Posts Tagged ‘physicians’

Healthcare Costs Wiping Out Your Income Gains

Monday, September 26th, 2011

If Americans’ incomes are not growing, part of the blame can be placed on the high cost of healthcare.  According to the Washington Post’s Sarah Klitt, “All evidence points to American voters not really caring about rising healthcare costs.  But here’s one pretty compelling reason they should:  The escalating cost of healthcare has wiped out nearly all income gains made by the average American family in the past decade.”

Research in the September issue of Health Affairs notes that American physicians are paid more per service than in other countries — in some instances, double the amount.  There is also a larger gap between fees paid for primary care and specialty care, when compared with other industrialized countries.  These higher fees translate to higher incomes for American physicians than those earned by their foreign counterparts, and are the primary driver of higher overall spending on physicians’ services.

The study — by Miriam Laugesen of the Mailman School of Public Health at Columbia University and Sherry A. Glied, also of the Mailman School and presently Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services (HHS) — compared fees paid by public and private payers for primary-care office visits and hip replacement surgery in Australia, Canada, France, Germany, the United Kingdom, and the United States.

The researchers determined that American primary-care physicians on average are paid 27 percent more by public payers for an office visit, and 70 percent more by private payers for an office visit, compared to the typical amount paid in other nations.  The largest difference in fees paid to American physicians versus fees paid to doctors in other countries was for hip replacements.  American physicians earned 70 percent more for these procedures by public payers, and 120 percent more by private payers, than the average fees paid to physicians in other countries.

“The gap between the fees paid for primary care and those for orthopedic services such as hip replacements is significantly bigger in the United States than it is in other countries,” Laugesen said.  “For decades, policymakers and medical leaders in this country have debated financial incentives to spur more doctors to become primary-care physicians.  Our work shows that continuing attention needs to be paid to the difference in payments across specialties, and how we can get better value for those expenditures.”

Additionally, American physicians reported higher salaries when compared with the other countries, despite the fact that there was minimal difference in the volume of services provided.  Laugesen and Glied suggest that the differences may reflect the fact that American physicians are paid more for their skill and time than doctors in other countries.  Whether or not those higher payments have merit is a question that the study did not address.  American primary-care physicians earned the highest average annual incomes ($186,582) while French ($95,585) and Australian ($92,844) primary-care physicians earned the lowest.  American orthopedic surgeons earned the highest average annual incomes at $442,450, followed by $324,138 for surgeons in the UK.  Although UK surgeons earned 50 percent more than surgeons in the other comparison countries, they earned 30 percent less than American orthopedic surgeons.

A study by the RAND Corporation determined that rapidly rising healthcare costs have eaten nearly all the income gains made by middle-income American families over the past 10 years, leaving them with just $95 per month in extra income, after accounting for taxes and price increases.  Had healthcare costs risen only as fast as the cost of other goods and services from 1999 to 2009, the same family would have had an additional $545 per month to spend in 2009.

“Accelerating healthcare costs are a primary reason that the so many American families feel like they are just treading water financially,” said David Auerbach, the study’s lead author and an economist at the RAND Corporation, a non-profit research organization.  “Unless we reverse the trend, Americans increasingly will notice that health costs compromise their other spending options.”

Between 1999 and 2009, healthcare spending in the United States nearly doubled, from $1.3 trillion to $2.5 trillion.  During the same timeframe, the percentage of the nation’s GDP devoted to health care rose from 13.8 percent to 17.6 percent.  Per-capita healthcare spending rose from $4,600 to just over $8,000 a year.

Although the numbers are arresting, they don’t necessarily translate to the daily routine of American families because many healthcare costs are hidden, according to the researchers.  Auerbach and co-author Dr. Arthur L. Kellermann, director of RAND Health, combined information from multiple sources to describe the obligation that rising healthcare costs placed on middle-income families with employer-sponsored health insurance from1999 to 2009.

“The complex way that the United States pays for healthcare often obscures the consequences of healthcare cost growth for most American families,” Kellermann said.  “This makes the challenge of controlling healthcare costs that much harder.”

