Hatch and Bennett are idiots

[CardiacCoug]

As are all the other Republicans who would not vote to prevent a scheduled 10% cut in Medicare payments to physicians.

At least in Texas our Republican Senators had the common sense to vote to maintain Medicare payments at the current level. Physician margins for Medicare patients are non-existent -- some already lose money by taking care of Medicare patients and there would be massive opting out of Medicare by physicians if payments were cut another 10%. Unless you just want to get rid of Medicare completely (which wouldn't be a bad thing) it needs to at least be funded at its current level.

Doctors are the only profession dumb enough to let our payers (government and insurance companies) decide how much they will pay for our services. It's ridiculous.

Here is a rundown of how Senators voted.

http://www.senate.gov/legislative/LI...te=00169#state

[MikeWaters]

Then don't be a medicare provider. Like most of the psychiatrists I know.

Oh wait, you need to be in a hospital, and the hospital will require you to be a medicare provider or no credentials.

Oops. Sounds like a personal problem!

[CardiacCoug]

Originally Posted by MikeWaters

Then don't be a medicare provider. Like most of the psychiatrists I know.

Oh wait, you need to be in a hospital, and the hospital will require you to be a medicare provider or no credentials.

Oops. Sounds like a personal problem!

Yeah, cardiologists have to be Medicare providers -- goes with the territory. But we don't have to accept new patients or see outpatients with Medicare only coverage.

It's going to become more and more difficult for old people with Medicare only to find doctors willing to take care of them on an elective/outpatient basis. And when we take care of Medicare patients in the hospital for heart attacks, etc. it's basically charity work -- it may barely cover your office/overhead expenses if you have an efficient practice, but you're not making any money, that's for sure.

[MikeWaters]

Originally Posted by CardiacCoug

Yeah, cardiologists have to be Medicare providers -- goes with the territory. But we don't have to accept new patients or see outpatients with Medicare only coverage.

It's going to become more and more difficult for old people with Medicare only to find doctors willing to take care of them on an elective/outpatient basis. And when we take care of Medicare patients in the hospital for heart attacks, etc. it's basically charity work -- it may barely cover your office/overhead expenses if you have an efficient practice, but you're not making any money, that's for sure.

Before you feel too bad for CC, for a non-invasive cardiologist, the 75th percentile is $373,592.

This definitely is not "not making money."

I hate whining docs (not saying CC is one) who bother to get privileges and take call (for their own financial gain), yet bitch when they have to save someone's life who can't pay. Even though that person may have financial ruin.

[CardiacCoug]

Originally Posted by MikeWaters

Before you feel too bad for CC, for a non-invasive cardiologist, the 75th percentile is $373,592.

This definitely is not "not making money."

I hate whining docs (not saying CC is one) who bother to get privileges and take call (for their own financial gain), yet bitch when they have to save someone's life who can't pay. Even though that person may have financial ruin.

I'll be an interventional cardiologist a year from now so that figure is a little low

It's not that you can't make a living in medicine or cardiology. It's just that a lot of what is done (like many of the hospital procedures, rounding, call etc.) is done because it's the right thing to do, not because it is profitable. That's OK, but there is only so much "break even" work for low reimbursement that doctors will tolerate.

I absolutely agree, though, that it takes a pretty twisted doctor who will feel sorry for himself when he is around people who are dying (most elderly, but some middle-aged and leaving behind kids, etc.) and going through expensive, painful procedures, surgeries, etc. I hope I never become one of those guys.

[MikeWaters]

Nobody wants to hear a guy makin 500k a year bitch that someone came into the ER without insurance.

They are probably more interested in hearing about why their insurance is costin them $700 per month, with matching employer donation, with a $1000 deductible.

[Cali Coug]

Originally Posted by CardiacCoug

I'll be an interventional cardiologist a year from now so that figure is a little low

It's not that you can't make a living in medicine or cardiology. It's just that a lot of what is done (like many of the hospital procedures, rounding, call etc.) is done because it's the right thing to do, not because it is profitable. That's OK, but there is only so much "break even" work for low reimbursement that doctors will tolerate.

I absolutely agree, though, that it takes a pretty twisted doctor who will feel sorry for himself when he is around people who are dying (most elderly, but some middle-aged and leaving behind kids, etc.) and going through expensive, painful procedures, surgeries, etc. I hope I never become one of those guys.

It is pretty hard to listen to whining about all the "break even work" cardiologists have to do and then see the average salary of a cardiologist.

[CardiacCoug]

Originally Posted by Cali Coug

It is pretty hard to listen to whining about all the "break even work" cardiologists have to do and then see the average salary of a cardiologist.

When a patient needs a heart catheterization, a physician with 15 years of post-high school education threads catheters into the heart, performs coronary angiograms, then makes a judgment on whether bypass surgery or angioplasty is required. Then he spends time discussing results with the patient and family, makes phone calls to arrange for further procedures if necessary, dictates a letter and description of the procedure, and follows-up with the patient the next day. He also assumes liability and deals with any complications related to the procedure.

Medicare reimburses a physician around $200 for that (and that would have been cut by 10%). That is not money straight into the bank account, obviously. The doctor is using most of that to pay overhead (rent, nurse, secretary, billing people, other office personnel, etc) while he is doing the procedure and subsequent associated work.

Compare that to what a plumber or auto mechanic charges for what they do and decide if you think that is reasonable reimbursement. I'm pretty sure a plumber charges a minimum of $200 just to come to your house and shit in your toilet.

[Cali Coug]

Originally Posted by CardiacCoug

When a patient needs a heart catheterization, a physician with 15 years of post-high school education threads catheters into the heart, performs coronary angiograms, then makes a judgment on whether bypass surgery or angioplasty is required. Then he spends time discussing results with the patient and family, makes phone calls to arrange for further procedures if necessary, dictates a letter and description of the procedure, and follows-up with the patient the next day. He also assumes liability and deals with any complications related to the procedure.

Medicare reimburses a physician around $200 for that (and that would have been cut by 10%). That is not money straight into the bank account, obviously. The doctor is using most of that to pay overhead (rent, nurse, secretary, billing people, other office personnel, etc) while he is doing the procedure and subsequent associated work.

Compare that to what a plumber or auto mechanic charges for what they do and decide if you think that is reasonable reimbursement. I'm pretty sure a plumber charges a minimum of $200 just to come to your house and shit in your toilet.

Yes, when you break it down to an individual transaction, it sounds like a bummer. When you see the compensation in the aggregate, it stops being such a tear-jerker. I have people ask me legal questions all the time that I answer for free. Attorneys at law firms have their time wasted all the time by stupid people who don't pay very much or who never pay at all. I doubt you cry at night for the average compensation of attorneys (which is far lower than that of cardiologists).

[MikeWaters]

Originally Posted by Cali Coug

Yes, when you break it down to an individual transaction, it sounds like a bummer. When you see the compensation in the aggregate, it stops being such a tear-jerker. I have people ask me legal questions all the time that I answer for free. Attorneys at law firms have their time wasted all the time by stupid people who don't pay very much or who never pay at all. I doubt you cry at night for the average compensation of attorneys (which is far lower than that of cardiologists).

But to a much stronger degree, the cardiologist doesn't have a choice.

The law firm talks to stupid people because it wants to.