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How Outdated Data Distorts Doctors' Pay

Unknown Lamer posted about a year ago | from the name-your-price dept.

Medicine 336

Hugh Pickens DOT Com writes "Peter Whoriskey and Dan Keating report at the Washington Post that Medicare annually pays $69.6 billion for physician services according to an arcane and little-known price list, known as the Relative Value Update over which doctors themselves exercise considerable and less-than-totally-transparent influence. A 31-member committee of the American Medical Association (AMA) recommends what Medicare should pay for some 10,000 procedures — with the fees based in part on how long it takes to complete each one. But this time-and-motion study often fails to take full account of changing technology and other factors affecting physician productivity, so anomalies result. For example, if the AMA time estimates are correct, then 41 percent of gastroenterologists were typically performing 12 hours or more of procedures in a day, which is longer than the typical outpatient surgery center is open and and one gastroenterologist in the Post story would have to work 26 hours, according to the committee time estimates, to accomplish what he gets done in a typical workday. Here's how it works: Medicare pays for a 15-minute colonoscopy as if it took 75 minutes resulting in a median salary for a gastroenterologist of $481,000. It is possible that in 1992, critics allow, when the price list was first developed, a colonoscopy actually took something close to 75 minute when doctors had to hunch over an eyepiece similar to that of a microscope for a look. But technology has advanced and now the images are processed and displayed on a large screen in high-definition video. Responding to criticism that the nation's method of valuing medical procedures misprices payments, a bipartisan group of legislators has drafted a bill that would reshape the way the nation pays doctors. The bill would require Medicare officials to collect data such as how much time doctors spend doing procedures and reducing the doctor payment for overvalued services. 'What started as an advisory group has taken on a life of its own,' says Tom Scully, who was Medicare chief during the George W. Bush Administration. 'The idea that $100 billion in federal spending is based on fixed prices that go through an industry trade association in a process that is not open to the public is pretty wild.'"

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Praise Legacy Data (1, Funny)

smitty_one_each (243267) | about a year ago | (#44421639)

Praise legacy data
Sad, racist H8ah
Or sweep it from chin
For cleanshaven win!
Burma Shave

Re:Praise Legacy Data (4, Interesting)

MichaelDelving (546586) | about a year ago | (#44422081)

Get out the pitchforks and torches, antisocialists.

What is interesting to me is that private hospitals negotiate rates with medicare and insurers, but basically set their own rates for the uninsured. My limited knowledge on the topic is merely based upon the few articles that have achieved my attention, but medicare rates are apparently the most reality-based, since the federal government gets to collect and analyze more of the pertinent data than anyone else. The private insurers have some strength in numbers/volume, and have their own data, and get to negotiate a bit. The uninsured are basically screwed, and are asked to pay many times what is charged to the insured or medicaid patients.

Google chargemaster, if you are interested.

Re:Praise Legacy Data (1)

NatasRevol (731260) | about a year ago | (#44422143)

You don't need to google anything. Just talk to someone who doesn't have any or good health insurance.

Re:Praise Legacy Data (3, Informative)

bkaul01 (619795) | about a year ago | (#44422201)

While it's true that doctors and hospitals set their own prices for the uninsured, that doesn't mean the uninsured are being screwed. In practice, it's often just the opposite: if you're paying directly, they'll give you a significant discount to not have to deal with the insurer. However, if they submit a claim to your insurer on your behalf, they can't give you that discount. I know a number of people who have encountered cash prices less than half what the insurer would be billed, from both dentists and doctors.

Re:Praise Legacy Data (1)

ebno-10db (1459097) | about a year ago | (#44422283)

I know a number of people who have encountered cash prices less than half what the insurer would be billed

Irrelevant, since what the insurer gets billed and what they pay have little to do with each other. People who think they're getting a great deal may still be paying more than the insurer would.

Re:Praise Legacy Data (1)

Gr8Apes (679165) | about a year ago | (#44422219)

The answer is "posted rates" much like car repair shops. All service providers have to post their rates, and that's the price for all. I know that puts a huge dent in insurers who like to negotiate back door deals, but it levels the playing field for all. Insurance and providers shouldn't mingle anyways, it an inherent conflict of interest.

Re:Praise Legacy Data (2)

sycodon (149926) | about a year ago | (#44422373)

And they should be hourly rates, set according to the education and certification of the Dr. Also, equipment should be charged at an hourly rate.

The opacity of actual costs is probably the most significant driver of increased costs.

Re:Praise Legacy Data (1)

Anonymous Coward | about a year ago | (#44422297)

I guarantee you that you can negotiate with the hospital as a private individual. I have direct knowledge of talking a $65,000 bill into a $1,400 bill. Seeing such a thing happen with relative ease made me question what my own insurance coverage is really paying for. Should the same bill have come to me and my insurer, I'd have paid enormously more than $1400.

There are other problems with this issue though, and that's that the entire system basically forces billing to be done at ridiculous rates because it is the right move from a business perspective. If a hospital knows that an insurer is going to come back with a 'most favored nation' type argument -- ie that hospital X billed lower for the same procedure, or even the same hospital had billed lower for another patient -- the only reliable defense is to simply continue to increase the amount billed time over time.

Can we have a real story (-1, Offtopic)

Anonymous Coward | about a year ago | (#44421657)

I heard that there was a super yacht that was hijacked by GPS spoofing. One would think Slashdot would cover such an important story. Can we please get an article or two on this?

Thanks,
Slashdot

Re:Can we have a real story (-1)

Anonymous Coward | about a year ago | (#44421695)

Mod this one down too. I love the smell of burning mod points from humorless mods

Re:Can we have a real story (0)

Anonymous Coward | about a year ago | (#44421761)

Just accept that your attempt at humour failed.

Re:Can we have a real story (1)

geirlk (171706) | about a year ago | (#44421703)

Speak for yourself, I find this interesting.

On the other hand, if you _really_ would like to see other stories on /., feel free to submit stories yourself. After all, that is how /. works.

Thanks,
The other 99% of /.

Re:Can we have a real story (1)

Anonymous Coward | about a year ago | (#44421715)

It is a joke. The story had been posted to Slashdot three times already.

