Doctors going broke

[BDKJMU]

This ain't good..

A few snippets from the article:
"NEW YORK (CNNMoney) -- Doctors in America are harboring an embarrassing secret: Many of them are going broke.
This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.......

.....Pentz said recent steep 35% to 40% cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue. "Our total revenue was down about 9% last year compared to 2010," he said.

"These cuts have destabilized private cardiology practices," he said. "A third of our patients are on Medicare. So these Medicare cuts are by far the biggest factor. Private insurers follow Medicare rates. So those reimbursements are going down as well."

Pentz is thinking about an out. "If this continues, I might seriously consider leaving medicine," he said. "I can't keep working this way."

Also on his mind, the impending 27.4% Medicare pay cut for doctors. "If that goes through, it will put us under," he said.......

......Beau Donegan, senior executive with a hospital cancer center in Newport Beach, Calif., is well aware of physicians' financial woes.
"Many are too proud to admit that they are on the verge of bankruptcy," she said. "These physicians see no way out of the downward spiral of reimbursement, escalating costs of treating patients and insurance companies deciding when and how much they will pay them."
Donegan knows an oncologist "with a stellar reputation in the community" who hasn't taken a salary from his private practice in over a year. He owes drug companies $1.6 million, which he wasn't reimbursed for.
Dr. Neil Barth is that oncologist. He has been in the top 10% of oncologists in his region, according to U.S. News Top Doctors' ranking. Still, he is contemplating personal bankruptcy.
That move could shutter his 31-year-old clinical practice and force 6,000 cancer patients to look for a new doctor......"
http://money.cnn.com/2012/01/05/smallbu ... &hpt=hp_c1" onclick="window.open(this.href);return false;

But wait, Obamacare is going to fix everything, right?

[death dealer]

We're fucked. Thank god dentistry is elective.

[JohnStOnge]

Just quite seeing Medicare patients. Of course if enough of them did that the response would be to have government force them to do it. And of course that's totally contrary to what this country is supposed to be about. No health care provider should EVER be forced to treat anyone. They should be free to decline to treat ANYONE for ANY reason. If someonbody shows up at th Emergency Room and the hospital has concerns about their ability to pay they should be able to turn them away. That's liberty.

And that also would eliminate the argument that we have to have universal health care because we have to pay for people anyway. No, we don't HAVE to pay for people anyway. We choose to. And we can choose not to We can say each person and/or family is responsible for paying for their OWN health care unless someone voluntarily chooses to be charitable to them or they have a voluntarily agreed upon contract with a health insurance organization to do it.

[BDKJMU]

Just quite seeing Medicare patients. Of course if enough of them did that the response would be to have government force them to do it. And of course that's totally contrary to what this country is supposed to be about. No health care provider should EVER be forced to treat anyone. They should be free to decline to treat ANYONE for ANY reason. If someonbody shows up at th Emergency Room and the hospital has concerns about their ability to pay they should be able to turn them away. That's liberty.

And that also would eliminate the argument that we have to have universal health care because we have to pay for people anyway. No, we don't HAVE to pay for people anyway. We choose to. And we can choose not to.

I agree. Problem is as I understand it is a lot of insurance companies set their rates to the medicare reinbursement rates.

Welcome to Obamacare.

[∞∞∞]

They should be free to decline to treat ANYONE for ANY reason. If somebody shows up at the Emergency Room and the hospital has concerns about their ability to pay they should be able to turn them away. That's liberty.

Maybe, but that delves into a deeper issue...breaking the Hippocratic Oath...something that's been passed on for centuries now and is ingrained into western medicine. You can talk about liberty and whatever, but (good) doctors take it pretty seriously and very much to heart. It's a sacred oath based on ethics...not freedom.

[JohnStOnge]

Maybe, but that delves into a deeper issue...breaking the Hippocratic Oath...something that's been passed on for centuries now and is ingrained into western medicine. You can talk about liberty and whatever, but (good) doctors take it pretty seriously and very much to heart. It's a sacred oath based on ethics...not freedom.

Regardless. Government should never force one person to provide a service to another. Unless of course you're talking about a person working directly for the government. A private health care provider should never be forced by government to provide care.

[dbackjon]

Just quite seeing Medicare patients. Of course if enough of them did that the response would be to have government force them to do it. And of course that's totally contrary to what this country is supposed to be about. No health care provider should EVER be forced to treat anyone. They should be free to decline to treat ANYONE for ANY reason. If someonbody shows up at th Emergency Room and the hospital has concerns about their ability to pay they should be able to turn them away. That's liberty.

