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Subscribe to RSSCongress may have rolled the country back from the so-called fiscal cliff, but the budget legislation passed this week missed a chance to fix doctors’ pay for treating Medicare patients -- a problem that’s been bugging doctors and patients alike for more than 10 years now.
Medical groups had hoped the House and Senate would use the fiscal cliff legislation as a chance to make the “doc fix” permanent. Instead, the bill provides a temporary patch, as it has done every year since 2003.
“Congress averted a drastic cut of 26.5 percent from hitting physicians who care for Medicare patients on January 1. This patch temporarily alleviates the problem, but Congress’ work is not complete; it has simply delayed this massive, unsustainable cut for one year,” American Medical Association president Dr. Jeremy Lazarus said in a statement. “Over the next months, it must act to eliminate this ongoing problem once and for all.”
Analysts agree.
“The bill sets Congress and the White House up to revisit these battles and a major deficit reduction effort in two months,” says Eric Zimmerman, a health care lawyer at McDermott Will & Emery, a Washington law firm. “Sometime between now and March 1, 2013, Congress and the White House will need to come to agreement on how to reapportion sequestration, fund the federal government for the balance of fiscal year 2013 and raise the debt ceiling, and Medicare and Medicaid spending will feature prominently in those debates.”
The American Academy of Family physicians estimates that the average family doctor would have suffered a $27,000 Medicare pay cut without the fix.
Some experts say the issue has helped scare doctors away from taking on Medicare patients. “This last-minute action on the part of Congress is a clear example of how the Medicare program is increasingly unreliable for physicians and patients,” Lazarus said.
AARP, which represents people over 50, makes the same argument. AARP executive vice president Nancy LeaMond praised Tuesday’s legislation but says it’s not enough. “Millions of seniors in Medicare will have the peace of mind in knowing that they will still have access to their doctors,” LeaMond says.
“However, for too long, the so-called ‘doc fix’ has been an annual game of chicken on Capitol Hill. And with another temporary patch in place, both the size of future cuts and the cost of fixing the flawed physician payment system continue to increase.”
The “doc fix” problem dates back to a 1997 law that was meant to cut costs. It gave doctors who treat Medicare patients modest raises for a while, but physicians started protesting loudly in 2002 when it provided for a pay cut. Instead of really fixing the formula, Congress just continually finds short-term solutions.
The Congressional Budget Office says it would cost $300 billion over 10 years to permanently preserve pay for Medicare doctors and Congress has never been able to agree on a good way to find the money. Easy sources of cash went elsewhere in the 2010 health reform law.
This year’s fix takes money mostly from hospitals to pay for it. It cuts Medicare payments to hospitals for taking care of patients overnight and as inpatients to the tune of about $10.5 billion over 10 years. It also reduces subsidies for so-called safety-net hospitals, some pharmacies and some dialysis facilities.
Hospitals are upset. “It is not in the best interest of patients or those who care for them to rob hospital Peter to pay for fiscal cliff Paul. These cuts could impact hospital services for those who need them the most,” says Chip Kahn, president and chief executive of the Federation of American Hospitals, which represents for-profit hospitals.
“While fixing the physician payment formula is essential, it should not be done by jeopardizing hospitals’ ability to care for seniors and their communities,” Rich Umbdenstock, president and chief executive of the American Hospital Association, said in a separate statement.
Related stories:
- Physicians brace for another doc fix
- What the fiscal cliff means for you
- Fiscal cliff compromise satisfies few
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gosh, and if reputable doctors / health care providers were protected from multi-trillion dollar frivolous lawsuits and did not have to pay $200k to $2 million in private insurance premiums,
dang, they'd welcome a $27,000 income reduction.
Agreed Tom! That and fix the insurance mess that requires hours a week of a dr's time to get paid for seeing patients. That would both improve care AND save everyone billions in wasted time!
Lets just screw medical care in general and spend all our money on useless new toys for the military. My GOD, we need more jets, subs, and aircraft carriers, people! Don't even think about putting some of THAT on hold for a few years until we get other things paid down. Gotta have the biggest cock on the dance floor, y'know.