Shop Online for Your Next MRI

Wednesday, December 29th, 2010

An Ohio physician is working with his peers and an online marketing firm to cut the cost of expensive diagnostic and laboratory tests so uninsured patients get the care they need.  Spearheading the effort is Dr. Doug Lefton of Fairlawn, OH, a former newspaper reporter turned physician.  After a story appeared in the Akron Beacon Journal highlighting the plight of these patients, Lefton was contacted by Tom Patton, CEO of PrePaidLab LLC, an Ohio online marketer of laboratory tests.  Coordinating with the Summit County Medical Society, Lefton made an arrangement with LabCorp., one of the nation’s largest testing companies, as well as with PrePaidLab.

The arrangement lets patients get their lab tests done for a fraction of the typical cost if they order them through the medical society’s website.  “These people that would ordinarily not be able to afford lab work are paying almost identical the amount the government pays for Medicaid,” Patton said.  “(The prices) are spectacularly low for something you can get on the market yourself.”  By way of example, a lipid panel test for cholesterol normally costs as much as $148 in Dr. Lefton’s practice area.  The same test costs just $18 via the website.  “It’s like using Amazon.com to buy your lab tests,” Lefton said.

Jeff Hughey, an Akron information systems technician – who has employer-paid healthcare insurance – used the online lab for a metabolic profile, a lipid panel and a hemoglobin test for blood sugar.  The three tests would cost him $400 if performed in a hospital diagnostics lab.  “Insurance doesn’t kick in until you have paid $2,000 out of pocket,” Hughey said.  “I just couldn’t afford $400 for three simple tests.”  Using PrePaidLab, the tests cost Hughey a total of $50.45, including a $9.50 service fee.  PrePaidLab created a physicians’ portal so patients who don’t have access to a computer or a credit card can order the tests and pay cash.

Overall Physician Compensation Levels Fell in 2009

Thursday, August 26th, 2010

The bad economy cuts into 2009 physicians’ paychecks.  Doctors’ salaries fell slightly in 2009, according to the 17th annual Physician Compensation Survey compiled by Modern Healthcare magazine.

The most recent survey tracked 23 specialties and determined that only five had average pay increases higher than the 2.7 percent inflation rate calculated by the Consumer Price Index.  These were dermatology, which rose 5.3 percent; pediatrics, which rose 4.5 percent; neurology and pathology, which rose 3.3 percent; and hospital medicine, which rose 2.8 percent.  Orthopedic surgeons topped out the compensation list with their average pay climbing 1.9 percent to $485,297.

Eight specialties saw slight decreases.  Plastic surgery was down 3.3 percent to $376,849; gastroenterology was down 2.8 percent to $409,628; intensive medicine was down 1.7 percent to $257,797; radiation oncology was down 1.7 percent to $420,661; urology was down 1.4 percent to $391,406; emergency medicine was down 1.1 percent to $266,826; invasive cardiology was down 0.9 percent to $450,016; and noninvasive cardiology was down 0.9 percent to $393,181.

According to William Jessee, M.D., president and CEO of the Medical Group Management Association, “Clearly, there had to be some impact from the economy.  Actually, I was pleased the numbers were as good as they were given the recession.  Certainly, it showed a comeback in the second half of 2009.”  A pediatrician, Jessee, added that primary-care physicians saw their pay rise by 2.8 percent last year, which he views as part of an effort to attract more medical school graduates to that specialty.  He warns against over-reacting to the data.  “Keep in mind the increase is not anything to write home about – 2.8 percent is not a windfall,” Jessee said.

Hospitals Need to Step Up Hiring to Keep Up With Demographics

Tuesday, February 16th, 2010

There will be a shortfall of 109,600 physicians by 2020 and 260,000 full-time nurses by 2025.  Demographic trends will not allow hospitals and other healthcare providers to maintain their current staffing patterns, according to a new American Hospital Association (AHA) study.

Assuming current trends remain the same, the researchers say that there will be a shortfall of 109,600 physicians by 2020 and 260,000 full-time nurses by 2025.  This will occur at a time when other industries will experience similar employee shortfalls.  The study, entitled Workforce 2015:  Strategy Trumps Shortage, notes that hospitals will have to retain their current employees while bringing in new physicians and nurses to provide necessary services.

“Hospitals and health systems need to rapidly implement these strategies, learn early implementation insights, and share successful practices.  Employers in other fields face the same challenges and are likely to use similar strategies,” the AHA study notes.  As an example, hospitals and other healthcare providers must redesign workflows by seeking employee input.

