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Medicare physician pay fell 26% since 2001. How did we get here?
[link=https://www.ama-assn.org/practice-management/medicare-medicaid/medicare-physician-pay-fell-26-2001-how-did-we-get-here?utm_source=BulletinHealthCare&utm_medium=email&utm_term=070823&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend&utm_effort=DAMR01]https://www.ama-assn.org/…&utm_effort=DAMR01[/link]
Medicare physician pay fell 26% since 2001. How did we get here?[/h3]
Whats the news: As part of its campaign to fix the unsustainable Medicare physician payment system, the AMA is outlining in a quick, easily navigable fashion why doctors Medicare payments must be tied to an inflation index called the Medicare Economic Index (MEI).
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We can cry all we want, but no govt. private payers or the public will care. They all think we are over paid.
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47 Replies
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A mix of two things mostly:
1. well-meaning, compassionate physicians who prefer to focus on patient care and patient welfare above all else and at the expense of the business of medicine. Meanwhile the crooks on the business side and politicians (who later fall into healthcare jobs on boards etc or in private equity) slowly slice and dice.
2. Cowardly physicians who actually do care about the business of medicine but are too cowardly to stand up for themselves let alone their profession.
We let this happen to ourselves. You think big pharma or big medical device companies are taking that kind of haircut on their earnings? Nope. They have a lobby. If physicians all contributed $2000 a year to form a lobbyist strategy, we would have a shot. Sadly, you cant just expect politicians to do the right thing. Also sadly, many physicians are either to cheap to pay $2000 or they are (perhaps rightly so) skeptical about how that money will be spent
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this is the most depressing aspect of American medicine. Our pay rates from Medicare (and thus insurance companies due to their negotiated multiple of medicare for their payment rates) have not only not kept up with inflation, they are actually decreasing.
Social security and government employees all got inflation adjustments. The American workforce have been getting significant wage increases the past few years. What did we get?????? CUTS! We should all be livid!
This is a much bigger deal than PE, DR vs IR, etc. We need to band together and fight this with all that we can. -
Quote from sartoriusBIG
A mix of two things mostly:
1. well-meaning, compassionate physicians who prefer to focus on patient care and patient welfare above all else and at the expense of the business of medicine. Meanwhile the crooks on the business side and politicians (who later fall into healthcare jobs on boards etc or in private equity) slowly slice and dice.
2. Cowardly physicians who actually do care about the business of medicine but are too cowardly to stand up for themselves let alone their profession.
We let this happen to ourselves. You think big pharma or big medical device companies are taking that kind of haircut on their earnings? Nope. They have a lobby. If physicians all contributed $2000 a year to form a lobbyist strategy, we would have a shot. Sadly, you cant just expect politicians to do the right thing. Also sadly, many physicians are either to cheap to pay $2000 or they are (perhaps rightly so) skeptical about how that money will be spent
Well said. I pay my annual ACR national and state chapter dues without any hesitation. Not sure where else I should be contributing. I wonder what percentage of radiologists do contribute.-
Very simple.
Supply and demand.
People actually want to be physicians. Heck, in the Soviet Union, physicians were paid the same as factory workers and still everyone wanted to be a physician. You have to pay coal miners a lot since no one actually wants to do that job. (Despite what you may hear about “coal jobs” in Appalachia they actually have to import miners from Mexico since Americans generally speaking won’t do it, despite the $100K+ salary.) You don’t necessarily have to pay physicians; the latest statistics from the local state medical school’s magazine said that there were [i][b]seven[/b][/i] fully qualified applicants for every medical school slot.
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Physicians are the weakest most divided party. Hospitals and insurance companies have consolidated to grow power. Hard or impossible for individual physicians to consolidate except perhaps through corporate employment entity, PE.
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But here’s the thing. Right now individual physicians are better off not consolidating. The best and most productive can write a better contract on their own than a group can. What happens when they are in limited supply.
Of course the pressure will be to replace them with NPPs but we have all seen how successful that will be. In fact, it just makes the real physician shortage even more acute, and makes health care worse an less affordable.-
Quote from Thread Enhancer
But here’s the thing. Right now individual physicians are better off not consolidating. The best and most productive can write a better contract on their own than a group can. What happens when they are in limited supply.