And that also would eliminate the argument that we have to have universal health care because we have to pay for people anyway. No, we don't HAVE to pay for people anyway. We choose to. And we can choose not to.

I agree. Problem is as I understand it is a lot of insurance companies set their rates to the medicare reinbursement rates.

Welcome to Obamacare.

This has been going on long before Obama came into office - but don't let that stop your mindless anti-Obama rant you picked up from your latest talking points memo.

[kalm]

Just quite seeing Medicare patients. Of course if enough of them did that the response would be to have government force them to do it. And of course that's totally contrary to what this country is supposed to be about. No health care provider should EVER be forced to treat anyone. They should be free to decline to treat ANYONE for ANY reason. If someonbody shows up at th Emergency Room and the hospital has concerns about their ability to pay they should be able to turn them away. That's liberty.

And that also would eliminate the argument that we have to have universal health care because we have to pay for people anyway. No, we don't HAVE to pay for people anyway. We choose to. And we can choose not to We can say each person and/or family is responsible for paying for their OWN health care unless someone voluntarily chooses to be charitable to them or they have a voluntarily agreed upon contract with a health insurance organization to do it.

A necessitous man is not a free man.

[CitadelGrad]

[quote="kalm"e]
A necessitous man is not a free man. [/quote]

A man who is forced to support a necessitous man is not a free man.

[CitadelGrad]

A man who is forced to support a necessitous man is not a free man.

[CitadelGrad]

A man who is forced to support a necessitous man is not a free man.

[kalm]

A man who is forced to support a necessitous man is not a free man.

Touché

[polsongrizz]

The problem here is more about insane college costs first.

[Ibanez]

I think we all know that the underlying problem is homosexuals.


Sent from my iPhone.

[travelinman67]

......Beau Donegan, senior executive with a hospital cancer center in Newport Beach, Calif., is well aware of physicians' financial woes....

No sympathy from me. The health care industry bleeds cash. Everything is tailored to benefit the physician's net worth FIRST!

Why in the hell would any service provider build a facility in Newport Beach, CA...one of the most expensive areas in CA?

They hope to target wealthy clientele who live nearby.

That wealth generation is drying up along with the rest of America's wealth...but that health care facility's expenditures/capital outlay continue to rise.

As I traveled around the country, I regularly witnessed large-scale new health care facility construction taking place in the most expensive (real estate) sections of town. It's a simple investment decision when there's a bull market...

...but...

...and here's the issue...

...the physicians who are making the management decisions are viewing their assets with the intent of maximizing holdings as "investments", not maximizing their business efficiency.

No wise business chooses the most expensive real estate to build their facility. (Most) Businesses look principally at logistical location (1st), value ($/taxes/regulatory), then all other factors (workforce, ease of implementing change, etc...).

This is a basic dilemna: Balance Sheet - v - P&L. The health care industry has become obsessively focused on the balance sheet, and resultingly long ago lost efficiency, then value, and ultimately profitability.

This discussion could last for years, but focusing on government funded programs like medicare as the cause of the industry's financial troubles is delusional.

[D1B]

......Beau Donegan, senior executive with a hospital cancer center in Newport Beach, Calif., is well aware of physicians' financial woes....

No sympathy from me. The health care industry bleeds cash. Everything is tailored to benefit the physician's net worth FIRST!

Why in the hell would any service provider build a facility in Newport Beach, CA...one of the most expensive areas in CA?

They hope to target wealthy clientele who live nearby.

That wealth generation is drying up along with the rest of America's wealth...but that health care facility's expenditures/capital outlay continue to rise.

As I traveled around the country, I regularly witnessed large-scale new health care facility construction taking place in the most expensive (real estate) sections of town. It's a simple investment decision when there's a bull market...

...but...

...and here's the issue...

...the physicians who are making the management decisions are viewing their assets with the intent of maximizing holdings as "investments", not maximizing their business efficiency.

No wise business chooses the most expensive real estate to build their facility. (Most) Businesses look principally at logistical location (1st), value ($/taxes/regulatory), then all other factors (workforce, ease of implementing change, etc...).

This is a basic dilemna: Balance Sheet - v - P&L. The health care industry has become obsessively focused on the balance sheet, and resultingly long ago lost efficiency, then value, and ultimately profitability.

This discussion could last for years, but focusing on government funded programs like medicare as the cause of the industry's financial troubles is delusional.

Oh, Bullshit!


