quote:

ORIGINAL: defiantbadgirl

DesideriScuri, I'm still waiting for an answer to my question regarding the exodus. With all other developed countries already having single-payer, where will the doctors go?

quote:

ORIGINAL: tazzygirl
You look it up. Im not your research bitch.

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quote:

ORIGINAL: defiantbadgirl
DesideriScuri, I'm still waiting for an answer to my question regarding the exodus. With all other developed countries already having single-payer, where will the doctors go?

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quote:

ORIGINAL: DesideriScuri

quote:

ORIGINAL: tazzygirl
http://heartsurgery.cqc.org.uk/survival.aspx
Survival rates for heart surgery in the UK as opposed to the US.
Its interesting... the rates are listed at the bottom of each section.

The question isn't who survives the surgery, but how many don't make it to surgery? The stats were only showing survival of the surgeries. If one has to wait (and I don't know if any do or don't), how many don't make it?

Lucylastic posted that it's 86 days wait for a non-emergency bypass surgery. Makes me wonder how many people die before getting to the surgery?

quote:

ORIGINAL: DesideriScuri

quote:

ORIGINAL: defiantbadgirl
DesideriScuri, I'm still waiting for an answer to my question regarding the exodus. With all other developed countries already having single-payer, where will the doctors go?

Home. They'll just up and retire. The limit on the number of Dr's pumped out by the AMA (Federally imposed monopoly) is going to severely curtail the number of physicians available as current doctors retire, retire early, or opt out of seeing government patients. It's the younger Doc's who haven't paid their loans off and/or haven't made enough to retire on that will be screwed.

And, don't those who feel they are stuck the ones that make the absolute best and most pleasant employees?

quote:

ORIGINAL: tazzygirl

quote:

ORIGINAL: DesideriScuri

quote:

ORIGINAL: defiantbadgirl
DesideriScuri, I'm still waiting for an answer to my question regarding the exodus. With all other developed countries already having single-payer, where will the doctors go?

Home. They'll just up and retire. The limit on the number of Dr's pumped out by the AMA (Federally imposed monopoly) is going to severely curtail the number of physicians available as current doctors retire, retire early, or opt out of seeing government patients. It's the younger Doc's who haven't paid their loans off and/or haven't made enough to retire on that will be screwed.
And, don't those who feel they are stuck the ones that make the absolute best and most pleasant employees?

Screwed?
http://www.forbes.com/sites/brucejapsen/2012/07/10/primary-care-doctor-pay-jumps-past-200k-as-obamacare-market-push-new-pay-methods/

quote:

“There’s a feeling within the industry that there is a primary care shortage across the U.S. From a demand perspective, it has to be made more attractive for those physicians to enter the field.”

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quote:

Yep, right there we have it. PCP's are going to have their pay increased to lure more physicians out of specializing. Bet that makes care costs drop. Right?

And, another thing you didn't mention, form that article, was the increased usage of Nurse Practitioners. Add in PA's and you will have a lower cost employee that can handle much of the patient load. But, your MD's will end up being less care providers and more supervisors of a team of NP's and PA's. In the rehab world, PT's do the assessments and set up the rehab schedule while PTA's tend to do more of the actual day-in day-out putting the patients through their paces. But, not surprisingly enough, this has been happening already. This started well before PPACA. This shift may have started while Clinton was President. Odd how market solutions crop up without Government force.

quote:

ORIGINAL: tazzygirl

quote:

Yep, right there we have it. PCP's are going to have their pay increased to lure more physicians out of specializing. Bet that makes care costs drop. Right?
And, another thing you didn't mention, form that article, was the increased usage of Nurse Practitioners. Add in PA's and you will have a lower cost employee that can handle much of the patient load. But, your MD's will end up being less care providers and more supervisors of a team of NP's and PA's. In the rehab world, PT's do the assessments and set up the rehab schedule while PTA's tend to do more of the actual day-in day-out putting the patients through their paces. But, not surprisingly enough, this has been happening already. This started well before PPACA. This shift may have started while Clinton was President. Odd how market solutions crop up without Government force.

First... I didnt mention anything beyond giving the link.

quote:


Second.. there are not enough PCP's now as it is. And, yes, there will be a greater demand as preventative care exceeds curative.
Third... NP's have been around a long long time. They arent going anywhere. And, personally, I happen to enjoy them. You may want to compare their training against a PA's sometime.

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Fourth... the hospitals here all have PCP clinics... its a wonderful thing. I see a resident, who takes the info and presents it to the Attending... who I see every visit. It allows him to oversee many cases.

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Fifth,... billing bundling will help immensely.

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Sixth... you really should start doing research on what you are speaking about. My PT, the one I have seen for over a year, is someone I work with every time I go in. Not the PTA's, which they do have.

quote:


Its time healthcare got a major overhaul. 80 million more people will have to be seen.. and more insurance companies will start requiring annual physicals.... requiring more access to primary care.
I really dont see why you have a problem with more care at a better rate.

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quote:

You implied something simply by giving the link.

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Then, why isn't it being done already?

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Why do they have PTA's, if no one ever sees them? And, well, I know what I'm talking about. Sure, I probably should have stated that I was speaking in generalities, but that's the way it goes. PTA's can not do the assessments and are not allowed to make changes to the rehab schedule. They can make observations, suggestions, and report to the PT, but only the PT is legally allowed to make the changes.

quote:

I don't have a problem with more care at a better rate. None at all. I support the use of PA's and NP's to reduce the patient load on MD's. But, as I said previously, this was done prior to government coming in. This was a developing Market solution. PA's still have to work under supervision of a MD, and I believe NP's do, too. To lower the cost, you'll find more and more NP's and PA's doing the day to day stuff and MD's doing more supervision and stuff that NP's and PA's are not allowed to do.

quote:

I have a friend who gets poison ivy every year, and it's an allergy issue for him. He gets it. He makes an appt. He gets a steroidal cream Rx. He fills it. He uses it. He gets over the poison ivy. It's a yearly thing and the entire process hasn't changed. He's pissed because he has to see a MD to get the steroidal cream Rx, and can't see the less expensive NP they have at the practice. That only makes sense to me, but the powers that be apparently have other ideas, too.

quote:

ORIGINAL: tazzygirl

quote:

You implied something simply by giving the link.