Of course the pressure will be to replace them with NPPs but we have all seen how successful that will be. In fact, it just makes the real physician shortage even more acute, and makes health care worse an less affordable.
As we have seen- Physicians will not benefit, the PE firm will. Power flows to its greatest concentration, or the iron law of oligarchy.
Medicine is too like labor and not enough like capital.-
Just say no.Youve got the power to. Unless you are drad I guess.
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Im sick of all of the whining. There has never been a better landscape for good, knowledgeable individual radiologists. Take your share of the prize!
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Quote from Thread Enhancer
Im sick of all of the whining. There has never been a better landscape for good, knowledgeable individual radiologists. Take your share of the prize!
Yes we are in an unique environment-seems like individual rads now have more negotiating power/clout than groups/hospitals.-
Quote from jd4540
Quote from Thread Enhancer
Im sick of all of the whining. There has never been a better landscape for good, knowledgeable individual radiologists. Take your share of the prize!
Yes we are in an unique environment-seems like individual rads now have more negotiating power/clout than groups/hospitals.
This is very important to realize if you are smart and willing to do a bit of hard work. As an individual one can negotiate a better deal than a group that has to subsidize the weak. The worst position to be in RN is a group with an exclusive contract to provide IR and night services that a hospital won’t subsidize. Must say no.
Well, actually being in a PE backed hospital group is worse because you have to deal with the skim on top of subsidizing the weak. -
Interestingly hospitals have done quite well for themselves during that time. The money is there, but doctors are just not very good at advocating for themselves especially considering all these hospital systems with billions in cash reserve doing so off the backs of doctors.
[link=https://revcycleintelligence.com/news/impact-of-future-medicare-cuts-on-physician-reimbursement]https://revcycleintellige…hysician-reimbursement[/link] -
I think our group leaders are afraid of asking for subsidy because they feel like they will alienate hospital, who may look for another group that won’t. Could be real, could be an unfounded fear. If unfounded, definitely leaving a lot of money on the table.
Quote from Thread Enhancer
Quote from jd4540
Quote from Thread Enhancer
Im sick of all of the whining. There has never been a better landscape for good, knowledgeable individual radiologists. Take your share of the prize!
Yes we are in an unique environment-seems like individual rads now have more negotiating power/clout than groups/hospitals.
This is very important to realize if you are smart and willing to do a bit of hard work. As an individual one can negotiate a better deal than a group that has to subsidize the weak. The worst position to be in RN is a group with an exclusive contract to provide IR and night services that a hospital won’t subsidize. Must say no.
Well, actually being in a PE backed hospital group is worse because you have to deal with the skim on top of subsidizing the weak.
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Group leaders are afraid. Yes.
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Quote from ChuckI
I think our group leaders are afraid of asking for subsidy because they feel like they will alienate hospital, who may look for another group that won’t. Could be real, could be an unfounded fear. If unfounded, definitely leaving a lot of money on the table.
I think this is true. However the bottom line is that we are at a point where the difference between receiving/not receiving subsidization from hospitals will make or break groups with respect to recruitment/retainment…To your point, are there other groups that can take on new contracts and manage to recruit/retain without subsidization? Past few years this has been RP/PE, despite all their doom/gloom I myself would not count them out. At the end of the day, there will be winners and losers given that there are only X amount of rads with an increasing need for coverage so something has to give. -
No PE, but there academic vultures with under, barely-staffed community arms that could be waiting in the wings. They generally seem to be willing to take on all-comers although they may be at the tipping point due to labor shortage.
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Just wow. -
Need medical education costs added to graph as well.
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I think our group leaders are afraid of asking for subsidy because they feel like they will alienate hospital, who may look for another group that won’t. Could be real, could be an unfounded fear. If unfounded, definitely leaving a lot of money on the table.
This is where a group needs some outside advice to give them the confidence to go for it, and to supply objective data re what they need to survive.
It also depends on how metastable your group is. If things are going pretty well, then maybe the risk is too much. But if things are bad, cant recruit etc, whats to lose. Your probably dying off as it is, why not try to hold it off. Do something!
