Good news, bad news

How about starting with the good news? Family medicine is among the 10 best paid occupations in the country, at least according to Forbes. Note: That's not the 10 best paid medical specialties; it's the 10 best paid occupations of any sort. Even better, at $161,490 per year, the average family physician makes $1,050 more than the average CEO. Congratulations! (No way to tell whether the CEO salary figures count golden parachutes, though ... )

You already know the bad news, I'm sure: While family physicians make the top-10 list, they're number nine, behind general surgeons, anesthesiologists, orthodontists, obstetricians and gynecologists, oral and maxillofacial surgeons, general internists, prosthodontists, and a group called "other physicians and surgeons" – those outside the "main specialties."

Don't despair. That doesn't mean that family physicians are the worst-paid physicians in the country. Other major specialties didn't even make it into the top 10. General pediatricians made 13th place, for instance, behind general dentists and psychiatrists. And lawyers show up in 16th place. See? Even the bad news isn't that bad.

Posted at 10:51AM Aug 04, 2009 by Bob Edsall  |  Comments[0]

Reforming health care insurance isn't enough

Liberals and conservatives alike seem to agree on one thing when it comes to President-elect Obama's health care reform proposal: It would succeed at reducing the ranks of the uninsured – by 26.6 million, according to one estimate.

Expanding health insurance coverage is a good thing, but make no mistake: It won’t fix our health care system. As blogger KevinMD noted in an open letter to Obama (and McCain), “Implementing your plan without a solid primary care foundation will doom your proposal to failure.”

After all, what good is it to insure more people if a) you don't have enough primary care doctors to care for them and b) the primary care doctors you do have are underpaid and overburdened? A recent ACP white paper explains the seriousness of the problem, citing a predicted shortage of 35,000 to 44,000 primary care physicians by 2025 unless immediate steps are taken to make primary care more attractive to medical students and more sustainable for practicing physicians. The white paper goes on to summarize 20 years of research demonstrating that primary care produces better outcomes at lower costs. (The AAFP also has an online summary of the literature.) The inescapable conclusion is that primary care is the key to a functional health care system and strengthening it should be the starting place for meaningful health care reform.

So how do we create a strong primary care foundation? For starters, we need to “pay more for what we want more of, and less for what we want less of,” to quote Newt Gingrich. In other words, pay more for primary care, particularly prevention and care coordination. FPM recently published a simple proposal from one family physician for moving the physician payment system in this direction. And the AAFP and other primary care organizations are working to bring about a medical home care management fee, among other ideas.

Of course, despite the evidence cited above, policymakers may not recognize the value of primary care until they have to – when the Boomers swarm Medicare and we really feel the sting of the primary care crisis. As blogger Dr. Bobbs warns, "When the tipping point is reached and the health care system finally cries 'Uncle!' and agrees to start properly reimbursing primary care docs, there isn’t going to be some vast repository of FP and IM docs who have been sitting around waiting to be called up. It’ll take quite a number of years to 're-primary care doctorize' American medicine."

Posted at 10:19AM Nov 26, 2008 by Brandi White  |  Comments[1]

How to get a 5.1 percent "raise" from Medicare

The Centers for Medicare & Medicaid Services released its 2009 physician fee schedule last week, and there's actually some good news: You could get a 5.1 percent pay boost from Medicare next year. But here's the bad news: You'll have to jump through a few more hoops in order to get it.

The potential 5.1 percent increase has three components:

First, there's a 1.1 percent update to the physician fee schedule, which all physicians will receive. This update was required by the Medicare Improvements for Patients and Providers Act of 2008, which averted a 10.6 percent decrease in physician payments.

Next, there's an incentive payment of 2 percent of your total Medicare allowed charges during 2009 if you use a qualified electronic prescribing (e-prescribing) system to transmit your prescriptions to pharmacies. You will also need to report one of three G codes with your claims to indicate either that you used e-prescribing for all medications prescribed during the visit (code G8443), you did not prescribe any medications during the visit (code G8445), or you did not use e-prescribing because the law prohibits it for the specific type of drug prescribed (such as a controlled substance), the patient requested it or the e-prescribing system was temporarily down (code G8446). If this sounds like too much trouble, note that if you don't switch to e-prescribing, your allowed Medicare charges will be reduced by 1 percent starting in 2012 and by 2 percent starting in 2014, when the incentive payments go away. But don't let that taint your view of e-prescribing. As family physician Ken Adler recently wrote in an article for FPM, "E-prescribing has come of age and is truly a win for everyone – patients, payers, pharmacies and physicians" because of the patient safety and other benefits it offers.

Finally, there's a 2 percent incentive payment if you successfully report measures under the Physician Quality Reporting Initiative (PQRI), which was launched in 2007. For 2009, there are 52 new quality measures to choose from, bringing the total number of measures to 153, but you only have to report on three measures 80 percent of the time. For an overview of how the PQRI works, see Measuring for Medicare: The Physician Quality Reporting Initiative.

If you have any e-prescribing or PQRI tips that you'd like to share with your colleagues, please post your comments below.

Posted at 05:24PM Nov 06, 2008 by Brandi White  |  Comments[2]