I read that article. Did it ever mention how much these doctors make? I understand that they don't make as much money as they did previously. . . but going broke?

this is no shock.  this has been predicted to happen numerous times but nobody listens.  it's the tip of the ice burg.  in ten years it'll be one of the most talked about stories there is.  how granny can't get a dr. to see her. 

I read that article. Did it ever mention how much these doctors make? I understand that they don't make as much money as they did previously. . . but going broke?



The median expected salary for a typical Physician - Family Practice in the United States is $174,666

What is going broke is  private practices.  Which costs the nurses, receptions, records people and other support staff jobs.   Trying to cover overhead while having less and less covered by medicare has the doctors either retiring early or switching to doctor mills like Sanford, Kayser Permentae, or one of the other mega companies.  This is similar to what is happening to downtown businesses in regards to the big box stores except the consumer doesn't gain anything in reduced price or increased service.

TMRfish Said:
 I read that article. Did it ever mention how much these doctors make? I understand that they don't make as much money as they did previously. . . but going broke?

Pentz said recent steep 35% to 40% cuts in Medicare reimbursements, if you take a cut like this from any business, it is going to be very difficult for it too make money. This will continue to get worse as EHR is going to be a requirement. So now they will have to spend $20-40 thousand on new software. Then how many million more people will have access too healthcare with obamacare? With a Dr. shortage already.

Right on, Swift.   The Big Box Store analogy is the best I've heard.  

I doubt many if any docs are going broke.   One of the main problems for the litte small group or independent guy  is that when Docs 'accept assignment' which means they take what the insurance company budgets for a service,  they are locked into what the insurance company will pay.
The insurance companies, despite many who accuse them of raising premiums and taking too large of profits, are hit with ever increasing costs for particular services (gee whiz type of surgeries and procedures - whether they are needed or not, even if an older cheaper method would do just as well, sometimes even better)  and of course, increasing demands for stuff that was unheard of even 5 or 10 years ago.    The commonest rising star of surgeries and rising costs  in USA is various weight reduction surgeries for example.  And all kinds of stuff that is not necessary for life or death, but for COMFORT - joint replacements, gyne surgeries of all kinds, and I could go on and on, etc. And enormous costs for things  that are controversial as to their effectiveness anyway - heart surgery,  knee surgery, back surgery, etc.    Billions are spent yearly for things that are of unproven effectiveness.   When I drive into town and look at the Billboards I cringe.  Or turn on the TV. Who will pay for all this stuff?? 
Medical suppliers and drug companies are selling the gullible American public Expensive space age stuff that is not needed in a lot of cases and often the stated and advertised advantages are unproven. And if something was medically needed often it could be done in a far more cheaper economical way but the patient demands and gets the space age expensive stuff.   Who will pay for it??  When an insurance company objects, the providers wimply point their fingers at the insurance company.  Everybody does this.   Me too, till I got appointed to a sort of advisory thing to a major insurance company and saw the coin on both sides. 
Medicine being a competitive business nowadays, is really consumer driven - what the public demands the public will get or go somewhere else. Been there seen that a million times -  Better do the gee whiz expensive stuff or the patient just goes down the street and gets it anyway.   Often procedures and drugs you simply don't get in most other countries!   Horrors!!!  Those primitive places!!   We're the bestest and mostest, so why are we now according to the Institute of Medicine number 40 - 41 in the world for longlivity, 24th for perinatal care, - An example - Canadians' life expectancy is just under 4 years LONGER than ours!!   Lots of politically unpopular reasons for this that no one talks about.  No politician will risk biting the voter's hand that votes for them. 
There is absolutely NO Incentive for the Docs, the hospitals, the patients, drug companies  or anyone else to try to cut costs, and God help the politician who tries to make those tough decisions.   We are all far too spoiled with our alleged 'best system in the world!'   That's another story, too - sorry for the rant!  
But going broke - nope - silly!    Some specialties do make ridiculously way too much, some like Family Practice and Peds and guys like Swift out in the front line in a rural area make far too little.  The system pays for space aged TREATMENT even when its of questionable value, not PREVENTION and primary care.  
Swift definitely knows what I'm talking about.   Though I've never met Swift, I have nothing but admiration for those front line guys and gals  in rural areas. 
 

Going off of Swift's post of median salary, I'd be one scared son-of-a-gun based on the below article.  Ouch!  That's quite the hole to climb out of even with a pretty decent expectation of income.  No wonder most doctors I know are also heavily into some other businesses.

 

Real life example of medical school debt

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• inShare37

by Pierce Hibma

Want to really understand the reality of US medical education debt? Then allow me to pull back the curtains to expose the financial monster that awaits me after I earn my MD.

