Medicare pays…or not

Monday, November 28, 2011

Should the potential NBA deal be ratified, the start of a new season will be pro basketball’s gift to the world. Understanding the terms of the deal and whether the players’ union or owners won probably mattered less to most fans than how their home team was going to do in the coming year. Interestingly, with other sports like the NFL, NHL and college basketball to watch, the need for the regular NBA season didn’t seem as crucial.

Watching two groups fight about splitting billions of dollars was more than a little irritating but in the coming month, another money struggle will hit closer to home. On January 1st, Medicare payments to physicians are scheduled to decrease by 27.4%. It seems like a lot because it is and Peter Carmel, the president of the American Medical Association, warns that it ” will force many physicians to limit the number of Medicare and TRICARE patients they can care for in their practices( http://www.ama-assn.org/ama/pub/news/news/2011-11-21-deficit-committee-failure-medicare-cut.page). No doubt, this is just another spitting match between the rich members of Congress on one side and the rich doctors on the other, except that numbers seem to say that doctors who take care of elderly Medicare patients aren’t getting rich. In 2011, if you went to see your doctor for a routine visit, Medicare would pay $19.79, $41.54 or $69.11 depending on the length and complexity of the medical problems but in 2012 that would drop by more than a quarter. By comparison, the average price for a single NBA ticket ranged from $17 to watch the Utah Jazz to $246 for the LA Lakers. If only your doctor could dunk a basketball.

Brinksmanship brought about an NBA deal and with it, Christmas basketball. The same scenario may play out for physician pay. For the past 12 years, Congress has rolled back the pay cuts before the January 1st deadline, but this is the same Congress that could not compromise on debt reduction and budget compromise. It will be an interesting ethical question that some doctors will face. If each Medicare patient costs more to care for than the payment received, should that patient be refused care? Or should the fee charged to look after non-Medicare patients be increased?

It’s hard to get excited about doctors who complain about not making enough money. But a hierarchy exists in medical pay just like the NBA. There are a few superstars who make a lot of money and then there is the rest of the team are well off but are certainly not rich. In medicine, it’s the surgeons who are the superstars. Depending upon where in the country they practice, their income can average more than a half million dollars a year. Primary care providers, like pediatricians, family practice and internal medicine doctors earn about $150,000.

There is a consequence to this earning divide. Medical students are choosing higher paying specialties over primary care and this change in the medical labor force will mean that there may be fewer doctors available to look after an aging American population. A 2011 study published in the Archives of Internal Medicine surveyed medical student attitudes in 1990 and 2007 and found that those preferring a career in primary care fell from 57% to 33%. The conclusion: “Persistent unfavorable perceptions of income disparity, workload, and stress appeared to counter the gains from perceptions of meaningful work”. (Arch Intern Med. 2011;171:744-749).

Show me the money was Jerry Maguire’s mantra and it seems that business news keeps creeping into both the sports and medical section of the news. Scores and statistics take a second row to newly minted free agent announcements. Medical discoveries take a backseat to ads touting the advantages of different Medicare plans. Somehow life was easier when it was the other way round.

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