic never charges me extra hours, but damned if I don't need to have my flasher fluid changed every time I go there...
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Replying to myself, but another thought: "Maybe some social programs are wasteful, maybe some are necessary." The issue here is that most of them are both. I don't know what the solution here is, but the polarizing nature of it means that no matter what we do, nobody is going to be happy about it.