Whoosh? (0)

Anonymous Coward | about a year ago | (#44421915)

you must be new here... a misunderstood joke is ALWAYS followed by a "Whoosh" post!

Re:Can we have a real story (0)

Anonymous Coward | about a year ago | (#44421823)

I want this at +5 _Redundant_

Technology costs? (3, Insightful)

JaySSSS (859968) | about a year ago | (#44421735)

So, it appears the article only talks about the time spent by the physician. I'm curious if the costs of the tools/technologies of these procedures have gone up, and how the doctors get paid for those (potentially) increased costs?

Re:Technology costs? (3, Insightful)

Shoten (260439) | about a year ago | (#44421763)

So, it appears the article only talks about the time spent by the physician. I'm curious if the costs of the tools/technologies of these procedures have gone up, and how the doctors get paid for those (potentially) increased costs?

Well, that's another part of the problem, I would say. If one cost isn't getting addressed/monitored, and the way to try and offset it is to have another cost kept arbitrarily high in a way that does not reflect reality, then you're going to lose visibility into the real economics of it all and get undesired effects. Add in the fact that a trade association representing the vendors (in this case) is a major driver in the price determination process and the lack of transparency, and you increase the likelihood of undesired effects even further, and practically guarantee that anyone who looks upon the result will question it.

Re:Technology costs? (2, Insightful)

gandhi_2 (1108023) | about a year ago | (#44421811)

We all know that medical procedures require no setup, cleanup, assistance, explanation, or double checking, and of course are only done by one single doctor and no staff. Biling and coding, technology costs and training, facility costs.... those don't count either.

Clock in, surgery, clock out.

Re:Technology costs? (3, Insightful)

thaylin (555395) | about a year ago | (#44421875)

The bill is usually itemized and accounts for these things. We are talking specifically about how much time the doctor is working on the case of the patient. They are billing at a rate for only being able to do one of these things a day, but are able to do 26, so their pay, at the cost the tax payer, has ballooned.

Re:Technology costs? (2)

SJHillman (1966756) | about a year ago | (#44421981)

Have you ever been to a hospital for any sort of procedure? The bill is broken down into about a billion items (including a line item for stuff like over the counter grade ibuprofen that you would expect to be free). They also happily charge anything you say or is said to you as a "consultation". All of that stuff is accounted for in addition to the fee for the procedure itself.

Re:Technology costs? (3, Informative)

MightyYar (622222) | about a year ago | (#44421841)

Even the AMA says the times are distorted, but they emphasize that the relative times are pretty good. Meaning, for the most part, a procedure that takes twice as long as another is accurately recorded as so in the data. Medicare is generally not covering providers' costs, to the point where most unsubsidized hospitals in poor areas have closed and doctors have to limit the number of Medicare patients they take. It's pretty clear that, in aggregate, doctors aren't fleecing the system. As such, the absolute numbers are pretty much meaningless and it's the relative numbers that count. If a certain type of doctor feels screwed out of some money because they don't think the ratios are correct, then let them take it up with the AMA - why would we want to get involved?

Full disclosure: my wife is a doc.

Re:Technology costs? (1)

Rich0 (548339) | about a year ago | (#44422187)

Medicare is generally not covering providers' costs.

Like the aforementioned gastroenterologist making $460k/yr?

The whole healthcare system is incredibly messed up. You get pockets of near-bankruptcy mixed with pockets of largesse.

Perhaps the solution is to just reduce reimbursements every year until the medical school acceptance rate is 90%?

Re:Technology costs? (1)

0100010001010011 (652467) | about a year ago | (#44422281)

- $460k/yr

How much of that goes to malpractice?
How much of that goes to med school loans, undergraduate loans, etc? CHEAP Med school in the US starts at $250k without interest.

Disclosure: Fiance is a doc.

Re:Technology costs? (1)

PopeRatzo (965947) | about a year ago | (#44422059)

I'm curious if the costs of the tools/technologies of these procedures have gone up, and how the doctors get paid for those (potentially) increased costs?

The same way you and I pay for the tools/technologies that we use. We write them off on our income taxes, amortize them over a period of time, etc.

I don't know if you're old enough to remember when doctors actually lived in the communities they service, solidly in the middle class. They might have lived in the nicest house in the neighborhood, but they lived in the neighborhood.

Only recently has medicine been seen as some sort of path to the top 1%.

You want to worry about someone who's income has shrunk? Look at the industrial worker who's making less than half of what they did 30 years ago (adjusted for inflation) and half of what they did in 1990 not adjusted for inflation. Maybe the worker who's handling your food and getting $7.50/hr. I'm not saying that a doctor should be paid the same as a person flipping burgers, or that they are equally important, mind, but the two have been in divergent directions for a long time now and it's starting to come apart at the seams.

And, if you look around your doctor's office, count the number of "technologies" that are so significantly different from what they were 20 years ago. The real significant increase has come at the hospital/diagnostic/lab location, where it is paid for the same way that all corporations pay for high-end equipment: by amortizing and tax write-offs. If you can justify the simplest blood tests approaching $1000, you'll have to be pretty creative. Or are you counting the doctor's new boat and mistress as part of the "new tools/technologies"?

Re:Technology costs? (2)

MightyYar (622222) | about a year ago | (#44422351)

Only recently has medicine been seen as some sort of path to the top 1%.

I don't know where you get your data. A typical new family medicine doc gets a decent low $100,000s salary [aol.com] and has enormous debts and malpractice insurance to pay off. A pediatrician gets even less. True, there are specialties where they make a lot of money, but this is not typical. A $2500/month payment on student loans puts a pretty big dent in your take-home, and you enter the work force in your 30s, so everyone else has an 8 or 10 year head start. The hours suck, and unless you are in something like radiology or psychiatry, you have to cover weekends and evenings somehow. You need to take continuing education credits and you need to pass re-certification exams on an ongoing basis. I would never become a doctor - I'd bet that, per hour, they make less than a school teacher.

Men are increasingly abandoning medicine for more lucrative financial jobs.

Full disclosure: my wife is one of those docs with a well-paying specialty.

