CMS reveals plans for changing physicians pay

[RJ]

Good thing? Or are we all doomed?


http://www.physiciansnewsnetwork.com/la_county/article_52f7b98c-1090-11e6-ac27-df456ed0da6d.html

[Hatton]

Too complex!!!!!  The retirement writing is on the wall.

[RJ]

Yeah, that would be nice. Not for some of us for a while...

[Zaphod]

Incredibly short sighted. Most of those things are not in the doctors control whatsoever. EMR intercommunications, quality? None of that matters as you dont make the systems or their ability to transfer data, and you cant make patients listen and do whats recommended. Same thing with the increased time/pt, that really doesnt do much at all except make someone feel better. Although no one likes to be honest about it you could dx/tx a large percentage of patients without ever seeing them physically, not all, but a lot more than anyone cares to admit.

In the end, they should have to prove that what they are measuring as "quality" actually makes a difference. I can nearly guarantee this setup with not help patients, but will create counter incentives for physicians and lead to a massive gaming of the system meaning misreporting, patient choosing, patients that have a hard time finding doctors, etc...etc...a lot of wasted time not spent with patients. Its like these people cant think at all. Are these issues not obvious?

 

It doesnt matter at all to me personally, I dont take insurance at all, Im just pointing out the obvious.

[John Shackleford]

It is a shame that "how well (physicians) treat patients" will now be equated with (or heavily weighted toward) patient satisfaction scores.  Frequently, taking care of people involves disappointing them or telling them hard truths.  In my opinion, satisfaction scores don't reflect any part of care quality.

[DarrVao777]

Well, I guess it will be an all-cosmetic / cash practice for me then.....

[VagabondMD]

12/31/17 cannot come soon enough!

(I should put that on my signature line. )

[SValleyMD]

This drives me bonkers. To echo others I just don't understand it nor does anyone else and since most of our physician leadership in our societies are so detached from the non academic rank and file I'll sure we'll be screwed to a certain extent

[Zaphod]

SValleyMD wrote:

This drives me bonkers. To echo others I just don’t understand it nor does anyone else and since most of our physician leadership in our societies are so detached from the non academic rank and file I’ll sure we’ll be screwed to a certain extent

Click to expand...

Sadly, many physicians ARE the problem. I dont know if they just have zero common sense or have never actually practiced clinical medicine, but they are super naive and idealistic in a has dangerous repercussions way. We seem to be one of the few professions that is so adept at self sabotage.

I just the other day had to correct some doctor on twitter posting some JAMA article no less, saying knowing costs using a pricing tool does not lead to better more efficient use of health care...etc...how do we save the world now, doctors, etc....When if you actually read the abstract only, almost no one used the tool at all. How is this a shocking or surprising result, and worse, why do we allow supposed reputable journals to promulgate such articles in such a light? Article should have been geared towards getting folks to pay attention, and said zip about prices, since it couldnt have been expected to happen. In any field where it is widely known and people can easily compare prices, like plastic surgery, etc...it works and people price shop and compare.

I mean seriously, it'd be akin to publishing a study with the headline "seat belts dont work", and then reading that while they were in cars equipped with seat belts, no one used one. So what? Besides, the healthcare market is neither transparent nor competitive to work even if a tool was available. Itd have to include all choices to work.

 

[Josh0731]

I can't imagine how these kinds of payment schemes are going to save money in any way short of just finding lame excuses to pay us less.  For the present time it seems like all that's happening is dollars are being shifted over to increasingly bloated hospital and insurance administrations who are hiring people to learn, interpret, implement, and track all of these metrics.  Then the large savvy healthcare companies who can afford large staffs to navigate the scheme will learn how to massage and present the right numbers to earn their financial rewards.  And doctors who do cosmetic work or practice in affluent areas will be able to avoid or screen risky patients from their practices. And hospitals and healthcare providers in less-advantageous situations serving the rural or urban poor will wind up being financially punished for doing so.  And down the road the carrot gets put on a longer stick so fewer and fewer people are worthy of higher pay under their system (its already at the point where a PG survey score of 4 instead of 5 can bump you from the top percentile to the lowest because all the ************************ scores are clustered at the top for nearly everyone).

I roll my eyes any time I hear a physician defend these systems because they just don't get how they're being played.

[VagabondMD]

Another example of: "I did not sign up for this."

I am glad to be seeing the light at the end of the tunnel.

[childay]

Obviously the devil is in the details.  Suspect we are all doomed.

[HawkeyeJD]

Look on the bright side, given this countries age demographics over the next 30 years there will be no shortage of people to work on and earn income from.  It may be annoying to have to put up with insurance and the government, but then again that is the system we have, it is not going to ever go back to "the way it was" and you should all be able to continue to earn substantially above the median household income for the long term.

 

I suppose the alternative is that we can go to the European model and many of you take substantial pay cuts (but don't pay much or anything for school) or we can go to the third world model and everything can be cash balance based on ability to pay.  I suspect most of you would also take (substantial) pay cuts under this model given the income demographics of this country.

 

And besides, with some of the incredible healthcare robotics, computer systems, and other things popping up, I'd be surprised if many physicians even have specialties to practice in come 20 years down the road.  If I were a doctor today, I'd be a lot more concerned about being rendered obsolete in the future than I would be concerned if I a few thousand dollars either direction any given year.

 

 

 

 

[DarrVao777]

HawkeyeJD wrote:

Look on the bright side, given this countries age demographics over the next 30 years there will be no shortage of people to work on and earn income from.  It may be annoying to have to put up with insurance and the government, but then again that is the system we have, it is not going to ever go back to “the way it was” and you should all be able to continue to earn substantially above the median household income for the long term.

 

I suppose the alternative is that we can go to the European model and many of you take substantial pay cuts (but don’t pay much or anything for school) or we can go to the third world model and everything can be cash balance based on ability to pay.  I suspect most of you would also take (substantial) pay cuts under this model given the income demographics of this country.

 

And besides, with some of the incredible healthcare robotics, computer systems, and other things popping up, I’d be surprised if many physicians even have specialties to practice in come 20 years down the road.  If I were a doctor today, I’d be a lot more concerned about being rendered obsolete in the future than I would be concerned if I a few thousand dollars either direction any given year.

 

 

 

 

Click to expand...

I understand you aren't in medicine but there's little (if anything) that is correct in your post.

[HawkeyeJD]

 

DarrVao777 wrote:

I understand you aren’t in medicine but there’s little (if anything) that is correct in your post.

Click to expand...

I suppose the onus would be on you to point out what, in your opinion, is factually inaccurate.  As best I can tell, everything I typed is either factually true or, to the extent my opinion, demonstrably true to a degree that lends credibility to my assertion.  Always interested in other's perspectives though.

In addition, just because I don't practice medicine, does not mean I am not in the healthcare system or that I don't have a perspective on the healthcare system that is just as valid as a practitioner within the system.