Yes, I implied... "read it".

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NP's can write prescriptions.

quote:

Opposite Ends of the Spectrum
The terminology for physician involvement in NP prescriptive authority spans a continuum including on-site physician supervision, professional collaboration, collaboration with agreed upon protocols or delegation, or no involvement whatsoever.
Twelve states and the District of Columbia have the most independent prescribing procedure: no requirement for physician involvement (including controlled substances schedules II through V):


Alaska
Arizona
District of Columbia
Idaho
Iowa
Maine (after first 2 years of supervised practice)
Montana
New Hampshire
New Mexico
Washington
Wisconsin (if NP is certified as an "advanced practice nurse prescriber.")
Wyoming



While most states have collaborative terminology, 13 states still use the term "supervise." NPs in these states are allowed to prescribe from schedules II through V unless otherwise noted:


California
Florida (no controlled substances)
Georgia (schedules III through V)
Hawaii (controlled substance rules not yet drafted)
Massachusetts
Michigan
Nebraska
North Carolina
Oklahoma (schedules III through V)
South Carolina (schedules III through V)
Tennessee
Texas (schedules III through V)
Virginia

quote:

quote:

Why do they have PTA's, if no one ever sees them? And, well, I know what I'm talking about. Sure, I probably should have stated that I was speaking in generalities, but that's the way it goes. PTA's can not do the assessments and are not allowed to make changes to the rehab schedule. They can make observations, suggestions, and report to the PT, but only the PT is legally allowed to make the changes.

The same way they have nursing assistants and RN's. An RN will still see and assess the patient each shift. The PTA's are there for the body mechanics, to ensure the exercises are being done the proper way. You know... its that pesky team work thing.

quote:

quote:

I don't have a problem with more care at a better rate. None at all. I support the use of PA's and NP's to reduce the patient load on MD's. But, as I said previously, this was done prior to government coming in. This was a developing Market solution. PA's still have to work under supervision of a MD, and I believe NP's do, too. To lower the cost, you'll find more and more NP's and PA's doing the day to day stuff and MD's doing more supervision and stuff that NP's and PA's are not allowed to do.

Then why werent salaries going up for PCP's?

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quote:

For anything? Apparently, it depends on where the NP is.

quote:

Each state decides the laws for NP's, including what they can and cannot write prescriptions for. Your state must not allow them to write for steroidal cream. Maybe you and your friend need to take it up with the licensure board there.

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Um, they were. The big push for MD's was specialization. The article even mentioned that specialists make almost double what PCP's make. And, I found it humorous that they were touting PCP pay increases being better, as a %, than specialists, and, as it turns out, it was only a meager 1.1% better increase over 5 years.

quote:

ORIGINAL: tazzygirl

quote:

For anything? Apparently, it depends on where the NP is.

Where did I say for anything?

quote:

Each state decides the laws for NP's, including what they can and cannot write prescriptions for. Your state must not allow them to write for steroidal cream. Maybe you and your friend need to take it up with the licensure board there.

Jumped the gun there, Bubba.

quote:

quote:

Um, they were. The big push for MD's was specialization. The article even mentioned that specialists make almost double what PCP's make. And, I found it humorous that they were touting PCP pay increases being better, as a %, than specialists, and, as it turns out, it was only a meager 1.1% better increase over 5 years.

Starting in 2011, the Medicare program began making additional quarterly payments, for a total of $560 million in 2011, to physicians deemed to be in primary care. Overall, fees for new and established office visits and several other services went up 10% for doctors in internal medicine, family medicine, geriatrics and pediatrics. General surgeons practicing in health professional shortage areas also began receiving 10% bonuses under a similar incentive system. The payments, which were authorized by the health system reform law to bolster stressed primary care and general surgery fields, will continue through 2016 unless the statute is overturned or repealed.
http://www.ama-assn.org/amednews/2012/05/28/gvsa0528.htm
PCP and Specialists make their money on insurance reimbursements, not paychecks.

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quote:

The payments, which were authorized by the health system reform law to bolster stressed primary care and general surgery fields, will continue through 2016 unless the statute is overturned or repealed.

quote:

ORIGINAL: tazzygirl

quote:

The payments, which were authorized by the health system reform law to bolster stressed primary care and general surgery fields, will continue through 2016 unless the statute is overturned or repealed.

That isnt Clinton.

quote:

The "doc fix" is the shorthand used to describe the nearly annual bill Congress passes to override another law they passed, the Sustainable Growth Rate (SGR) formula, which was enacted in 1996 to try to keep Medicare costs under control. Almost every year since it has been overridden by Congress because it doesn't actually work. If it's not fixed this year, providers will be hit with a nearly 30 percent cut in their reimbursements.

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quote:

ORIGINAL: tazzygirl
Overturned or repealed should have clued you in on it being part of the ACA.

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quote:

ORIGINAL: mnottertail
The $700B reduction the bulk of which is by primarily reducing rates?   Where is that credible citation, cuz that would seem to be at issue.

quote:

Those Medicare savings -achieved through reduced provider reimbursements and curbed waste, fraud and abuse, not benefit cuts – appear in the House Republicans’ FY 2013 budget, which Ryan authored.

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