Thursday, January 22, 2009

Show me the Money

The WSJ health blog today asks where the money is going to come from to fund the anticipated increased remuneration of primary care physicians during the Obama reign. Here're the options given in the online blog poll:
A) Cut subsidies to Medicare Advantage
B) Pay hospitals less for high-margin services such as radiology
C) Lower Medicare reimbursements for care and procedures by specialists
D) The money shouldn’t come out of existing health-care spending
E) Primary care doesn’t need more money

Guess which option is winning? Well of course it's choice "C". Because you know those unscrupulous specialists who do procedures, i.e. non-cognitive medical interventions that a properly trained chimpanzee or even a bonobo could do, ought to be coughing up chunks of change for the poorly paid underclass of primary care docs. Bringing up the rear in the poll is "money ought not to come out of existing health care spending". In other words, don't even think about supplementing physician payment with any more federal money than they already get, dammit!

Why do we keep accepting the conventional wisdom that this is a zero sum game? We just forked out $700 bill to greedy bankers on Wall Street. It took us 50 nanoseconds to decide it would be a good idea to send $80 bill to AIG. If Obama wants to truly reform health care, he's going to need primary care docs; much more than our economy needs a privately owned company like AIG to survive. That puts physicians in the proverbial driver's seat, right? This emphasis on the pay discrepancy between specialists and primary care is just what the policy wonks in DC want. It's the angle they can use to avoid a federal bail out of the American health care train wreck. Just siphon money from the surgeons and proceduralists!


Anonymous said...

Dr. Parks, great stuff as usual.

I agree it shouldn't be a zero sum game. Part of that is I think it's important that we value the cognitive aspects of surgical/nonsurgical specialties as much as we value the cognitive aspects of primary care.

A psychiatrist makes more money doing 3 15 minute med checks than a single 45 minute session of therapy.

An orthopedic surgeon doesn't get paid any more for a thorough physical exam than he does for saying 'well let's do an exploratory arthroscopy'.

I think it goes beyond primary care vs. specialty.

Anonymous said...

They are already making changes to Medicare-C/Advantage to bring the payments and costs more in line with the traditional A/B/D plans.

My hope is with the move to ICD-10, with more specific coding, what is billed will be more in line with what was done, and thus appropriate payment. Hopefully you won't have to bill NOC codes and justify what you billed, to get fair payment for a complicated procedure. At the same time, hopefully we'll get more appropriate E&M billing, which seems to be chronically upcoded.

Anonymous said...

Study after study after study demonstrates that doctors undercode far more often than they overcode. Not sure if you mistyped or are ignorant.