Re:Technology costs? (0)

Anonymous Coward | about a year ago | (#44422147)

To the point ... healthcare in the US is a total fuckn rip-off, it's a big business profit center, not for helping people. Perhaps some doctors make less but the whole healthcare system needs to be rebuilt. Know of an elder person went in hospital with flu, for check-up to be safe, they admitted ran lot's of tests, nothing found. After five days sent person home. I seen the billl almost thirty grand... fuckn crooks. A mom could have done the same shit with a couple cans of chicken soup.

So What (0, Troll)

The Cat (19816) | about a year ago | (#44421739)

Impossible to fix it. Private business will loot the treasury until there's nothing left. Everyone's paid off. The fix is in.

Watch the Bumpus Hounds scene from A Christmas Story when they eat the turkey. That's America's future.

Americans are too fucking stupid to fix it.

Re: So What (1)

O('_')O_Bush (1162487) | about a year ago | (#44421819)

That is a pretty big claim coming from someone who didn't offer realistic or practical solutions given how politics of work in the U.S. and everywhere else. It is almost as if you wanted to America-bash without having much of an idea of what you are talking about.

If you are any smarter than the Americans, let's see an idea that could be written on a piece of paper and pass both houses within a few weeks. Because otherwise, there aren't many options other than violent overthrow, at which point it could be said that America is really no better primed for that than any other developed country.

Re: So What (0)

Anonymous Coward | about a year ago | (#44422083)

let's see an idea that could be written on a piece of paper and pass both houses within a few weeks

Pay raise for congress.

Oh you meant something that would pass both houses and make things better for the rest of us, didn't you?

Re:So What (1)

Major Ralph (2711189) | about a year ago | (#44421831)

Impossible to fix it.

Americans are too fucking stupid to fix it.

Pick one

Re:So What (1)

NicBenjamin (2124018) | about a year ago | (#44421907)

Strictly speaking he doesn't have to. If something is inherently unfixable EVERYONE is too fucking stupid to fix it. It's kinda dickish to put it that way, but hey. It's slashdot.

If dickishness were banned my posts wouldn;t get a +1 from karma bonus.

Re:So What (0)

gandhi_2 (1108023) | about a year ago | (#44421833)

Government business will send guys with guns to your house to loot your treasury until there's nothing left. The voters are paid off. The fix is in.

Watch a bunch of zombies eating the last survivor. That is socialism's future.

Liberals are too fucking stupid to avoid it.

Re:So What (0)

Anonymous Coward | about a year ago | (#44422199)

LOL. The 'conservatives' are the ones wanting to spend everything on guys with guns.

Who will come to your house to loot your treasury until there's nothing left.

Re:So What (1)

lightknight (213164) | about a year ago | (#44421889)

Nonsense. The public will loot the public treasury...after all, it is a form of the commons!

And in general, no one cares about the commons, until they are gone.

Punish efficiency (0)

Anonymous Coward | about a year ago | (#44421741)

So we no longer want to reward efficiency? Since these doctors spent the time and money to get equipment that's less invasive and works better/faster/cheaper, we should cut their pay.

Re:Punish efficiency (2)

SJHillman (1966756) | about a year ago | (#44422055)

I have two barbers I like. One is an old guy who has been doing it forever. He does a good job, but only uses scissors and a comb so it takes about 30 minutes for him to cut my hair. He charges $18. The other guy is in his early 20's and has a nice selection of electric razors. The end result is just as good (maybe better), and takes less than 15 minutes. He charges $11.

The first guy is struggling because he's not willing to get the training or the tools to be more efficient, so he can't see as many people and he's already at the upper limit of what the market will bear in this area. The second guy has taken right off because he can deliver a cheaper, faster haircut with no loss in quality. I'd be surprised if he hasn't already recouped his investment several times over. I'd also be surprised if this didn't scale to the medical industry with prices is the three, four and five figure ranges.

Re:Punish efficiency (0)

Anonymous Coward | about a year ago | (#44422409)

I have two barbers I like. ...... The end result is just as good (maybe better), and takes less than 15 minutes.

I'm nearly 60, have had shoulder length hair since college and snip off about an inch every ~6 weeks, takes less than 5 minutes. What is my lifetime barber shop savings? Make sure to include my time savings along with the direct cost savings.

Re:Punish efficiency (1)

NatasRevol (731260) | about a year ago | (#44422225)

So you're ok with your taxes going to pay for 26 hours of work in an 8 hour day?

Efficiency is doing things faster AND/OR cheaper.

9k for 5 minutes (1)

Anonymous Coward | about a year ago | (#44421745)

A torn meniscus repair takes 5 minutes and costs $9000. Wish I made that kind of money. OK. So the cost was broken down into 3 ~$2500 procedures and the balance was assorted stuff like anaesthesia and bandaids. But still, 5 minutes of time for $7500 in doctor pay of which the assisting nurse will $3.50.

Gak (1)

Impy the Impiuos Imp (442658) | about a year ago | (#44421753)

"Cut Medicare spending? Why do they want old people to die? Our seniors have earned this?"

Just wait for it.

It's only tens of billions of other peoples' dollars a year. Why bother checking up vs. what insurance companies pay, who have incentive to not be wasteful?

Re:Gak (0)

Anonymous Coward | about a year ago | (#44422097)

Why bother checking up vs. what insurance companies pay

Because it's generally a secret. Even the doctors have a hard time getting the insurance companies to tell them what they're going to pay for a procedure in advance (and you thought patients had a hard time figuring out what something is going to cost them).

Taking it up the colonoscopy (2)

Mike_Shane (10477) | about a year ago | (#44421765)

Sorry no information in this comment I'm just throwing out there that in my opinion since insurance companies are increasingly becoming the payors for services rather than individuals it seems stories like this are becoming more prevalent. I mean, and I stand to be corrected it seems that the medicare system now has a "watchdog/whistleblower" vis a vis the insurance companies. It appears to me insurance companies don't like to pay the costs it used to be OK for the average joe to mortgage their house/ruin their future for.