Actually, the whole lawsuit argument is a red herring and completely false. The average medical malpractice settlement is between $109,000 - $195,000 according to the US Department of Justice. If you factor in that only 1 in 5 medmal suits are won then the "average" goes down to $39,000 on the high end.
The law is actually structured to favor doctors. This is of course by state but here in NY there is a 2.5 year statute of limitations to bring medmal actions (as opposed to the typical 3 year for every other type of negligence including attorney malpractice). In addition, the statute of limitations begins to run at the date of occurrence not the date of discovery (small caveat: things that were never meant to be left in the body...gauze, clamps, sponges and the like go from date of discovery but that's pretty much it, if it was meant to be left in the body or the "damage" didn't present itself for 10 years you have 2.5 years from the original incident). Therefore, most malpractice actions fall into 1 of 2 categories:
Way the hell outside the statute of limitations which means summary judgment and plaintiff loses
or
Ridiculous malpractice like cutting off the wrong leg or something.
The defense to malpractice is so forgiving its unbelievable. It just has to be an acceptable practice somewhere in the country and a reasonable doctor would have done the same... that's it. So as long as you're not doing things so far outside the scope of being a doctor where other doctors would look at you and say "what the hell are you doing?" you basically are judgment proof. That doesn't mean you won't get sued, it just means it'll be over before it starts.
The reason there are so many lawsuits is because is because there are an incredible amount of incompetent doctors and people like "free" money. However, unless the doctor was truly incompetent, they will win, generally every time.
The problem is settlements are only the tip of the iceberg, and I think you know that. The cost that goes into successfully defending claims is huge. And that doesn't even touch the cost of defensive medicine, which has been estimated to be up to 20% of all medical costs.Furthermore, the cost of insurance is huge for high risk specialities, and this is passed on to the consumer (patient) in some form
This is a false dichotomy. There are many other types of med mal suits. My sister used to defend these claims and saw a much bigger variety
The "standard of care" is the same argument that applies to most other torts, otherwise called the "community standard". Trying to single this out as somehow different is inaccurate
Do you have any proof for such an outrageous claim? As it stands now, doctors are some of the most educated people in the US. They have to undergo 4 years of post grad training and anywhere from 3-10 years of a graduated apprenticeship before they can practice on their own. They have to take countless board exams and recertify every 10 years while accumulating enough CMAs every year as required by their governing boards
That is more than is required of lawyers for example
When you have >50% of docs being sued, and >90% of high risk specialists being sued, the only logical conclusion in light of docs long training is that its too easy to sue in this country
@Eric
1. Costs of defending are huge, but as per my 2 categories argument, most don't need defending. They need a summary judgment motion which shouldn't be more than a $1,000 from even the most high priced lawyer. Falls outside of the statute of limitations, summary judgment. Also, that may be considered frivolous and the attorney's fees may get paid for by the plaintiff.
2. There really aren't that many types. Either the doctor monumentally screwed up or did not act as a reasonable professional would have or it's outside the statute of limitations. The trials usually hinge on "what's acceptable." That's when experts (doctors) come in and charge astronomical sums (like $10,000) for a few hours of testimony and the parties try to discredit each other's experts.
3. While the typical tort standard is: Reasonable and prudent person under the same or similar circumstances, the professional standard is a bit more forgiving for professionals. It is a reasonable and prudent PROFESSIONAL under the same or similar circumstances. While PERSON can imply any level of intelligence (and it includes the mentally challenged), the reasonable PROFESSIONAL is a much stricter standard in terms of what a PROFESSIONAL would do. Therefore, so long as they're in the bounds of PROFESSIONAL then there's no problem. It's not what any idiot would do in the doctor's place, it's what any other DOCTOR would do in the doctor's place. If you can't meet that burden, you should get your license revoked. As lawyers, we're held to that same standard and I reiterate, if you can't meet it, you should be disbarred.
