[mudil]

I am a doctor, an anesthesiologist. I don't like AMA. But to blame AMA is a complete nonsense. (AMA really is just an insurance and loan agency, just like AARP.)

The real problem is government regulation of our profession, of the whole clinical process, and of devices and medications.

Those of you who go up in arms when government sticks its nose in your internet business, should imagine how it is to deal with the government that is there all the time for us. For example, how about trying to bill Medicare for a surgery, when one phrase--one phrase-- is missing from the documentation, and I don't get a penny for a 4 hour surgery?

[Shinkei]

I don't believe you.

I am a physician too and you are repeating a lot of the falsehoods that are perpetuated among those that don't understand the billing process or aren't actually physicians.

AMA is an insurance and loan agency? I... I... don't know what to say to this. How about start by reading this (poorly written, but summary nonetheless):

http://en.wikipedia.org/wiki/American_Medical_Association

and one of their most influential functions:

http://en.wikipedia.org/wiki/Specialty_Society_Relative_Valu...

It's true that insurers set up arbitrary requirements (for sentinel effect, mostly) to try and refuse reimbursement, but often a simple change and resubmission will result in payment. These are issues that are dealt with in your contract with the insurer--have you read this contract? If not, then you can't complain! Even the CMS has a contract with its physicians.. and contrary to popular belief, they pay pretty well for most anything. It's Medicaid that is atrocious... especially since it covers children/poor and will often limit their access to healthcare.

[mudil]

Sure it's true. If I do two cases, and my billing times overlap even by one minute, I am not going to get paid for either one of them by Medicare. If I place an epidural in Medicaid pt, I get paid something like $36 for the placement, and I don't get a penny for watching this pt for next 18 hours.

The question is why medicine is becoming the most miserable profession (with polling data to back it up) while the gov't interference in it is at all time's high and going higher and higher all the time.

[FireBeyond]

"If I place an epidural in Medicaid pt, I get paid something like $36 for the placement, and I don't get a penny for watching this pt for next 18 hours."

Wuh? I'm not a physician. But I do work for an ambulance service. And my day job has involved working with insurance reimbursement algorithms for Hospital and Insurance Administrators.

But "$36 for epidural and not a penny for the next 18 hours?"

You might want to look into that. Medicaid allows a Maximum Fee of $1.16/minute for an anesthesiologist's time.

"Essentially, hospitals will be reimbursed at $669.90 for the epidural procedure performed in the hospital setting; whereas, in office setting, after removing the portion designated for the physician professional fee, office practice expense will be reimbursed at $30.28 to $34.36 a whopping 2,315% to 2,668% with SGR cut and 1931% to 2312% without SGR cut more in the hospital setting."

Yes, epidurals are cut - but under what circumstances are you monitoring a patient bedside for 18 hours in a non-hospital setting?

And for every one of these examples, there's a flip-side:

Wisdom teeth under general anesthesia.

"Hi, I'm Mr X and I'll be your anesthesiologist today. How you doing? Now, to confirm, no allergies, right? And it says you weigh 180lb? Great, see you in theater!"

Bill:

"Pre-operative anesthesiologist consultation: $662"

For about 90 seconds. Now, I know the principles of anesthesia, though I'd never claim my knowledge was within orders of magnitude of that of a specialist, but I routinely perform RSI for ET intubation, and I know all about "the charge isn't for the time, it's the knowledge", but nonetheless.

[thecage411]

I don't think your example is very strong. It's not exactly clear what you mean by government "sticks its nose in your internet business" but for most that probably means regulation. But in your example Medicare is just a really big insurance company; if a private sector insurance company denied your claim for some stupid reason would you complain about the private sector? I'm sure there are examples of onerous regulations that would make a better example?

[chimeracoder]

> But in your example Medicare is just a really big insurance company

I agree that there are better examples of government regulation directly impacting medical practice, but this example illustrates the power of a monopsony[0].

To overgeneralize, the same way that monopolists (single suppliers) can exercise power over purchasers in ways that we might deem unfair, monopsonists (single consumers) can exercise power over suppliers in ways that we may also deem unfair or harmful.

These effects are not limited to Medicare patients or providers, by the way. It's not hard to make the case that customers who can choose between Comcast and Verizon FiOS are harmed by the fact that cable companies are regional monopolies in most other markets.

Similarly, even if you have a private insurance plan, there are a number of ways that you are affected by Medicare's policies indirectly, in ways that you would not if they weren't such a big player.

[0] https://en.wikipedia.org/wiki/Monopsony

[mudil]

The Association of American Medical Colleges (www.aamc.org) sets number of medical students, and not AMA.

[riahi]

The number of medical students is wholly irrelevant to the conversation at hand. We currently have more residencies than medical students, so spots are filled by foreign medical grads.

However, in about 2-3 years, there will be more American medical students than there will be residency spots. Still have the same problem: the bottleneck in training is the residency.

So, blaming the AMA or AAMC for keeping medical student numbers down is pointless. They are not the final gatekeeper for the creation of doctors. Residency training is that gatekeeper.

[autokad]

last year there were more grads than residency spots.

[sizzle]

http://www.scpr.org/programs/airtalk/2014/04/15/6508/ can you comment on this radio segment please?

[GFK_of_xmaspast]

Bet you're pretty happy to have the government there with barriers to entry for your profession tho, keeping supply down.