 

I am a third medical student at a private medical school in the Midwest. Fortunately, I was able to graduate from college without any financial debt thanks to an athletic scholarship. Unfortunately, I, like many other medical students, pay for my entire medical education and living expenses through student loans.

The average medical school debt today, according to the Association of American Medical Colleges is $156,456. I can only wish that was true for me. Perhaps the best way to understand the burden of a current medical student’s debt is by example. Here is an approximation of my real-life medical school debt assuming I select forbearance during residency and repay the loan over 15 years:

Annual cost of tuition: $48,000
Annual cost of attendance: $67,500 (Includes costs of books/supplies, loan fees, health insurance, licensure fees, living expenses, and transportation allowance)

Total balance after medical school: $270,000
Amount subsidized: $34,000
Amount unsubsidized: $236,000

Interest incurred during 3 years of residency: $100,000
Total balance after residency: $370,000

Monthly payment after residency: $3,370 (180 total payments)
Interest incurred after residency: $237,000
Total repayment: $607,000

These financial conclusions were reached via the Association of American Medical Colleges’ Medloans Calculator. Again, these numbers are approximations and many different repayment plans exist, but it certainly highlights the massive financial burdens placed on today’s medical students.

Pierce Hibma is a medical student.

Submit a guest post and be heard on social media’s leading physician voice.

swift Said:

I read that article. Did it ever mention how much these doctors make? I understand that they don't make as much money as they did previously. . . but going broke?



The median expected salary for a typical Physician - Family Practice in the United States is $174,666

What is going broke is  private practices.  Which costs the nurses, receptions, records people and other support staff jobs.   Trying to cover overhead while having less and less covered by medicare has the doctors either retiring early or switching to doctor mills like Sanford, Kayser Permentae, or one of the other mega companies.  This is similar to what is happening to downtown businesses in regards to the big box stores except the consumer doesn't gain anything in reduced price or increased service.

I see what you are saying  here is a good example: June 2010 wife broke her wrist. entered trinty at 4:am (she fell down) was in the hospital for a total of 38 hrs. total charges without the 5 followup visits was 17,344.52 Insurance said the hospital charged 2348.11 to much and that is what I have for out of pocket.
another fact. she had catract surgery Dr.asked who was the insurance carrier I said none the bill was 1724.88 so I told the Dr. to just run it thru BCBS all of the sudden the bill was 2462.77 but the adjusted payment to the Dr. was 2295.81 I had to pay the difference  that was Dr. williams in Minot it was Trinity for the wrist.

marksman Said:

swift Said:

I read that article. Did it ever mention how much these doctors make? I understand that they don't make as much money as they did previously. . . but going broke?



The median expected salary for a typical Physician - Family Practice in the United States is $174,666

What is going broke is  private practices.  Which costs the nurses, receptions, records people and other support staff jobs.   Trying to cover overhead while having less and less covered by medicare has the doctors either retiring early or switching to doctor mills like Sanford, Kayser Permentae, or one of the other mega companies.  This is similar to what is happening to downtown businesses in regards to the big box stores except the consumer doesn't gain anything in reduced price or increased service.

I see what you are saying  here is a good example: June 2010 wife broke her wrist. entered trinty at 4:am (she fell down) was in the hospital for a total of 38 hrs. total charges without the 5 followup visits was 17,344.52 Insurance said the hospital charged 2348.11 to much and that is what I have for out of pocket.
another fact. she had catract surgery Dr.asked who was the insurance carrier I said none the bill was 1724.88 so I told the Dr. to just run it thru BCBS all of the sudden the bill was 2462.77 but the adjusted payment to the Dr. was 2295.81 I had to pay the difference  that was Dr. williams in Minot it was Trinity for the wrist.

Many  places will give a self pay discount.  When somebody does not have third party payer there is streamlined billing that can occur.  If you do not have to pay a medical coder, and business office staff for implementing the insurance process you can give the customer a discount.  I suspect if you find it bothersome to receive a discount I'm sure the office will be glad to take your full payment.

Another problem I see is the lack of internal fortitude that many people have nowadays.  I hear on a daily basis, "the weekend is coming so I thought I should get something for this cold"  and  "I woke up with a scratchy throat and came right in". 

People need to give colds a chance to clear on their own.  In our urgent care/ER upwards of 80% of visits are not necessary.  Which drives heathcare costs through the roof.  With average ER waits in Cities hovering around 6 hours for sure other peoples ideas of emergencies are different than ours.