So what. Doctors SHOULD be paid more. (5, Interesting)

blahbooboo (839709) | about a year ago | (#44421767)

You know I am sick and tired of everyone blaming doctors for the cost of healthcare in the US. When in fact, doctors salaries are a miniscule portion of US healthcare, especially compared to drugs and device costs and hospital CEO pay! Doctors should be paid MORE. Yes I said it, more! What other profession do you study at least 12 years before you make a decent salary, take on at least $250k in school loans, and work 12 hour days for your entire career?

Yes doctors make good money but it's far less than other folks in the US make who are far less deserving. How about addressing the seriously disgusting salaries on wall street? Should a computer nerd working in Morgan's computer risk group really be making $500k which is FAR more than the majority of doctors? What about the asshole investment bankers making millions at Goldman figuring out new ways to screw every US citizen out of a couple of pennies. Meanwhile the doctor is someone who makes you feel better and often will save your life.

p.s. I am not a doctor. I just work with a lot of them and see how hard a life they have nowadays.

Re:So what. Doctors SHOULD be paid more. (3)

Draknor (745036) | about a year ago | (#44421883)

I work in the healthcare IT field (formerly at an IT vendor). The reality is -- health care organizations are becoming IT shops. And that's expensive. Big iron servers, expensive SAN storage, workstations in every clinic office / nursing unit, and certified trained staff to run it all... It adds up.

There's definitely some research that suggests it results in better care -- warnings for med interactions, doing the right procedure on the right patient, etc. But it's really being driven in the name of compliance (and CYA). Document & audit trail EVERYTHING, so you can justify the charges if Medicare comes knocking for an audit. Or in case there's a lawsuit. It's complicated, and expensive. And Medicare (and the insurance companies) just make it more complicated & expensive by increasing complexity of the billing rules.

Re:So what. Doctors SHOULD be paid more. (1)

thaylin (555395) | about a year ago | (#44422057)

Except that is itemized on lines other than the actual physicians time, which is the line item this is talking about.

Re:So what. Doctors SHOULD be paid more. (2)

SJHillman (1966756) | about a year ago | (#44422113)

I'm also in IT in a healthcare facility. Our department has exploded in the last five years and IT staff has gone from one person ten years ago to nine people now. Likewise, our server rooms were getting packed to capacity before we started migrating everything possible to VMs within the past year. It's amazing the record keeping we're required to keep (by the state) for auditing... backup jobs, server updates, software updates, etc. I spend an average of five to ten hours each week just documenting crap that we might need for an audit. Working on getting some of that automated, but that takes back seat to other projects we need to do to stay in compliance.

And this is the same state that owes us six figures in back pay for medicare.

Re:So what. Doctors SHOULD be paid more. (1)

stenvar (2789879) | about a year ago | (#44422153)

I work in the healthcare IT field (formerly at an IT vendor). The reality is -- health care organizations are becoming IT shops.

The reality is also that all that IT contributes little to day-to-day healthcare.

Re:So what. Doctors SHOULD be paid more. (1)

SJHillman (1966756) | about a year ago | (#44422267)

Then why do nurses and doctors bitch so much if the servers have so much as a hiccup? They spend more time on various software programs than they do with actual patients.

Re:So what. Doctors SHOULD be paid more. (0)

Anonymous Coward | about a year ago | (#44421895)

they should also address the disgustingly high malpractice insurance that they all have to pay out of pocket. As usual its always the leeching lawyers that makes the most money off of legitimate service providers.

Re:So what. Doctors SHOULD be paid more. (3, Insightful)

h4rr4r (612664) | about a year ago | (#44422009)

Bullshit. The simple fact is that tort reform does not lower costs, look at Texas to see this. What it does do is mean that you can be crippled by a doctor, forever unable to work and get less than he makes in a year out of it.

If you want to make that kind of money you have to be willing to take some risk. Tort reform is simply the doctors privatizing the profits and socializing the losses when they fuck up. This is because once those meager limited payouts runout we as a society have another person to pay for on disability.

Re:So what. Doctors SHOULD be paid more. (1)

thaylin (555395) | about a year ago | (#44421909)

So what you are saying is we should allow doctors pay to continue growing exponentially, on the governments dime? If it wasnt for medicare/medicaide and other insurances doctors would not make what they do now.

Re:So what. Doctors SHOULD be paid more. (0)

Anonymous Coward | about a year ago | (#44421933)

You think doctors collect most of the money medicare pays out? Cute.

ObamaCare fueled a huge wave of consolidation in the health care industry. All those small doctors offices and medical centers out there are now owned by big hospitals. You can bet your bottom dollar that how much medicare pays for ANYTHING has no connection to physician salaries. Executives and shareholders take the excess.

Re:So what. Doctors SHOULD be paid more. (1)

blahbooboo (839709) | about a year ago | (#44422177)

No, I do not. If you read my comment the first sentence addresses this...

Re:So what. Doctors SHOULD be paid more. (2)

ebno-10db (1459097) | about a year ago | (#44422391)

ObamaCare fueled a huge wave of consolidation in the health care industry.

ObamaCare aka the Great Bogeyman. It's barely started to take effect and yet you're saying it "fueled a huge wave of consolidation in the health care industry" (note past tense). Next it'll be blamed for natural disasters.

Re:So what. Doctors SHOULD be paid more. (1)

lightknight (213164) | about a year ago | (#44421943)

Hey, hey, you, get back in line. We need you to express jealousy of another's wages as some form of moral righteousness, not try to reason why one person might be paid more than another. ;-)

You're arguing about how people value each other's work, and that's an entirely subjective phenomenon. And let's be honest, programmers are getting paid poorly these days, with other fields (doctors, lawyers, engineers, etc.) coming under the knife. They want the doctors to be replaced with nurses to cut costs...and the lawyers? Maybe some clerks or paralegals will do them in. Oh, but engineers? Well, it's hard to replace an engineer...so they're just outright attacking their wages / salaries. I tell you, gaze upon what has happened to programmers, and you will see what is coming down the pike for the others...