As stated in previous posts, it matters how you present it and what kind of relationship you have with the hospital.
The awkward neuroradiologist president demanding a generalized subsidy wont fly, but the respected leader asking for help in specific areas with data, eg for overnight or ir, can succeed.
I think you have to start that conversation. If you havent, and you are struggling, big mistake if you and your health system are at all aligned. -
I think our group leaders are afraid of asking for subsidy because they feel like they will alienate hospital, who may look for another group that won’t. Could be real, could be an unfounded fear. If unfounded, definitely leaving a lot of money on the table.
This is where a group needs some outside advice to give them the confidence to go for it, and to supply objective data re what they need to survive.
It also depends on how metastable your group is. If things are going pretty well, then maybe the risk is too much. But if things are bad, cant recruit etc, whats to lose. If you are dying off as it is, why not try to save the group. Do something!
As stated in previous posts, it matters how you present it and what kind of relationship you have with the hospital.
The awkward neuroradiologist president demanding a generalized subsidy wont fly, but the respected leader asking for help in specific areas with data, eg for overnight or ir, can succeed.
I think you have to start that conversation. If you havent, and you are struggling, big mistake if you and your health system are at all aligned. -
Quote from boomer
I think our group leaders are afraid of asking for subsidy because they feel like they will alienate hospital, who may look for another group that won’t. Could be real, could be an unfounded fear. If unfounded, definitely leaving a lot of money on the table.
This is where a group needs some outside advice to give them the confidence to go for it, and to supply objective data re what they need to survive.
It also depends on how metastable your group is. If things are going pretty well, then maybe the risk is too much. But if things are bad, cant recruit etc, whats to lose. If you are dying off as it is, why not try to save the group. Do something!
As stated in previous posts, it matters how you present it and what kind of relationship you have with the hospital.
The awkward neuroradiologist president demanding a generalized subsidy wont fly, but the respected leader asking for help in specific areas with data, eg for overnight or ir, can succeed.
I think you have to start that conversation. If you havent, and you are struggling, big mistake if you and your health system are at all aligned.
I don’t disagree with this approach but seems like stuff doesn’t change until there is a staffing shortage that starts affecting work flow for clinicians/hospitals (eg. turn-around times for beds, ER etc)…If I was a hospital administrator and a PP group was asking for assistance with recruiting, I would 1st ask them to shorten/eliminate partnership tract and/or given full parity to any new hires right off the bat. This has been happening to a certain extent (eg. shorter tracts). Many groups are resistant to this as it can potentially upset current partners that did not get the same deal, which then makes retainment an additional issue. -
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Quote from Thread Enhancer
Just say no.
For now that will work but for how long?
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Quote from drad123
Quote from Thread Enhancer
Just say no.
For now that will work but for how long?
IDK. Beats the alternative though. Might as well get it while you can. Do a great job, make yourself indispensable and it will probably go on for a long time at least for you. Who knows about those that don’t believe in themselves or can’t keep up.
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Quote from Voxel77
Quote from sartoriusBIG
A mix of two things mostly:
1. well-meaning, compassionate physicians who prefer to focus on patient care and patient welfare above all else and at the expense of the business of medicine. Meanwhile the crooks on the business side and politicians (who later fall into healthcare jobs on boards etc or in private equity) slowly slice and dice.
2. Cowardly physicians who actually do care about the business of medicine but are too cowardly to stand up for themselves let alone their profession.
We let this happen to ourselves. You think big pharma or big medical device companies are taking that kind of haircut on their earnings? Nope. They have a lobby. If physicians all contributed $2000 a year to form a lobbyist strategy, we would have a shot. Sadly, you cant just expect politicians to do the right thing. Also sadly, many physicians are either to cheap to pay $2000 or they are (perhaps rightly so) skeptical about how that money will be spent
[b]Well said. I pay my annual ACR national and state chapter dues without any hesitation. Not sure where else I should be contributing. I wonder what percentage of radiologists do contribute. [/b]
I became an AMA member last year after reading about their campaign to reform CMS. Aside from ACR/state chapter, perhaps RADPAC?-though I always thought they were essentially ACR -
Quote from Voxel77
Quote from sartoriusBIG
A mix of two things mostly:
1. well-meaning, compassionate physicians who prefer to focus on patient care and patient welfare above all else and at the expense of the business of medicine. Meanwhile the crooks on the business side and politicians (who later fall into healthcare jobs on boards etc or in private equity) slowly slice and dice.
