DB'S MEDICAL RANTS

Internal medicine, American health care, and especially medical education

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Take from the rich, give to the poor?

As per KevinMD, Dr. Wes writes Final Rule Hieroglyphics

Is there any wonder that the guys who do the work are completely and utterly baffled by such a payment system? In every instance, the system obfuscates and confuses while supporting it’s own network of highly-paid sycophants to decipher the hieroglyphics.

What an absolute and utter mess our system of physician payment has become. Even specialist societies, have to “continue to review the final rule and provide rate analysis of the impact on EP (electrophysiology) services in the weeks to come.” (emphasis mine)

Most of us already know what the Robin Hoods of bureaucracy are going to do: steal from the rich (specialists) and give to the poor (generalists). After all, that’s what “budget neutrality” is all about. But it’s much easier to plug a number in to a computer formula than speak with people.

I was criticized strongly yesterday when I advocated readjusting payment schedules and stating that I knew and would actually experience schadenfreude as the proceduralists whine.  I stand by my statement, because over the past 15 years the rich in medicine have taken from the poor.  I only ask for a more reasonable disparity among specialties.  Please read my time based payment proposal If They Asked Me.  I do not expect generalists to have higher or even equal incomes to those whose training takes much longer.  I do expect more rationale disparities.  I do propose a major change in payment, which gets rid of obtuse rules.

We are not asking to take from the rich that which they have earned, rather we are asking for the rich to quit taking from the poor.  Read the RUC discussions to understand the roots of this problem.

Please note that I personally do not do outpatient practice.  I am an academician who only does hospital work.  I am not self serving here, rather I want to propose solutions that will help patient care.  A strong generalist physician work force will improve patient care dramatically.  We must develop solutions to support family physicians and general internists.  For those beliefs I will not apologize.

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