4. My girlfriend is in med school and I can attest to how much work goes into it. Four years of med school, three years of residency (4 for surgery) and then 3-5 for a fellowship if the person so chooses to subspecialize. They take 3 board exams, 1 after 2nd year, 1 during 4th year and 1 during residency. They also recertify every 10 years for their specialty. However, their testing is no more comprehensive than a lawyers (believe me, I've watched and listened to my girlfriend study). They merely get tested on a set number of things for their boards that don't encompass all of medicine for each exam. These are also only like 4 hour exams. To clue you into what a NY attorney must do I'll explain: (1) We must take the MPRE which is an ethics exam which is 60 multiple choice questions (not really difficult but the questions are intentionally tricky and often not straight forward) within 3 years of taking the bar exam; (2) The bar exam consists of approximately 2 days made up of four three and a half hour parts (That's 14 hours total). These parts are 50 multiple choice and 6 essays based on 27 different areas of NY State law. The second day is 200 multiple choice questions based on Federal and Common law. See, I had to memorize 3 entirely separate systems of law and be able to regurgitate that knowledge on command. Doctors do not do anything near that. My girlfriend (who is at the top of her class and has scored in the top 3% of the nation on her boards) has never written an essay. Doctor's strictly memorize and get tested by answering multiple choice questions. There's very little "analysis." In fact, I'm often shocked by how little they teach doctors to analyze issues. They seldom teach doctors basic medical things, mostly concentrating on obscure diseases that one hundredth of one percent of people would ever get. In terms of training, yeah the residency is "training" just like when someone gets hired for a job, they get "on the job training." In fact, after the 1 year internship, a doctor can open their own practice.
I don't support frivolously suing doctors. I think it serves nothing more than to drive up medical costs. However, I absolutely support (and so do most competent doctors) suing the hell out of incompetent doctors. Thanks to lawyers and the law, next time you go to the doctor's office and you don't receive some form of malpractice, that's because we've driven up the standard of care to something that doesn't kill or maim patients.
Next time you want to speak about this, instead of having anecdotal "evidence" from people you know, why not speak about something you have personal experience with. I know what goes into being an attorney, medical malpractice suits, being a doctor... you clearly don't.
do you have any stats backing this up? Frankly, I find it hard to believe. Furthermore, even if true, the fact that most don't need defending and can be dealt with by a simple summary judgement again gives support to the argument that we have too many frivolous lawsuits. Additionally, with every lawsuit, even unsuccessful ones, malpractice insurance premiums rise further elevating total costs.
Also, would you like to address the fact that defensive medicine is a huge contributor to costs?
2. Disagreed. I find it patently ridiculous that you lump all med mal claims into 2 categories. If true, that would mean that almost none go to trial, which is not true. Tens of thousands of med mal trials happen every year. Thus, this argument of yours is proven false
youre actually contradicting yourself here. Its actually LESS forgiving for professionals--its harder to keep up with a professional than a person, esp a mentally challenged one.
4. Im not going to get into a pissing match with you about which is tougher, legal or medical education. There's no question that medical education has stricter acceptance criteria (avg GPA of med school matriculants is higher than law school matriculants), that med education is longer (no residency for lawyers with an incredibly arduous training for docs) and no need for a bar exam for lawyers every 10 years (unlike docs, who retake boards)
These are facts. Your opinion that law requires more analysis is just that--opinion.
At any rate, the point is that both lawyers and doctors are highly trained professionals, so to assert that there are "an incredible number of incompetent doctors" is ridiculous and absurd. Percentagewise, very few docs are incompentent. I would challenge you to prove that there are more incompetent docs than lawyers.
that was true in 1920. Today it is impossible to get hospital accreditation with this.
I find it laughable that you follow an entire paragraph about you and your girlfriend's experiences with an admonishment about "anecdotal evidence" Hahah...what do you think you were doing??? You didn't cite ONE source in your whole post!
Calm down. Clearly you got a dose of internet courage and are taking a tone you probably wouldn't take in real life. This is an adult discussion--no need for that
I use medicare and am finding more and more doctors and specialists dropping medicare and mdicaaid due to the bad returns on care,,,, My co-pays are growing and being retired does not help due to Social Security. If it were not for a military pension I would have to go back to work and it is hard for me being an amputee.
Sorry to hear that. But let's be thankful that these much needed programs didn't get the axe! I can only imagine what things would be like if they were forced to be privatized!