“Medical Home” – Closest Care to a House Call

Wednesday, December 30th, 2009

Medical home approach to healthcare can cut hospitalizations and ER visits.  It’s almost – but not quite – a house call.

A new healthcare concept called “medical home” is emerging across the country, especially in Illinois.  It is primary care devoted to prevention and to helping people with chronic conditions such as diabetes or arthritis manage their illness.  In a medical home, a physician oversees a team of nurses, physicians’ assistants and health coaches who make certain that their patients get the care, support and education they need.  Another benefit is that the plan frees up the doctor’s time to focus on the more serious medical issues.

Medicare recently announced a similar initiative, and healthcare reform legislation could champion medical homes.  One pioneer in the field is Group Health Cooperative, a Seattle-based HMO that plans to convert 26 clinics in Washington and Idaho to medical homes.  The pilot program, established two years ago, reduced ER visits by 29 percent and hospitalizations by 11 percent while improving the quality of care, according to a report in the September issue of the American Journal of Managed Care.

For medical homes to function properly, physician compensation will have to change, says Dr. David Swieskowski, chief executive of the Des Moines-based Mercy Clinics, Inc.  The model works optimally when physicians are full-time, salaried employees.  This payment arrangement is fairly rare, and insurance companies don’t reimburse physicians for taking extra time to talk to patients.

Medicaid introduced a version of medical homes in Illinois through Medicaid in 2006 and 2007.  During that time, Medicaid assigned 1.9 million people to physicians who agreed to coordinate care for an extra monthly fee.  As a result, immunizations, vision screenings and other types of basic care have improved, state officials say.

Physicians Line Up To Support A Public Option

Monday, September 21st, 2009

A random survey of 2,130 physicians found that 73 percent support a public option as one element of healthcare reform legislation.  That breaks down to 63 percent of physicians supporting both public and private options; 10 percent supporting a public option only; and 27 percent favoring private options only.  The poll was conducted by New York’s Mount Sinai School of Medicine internists and researchers Dr. Salomeh Keyhani and Dr. Alex Federman.nmrally20in20support20of20public20option20and20bingaman20july2015

The majority of physicians who favor giving their patients a choice of public or private insurance are in tune with President Barack Obama’s position and that of many congressional Democrats.  Polls of average Americans have found that between 50 and 70 percent support a public option.  In other words, physicians support the public option more strongly than the general population.  This contradicts one of the canards of the healthcare debate – that doctors will resist reform for fear of seeing their incomes erode.

“Whether they lived in southern regions of the United States or traditionally liberal parts of the country, we found that physicians – whether they were salaried or they were practice owners, regardless of whether they were specialists of primary care providers, regardless of where they lived – the support for the public option was broad and widespread,” Dr. Keyhani said.

The survey was published Monday, September 14, in the online New England Journal of Medicine. It was funded by the Robert Wood Johnson Foundation, a healthcare research organization that supports reform legislation.

Medicare: The Free Market Option

Tuesday, September 8th, 2009

Medicare gives patients more choice, and a greater range of free-market options than does private insurance.  While Medicare has had its financial challenges, it is an example of a government-run program that gives patients choice.  Sometimes, private insurers refuse to include physicians in their plans; Medicare does not exclude physicians.

The insurance companies insist the idea of healthcare reform to include a public option – such as Medicare – but it’s important to look at the facts that includes a government-run plan.  According to a recent article in Mother Jones magazine, “Survey results demonstrate that Medicare beneficiaries are less likely than those with private coverage to High healthcare cost, advanced healthcare directivereport negative experiences with their insurance plans – including having expensive medical bills for non-covered services, being charged a lot more than insurance would pay, and physicians not taking their insurance.”

According to a study by the Commonwealth Fund, 37 percent of Medicare patients are completely satisfied with their coverage and report few problems accessing and paying for healthcare.  Only 20 percent of people with employer provided plans reported the same level of satisfaction.

One argument often used against the public health plan option is the following: I want to choose my own doctor, and I don’t want a government bureaucrat making that decision.  That’s wrong.  Under private healthcare plans, your only choice is to pick a doctor who has negotiated costs with your insurance company.  Doctors unwilling to negotiate are excluded.