Wait, this make sense. Carry on....

[JohnStOnge]

A necessitous man is not a free man.

I had to look up "necessitoud" but now that I have i disagree. I got definitions like "lacking in possessions" and "poor." I think it's certainly possible to be poor and free.

Before I was married my philosophy was that you don't own your possessions. Instead, your possessions own you. I never had much and it was intentional. I never wanted more than I could fit into one of those small U haul trailers that you could pull behind a car. And the care was always an old one that I bought with cash. I did not want to feel pressure to make much money in order to sustain my lifestyle. And I was "free-er" then than I am now that I make a six figure income, own a house and a couple of vehicles, etc.

Not saying that I'm not happy now. There are plusses and minuses. But I was definitely "free-er" then. My lifestyle was one that could be sustained on very little and nobody else depended on me.

[BDKJMU]

......Beau Donegan, senior executive with a hospital cancer center in Newport Beach, Calif., is well aware of physicians' financial woes....

No sympathy from me. The health care industry bleeds cash. Everything is tailored to benefit the physician's net worth FIRST!

Why in the hell would any service provider build a facility in Newport Beach, CA...one of the most expensive areas in CA?

They hope to target wealthy clientele who live nearby.

That wealth generation is drying up along with the rest of America's wealth...but that health care facility's expenditures/capital outlay continue to rise.

As I traveled around the country, I regularly witnessed large-scale new health care facility construction taking place in the most expensive (real estate) sections of town. It's a simple investment decision when there's a bull market...

...but...

...and here's the issue...

...the physicians who are making the management decisions are viewing their assets with the intent of maximizing holdings as "investments", not maximizing their business efficiency.

No wise business chooses the most expensive real estate to build their facility. (Most) Businesses look principally at logistical location (1st), value ($/taxes/regulatory), then all other factors (workforce, ease of implementing change, etc...).

This is a basic dilemna: Balance Sheet - v - P&L. The health care industry has become obsessively focused on the balance sheet, and resultingly long ago lost efficiency, then value, and ultimately profitability.

This discussion could last for years, but focusing on government funded programs like medicare as the cause of the industry's financial troubles is delusional.

Of course it is, and I don't blame them. If you went through 12-13 years of training (4 yr college, 4 years med school, 4-5 yrs internship/residency working super long hrs for low pay, then were 30+ with 200-300k in student loans to pay off, you would be thinking about maximizing your wealth too. Then if your loans paid were off by your late 30's-40s, you want to be making up for the last 15-20 years.

[kalm]

A necessitous man is not a free man.

I had to look up "necessitoud" but now that I have i disagree. I got definitions like "lacking in possessions" and "poor." I think it's certainly possible to be poor and free.

Before I was married my philosophy was that you don't own your possessions. Instead, your possessions own you. I never had much and it was intentional. I never wanted more than I could fit into one of those small U haul trailers that you could pull behind a car. And the care was always an old one that I bought with cash. I did not want to feel pressure to make much money in order to sustain my lifestyle. And I was "free-er" then than I am now that I make a six figure income, own a house and a couple of vehicles, etc.

Not saying that I'm not happy now. There are plusses and minuses. But I was definitely "free-er" then. My lifestyle was one that could be sustained on very little and nobody else depended on me.

Oh boy I get what you're saying here completely.

It was a rather snarky FDR quote on my part, but his point was that if wealth and power become too consolidated then everyone's freedom can be diminished at the hands of the producer class.

[SeattleGriz]

The problem here is more about insane college costs first.

Coupled with the fact many Doctors don't know how to run a business.

[travelinman67]

No sympathy from me. The health care industry bleeds cash. Everything is tailored to benefit the physician's net worth FIRST!

Why in the hell would any service provider build a facility in Newport Beach, CA...one of the most expensive areas in CA?

They hope to target wealthy clientele who live nearby.

That wealth generation is drying up along with the rest of America's wealth...but that health care facility's expenditures/capital outlay continue to rise.

As I traveled around the country, I regularly witnessed large-scale new health care facility construction taking place in the most expensive (real estate) sections of town. It's a simple investment decision when there's a bull market...

...but...

...and here's the issue...

...the physicians who are making the management decisions are viewing their assets with the intent of maximizing holdings as "investments", not maximizing their business efficiency.

No wise business chooses the most expensive real estate to build their facility. (Most) Businesses look principally at logistical location (1st), value ($/taxes/regulatory), then all other factors (workforce, ease of implementing change, etc...).