How do I know the cost of a summary judgment motion? I'm an attorney, that's how I know. Done them, won them.
Defensive medicine is not a high cost, in fact in brings down cost. Being proactive (though using common sense and not ordering ridiculous tests) is always cheaper in the long run. Might cost a little more now, but doing the opposite is penny smart and pound foolish.
No, I did not contradict myself. It's MORE forgiving. Because, so long as they didn't deviate from the VERY NARROW guidelines, they're fine. To put this in laymen terms, which clearly are needed here... If I'm trying a simple negligence case, I can argue any god damn conceivable thing under the sun a "reasonable" person would do, which if you didn't catch on are a whole hell of a lot of things, most completely counter intuitive to what an actual "reasonable" person would do. Now, if I'm in a malpractice action, as the defense attorney, I have to argue that it's not what any idiot would do, it's what a professional would do, if the professional does this and it's fairly standard, then I'm golden. If my client deviated from a standard practice, he's screwed and rightfully so. As a professional it's very easy to NOT commit malpractice. You know what I do as an attorney to not commit malpractice? I do not go outside the guidelines of my profession, very easy. If there's a rule, I follow it. If I have a question, I ask or do research. I don't make @!$%# up on the spot and hope that everything will turn up roses.
I don't care who accredits what, after 1 year, a doctor can lawfully practice. If you think a lawyer with one year of training can waltz in to any law firm and start making ridiculous money, I'd suggest picking up a paper (perhaps a law journal) and read the current state of attorney hiring. We all get "on the job training" doctor's just call their's "residency." Once a week they have "grand rounds" where they'll listen to a specialist talk about a specific area of medicine for a couple hours. Lawyers have this too, we call it staff meetings, continuing legal education, bar association committee meetings, it's all the same. By the way, their not tested on grand rounds material, it's just extra knowledge.
The reason I used my girlfriend is that, I've basically been living with it for years now. Granted it's not first hand experience, but it feels like I have it. However, my source deals directly with med students, residents and attendings on a daily basis and knows the actual ins and outs of medicine. While technically it's anecdotal, it's really more of a near first hand account of the goings on.
As stated previously, you clearly have no medical or legal training, just an opinion. I can't force you to have a correct opinion, no more than I can control the fact that I'm right.
ED.. Defensive medicine is a HUGE cost to the system. I know because I am a doctor! A kid comes in with a headache due to sinus issues, the parents come in with a list of possible causes from the internet, the doctor uses reasonable care in treating the sinus infection. The kid months later is found to have a brain tumor so the parents sue the doctor for not performing a dozen other tests that would have been worthless in almost every other case. It ends up being settled out of court by the ins company because they know a jury would find against the doctor. These things happen and when there are commercials 24/7 on TV about calling XYZ law firm if you even feel your doctor didn't treat you properly, there is a problem.
Mike, then that is something that must be dealt with at the AMA level. Either determine what is or what is not a standard course of treatment. If running a battery of tests is not "standard" then as an attorney I should not be able to find an expert witness saying that it was standard to run those tests. Get your profession straightened out before others are accused. I'm not saying there aren't greedy lawyers out there who are litigation crazy and will pounce on anything. But if it's not a standard professional practice to scan for a brain tumor when the patient presents with nothing more than a headache, then the plaintiff will lose in court (well that's actually dependent on the jury and no one can control that). As an attorney, I'm held to the same standards. You know what we did? Codified it into the Model Rules of Professional Ethics. When a lawyer deviates from it, we consult the rules and the interpretations and come to a conclusion.
Want to solve these types of lawsuits? Get the AMA to create a standard of practice. Then physicians have a codified document to reference should they feel the need. However, this doesn't address the bigger issue that medical costs are so out of whack with reality. The industry has done it to themselves through extreme greed. I'm not saying attorneys are innocent by any means, but when it costs $400 to see a doctor for about 5 minutes, we've got a bigger problem than suing doctors who commit malpractice.
How about the AMA gangs up against the HMOs to refuse to abide by their standards and give patients the treatment they need for a reasonable price? I know that if I tried to charge a client $12,000 for two hours of work (when my mom had her appendix out that's how much the surgeon charged, not including anything else but his time) I'd get sued and probably disbarred. Oh, and getting sued would cause my malpractice insurance to go up as well.