In seeing the way the healthcare debate has been framed, perhaps the administration would have been better off describing the proposed reform as the extension of Medicare to the entire population.

A public health plan option will not introduce a bureaucracy into healthcare; that bureaucracy already exists.

Healthcare’s Best-Kept Secret: Nurse Practitioners

Thursday, August 13th, 2009

If healthcare reform is to successfully overcome the realities of Washington politics, there is one problem in covering the millions of Americans who lack insurance coverage – the physician shortage.  Currently, there is a 30 percent shortage of primary-care physicians, and with less than 10 percent of 2008 medical school graduates choosing that career track.  When Massachusetts enacted mandates for universal health insurance in 2006, the state’s primary-care physicians48019286 were overwhelmed.  A similar scenario could occur on a national scale.

Nurse practitioners — who have advanced nursing degrees, are licensed by the state and often are allowed to prescribe medications — may fill that void because they can treat and diagnose patients at less cost than physicians.  Medicare reimburses nurse practitioners at 80 percent of what they pay doctors for similar services.

Nurse practitioners are vital to healthcare reform because they focus on patient-centered care and preventive medicine.  The House of Representatives has listed nurse practitioners as primary-care providers on their healthcare reform legislation bill.  The profession lobbied intensely to include this legislative language so they can play an important role in a revamped health system.

“We seem to be healthcare’s best-kept secret,” said Jan Powers, health policy director for the Academy of Nurse Practitioners.  Although nurse practitioners typically have less medical education than physicians, they are well trained in skills such as bedside manner and counseling.  “In the United States, we are so physician-centric in our health system.  But it should be about wellness and prevention, not about procedures and disease management,” said Rebecca Patton, president of the American Nursing Association.

“Give ‘Em Hell Harry” Tried to Give Americans National Healthcare

Tuesday, August 11th, 2009

Harry Truman had been Vice President for just 82 days when Franklin Delano Roosevelt’s death catapulted him into the presidency and the spotlight.  One of his earliest initiatives was to propose a new national healthcare program in a November 19, 1945 message to Congress.

Truman argued that the federal government should be a major player in the healthcare arena.  “The health of American children, like their education, should be recognized as a definite public responsibility.”  The most jb_modern_fairdeal_1_econtroversial aspect of Truman’s plan was an optional national health insurance fund, which would be run by the federal government and open to all Americans.  Participants would pay a monthly fee, which would cover all of their medical expenses.  The government would pay physicians who joined the program for services rendered, and reimburse the policy holder for lost wages due to illness or injury.

The legislation introduced into the Senate and House of Representatives ran headlong into the American Medical Association’s (AMA) strong opposition.  “The AMA characterized the bill as ‘socialized medicine’, and in a forerunner to the rhetoric of the McCarthy era, called Truman White House staffers ‘followers of the Moscow party line'”.

Once the Korean War started, Truman was forced to abandon his healthcare bill.  Despite his failure, he successfully brought the issue of healthcare in America to the forefront.  When Lyndon Johnson signed Medicare into law at the Harry S. Truman library, he said it “all started really with the man from Independence.”

Challenges Impact Physicians’ Choice of Specialties

Tuesday, July 21st, 2009

Patrick Sweeney, M.D., spinal surgeon, inventor and owner of the Center for Minimally Invasive Surgery in Mokena, IL, believes that private surgerypractitioners are under enormous stress right now, primarily in terms of overhead and contracting with insurance companies and other referral sources.  Dr. Sweeney says there is a strong possibility that traditional private practitioners may become a thing of the past over the next five to 10 years, given the way the healthcare system is evolving.

In a recent interview for the Alter+Care Podcasts on Healthcare, Dr. Sweeney noted that “A few powerful payers control a good share of our reimbursement market.”  Reimbursement issues also are luring younger physicians to work in large hospital-owned practices — where the financial risk is limited — and in lower-pressure specialties with less legal exposure and shorter work hours.  That’s bad news because it means that fewer new physicians are choosing to specialize in essential fields like general surgery, OB/GYN, ENT and neurosurgery, areas where critical shortages already exist.

To listen to Dr. Sweeney’s full interview on the challenges facing today’s and tomorrow’s physicians, please click here.