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View Diary: Ahead of meeting, speculation (74 comments)

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  •  Doc Fix (0+ / 0-)

    For the first time, I'm actually starting to get a little bit worried about the so called "doc fix".

    This year, just like every other recent year, we've been looking at a big pay cut. Previous years, this has been delayed each time. I'm starting to get a little skittish about whether or not it will be addressed this time.

    Docs pretty much have to decide by Dec. 31st if they want to continue to see Medicare and Medicaid patients.

    My professional societies have sent out some worrisome recommendations. ACP (which is the biggest society for internal medicine docs) has recommended re-evaluating your Medicare position. They have stopped short of recommending withdrawing from Medicare, but have even included recommendations such as:

    cope with far less Medicare revenue, especially if Congress waits until sometime in January to retroactively avert the cuts.

    •Obtain a line of credit

    •Temporarily reduce staff or office hours

    •Delay nonurgent, routine appointments of Medicare patients until the crisis is resolved

    This is not a "sky-is-falling" sort of organization. And they are seriously recommending that you take out a loan, or you lay off staff, or you delay appointments.

    (Wouldn't that be a fine plan? Lay off staff right after the holidays. Nothing like layoffs to encourage office cohesiveness. Our own little anti-stimulus plan.)

    This is not a particularly conservative political organization either, by the way. They've previously come out in favor of a single payer system.

    The American College of Physicians agrees that there are really only two options, though they are both government solutions: (1) an efficient, single payer national health program, or (2) a more expensive, administratively complex, inefficient, highly regulated and heavily subsidized fragmented system of a multitude of private plans plus public programs, with means testing and mandates to participate. It doesn’t seem like a difficult choice.
    The American Geriatrics Society reminds me that the Centers for Medicare and Medicaid Services are not planning on holding claims this year. (Previously, they held claims while waiting for Congress to pass a delaying measure.) We will have to submit claims on time and they will get processed normally. This will be more than a 26% pay cut (when you already make less for taking care of a MC patient in the first place).

    These things are a bit scary.

    Some more of my colleagues will make the choice to stop seeing Medicare and Medicaid patients. This may be part of the Tea Party agenda. If the MC system unravels, then it can be replaced by some sort of cash-in-hand or premium insurance substitute (and then for others a scramble to find docs willing to do reduced payment schedules and charity care).

    Docs aren't hurting in the same way that many people will be if cuts go through, obviously. But as a result of failing to find a more permanent doc fix, many other people will be hurt as well.

    The plural of anecdote is not data.

    by Skipbidder on Fri Dec 28, 2012 at 01:40:38 PM PST

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