Deciding on when to go see a doctor is always a tough question for us non-medical people.  How many times have you run across someone who has waited too long before coming in, things like meningitis, or a collapsed lung from pneumonia (my bad!) come to mind.  Or, oh so many years ago when I had my first sinus infection that I probably waited too long on, only to have to get roto-rootered about 9 months and 10 rounds of antibiotics later (ok, maybe 6).

It may seem clear cut to physicians, but it is anything but clear at times for the rest of us.   

Perhaps you guys can clear something up though that has puzzled me for a spell.  For the life of me, I don't understand how an unnecessary ER visit for a cold causes a heart valve replacement to cost $50-75k, or thecost of the next person's ER visit to be higher (out of pocket for the non-insured).  Can either of you connect those dots for me?  I think I understand the effects it has on insurance, but on the raw costs I just don't get it.

And as far as charging lower costs for the uninsured, yep been there on that one in the past.  I liken it to something similar as the furniture stores that provide discounts for cash as opposed to using their credit programs.  A person can save a lot on furniture if they don't buy it on credit!

Pentz said recent steep 35% to 40% cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue. "Our total revenue was down about 9% last year compared to 2010," he said.

 

"These cuts have destabilized private cardiology practices," he said. "A third of our patients are on Medicare. So these Medicare cuts are by far the biggest factor. Private insurers follow Medicare rates. So those reimbursements are going down as well."

 

12 entrepreneurs reinventing health care

 

Pentz is thinking about an out. "If this continues, I might seriously consider leaving medicine," he said. "I can't keep working this way."

 

Also on his mind, the impending 27.4% Medicare pay cut for doctors. "If that goes through, it will put us under," he said.

Where do these dollars for medicare reimbursements originate from?

I get tired of the "life expectency" stats being used to condemn our medical system. Those stats include deaths from drugs, murder, suicide, obesity, infant deaths (native american reservations struggle here), cancer from tobacco, yadda, yadda. Good medical care can only do so much if people live like they have a death wish!

People's lives get shortened by behavior, and we're so spoiled we can make lots of bad choices in the US. It's not because our medical system is crappy, it's our fat lazy bored drug loving lifestyle.

what you guys are discussing is called "cost shifting".  All hospitals/doctors/clinics do it.  Insurance gets charged a much higher rate because they pay the majority of the dollars to these facilities.  they have to do this to offset the non-payers and the cash payers.  It all averages out for the docs/clinics.

eyexer you couldn't be more wrong.  In order for a clinic or hospital to receive insurance payments for service they sign a contract with those insurance companies with discounts built in.  pretty much all insurance companies use the CMS chargemaster.  Which dictates what each visit should be charged.

Your right Bobkat.  I tell that same thing to my nurse it happens.

GST, Medicare is insurance our citizens over 65 have.  Most of them paid medicare taxes through out their employed years for the privlage of having this insurance.  The medical providers receive payment from medicare for a service no differant than BCBS or Aetna (execpt hugely discounted). 
To put it in terms you would understand, Say you took out crop insurance and when you attempted to redeem it they only gave you 40% of what you should have gotten.

swift Said:
eyexer you couldn't be more wrong.  In order for a clinic or hospital to receive insurance payments for service they sign a contract with those insurance companies with discounts built in.  pretty much all insurance companies use the CMS chargemaster.  Which dictates what each visit should be charged.

Your right Bobkat.  I tell that same thing to my nurse it happens.

GST, Medicare is insurance our citizens over 65 have.  Most of them paid medicare taxes through out their employed years for the privlage of having this insurance.  The medical providers receive payment from medicare for a service no differant than BCBS or Aetna (execpt hugely discounted). 
To put it in terms you would understand, Say you took out crop insurance and when you attempted to redeem it they only gave you 40% of what you should have gotten.

exactly.  blue cross has been doing this on a huge scale forever.  who the hell do you think picks up the difference in cost?  isn't the hospital/doctor.  it's those with insurance that don't have negotiated cost and the cash payers.  The advent of HMO's are what really started the escalation of medical costs.  ND is a perfect example.  Blue Cross insures I believe 90% of all insureds in the state.  So if you have negotiated prices with 90% of all medical procedures in the state the remaining 10% have to absorb that discount.  If you have a surgery that the hospital has to have $1000 dollars for to make ends meet and they negotiate a $900 fee to blue cross, then the remaining people that have that surgery will have to pay probably $1200 or more for the same surgery.  And I might add there's no way in hell one insurance company should be allowed to cover that big of a percentage of one states population. 

eyexer Said:

swift Said:
eyexer you couldn't be more wrong.  In order for a clinic or hospital to receive insurance payments for service they sign a contract with those insurance companies with discounts built in.  pretty much all insurance companies use the CMS chargemaster.  Which dictates what each visit should be charged.