2. Cowardly physicians who actually do care about the business of medicine but are too cowardly to stand up for themselves let alone their profession.
We let this happen to ourselves. You think big pharma or big medical device companies are taking that kind of haircut on their earnings? Nope. They have a lobby. If physicians all contributed $2000 a year to form a lobbyist strategy, we would have a shot. Sadly, you cant just expect politicians to do the right thing. Also sadly, many physicians are either to cheap to pay $2000 or they are (perhaps rightly so) skeptical about how that money will be spent
Well said. I pay my annual ACR national and state chapter dues without any hesitation. Not sure where else I should be contributing. I wonder what percentage of radiologists do contribute.
where else?
AMA.
yeah, I know, mixed bag there, but it is one of the few organizations large enough to oppose organized business lobbies, such as the hospital lobby and the insurance lobby.If you think, as I have, that “well, they haven’t been able to in the past”, I would only say “proof positive that whatever we have done is insufficient and more money needs to be given”
Physicians are notoriously short sided and cheap when contributing to political organizations that should represent us. And we are reaping the consequences of that.
I wrote about this in some detail in Medical Economics last year. Here is the article
[link=https://www.medicaleconomics.com/view/why-richard-nixon-s-ghost-is-haunting-cms]https://www.medicaleconomics.com/view/why-richard-nixon-s-ghost-is-haunting-cms[/link]
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Why are all lawmakers attorneys? Why arent more lawmakers physicians?
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[link=https://www.beckershospitalreview.com/finance/cms-pitches-physician-payment-rule-for-2024-8-things-to-know.html?origin=QualityE&utm_source=QualityE&utm_medium=email&utm_content=newsletter&oly_enc_id=0472E8007634G3E]https://www.beckershospit…enc_id=0472E8007634G3E[/link]
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This is so depressing. Could easily be fixed by our lawmakers who are wasting their time on other nonsensical issues.
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Yet more cuts
[link=https://radiologybusiness.com/topics/healthcare-management/healthcare-policy/medicare-fee-schedule-proposes-pay-cut-diagnostic-and-interventional-radiology-ditching-auc-program?utm_source=newsletter&utm_medium=rb_news]https://radiologybusiness.com/topics/healthcare-management/healthcare-policy/medicare-fee-schedule-proposes-pay-cut-diagnostic-and-interventional-radiology-ditching-auc-program?utm_source=newsletter&utm_medium=rb_news[/link]-
Biden is busy motorboating infants, every politician is investigating every other politician and American healthcare is circling the drain.
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Napoleon is always right. I will work harder.
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Likely not an urgent issue to address unless it somehow leads to crises with staffing and unreasonable wait times for OP visits.
At this rate, private practices will continue their demise and all physicians will be hospital employees. Not even sure how this affects employed physicians year to year as their rates seem to be based more on supply/demand. At some point employed rads may have better deals their PP rads, since hospitals can shuffle around funds where most needed.
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At some point. I think we are already there jd.
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Some PPs I have friends at make good money, but they work really hard for it. The volumes are so high that the partners are almost forced to work more. Even when they make more, that’s not worth it for some people to be working more than they want. Employed model has its pros, you do what the contract entails and no more. But also of course that has its cons.
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Physicians need to form some type of legitimate physician-led and driven association and political action group focusing on issues like this addressing reimbursement cuts, tort reform, protection of individual physician rights etc.. I think state medical associations try, but its not enough. People need to look at studies and see when theres less frivolous malpractice lawsuits, healthcare prices can actually fall etc.. I dont think people understand these things. Replacing entire ERs and hospitalists with med-levels is a cheap administrative solution that will undermine the healthcare system in the long run. So, lets form one.
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Country is going broke folks, only going to get worse.