Re:So what. Doctors SHOULD be paid more. (1)

thaylin (555395) | about a year ago | (#44422001)

This is not subjective, and we are not talking about how someone values someone elses work. We are talking about specifically manipulating the data to make more money. IF you went to a mechanic and he told you he was going to charge you $70 a hour for work and it would take 8 hours to do the work, but then gave you the car back in 1 hour would you still be willing to pay for the 8 hours?

Re:So what. Doctors SHOULD be paid more. (0)

Anonymous Coward | about a year ago | (#44422261)

...but that is what already happens. The standard time listed to complete the job assumes no power tools.

Re:So what. Doctors SHOULD be paid more. (1)

thaylin (555395) | about a year ago | (#44422309)

No, it assumes the tools, and use of the tools (even though in a doctors visit everything is itemized including the tool usage). I have worked for a garage, my mother still does. At $70 an hour the mechanic gets 20-35 (more or less) and the rest goes to the shop for the tools use, bay use and profit. If you are paying 8 hours work but getting 1 hour of actual work, you are being ripped off.

Re:So what. Doctors SHOULD be paid more. (3, Insightful)

NicBenjamin (2124018) | about a year ago | (#44422005)

Lawyers study as long as Doctors, get as many loans, and make less. Most Law School grads make under $50k. Vets are worse. It's harder to get into vet school then MedSchool, the coursework is harder (you have to know medical care for multiple organisms), the loans just as bad, and $50k is a really good salary for a Vet. Hell do you think ANY humanities PhD is ever gonna pay off his student loans?

I would have a lot more sympathy for American Doctors if their foreign counterparts didn't make do with a much less pay. Luxembourg is an incredibly expensive country to live in, yet their Doctors make 30% less then our doctors. Yeah we overpay our MBAs, and MPHs, but it's very hard for me to sympathize with a guy who does the exact same job as a Doctor from Winnipeg for $40,000 more and complains he isn't paid enough.

Re:So what. Doctors SHOULD be paid more. (2)

blahbooboo (839709) | about a year ago | (#44422129)

Lawyers study as long as Doctors, get as many loans, and make less. Most Law School grads make under $50k. Vets are worse. It's harder to get into vet school then MedSchool, the coursework is harder (you have to know medical care for multiple organisms), the loans just as bad, and $50k is a really good salary for a Vet. Hell do you think ANY humanities PhD is ever gonna pay off his student loans?

I would have a lot more sympathy for American Doctors if their foreign counterparts didn't make do with a much less pay. Luxembourg is an incredibly expensive country to live in, yet their Doctors make 30% less then our doctors. Yeah we overpay our MBAs, and MPHs, but it's very hard for me to sympathize with a guy who does the exact same job as a Doctor from Winnipeg for $40,000 more and complains he isn't paid enough.

I disagree as your facts appear to be incorrect.

1. Lawyers have 3 years of school and no residency. Doctors have 4 year schooling, 4 years of residency, and more residency if they specialize. Cardiologists often don't finish training until their mid-30s. I don't follow how you say they study "as long"? They aren't even close to similar.

2. You're not comparing properly. In Canada med schools are far less than the US ones. About 1/3 less according to the article. Thus, the society subsidizes some of the costs of their training. So they don't have large loans with interest to pay off which enables them to be paid less...
http://oncampus.macleans.ca/education/2011/06/01/should-med-school-be-free-in-canada/ [macleans.ca]

Re:So what. Doctors SHOULD be paid more. (1)

Anonymous Coward | about a year ago | (#44422007)

Nurses and primary care physicians should make more, specialists should make less. I've seen enough specialists work to know that they are not pulling 12 hour days. Although, I'm sure they did when they were training. Don't get me wrong, there should be a strong incentive. I expect them to make more than my engineering salary. But its out of balance, and we are the ones paying.

The Wall Street issue is a completely separate problem, and has nothing to do with this.

Re:So what. Doctors SHOULD be paid more. (1)

SJHillman (1966756) | about a year ago | (#44422195)

Specialist vs generalist is supply and demand. Specialists in any field cover a niche. If I have an issue with my Exchange server that no one on the IT team can figure out, I call in a specialist. He might charge twice what it would cost for the IT team to figure it out, but he can solve the problem much faster and give more confidence in his solution - which is exactly why he can charge more.

Re:So what. Doctors SHOULD be paid more. (0)

Anonymous Coward | about a year ago | (#44422103)

Agreed. There are certainly things to improve, but I wouldn't consider cutting doctors' pay until after we cut the wasteful flow of cash to pharmaceutical companies:
http://www.latimes.com/news/opinion/commentary/la-oe-kellermann-medicare-drug-costs-20130329,0,6694807.story

Re:So what. Doctors SHOULD be paid more. -- Wrong (0)

Anonymous Coward | about a year ago | (#44422135)

Hate to burst part of your bubble, but whining about doctor pay doesn't wash.

My modest proposal: Free medical school for all.

Every year, the med school cohort is about 20,000 per year (~80K in school at any given time https://www.aamc.org/data/facts/). The total bill for this (assuming your $250K/student/year) sums to $20 billion / year. In 2011, total healthcare spending was $2.7 trillion (http://go.cms.gov/13juHDi).

This means that paying for everyone's medical school would add 0.74% to the annual healthcare bill.

No more doctor shortages, as it would only be a pittance to increase the availability of doctors relative to total spending -- All the GPs you could ask for!

Unburdened by debt, these newly minted doctors (not "socialized", merely educated for free -- like soldiers or most children) could enter the health market unburdened by crushing debt. And without your rationalization of "poor doctors learn so hard and have debt", their actual work/pay schedules could be rejiggered re: social benefit and working hours.

And comparing them to Goldman assholes? Please! Doctors actually produce some social good. Goldman, notsomuch.

However, you are naturally correct that the real cost drivers are Big Pharma and fee-for-service hospitals. Broken patent law + "evergreening" drugs siphons gigantic sums from real healthcare delivery into what are essentially ill-gotten rents supported by regulatory capture.

Fixing the catastrophically broken system at large is not likely to happen, but ensuring that enough primary care physicians enter the market is within easy reach; there are certainly more than enough idealistic and talented people to fill all of the required slots. And even such a humble speciality makes good coin. And its attractiveness would certainly increase for those on the fence... with no student debt to look forward do.

