Tuesday, March 10, 2009

Does Congress Get It?

While working directly for a hospital has some advantages, I have become increasingly aware of how the conflict of interest between hospitals and the physicians they employ is bad for healthcare. For quite some time the way hospitals get paid and the way physicians get paid has been in direct conflict. This is why "Length of Stay" is a term laced with gold. While I do not believe I have ever discharged a patient inappropriately, I would be lying if I said that it didn't cross my mind when a patient that is in that illustrious "gray zone" wants to stay "one more day". I have yet to decide if this is a good thing or not. It certainly becomes an issue with my customer... I mean patient satisfaction.

But when Congress talks about cutting payments to physicians, do they freaking realize that an increasing number of physicians (and almost NO primary care physicians) are not the ones who receive these payments? The hospitals get them. Most primary care physicians under the age of 40 are working directly for a hospital under a contract that has a payment structure that may or may not take into account how much cash the hospital collects from insurance companies and (increasingly) the government. When the government attempted to Robin-Hood from the proceduralists and give a lil to the little guys (the primary care doctors), a lot of hospitals, including my own, they attempted this by increasing the RVUs granted to PMDs and reducing the RVUs granted to proceduralists. So a lot of hopsitals convinced proceduralists that they would have to take a modest pay cut because they couldn't bill as many RVUs. And did most hospitals pass said-cash-flow on to the intended recipients? No. They pocketed it. And now the PMDs were genereally left in the exact same position having to see just as many patients for the same salary.

So if we actually cut physician payments 21%... tell me, Dear Reader, how do you think a hopsital who employs a physician is going to take that? Are they going to sustain the salaries of the primary care doctors (and the rest of us for that matter) out of the mountains of profit these not-for-profit hospitals make? Or are they going to continue to do business as usual, and give their doctors a take-it-or-leave-it offer? Or are primary care doctors now going to be instructed to see 60 patients a day to maintain their already-behind-the-curve salaries.

I was hoping for some real healthcare reform. There do need to be changes. But what I see coming down the pipeline scares the living shit out of me. They know not what they do.

Maybe our lawmakers should be required to have Medicare/Medicaid. Shit. Give it to them on my dollar, I don't care. Let them try to find a doctor who's able to spend an appropriate amount of time with them and still make more than the receptionists.


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