P******t
发帖数: 1717 | 1 老调重弹？狼真的来了？
http://money.cnn.com/
http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/ind
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.
Industry watchers say the trend is worrisome. Half of all doctors in the
nation operate a private practice. So if a cash crunch forces the death of
an independent practice, it robs a community of a vital health care resource.
"A lot of independent practices are starting to see serious financial issues
," said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises
independent doctor practices about their finances.
Doctors list shrinking insurance reimbursements, changing regulations,
rising business and drug costs among the factors preventing them from
keeping their practices afloat. But some experts counter that doctors' lack
of business acumen is also to blame.
Loans to make payroll: Dr. William Pentz, 47, a cardiologist with a
Philadelphia private practice, and his partners had to tap into their
personal assets to make payroll for employees last year. "And we still
barely made payroll last paycheck," he said. "Many of us are also skimping
on our own pay."
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.
12 entrepreneurs reinventing health care
"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.
Federal law requires that Medicare reimbursement rates be adjusted annually
based on a formula tied to the health of the economy. That law says rates
should be cut every year to keep Medicare financially sound.
Although Congress has blocked those cuts from happening 13 times over the
past decade, most recently on Dec. 23 with a two-month temporary "patch,"
this dilemma continues to haunt doctors every year.
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.
Changes in drug reimbursements have hurt him badly. Until the mid-2000's,
drugs sales were big profit generators for oncologists.
In oncology, doctors were allowed to profit from drug sales. So doctors
would buy expensive cancer drugs at bulk prices from drugmakers and then
sell them at much higher prices to their patients.
"I grew up in that system. I was spending $1.5 million a month on buying
treatment drugs," he said. In 2005, Medicare revised the reimbursement
guidelines for cancer drugs, which effectively made reimbursements for many
expensive cancer drugs fall to less than the actual cost of the drugs.
"Our reimbursements plummeted," Barth said.
Still, Barth continued to push ahead with innovative research, treating
patients with cutting-edge expensive therapies, accepting patients who were
underinsured only to realize later that insurers would not pay him back for
much of his care.
"I was $3.2 million in debt by mid 2010," said Barth. "It was a sickening
feeling. I could no longer care for patients with catastrophic illnesses
without scrutinizing every penny first."
He's since halved his debt and taken on a second job as a consultant to
hospitals. But he's still struggling and considering closing his practice in
the next six months.
"The economics of providing health care in this country need to change. It's
too expensive for doctors," he said. "I love medicine. I will find a way to
refinance my debt and not lose my home or my practice."
If he does declare bankruptcy, he loses all of it and has to find a way to
start over at 60. Until then, he's turning away new patients whose care he
can no longer subsidize.
"I recently got a call from a divorced woman with two kids who is unemployed
, house in foreclosure with advanced breast cancer," he said. "The moment
has come to this that you now say, 'sorry, we don't have the capacity to
care for you.' "
Small business 101: A private practice is like a small business. "The only
thing different is that a third party, and not the customer, is paying for
the service," said Lion.
"Many times I shake my head," he said. "Doctors are trained in medicine but
not how to run a business." His biggest challenge is getting doctors to
realize where and how their profits are leaking.
My biggest tax nightmare!
"On average, there's a 10% to 15% profit leak in a private practice," he
said. Much of that is tied to money owed to the practice by patients or
insurers. "This is also why they are seeing a cash crunch."
Dr. Mike Gorman, a family physician in Loganvale, Nev., recently took out an
SBA loan to keep his practice running and pay his five employees.
"It is embarrassing," he said. "Doctors don't want to talk about being in
debt." But he's planning a new strategy to deal with his rising business
expenses and falling reimbursements.
"I will see more patients, but I won't check all of their complaints at one
time," he explained. "If I do, insurance will bundle my reimbursement into
one payment." Patients will have to make repeat visits -- an arrangement
that he acknowledges is "inconvenient."
"This system pits doctor against patient," he said. "But it's the only way
to beat the system and get paid." | A*******s
发帖数: 9638 | 2 This trend forced me to join a hospital, sadly. But will come out whenever
is possible. | c**********m
发帖数: 2088 | 3 这就是没有pension的悲剧，
什么都是浮云，只有pension才是稳定的靠山。 | m*********c
发帖数: 253 | 4 LOL
【在 c**********m 的大作中提到】
: 这就是没有pension的悲剧，
: 什么都是浮云，只有pension才是稳定的靠山。
| C*****D
发帖数: 1299 | 5 a little bit over-exaggerated.
Though most physicians don't want to hear this, the current situation should
be partly blamed by physicians themselves.
Way too much unnecesary tests or procedures.
Like not long time ago, someone posted a pathology report, more than half
the immunostains should not be ordered at all.
range
resource.
【在 P******t 的大作中提到】
: 老调重弹？狼真的来了？
: http://money.cnn.com/
: http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/ind
: 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.
: Industry watchers say the trend is worrisome. Half of all doctors in the
: nation operate a private practice. So if a cash crunch forces the death of
: an independent practice, it robs a community of a vital health care resource.
| c**********m
发帖数: 2088 | 6 well, physicians have to pay back their loans.
remember the JHU who asks its student to deposit 300K on July 1?
after 10 years, 300K becomes 700k.
should
【在 C*****D 的大作中提到】
: a little bit over-exaggerated.
: Though most physicians don't want to hear this, the current situation should
: be partly blamed by physicians themselves.
: Way too much unnecesary tests or procedures.
: Like not long time ago, someone posted a pathology report, more than half
: the immunostains should not be ordered at all.
:
: range
: resource.
| C*****D
发帖数: 1299 | 7 medical tuition should be reduced. Resident salary should be increased (at
least to PA level).