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United Physician Alliance
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US has been going broke for years/decades, yet somehow we find money when “needed:
Since the war began more than a year ago, the United States has given Ukraine more than $113 billion in aid. -
We need to fight these cuts. This sh!t is ridiculous. Constant cuts despite the worst inflation of our careers.
I have money to donate to the fight. I just don’t know who is fighting for my behalf….who has got our backs????
I really do not trust ACR/SIR…..its full of ladder climbing academics who don’t give a sh!t about PP. -
Quote from Robotrad
We need to fight these cuts. This sh!t is ridiculous. Constant cuts despite the worst inflation of our careers.
I have money to donate to the fight. I just don’t know who is fighting for my behalf….who has got our backs????
I really do not trust ACR/SIR…..its full of ladder climbing academics who don’t give a sh!t about PP.
If you don’t trust the ACR then I’m assuming you don’t trust the AMA. However flawed these organizations are, I think they are the only show in town…fighting these cuts annually at best only slight mitigates/delays them. CMS payment needs to reformed by congress. -
To my surprise I have noticed the AMA seems to be marketing their claims that they are fighting the annual paycut game (for those that aren’t clear, by paycut game I mean the annual CMS statement of “we’re cutting your pay by 10%. Oh, ok, you win, we’re only cutting it by 3.5%”).
I have not felt that historically the AMA fought for doctors’ interests, however if they are truly making a genuine effort to end this annual sh!tshow then I would start supporting them. I have a lot of skepticism though. The ACR/RADPAC has not been successful, in my opinion, in fighting these cuts but I still donate to them because to my knowledge they are the only significant group claiming to support our interests. -
Quote from sandeep panga
To my surprise I have noticed the AMA seems to be marketing their claims that they are fighting the annual paycut game (for those that aren’t clear, by paycut game I mean the annual CMS statement of “we’re cutting your pay by 10%. Oh, ok, you win, we’re only cutting it by 3.5%”).
I have not felt that historically the AMA fought for doctors’ interests, however if they are truly making a genuine effort to end this annual sh!tshow then I would start supporting them. I have a lot of skepticism though. The ACR/RADPAC has not been successful, in my opinion, in fighting these cuts but I still donate to them because to my knowledge they are the only significant group claiming to support our interests.
Agree with the skepticism. At face value I’ve been somewhat encouraged by the AMA and thus joined for the 1st time. They have had a bunch of webinars past year or so on the topic (next one is on 7/27, “Fix Medicare Now August Recess Campaign”)…Who knows where this goes but the key things that need to change are: 1). Eliminate zero-sums game/budget neutrality and 2). Incorporate annual COL raises (hospitals already have this). AMA strategy is looking for long-term reform, while the ACR/RADPAC was always about trying to minimize the cuts after the fact which is simply a race to the bottom. -
None of these organizations have been successful. Physicians need to create something new to protect our profession.
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Agreed. For the first time, I am thinking about joining the AMA, as well.
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Quote from RollTide
Agreed. For the first time, I am thinking about joining the AMA, as well.
Yes. It’s really not expensive. I figure I will give them 2-3 years of membership and see what happens…
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Quote from sartoriusBIG
A mix of two things mostly:
1. well-meaning, compassionate physicians who prefer to focus on patient care and patient welfare above all else and at the expense of the business of medicine. Meanwhile the crooks on the business side and politicians (who later fall into healthcare jobs on boards etc or in private equity) slowly slice and dice.
2. Cowardly physicians who actually do care about the business of medicine but are too cowardly to stand up for themselves let alone their profession.
We let this happen to ourselves. You think big pharma or big medical device companies are taking that kind of haircut on their earnings? Nope. They have a lobby. If physicians all contributed $2000 a year to form a lobbyist strategy, we would have a shot. Sadly, you cant just expect politicians to do the right thing. Also sadly, many physicians are either to cheap to pay $2000 or they are (perhaps rightly so) skeptical about how that money will be spent
I would add:
-It’s whole frog in a slowly heating pot of water analogy (or death by a thousand cuts). This stuff happened in small increments (albeit annually) so much easier to take.
-Part of the issue is that we were “ok” with it since we still do quite well compensation wise despite all these cuts (though there seems to be a breaking point)
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