Your right Bobkat.  I tell that same thing to my nurse it happens.

GST, Medicare is insurance our citizens over 65 have.  Most of them paid medicare taxes through out their employed years for the privlage of having this insurance.  The medical providers receive payment from medicare for a service no differant than BCBS or Aetna (execpt hugely discounted). 
To put it in terms you would understand, Say you took out crop insurance and when you attempted to redeem it they only gave you 40% of what you should have gotten.

exactly.  blue cross has been doing this on a huge scale forever.  who the hell do you think picks up the difference in cost?  isn't the hospital/doctor.  it's those with insurance that don't have negotiated cost and the cash payers.  The advent of HMO's are what really started the escalation of medical costs.  ND is a perfect example.  Blue Cross insures I believe 90% of all insureds in the state.  So if you have negotiated prices with 90% of all medical procedures in the state the remaining 10% have to absorb that discount.  If you have a surgery that the hospital has to have $1000 dollars for to make ends meet and they negotiate a $900 fee to blue cross, then the remaining people that have that surgery will have to pay probably $1200 or more for the same surgery.  And I might add there's no way in hell one insurance company should be allowed to cover that big of a percentage of one states population. 

How would you work the CMS chargemaster into the mix?  And if what your claiming is true why would any clinic give self pay discounts?  Besides the fact that "pigeon holing" or charging different amounts for same service is illegal for anyone that has a medicare contract.  I wish what your saying was true. We might be able to keep a couple office staff that will be cut loose when the medicare cuts come about.

Several years ago in Rapid City BCBS flexed their muscles demanding big discounts and the medical providers and hospitals said no thanks.  Anyone with BCBS was out of luck in Rapid.  Unfortunately Medicare is roughly 75% of the third party payer in the Dakotas.  So they have us by the short hairs. 

Swift, so I understand here,  the Medicaid dollars were somewhat of a "tax" paid by individuals to "insure" they have low cost health care correct?

Also to be correct here, these medicaid dollars are being paid to your clinic from the govt? 

And the article is saying these doctors are going broke because these govt Medicare dollars are disappearing thru cuts?  

Could one make the assumption these govt dollars were then "subsidizing" these doctors and their private clinics to some degree thru these Medicare payments?

swift Said:


GST, Medicare is insurance our citizens over 65 have.  Most of them paid medicare taxes through out their employed years for the privlage of having this insurance.  The medical providers receive payment from medicare for a service no differant than BCBS or Aetna (execpt hugely discounted). 
To put it in terms you would understand, Say you took out crop insurance and when you attempted to redeem it they only gave you 40% of what you should have gotten.

 If we'd just go single payer the gov't would get what they want.  They'd know pretty much everything about everyone.

gst Said:
Swift, so I understand here,  the Medicaid dollars were somewhat of a "tax" paid by individuals to "insure" they have low cost health care correct? NO there is no medicaid tax.  It's a medicare tax

Also to be correct here, these medicaid dollars are being paid to your clinic from the govt?  Medicaid pays insurance payment for services

And the article is saying these doctors are going broke because these govt Medicare dollars are disappearing thru cuts?  Any reduction in insurance payment is castestrophic

Could one make the assumption these govt dollars were then "subsidizing" these doctors and their private clinics to some degree thru these Medicare payments? NO, these are subsidizing the elderly populations healthcare costs. 
To give you an comparison.  IF you take your Farm subsidy and buy groceries with it, the subsidy is yours not the grocers,  Understand now?

swift Said:


GST, Medicare is insurance our citizens over 65 have.  Most of them paid medicare taxes through out their employed years for the privlage of having this insurance.  The medical providers receive payment from medicare for a service no differant than BCBS or Aetna (execpt hugely discounted). 
To put it in terms you would understand, Say you took out crop insurance and when you attempted to redeem it they only gave you 40% of what you should have gotten.

swift, the bottom line here is "tax dollars" paid in by "taxpayers" are collected by the govt and then end up in medical professionals pockets. Acccording to this article without these payments doctors are going broke. So how are these payments of taxpayer dollars not subsidizing these doctors and clinics?
 
These "tax dollars" are paid by "tax payers" into the govt coffers with the intent  to ensure avalible low cost health care. Simply because they have line specific program they are dedicated to and paid under do not mean they are any different than other tax dolars collected with  intents to provide an end result from the govt that are often refered to as "subsidies".