<i>"The bottom line: Under Medicare’s bizarre rules, hospital doctors are paid as much as three times more for patient care than those in private practice."</i><p>And absolutely nowhere in the article does it talk about how the cost of preventing fraud by single practitioners is the similar to the cost of investigating a single hospital. [1]<p>Trying to administer a national system to individual providers leaves gaping holes which crooks drive dump trucks through to load up on 'free' taxpayer dollars. So fix that problem and payments can get normalized.<p>The actual bottom line is that Medicare doesn't make "bizarre" rules, they make rules to try to minimize fraud and maximize patient benefit, if a rule seems "bizarre" you need to then go back and figure out what the motivations for that rule are.<p>[1] <a href="http://www.gao.gov/products/GAO-13-104" rel="nofollow">http://www.gao.gov/products/GAO-13-104</a>
Lack of tort reform, "defensive medicine" and the inevitability of being forced to work for a medium+ sized group or hospital have made the career increasingly unattractive. Something is amiss when 9 out of 10 physicians would discourage children from going into the field.[0]<p>[0] : <a href="http://www.thedoctors.com/ecm/groups/public/@tdc/@web/documents/web_content/con_id_004676.pdf" rel="nofollow">http://www.thedoctors.com/ecm/groups/public/@tdc/@web/docume...</a>
The article is quite incomplete. The highest price is the opportunity cost of doctors going into billing instead of doing clinical work - especially for hospitals<p>I can say first hand that there is an <i>extremely</i> lucrative business-opportunity for physicians to go full time in billing - using domain knowledge and a careful study of the billing schemes to increase financial returns.<p>For exemple, what if you could identify the patient cases where manual recoding has the highest probable financial return, and compare individual returns to the cost of the human resources you have at hand (from medical coders to physicians) - to assign the best human resource to each case?<p>In a highly complex case, recoding by a physician who perfectly knows the coding and billing rules can easily double the value billed.<p>So for a >200k case, it can be worth having a physician spend 20 minutes carefully studying every aspect of the file, aided by specific software modelling the possible billing scenarios.<p>If you add some programming knowledge and statistical knowledge, all this can be easily automatized, and make even more lucrative.<p>A full industry is created, based on exploiting the arcane artificial rules imposed on the system - just like for taxes.<p>The real problem here it that it takes doctors, for which the next best alternative use would have been doing clinical work on patients.<p>I guess a society only gets what it pays for.
Could this be by design? A private practice seems like a waste of resources. Imagine the unused medical devices or the large number of support staff around just one or two doctors.<p>To quote, <a href="http://www.kevinmd.com/blog/2009/02/are-days-of-independent-physician.html" rel="nofollow">http://www.kevinmd.com/blog/2009/02/are-days-of-independent-...</a><p>`These trends will ensure that the consolidation of doctors into larger groups will continue. Whether this definitively benefits patient care is still unclear, but I suspect that patient outcomes will likely improve as this movement continues.`
<i>“I miss being in private practice and being my own boss,” says Alexander, the Illinois cardiologist. “I would have said 30 years ago that I planned on dying with my boots on and practicing until I couldn’t practice anymore. Now, do I look forward to retirement? Yes.”</i><p>This will be the single greatest cause behind the looming physician shortage and subsequent decline in standard of care. How much harder do you work, for yourself, in a startup - versus for someone else, as an employee? It's NO DIFFERENT for doctors.
<i>Since 2007, when the government began repeatedly cutting Medicare payments to doctors, the number of cardiologists working for U.S. hospitals has more than tripled, while the number in private practice has fallen 23 percent, according to the ACC. Jay Alexander, a cardiologist who co-owned a practice in Lake County, Ill., says he sold out to a local hospital after his Medicare revenue dropped 35 percent. Now the government pays Alexander three times as much to perform the same tests and procedures—far more than he would have needed to keep his private practice open. “If this was government’s solution to reducing health-care costs, they should have their heads examined,” he says. “This is an unfortunate consequence of bad planning.”</i>
The "high price," I suppose, is the reduction in private practice physicians. Since the article provides no evidence that private practice is superior (for society) to hospital practice, I'm left unable to assess whether this is in fact a "high price" at all.<p>Presumably this is not accidental but is instead a manifestation of an intentional policy. The details of this policy are left unaddressed by the article, as are its pros and cons.
For what it's worth, most of the physicians I know presume that this was set up expressly to incentivize physicians to become hospital employess. The thought is that when the time comes to ratchet down reimbursements, the hospitals have no choice, while independent physicians vote with their feet by choosing not to participate. There are already a few internists I know who will not take new Medicare patients, even though that's not supposed to be charity reimbursement.