Re:So what. Doctors SHOULD be paid more. -- Wrong (1)

blahbooboo (839709) | about a year ago | (#44422165)

Huh? Did you even read my comment?

Re:So what. Doctors SHOULD be paid more. (1)

stenvar (2789879) | about a year ago | (#44422139)

You know I am sick and tired of everyone blaming doctors for the cost of healthcare in the US. When in fact, doctors salaries are a miniscule portion of US healthcare, especially compared to drugs and device costs and hospital CEO pay! Doctors should be paid MORE

Everybody makes these arguments: "we should be paying more for drugs, they save so much money on doctors", "we should be paying more for CEOs, they can save so much money", etc. The problem is: nobody knows how much any of these "should" be paid, and if you leave this to committees and planners to decide, costs spiral out of control. The only way to have people paid what they "should" be paid is to have a fairly free and unregulated market.

Re:So what. Doctors SHOULD be paid more. (5, Interesting)

ebno-10db (1459097) | about a year ago | (#44422237)

Doctors should be paid MORE. Yes I said it, more!

Depends on the doctor. Primaries aren't getting rich, but some specialists are. That explains why we have too many specialists and not enough primaries. I don't buy that most specialties are all that much more difficult than being a primary. As per the article median gastroenterologist income is $481k. IIRC that's 2.5x what a primary makes. Moreover, income often has little to do with the difficulty of a specialty. Radiologists are amongst the highest paid, not because it's so difficult, but because you can flip through scans pretty quickly and charge for each one. The actual scans are done by techs.

The ratio of specialist to primary pay is largely controlled by the AMA's "advisory" committee, so they are very much a part of this. The AMA has long had a pro-specialist bias.

How about addressing the seriously disgusting salaries on wall street?

Does getting ripped off by one group mean we shouldn't also worry about getting ripped off by another group?

Should a computer nerd working in Morgan's computer risk group really be making $500k which is FAR more than the majority of doctors?

It's not the computer nerds making $500k/yr.

Re:So what. Doctors SHOULD be paid more. (2)

Rich0 (548339) | about a year ago | (#44422333)

You know I am sick and tired of everyone blaming doctors for the cost of healthcare in the US. When in fact, doctors salaries are a miniscule portion of US healthcare, especially compared to drugs and device costs and hospital CEO pay!

Well, looking at this graph [aetna.com] , which I'd say looks like most I've seen, for every dollar that gets spent on drugs, two dollars get spent on doctors. In most cases it is the drug that actually has the health benefit, and the doctor just figures out which one is the most appropriate one to prescribe. I'm not sure where this particular breakdown stuck devices - often they're treated as drugs (they're certainly regulated in a similar fashion).

Now, there are certainly plenty of ways to make drugs cheaper, but you can't really pick any part of the US healthcare system and say "hey, this one part is fine - just make everything else cheaper."

As far as schooling/etc goes - the cost of medical school certainly is higher, but that is simply because that is what the market will bear. No idiot is going to spend $250k to get a PhD in Biochemistry, because Biochemists get paid peanuts (despite the fact that they invent half of those drugs, devices, and procedures the doctors end up using).

The whole 12-hour-day thing is a culture thing - there is no need to have doctors working those kinds of hours. Just educate more of them, and have them work more reasonable shifts. If anything those hours probably chase off many who would otherwise want to work in the profession (something the AMA probably counts on). Medical school selects for workaholics and it shouldn't be surprising that workaholics like to work. It isn't some kind of virtue. There is certainly a need for continuity of care which isn't always conducive to a 9-5 M-F schedule, but if individual doctors took on fewer patients they could still give the ones they take better care while spending less time doing it.

Lots of people work hard. Few get paid the kinds of salaries doctors collect.

As far as investment bankers making $500k goes - that is nuts as well. However, you can't point to the 0.001% of workers who make such insane salaries as justification. How about looking at the average US salary of full-time PhD holders of $80k/yr [wikipedia.org] ?

Re:So what. Doctors SHOULD be paid more. (1)

c (8461) | about a year ago | (#44422379)

Doctors should be paid MORE. Yes I said it, more!

Whether they should make more or less isn't quite the issue at hand.

The real problem is that there's essentially no sane way to understand health care costs.

You say doctors work 12-hour days? Well, what if Medicare says some are billing for 26-hour days, and a hospital maybe says they're only spending 6 hours in surgery (that's a wild guess)? So, what's their hourly wage? How much of it goes to medicine, and how much of it is administrative busy-work? Can it be made more efficient? How?

If we haven't really got a clue how much doctors are being paid for the work they're actually doing (versus, say, the base costs needed to run their practices, hospitals, etc), then how in the hell can someone come up with a rational argument about whether or not they need to be paid more or less? And the same point applies to virtually every aspect of health care. Drugs, medical procedures, hospital costs versus billing, lab costs, technology costs, nursing staff, admin workers... you name it, and there's virtually no well-understood relationship between what it costs and how patients pay for it.

That's the real problem. Not how much doctors are paid, but the fact that health care is basically a big fucked up black box which nobody really understands how it works or how to make any part of it better.

Re:So what. Doctors SHOULD be paid more. (1)

fermion (181285) | about a year ago | (#44422417)

I know a lot of people who study 10-12 years and make, make 30-50K for years afterwords, and if they are luck they can get into 100-150K by the time they middle aged. I don't know that anyone deserves money more than anyone else, particularly doctors. After all most doctors haven't actually generated new knowledge or created an innovative solution. Yes, a few like Michael E Debakey are more than technicians, but if we are honest are just highly skilled technicians, not trained in high level skills o research, development, or engineering.

I would agree that we have a shortage in primary care physicians, so they should be paid more.

Yes, c-level executives are paid a lot, but I think they would argue, just like doctors, that the excessive pay is justified because they make sure that everyone else gets paid. The question is does the family of a person in the fast food industry deserve to poor just because they could not get accepted to medical school. Does a person who completes medical school automatically deserve to be in the top 1%?

