Making money in medicine, especially as a surgeon is getting harder everyday. Not only is it a jungle out there, but you have to work your butt off to make it through the jungle. The rules keep changing and our government facilitates the restriction of doctors' rights.
The global fee is an awful creation by Medicare. Unfortunately, most insurance companies have picked it up and pay similarly. Most cases now are a 90 day global fee, where the postop visit and any complications or take-backs are covered under the global fee...in other words, if your hernia patient is a 68 year old, diabetic, obese smoker and you do the best operation you can and they end up pussing out their mesh and you have to take them back to the OR 3 times for various wash-outs and the ever popular wound-vac, you get the same payment as the 40 year old health person that had no problems. Guess what, I bet many physicians are going to start cherry picking patients as this goes on. Most of these patients are medicare (who have these complications) so it will probably result in physicians taking fewer Medicare patients, or just unsubscribing altogether.
Office overhead makes a huge difference in what you get paid. If your overhead is 70% vs 45% and your collections are $700,000 a year, that means the difference between a take home salary of $210,000 vs. $385,000. Not only is good management important, but you have to be sure your office staff is not stealing money. I personally know 3 physicians who have had over $500,000 each stolen from their practices by office managers. Most of the theft occurred over a period of years.
As far as socialized medicine goes, anybody who wants that should ask themselves whether they want FEMA in charge of our healthcare. Our Federal Government is a failure in progress. I thought all of those people carrying around the "Ron Paul for President" signs were part of some kind of cult. I finally checked out his website and was rather surprised. He actually has some good ideas, most of which involve limiting our Federal Government and letting free markets decide. Medicine could use some more free market ideas. I am not the only one who thinks that doctors border on being indentured servants or slaves.
There was just a case in Illinios where a number of primary care docs decided to drop Medicaid because it reimbursed so poorly. Unfortunately, their group did not have the proper corporate structure and the Federal Labor board determined that what they did constituted "Racketeering" and required them to keep taking medicaid patients, as they were the only primary group in a large radius. They tried to defend their position by saying this constituted slavery, but of course, it didn't work. You can read a great summary of the case and ruling at the HollandHart law firm weblog. Here is the link.
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