The end of emergency medicine

[White.Beard.Doc]

Congress passed their new law banning surprise billing last night. They gave the insurance companies unilateral power to set rates for emergency care. The rates don’t need to be reasonable. The rates will be whatever the insurers decide to pay.

Emergency medicine will die a slow and painful death. Emergency physician salaries will fall to the lowest levels of compensation.

Emergency medicine was hard hit by COVID, with job cuts, pay cuts, and now this. Well, it was a good run, but the private equity owned groups were pigs, and pigs get slaughtered. It is so sad. The private equity pigs raped the public and in the process, they have now destroyed the future ability of emergency physicians to make a decent living. I feel terrible for all of those bright young residents who chose the specialty.

[Tangler]

Sorry. Hang in there. I too worry about young doctors. Huge sacrifice (opportunity cost etc) and tuition is absurd. In 1996 i borrowed a lot of money to go to medical school and every doc i talked too told me i would be more than fine financially (do not worry about paying back those loans, you will be fine). I was stressed about school, and about borrowing money but hearing reassurance from the older docs was helpful.

Can we assure medical students that the cost of tuition (let alone time/human capital) is worth it?

ROI?

I am a very debt averse person. Debt = risk.

Financial debt, opportunity cost, etc. make me wonder.

I may be wrong, but i have told my nephew and niece: “whatever you do, don’t borrow a ton of money for education or anything else“

No guarantees in life.

My Nephew is a freshman in college and he got a full ride at a state school on a golf scholarship (he loves golf, and as a freshman he is 2nd best player on whole team!). He is saving his 529 for possible graduate school (studying finance).

Covid made me realize:
1. doctors don’t have a recession proof job
2. I need an emergency fund
3. ROI for medicine?
i won, but did i just get lucky and “time the market “ ?

Maybe i am just getting old but the cost of tuition for higher education in this country needs to be addressed. People respond to incentives.

[Eye3md]

Wow, that’s crazy. Congress had a chance to support docs, but instead, chose to follow the money and let the high powered insurance lobby direct their votes.

I assume this would apply to almost any hospital based physician (rads, path, anesth, etc...), correct?

[Tim]

Wow, that’s crazy. Congress had a chance to support docs, but instead, chose to follow the money and let the high powered insurance lobby direct their votes.

I assume this would apply to almost any hospital based physician (rads, path, anesth, etc...), correct?

This was included as part of the Covid-19 $900b funding deal.
https://www.politico.com/news/2020/1...pending-449416

Envision Healthcare and TeamHealth had long lobbied against it.

The choices as I understand it were for in hospital services:
Medicare
Insurance (hospital and physicians)
Physician (unknown) with balance to the patient
Hospitals and insurance companies were refusing to offer competitive rates to physicians. Hospitals need rads, path, anesth, and ED.
Unintended consequence is they may now have to negotiate on behalf of every physician in their services. Hospital contracts with groups and physicians have allowed them to avoid this leaving the groups and physicians at a disadvantage with insurance companies.

"The private equity pigs raped the public". Is a price determined by insurance, hospital and physician a disaster? Insurance companies have offered different reimbursement rate and have aligned to different hospital systems as well. I think insurance companies want to be in major markets and cannot handle individual small independent groups and physicians.
It could be those groups can now get the "best insured reimbursement" available, which is better than medicare or poor collections. Naive but it is a hope.

[Hatton]

I think the publicity about the obscene amounts of surprise bills led to this. I am basing this comment on articles that I have read in the WSJ not any personal experience. In general I think "corporate" owned health care is a bad trend and this includes hospitals. It may be more efficient at billing and coding but better billing does not equal better care. The emphasis on notes to allow upcoding is a pet peeve of mine.

[CordMcNally]

Have we seen the text of the bill? I don't believe EM pay will fall to the lowest levels of compensation...at all. Everyone in medicine always thinks the sky is falling and it never does. This will be similar.

[VagabondMD]

Have we seen the text of the bill? I don't believe EM pay will fall to the lowest levels of compensation...at all. Everyone in medicine always thinks the sky is falling and it never does. This will be similar.

I agree with this take. Perhaps the pendulum will swing some in one direction, before swinging back again. Chicken little scenarios rarely play out to the most extreme outcome.

[CordMcNally]

I agree with this take. Perhaps the pendulum will swing some in one direction, before swinging back again. Chicken little scenarios rarely play out to the most extreme outcome.

This will likely be bad news for many of the CMGs and anyone else who doesn’t try to negotiate in good faith with insurers or who purposefully tries to be out of network. But most of us would all probably agree on some level that CMGs getting out of medicine would be good for medicine as a whole.

[Anne]

I’m no expert but I would think the proliferation of CMG sponsored residency programs would be a bigger hit to emergency medicine than this bill would be.

[CordMcNally]

I’m no expert but I would think the proliferation of CMG sponsored residency programs would be a bigger hit to emergency medicine than this bill would be.

Maybe this bill could get two birds with one stone...

[White.Beard.Doc]

Have we seen the text of the bill? I don't believe EM pay will fall to the lowest levels of compensation...at all. Everyone in medicine always thinks the sky is falling and it never does. This will be similar.

I hope you are correct. But the American College of Emergency Medicine says this is going to be a major disaster.

[CordMcNally]

I hope you are correct. But the American College of Emergency Medicine says this is going to be a major disaster.

That personally doesn't surprise me based on my view of ACEP and CMGs but I think that has been hashed out in previous threads.

[billy]

Doesn't taking medicare and medicaid rates off the table for arbitrating the "average rate" when settling the surprise billing help though?
I get it's bad for practices that only charge out of network fees (I'm guessing some CMG ERs do this), but some version of this bill was going to inevitably be passed- you cant beat the public opinion of "I went to my in-network hospital for my emergency, or used my in network surgeon/hospital combo for my procedure, but got out of network billed that my insurance wont pay for ER, Anesth, etc), why should I pay?"

[EntrepreneurMD]

Welcome to my primary care 1 physician world of no leverage with insurers. You just have to be more efficient and resilient. I know some ER docs that have opened up successful urgent cares. You know I'm all about BYOB. That's "be your own boss" not "bring your own bottle" although after this you may want to bring your own booze.

...I remember 15 years ago hearing talk about how medicine as we know it is collapsing! If you think this is indeed big news, don't try to fight at this point - buy health insurance stocks. I play both sides by owning healthcare funds. When in Rome; when the pendulum has swung for insurers.

An indirect way of saying income stream diversification to offset the shock in any one of those streams.

[MPMD]

"the revolution always seems to be right around the corner."
-very old nephrologist at my med school, counseling calm in the face of stories about the demise of medicine

"all i know is that every year i've made more money."
-old ER doc at my med school, counseling calm in the face of stories about the demise of medicine

my take on the future of EM is that it's going to get harder and harder for people who are poorly trained and who think their job is to provide low-medium quality care for those who they deem to be worthy of their time. the converse of this is to be really well trained and understand that the ED is there to do a bunch of things other than GSW to chest and e-CPR. the doc who is handling things for PMDs at night and sending them a message rather than waking them up and who doesn't feel the need to fight an epic battle against every operational change is going to be the successful one in the new world.