From an objective economic perspective, most doctors make too much money because we have too many of them. As mentioned, GPs may make too little money because we have too few of them. It could also be that the system of medical school in the US has distorted the pay and expectations of the medical community. Since the 1960's, the restrictions based on race and gender have been removed, yet the number of slots in medical school and residency have not been significantly increased. White males are still overrepresented.

All kudos to the congressmen raising the issue (1)

Bruce66423 (1678196) | about a year ago | (#44421781)

But they may want to be cautious the next time they go to a doctor; they might be quite upset at the pay cut...

non-transparent (0)

Anonymous Coward | about a year ago | (#44421809)

"... prices that go through an industry trade association in a process that is not open to the public is pretty wild."
It's okay to question the practice of non-transparency if national security isn't involved. Invoke national security and all bets are off.

Auto Mechanics (0)

Anonymous Coward | about a year ago | (#44421843)

My car dealer does this also. My car may be physically in the shop for 4 hours, but somehow 6 hours of work is performed (by a single mechanic).

Re:Auto Mechanics (2)

SJHillman (1966756) | about a year ago | (#44422205)

My mechanic never charges me extra hours, but damned if I don't need to have my flasher fluid changed every time I go there...

No incentive for accuracy (2)

Gothmolly (148874) | about a year ago | (#44421903)

When the money comes from a Monoply box, there's no incentive for accuracy, only more money.

Maybe we could try capitalism & light regulati (2)

gestalt_n_pepper (991155) | about a year ago | (#44421927)

The light regulation being complete price and quality transparency, with the prices for all procedures and outcome statistics easily available online. Put the prices for the 100 most common procedures on posters in large type every 200 feet in every hospital. Put a booklet in every hospital and clinic room. Even insured people frequently have a high co-pay. Think prices wouldn't drop?

Other prices would come down quickly if congress were to deregulate. Allow insurance and prescription drug purchases across state and international lines and prices would drop in a hurry.

Moreover, the whole "prescription" idea is a bit of a racket. If I want to buy a stronger zinc oxide cream for foot problems, I have to see a doctor and get a prescription. For foot cream with 5% zinc oxide. I mean, WTF? It's time to release all but the most dangerous drugs into the wild.

My 2 bitcoins.

Re:Maybe we could try capitalism & light regul (2)

thaylin (555395) | about a year ago | (#44421977)

So in order to fix under regulation, we reduce regulation.. To me that does not sound like the fix.

Re:Maybe we could try capitalism & light regul (1)

stenvar (2789879) | about a year ago | (#44422169)

Health care has been heavily regulated for decades and costs have spiraled out of control. Obviously, regulation isn't working, and hence we should have less of it, not more. In different, the problem is overregulation.

Re:Maybe we could try capitalism & light regul (1)

thaylin (555395) | about a year ago | (#44422253)

Costs have spiraled out of control because of insurance and underregulation. Have you ever looked at a demand chart for medical usage with and without insurance? I have and it is not pretty.

Re:Maybe we could try capitalism & light regul (1)

Svartalf (2997) | about a year ago | (#44422263)

And you'd regulate the heck out of it. The more regulation you have the more costs you have. Pure and simple. Got to be a happy medium- and YOU aren't asking for that.

Re:Maybe we could try capitalism & light regul (0)

Anonymous Coward | about a year ago | (#44422181)

The light regulation being complete price and quality transparency, with the prices for all procedures and outcome statistics easily available online. Put the prices for the 100 most common procedures on posters in large type every 200 feet in every hospital. Put a booklet in every hospital and clinic room. Even insured people frequently have a high co-pay. Think prices wouldn't drop?

Other prices would come down quickly if congress were to deregulate. Allow insurance and prescription drug purchases across state and international lines and prices would drop in a hurry.

Moreover, the whole "prescription" idea is a bit of a racket. If I want to buy a stronger zinc oxide cream for foot problems, I have to see a doctor and get a prescription. For foot cream with 5% zinc oxide. I mean, WTF? It's time to release all but the most dangerous drugs into the wild.

My 2 bitcoins.

The problem with insurance is not that who you can buy from is regulated it's that for-profit insurance fundamentally adds systematic inefficiency and should never be used of something like basic healthcare.

Re:Maybe we could try capitalism & light regul (1)

Svartalf (2997) | about a year ago | (#44422277)

Try a little different line there and you'd have it.

Private insurance typically pays out 30% of what Medicare pays out.

Medicare pays out 25-30% maximum in most cases with a few exceptions like powered wheelchairs for the disabled. They don't do dental. They don't do vision.

Tell me again that it's JUST the for-profit industry...

Re:Maybe we could try capitalism & light regul (0)

Anonymous Coward | about a year ago | (#44422233)

My 2 bitcoins.

Uh, that's a hundred bucks, dude.

You must be a good tipper.

Balance (1)

Some Guy (21271) | about a year ago | (#44421937)

What about the opposite problem? Doctor performs a procedure in his office which includes the use of a $100 disposable device. Medicare pays him $35 for that procedure. Doctor either eats that difference, or chooses not to see Medicare patients.

This is a red herring. If they are looking to save money, look at the lawyers, insurance companies, and drug companies.

(I am not a doctor, nor do I play one on TV.)

Re:Balance (1)

h4rr4r (612664) | about a year ago | (#44422043)

Then Medicare should instead provide the device. Let them buy those in bulk and give them to the dr for this procedure.

Tort reform does not lower cost, it only shifts the risk to the patient. Since with it a doctor can cripple you and payout less than you make in a decade. So we can rule out the lawyers. The insurance companies sure make good money, but they take a percentage so if procedures were cheaper they would make less. Drug companies are a problem, but the solution there is to stop them from advertising and giving free stuff to doctors.

Step 1 should be to require doctors to publish their rates for procedures. Then let my insurance company reward me if I save them money by choosing good value doctors. Step 2 should be to forbid any form of advertising by drug companies. Buying a doctor lunch should be a felony for a drug company rep.

Re:Balance (0)

Anonymous Coward | about a year ago | (#44422159)

So you spend over a decade of your life and a huge sum of money in medical school to become a doctor and you would prescribe medicine to your patients based on who buys you lunch? I don't think so.