ED.. The issue is that you can always find someone that will say anything is a standard tx. Right now there are those who will insist that a mercury enema is beneficial. Also medicine is NOT an exact science where you do XYZ for every patient, there is still quite a bit of art when it comes to medicine. Also some long time accepted standards of care have been determined through research to actually not be the best care.
A good example: Antibiotics for peds ear infections is recognized as overprescribed, yet if a parent comes in and a physician doesn't give an antibiotic that has been shown effective then that physician could arguably not be providing the "best care" by one doctor while another considers the greater societal good of waiting. It becomes an ethical issue vs. a scientific one. Many physicians have cut back on prescribing antibiotics as prof stds rec such, but any single case can be second guessed because there is no way to create a one size fits all standard. Unlike some professions medicine cannot simply create a simple black and white standard because humans are quite unique in body shape, size, genetics, environmental factors, etc.
Another example is that of PSA screenings, the current standard of prostate care may questionably be creating a lower quality of life with little benefit to ~90% of patients, yet if you are somehow in that 10% then you can argue that the doctor was somehow negligent for not being aggressive as possible.
All of that said, docs are working to develop best practices and have in many areas but the system/human body is too complex for stds to be perfect.
I do agree that tort reform is not the sole solution to medical care costs, as the greatest burden on the system IMO is associated with insurance. However, I can remember when lawyers thought it to be unethical to ambulance chase and to advertise on TV that one should consult a lawyer just to figure out if a lawsuit might be possible because that person just might get rich in a settlement.
Thats not what I asked. I asked if you had any stats to back up the claim that most med mal cases are resolved with summary judgement
Furthermore, you conveniently ignored my statement that if most are summarily dismissed, that only proves that there are too many frivolous suits
This is absurd. You do not know the difference between preventative medicine and defensive medicine. Preventative medicine can save lives down the road with proper screening--defensive medicine is ordering unnecessary tests purely to avoid legal problems
If I did a CT head on you now, that would do nothing for your health. However, it might save me from liability if you were consequently found to have an intracranial process (however unlikely that were to be or even if there was no reason to suspect it at the time).
However, if I checked your lipids, that may be indicated and save you from a heart attack
Yes you did. It is easier to deviate from a stricter set of parameters than a looser set. I can't make it any simpler for you
A doc cant make ridiculous money if no hospital will give him priveleges, and he is not board certified. A lawyer can make good money after only 3 years of school--a doc can't (cause med school is 4 years)
This is spoken just like someone who has never done a residency, and whose only knowledge is from one person, likely an intern
There are key differences:
1) Uniformity: All training hospitals across the US are certiefied by the acgme. They must show that they have an adequate patient volume, variety of disease processes, exposure to modern techniques, etc. Some may excel more than others, but a guaranteed baseline is mandatory, or training priveleges are revoked.
"on the job training" has no such guarantee. You may say you get this at your firm, its huge, its the best in NY, yada, yada, but you cannot promise that for all lawyers at every firm. I can for residency
2)Didactics. Residency has at least 4 hours of required conference per week. Furthermore, the conference must cover topics set forth by the acgme to provide comprehensive medical education. To equate this to staff meetings is laughable
furthermore, you cannot guarantee that every law firm has this many hours of education per week. I can for residency
I can go on and on but you get the idea. Residency is supervised training with very specific minimum requirements that must be upheld. Law firms have no such requirement. your firm may do a good job, but you cannot comment on all of them
Not only is it not first hand experience, it is all anecdotal anyway. Ive listed facts for you; you've given nothing but opinion in return
Wrong. I have completed an internal medicine residency, a cardiology fellowship, and 1/4th of a super-fellowship
Wrong. I have given facts (higher gpa for med school, acgme requirements for residency). You have given barely any facts.
Self congratulations are prob the only type you'll get here, or anywhere
So hospitals wont get paid for keeping Medicare recipients inpatient but CMS will penalize hospitals for discharging them too early. Brilliant! Patients get taken care of and no one has to pay for it. Too bad the approach will fail miserably in the long run.