This is a basic dilemna: Balance Sheet - v - P&L. The health care industry has become obsessively focused on the balance sheet, and resultingly long ago lost efficiency, then value, and ultimately profitability.

This discussion could last for years, but focusing on government funded programs like medicare as the cause of the industry's financial troubles is delusional.

Of course it is, and I don't blame them. If you went through 12-13 years of training (4 yr college, 4 years med school, 4-5 yrs internship/residency working super long hrs for low pay, then were 30+ with 200-300k in student loans to pay off, you would be thinking about maximizing your wealth too. Then if your loans paid were off by your late 30's-40s, you want to be making up for the last 15-20 years.

I'm not disputing the physicians' desire to amass wealth. I'm pointing out that the way to amass wealth is through proper management ("production"/marketing) of their skill/knowledge. Building a facility out of gold on the most expensive land in the region adds nothing to the P&L. They'd be better served building a facility designed to maximize service (efficiency) and minimize capital outlay.
Our nation is at this crossroads with healthcare principally because the industry has focused more on the Balance Sheet and managing unbeforeseen (uncollectable/unsupportable) receivables, resulting in a consumer backlash. Govt. funded healthcare costs are a small component of the motivation to reform the industry: The govt.(leadership) truly isn't committed to reforming the industry, for many reasons, primarily because it isn't THEIR money being spent.

[bluehenbillk]

I've worked in this industry for almost a year now & have some sense of what is going on.

Over the past 10-20 years there was an explosion of surgery centers and doctor-run practices built by individuals or more commonly groups of doctors as a way for them to make more $$ than they made working at a hospital.

The more recent trend now is that either doctors or folding these practices back into hospitals or hospitals are buying these practices.

There is a lot correct though with the fact that we will be looking at a shortage of doctor's say by 2020. Not to compare it to religion but you can see parallels between doctors & the Church. Lots of older doctors and not nearly enough younger ones coming out to replace them...

[kalm]

Of course it is, and I don't blame them. If you went through 12-13 years of training (4 yr college, 4 years med school, 4-5 yrs internship/residency working super long hrs for low pay, then were 30+ with 200-300k in student loans to pay off, you would be thinking about maximizing your wealth too. Then if your loans paid were off by your late 30's-40s, you want to be making up for the last 15-20 years.

I'm not disputing the physicians' desire to amass wealth. I'm pointing out that the way to amass wealth is through proper management ("production"/marketing) of their skill/knowledge. Building a facility out of gold on the most expensive land in the region adds nothing to the P&L. They'd be better served building a facility designed to maximize service (efficiency) and minimize capital outlay.
Our nation is at this crossroads with healthcare principally because the industry has focused more on the Balance Sheet and managing unbeforeseen (uncollectable/unsupportable) receivables, resulting in a consumer backlash. Govt. funded healthcare costs are a small component of the motivation to reform the industry: The govt.(leadership) truly isn't committed to reforming the industry, for many reasons, primarily because it isn't THEIR money being spent.

Nice work on this thread T.

The problem is that everything about the industry from education costs, to infrastructure, to pills, to insurance is inflated.

[death dealer]

Nice work on this thread T.

The problem is that everything about the industry from education costs, to infrastructure, to pills, to insurance is inflated.

Not salaries.

[travelinman67]

I've worked in this industry for almost a year now & have some sense of what is going on.

Over the past 10-20 years there was an explosion of surgery centers and doctor-run practices built by individuals or more commonly groups of doctors as a way for them to make more $$ than they made working at a hospital.

The more recent trend now is that either doctors or folding these practices back into hospitals or hospitals are buying these practices.

There is a lot correct though with the fact that we will be looking at a shortage of doctor's say by 2020. Not to compare it to religion but you can see parallels between doctors & the Church. Lots of older doctors and not nearly enough younger ones coming out to replace them...

Again, chasing short-term profits.

Every generation of my family has had one member become a physician going back to the mid-1800's. I could write (rant) about med school matriculation for hours...but my summarized opinion is that it's more about fulfilling agendas and/or nepotism (think country club admission), than candidate merit. The "winners" spend another 5-6 years of round the clock studies, add a few hundred thousand dollars of debt, capped off with the arduous (sadistic) internship/residency requirements imposed upon new physicians, and the "shortage" explanation becomes apparent. Like the Presidency...the few people who choose to tolerate the selection process "hell" and subsequent abuse, are people who (generally) are obsessed with obtaining power (or wealth) at all costs: Not people whose character is best suited for the high-responsibility/performance/ethics of the position.