Re:Balance (1)

SJHillman (1966756) | about a year ago | (#44422231)

And you think doctors don't already prescribe medication based on which pharmaceutical company buys them lunch?

Re:Balance (1)

Svartalf (2997) | about a year ago | (#44422355)

Actually, Medicare's out of touch with reality.

It's bureaucrats determining what is medically necessary and when they do how much they're willing to pay for it so that they can cover their own *sses and make their budgets look "good" so they can get more from Congress.

Supplying the device? I don't think so. It'd probably injure you. Honest.

Re:Balance (1)

Svartalf (2997) | about a year ago | (#44422337)

It's not just insurance companies, lawyers, and big pharma to blame. You fingered a solid part of the cause and then you go and blame insurance companies (which are part of the problem, but not the root cause...they typically only pay 30% over what Medicare pays- and typically, they'd have paid only $25, not $35- that's more the private insurance payout in most cases...)- go for one of the root causes. Big pharma just simply comes out of your pockets in most cases and not out of the doctor's hide. Not so sure about the malpractice story. Some of this is legitimate. Much of it isn't. Thing is...could you tell? Could anyone else? In the end, what you're seeing is government regulation causing a LOT of these woes.

15 minutes triggers the BS detector (3, Informative)

chooks (71012) | about a year ago | (#44421983)

15 minutes for a colonscopy? Where do they get this number? Getting informed consent can take 15 minutes just by itself (and is something the doc has to do). 15 minutes sounds like the best-case scenario (e.g. a screening colonscopy on a healthy 50 year old with no findings) and a number to sensationalize the article. What is the distribution of times that the procedure takes? Maybe 75 minutes is actually a reasonable time to expect the procedure to take on average?

That the health care system in this country is screwed up is not at issue. The article wants to point out the ludicrousness of the reimbursement mechanisms in place. Putting in a context-free and unexplained statistic only weakens its argument.

You know the worst part? (1)

NicBenjamin (2124018) | about a year ago | (#44422037)

The way private sector insurance companies determine prices is even more fucked up, because they always end up paying more then Medicare.

Granted frequently that's because hospitals flat-out refuse any proposal to pay less then Medicare offers, but you'd think if the private sector was actually good at setting health prices they'd have found a way to do so that was better-sounding then "pay whatever the government will pay, plus 20%, because that asshole plays hardball."

Who pays for the Technology? (1)

DodgeRules (854165) | about a year ago | (#44422061)

While it is stated: "... technology has advanced and now the images are processed and displayed on a large screen in high-definition video.", the cost of the technology and the "overage" in cost per procedure goes hand in hand. It may now only take 15 minutes to preform what used to take 75 minutes, but if the doctors are only reimbursed for their time for the procedure, they would never be able to afford the technology which would put them back to 75 minute procedures.

This technology not only helps to produce more accurate test results, but allows more patients to be able to have these tests each day. That all comes at a cost. If a procedure is reimbursed $100 for a supposed 60 minute procedure using older technology, and that procedure now only takes 15 minutes using newer technology, More of the $100 has just been shifted from doctor salary to technology cost.

Instead of cutting the cost of the procedures, they need to find the doctors and facilities that are scamming the system, billing for procedures that aren't actually performed. (Like Columbia/HCA that Governor Rick Scott of Florida resigned from as Chief Executive in 1997 amid a controversy over the company's business and Medicare billing practices. He was not implicated, but the company ultimately admitted to fourteen felonies and agreed to pay the federal government over $600 million.)

Wait... (1)

argStyopa (232550) | about a year ago | (#44422079)

Let me see if I understand this: A centralized, bureaucratic, government-run program is sclerotically unresponsive to the market, cost-inefficient, and ultimately impairs the ability of
- individuals to get the care they need
- professionals to get compensated to the degree due based on current practices, technology, understanding, etc.
- competitive forces to keep prices down. ...seriously?

That's unpossible. I'd ask my friend Adam Smith to comment, but I think he's banned from Slashdot.

Hey, more rules and bureaucracy will fix that! (0)

Anonymous Coward | about a year ago | (#44422155)

Why, when a complex system with thousands of pages of rules gets gamed because there's billions of dollars at stake, I'm sure making it even more complex with even more rules is going to fix the problem.

Right?

The truth of the matter... (1)

Svartalf (2997) | about a year ago | (#44422239)

Is that Medicare pays approximately 25% of those so-called rack-rates. Private insurance typically pays 30% over the Medicare pay rates.

Overcharged? Perhaps. It's all this BS, though, that we're discussing right now (and Congress is mandating) that's causing it.

Want to actually make affordable healthcare? FIX THAT FIRST.
(Hint: It doesn't get fixed by bureaucracies like this and it doesn't get fixed by doing socialized medicine.)

Washington Post Accurate? (1)

dcw3 (649211) | about a year ago | (#44422279)

Having just had my first colonoscopy just last week, I can vouch that it took the doctor much longer than the Washington Post is claiming. I spoke with him before and after the procedure. Did it take 75 mins? Maybe slightly less if you consider that he wasn't with me the entire time, and I couldn't even confirm that it was him who did the procedure, since I was knocked out. How much time should the doctor spend talking to you, and reviewing the results, even if the specific procedure was 15 minutes?

Charge master BS needs to stop (1)

Joe_Dragon (2206452) | about a year ago | (#44422317)

Each hospital needs to have an price list that is easy to find and must show the all in price for doing X it's ok to show an rage but there will be limits on how big it can be.

Also any ER care must be an fixed price for all hospital in the same area

I'm not a gastroenterologist but I am (5, Informative)

mark_reh (2015546) | about a year ago | (#44422389)

a dentist, and even I can tell you there's more to the story here. That 75 minute colonoscopy is probably an average. No one can predict exactly how long any given procedure will take on any specific patient. If a patient has no polyps, the procedure goes faster. If they find polyps and remove them (that's how colonoscopies prevent cancer) it takes longer. Patient anatomical variations and other medical complications can affect the time required.

I run into the same thing with my patients. A simple 15 minute restoration on a cooperative adult patient can turn into an hour long ordeal on an uncooperative 5 year old, but insurance pays the same for either one.

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