Hey, it makes a twisted sort of sense. If fewer doctors accept Medicare patients, then more Medicare parients will not get treatment, and thus will die earlier. That will save even more money on Medicare.
"Congress just continually finds short-term solutions."
This kind of thinking is what passes for leadership in both the public and private sectors. Next quarter, next election. The Native Americans used to base their decision-making on the effect it would have on the next seven generations. Had we done that in the 1950's, had we listened to truly great leaders like Eisenhower and our Founding Fathers, just think what a different country it would be. Now, I have deep doubts that the human race will last another seven generations. Mother Nature will just wipe us out and move on. She DOES think ahead.
I've got to agree with you on this one. To me, since the 80's and the 'me me me' mentality, some people want the entire nation privatized, for-profit, instant gratification...and it makes me sick! I often worry (though TRY not to..it just makes things worse) about the generations that will be caring for me in my old age! Be if government, family, etc. Less and less do some think about anyone but themselves!
Who was president in 1997 when all of this began? Bill Clinton.
and George W Bush was wonderful for the budget & the economy... oh yeah!
Thank George for the tax cuts, WTC bombing, unnecessary wars, return to deficit spending, doubling of the debt, and financial meltdown that flushed the country down the toilet.
Greg, George Bush did not do all of this by himself! This is something that has gone on for decades and is continuing on now! We have no freaking budget!! George Bush did not cause the WTC terrorist attacks, don't know where you come up with that information. Everything is not George Bush's fault or Obama's fault!
And who are the biggest benefactors and causes of medicare fraud...
who?
Rick Scott
Do you want Congress to act, then they must first rid themselves of any "free" medical care that they now receive from Taxpayers dollars. Then they must submit themselves to the same conditions that now face the public in securing proper health care and treatments.
Bet you that Congress would then feel the pangs of being a member of the Public rather than a pampered member of the elite.
While I agree that Congress should be thrown in with the "average" American in terms of having to pay for all or a percentage of ridiculously priced healthcare... to be fair, Congress's plan is the same plan that EVERY federal employee chooses from. The janitor at some federal installation in Alaska can get the exact same healthcare package as does every Senator and Representative.
However, I do think that Congress should have their healthcare taken away and be made to pay for it out of pocket... then let them say that single payer healthcare is evil and can't work in this country. Better yet, lower their salary to the average salary in America ($51,000 I believe) and ask them to pay for healthcare or contribute "x" percentage towards healthcare. Then I think we'd see some real change.
Or, if they would just see that "Obamacare''s premise is to open up great health care, like what the govt. has, to everyone, create better pricing and care with competitive cost, eliminating the red tape and middle men..we would be a healthy nation (again!) I guess people don't realize that with fewer people able to pay for medical care, that the health industry receives taxpayer dollars when the poorest-(hourly wage earners), most fragile-children and elderly, etc. cannot pay their emergency visits to the hospitals or walk-ins! If they could just understand that!
It may be time to run Obama out of Washington, tarred and feathered! He has screwed everyone with his BULL SH!T. And the mainstream news media allows him to really destroy the poor and the middle class. Poor people should sell news journalists' body parts to feed their family.
Rober34, Your not making much sense. Obama is a Democrat, the Democrats support the middle class and the poor. The Republicans support cutting aid to the middle class and poor while maintaining corporate welfare for big oil and many other industries.
Instead of venting about things that cannot happen, running out of Washington, tar and feathering, why don't you contribute to the conversation explaining how Obama is destroying the poor and the middle class. He just prevented taxes from going up for the poor and middle class. He has a structure to provide health insurance to the poor and middle class that the greedy businesses won't provide.
Rober34, if this issue goes back to a 1997 law and has been addressed by temporary fixes by congress ever since, how do you figure this is Obama's fault? Do you understand that statements like that only serve to make you look irrational?
It's not the cost of a settlement that puts fear in the heart of a doctor; it's the fact that even the most nonsensical allegation will find a lawyer willing to turn it into a suit, which is hugely distracting and which can damage a doctor's reputation even if he prevails. However, I don't think the costs of insurance are eating into the standard of living for the average physician. Most of us are adequately compensated.