【在 c**********m 的大作中提到】
: well, physicians have to pay back their loans.
: remember the JHU who asks its student to deposit 300K on July 1?
: after 10 years, 300K becomes 700k.
:
: should
| c**********m
发帖数: 2088 | 8 300k for many chinese are very high,
but for us, 300k is a piece of cake..
【在 C*****D 的大作中提到】
: medical tuition should be reduced. Resident salary should be increased (at
: least to PA level).
| C*****D
发帖数: 1299 | 9 教授，你是一个人用这ID吗？
有一阵，都觉得你开始提高素养了。
【在 c**********m 的大作中提到】
: 300k for many chinese are very high,
: but for us, 300k is a piece of cake..
| A*******s
发帖数: 9638 | 10 Defensive medicine.
Like kobejordan's case, ETOH toxicity caused some neurological deficits, we
have to run a stroke workup. Medicare will pay over $10,000 to the hospital.
How much should cost? A fee for EMT, a good nose from one EMT guy and a
drug screening. At most $1000.
should
【在 C*****D 的大作中提到】
: a little bit over-exaggerated.
: Though most physicians don't want to hear this, the current situation should
: be partly blamed by physicians themselves.
: Way too much unnecesary tests or procedures.
: Like not long time ago, someone posted a pathology report, more than half
: the immunostains should not be ordered at all.
:
: range
: resource.
| | | A*******s
发帖数: 9638 | 11 觉得教授离开了几个月后好像有点变化， 这个ID肯定是他MM的。
【在 C*****D 的大作中提到】
: 教授，你是一个人用这ID吗？
: 有一阵，都觉得你开始提高素养了。
| c**********m
发帖数: 2088 | 12 没什么变化，变老了点儿。。lol
【在 A*******s 的大作中提到】
: 觉得教授离开了几个月后好像有点变化， 这个ID肯定是他MM的。
| c**********m
发帖数: 2088 | 13 问Aplusplus个问题。
假设您当年选了数学系拿到博士进入花儿街当Quant Analyst, 年收入20-30万，工
作比较stressful。。。
跟您现在的生活，您会选择哪一条路？
假设您可以重新选择自己的道路。。
【在 A*******s 的大作中提到】
: 觉得教授离开了几个月后好像有点变化， 这个ID肯定是他MM的。
| a**e
发帖数: 5094 | 14 加州政府已经破产了，没有比您老的pension更浮云的了。这年头，除了埋自家后院的
金条，其他都不保险
【在 c**********m 的大作中提到】
: 这就是没有pension的悲剧，
: 什么都是浮云，只有pension才是稳定的靠山。
| a**e
发帖数: 5094 | 15 嗯，确实，教授现在看起来更像教授了
【在 A*******s 的大作中提到】
: 觉得教授离开了几个月后好像有点变化， 这个ID肯定是他MM的。
| c**********m
发帖数: 2088 | 16 政府再破产，也不会亏待它的员工的。体制内的人总是吃香的喝辣的，对外称财政困
难，对内照样依旧。。
的金条，其他都不保险
【在 a**e 的大作中提到】
: 加州政府已经破产了，没有比您老的pension更浮云的了。这年头，除了埋自家后院的
: 金条，其他都不保险
| A*******s
发帖数: 9638 | 17 人生的精彩之处就是不可逆转， one way ticket, man.
“早知今天，何必当初”恐怕是人类最悲情的感叹了。 ：）
【在 c**********m 的大作中提到】
: 问Aplusplus个问题。
: 假设您当年选了数学系拿到博士进入花儿街当Quant Analyst, 年收入20-30万，工
: 作比较stressful。。。
: 跟您现在的生活，您会选择哪一条路？
: 假设您可以重新选择自己的道路。。
| c**********m
发帖数: 2088 | 18 假设您可以重新选择自己的道路。。
您会选择哪条路呢？假设。。。
【在 A*******s 的大作中提到】
: 人生的精彩之处就是不可逆转， one way ticket, man.
: “早知今天，何必当初”恐怕是人类最悲情的感叹了。 ：）
| A*******s
发帖数: 9638 | 19 我不知道。 我父亲是名校数学系的， 比较起来， 我父亲觉得我比他成功；我觉得他
比我舒服。 仅此而已。
【在 c**********m 的大作中提到】
: 假设您可以重新选择自己的道路。。
: 您会选择哪条路呢？假设。。。
| c**********m
发帖数: 2088 | 20 哈哈，终于知道了你为什么对教授类的人员有偏见，小时候的经历啊！ lol
你爸要是在美国，he will be rich...
【在 A*******s 的大作中提到】
: 我不知道。 我父亲是名校数学系的， 比较起来， 我父亲觉得我比他成功；我觉得他
: 比我舒服。 仅此而已。
| | | A*******s
发帖数: 9638 | 21 扯， 我对中国大学教授从来就是五体投地， 不过对臭老九不屑一顾。 lol
【在 c**********m 的大作中提到】
: 哈哈，终于知道了你为什么对教授类的人员有偏见，小时候的经历啊！ lol
: 你爸要是在美国，he will be rich...
| c**********m
发帖数: 2088 | 22 对美国教授不屑一顾？lol
【在 A*******s 的大作中提到】
: 扯， 我对中国大学教授从来就是五体投地， 不过对臭老九不屑一顾。 lol
| a**e
发帖数: 5094 | 23 体制内，哈哈。教授您老比较适合回中国，以欺压老百姓为自豪
【在 c**********m 的大作中提到】
: 政府再破产，也不会亏待它的员工的。体制内的人总是吃香的喝辣的，对外称财政困
: 难，对内照样依旧。。
:
: 的金条，其他都不保险
|
|
