Medicare Compliance & Reimbursement

If you make a list of low-paying jobs in America, physicians won't figure in it -- at least not at present. But with the 21 percent Medicare rate cut in the offing, docs are already looking farther afield than the private practice option to make up the for missing revenue.

The Senate voted March 10 to delay the cut in Medicare physician reimbursement, pushing the implementation date to October 1. The House of Representatives had already endorsed a postponement, so the proposal goes back to the House to prepare a bill for President Obama's signature. But doctors aren't raising their hopes too high for a reprieve. The fix is only a temporary stay and no one quite knows how the cookie will crumble on Oct. 1, notes Barbara Kram in her post on www.DotMed.com.

In a post on www.CNNMoney.com, senior writer Parija Kavilanz says that after this cut is effective, income levels in the medical profession will no longer make it such a lucrative option. Kavilanz, in the post, quotes said Dr. William Schreiber, a primary care physician, saying in no uncertain terms "the cuts will hit me."

Schreiber sees 120 patients a week on an average, Kavilanz reports in the post. About 30 percent of these 120 are enrolled in Medicare, while 65 have private insurance plans that connect their payments on Medicare's rates. It's just 5 percent of Schreiber's patients who pay on their own. Simple calculations show Schreiber stands to lose $3 out of every $5 he currently earns.

"After the costs of my own benefits are deducted, that will leave me with the equivalent of a minimum wage job," Schreiber is quoted as saying.

And with eight of every 15 patients of Schreiber's schedule on Medicare, "I'm stuck," is all he can say. As of now, "I have to see them. I don't have a choice," Schreiber said in the post. "It's not a case of closing my doors to Medicare to get back at someone for cutting my salary. It's a case of economic survival."

To offset the cuts, more physicians could be looking at dropping private practices and working in prisons instead, writes Kavilanz in another post on www.CNNMoney.com.Working in jailhouses? It does make sense, says Kavilanz, because it will mean better pay, better hours,retirement benefits and free malpractice insurance.

As a case in point, in 2009, private contractor Prison Health Services (PHS) saw a whopping 77 percent raise over 2008 in the number of respondents applying for jobs opportunities.

In 2009, 22 out of 150 students at the at the University of Massachusetts Medical School chose the correctional health care clerkship as their first choice, notes Kavilanz in the post. This was around double the average of 11 every year.

According to Dr. Michelle Staples--"Horne, medical director for the Georgia Department of Juvenile Justice, "students are looking for an employer who offers flexible work hours and a steady paycheck. Correctional health care offers both." The long-term benefit, says Staples--"Horne, is that these students also benefit from pension plans. Further, Staples--"Horne told Kavilanz that working in  orrectional settings also makes sense because correctional physicians' starting salaries are around $140,000, roughly the same as the average school loan for graduating med students.

(Editor's note: Parija Kavilanz's posts on www.CNNMoney.com can be read at: www.money.cnn.com/2010/03/04/news/economy/medicare_doctor_costs/; www.money.cnn.com/2010/03/01/news/economy/medicare_cuts_rates_consumer_impact/index.htm?postversion=2010030211; and www.money.cnn.com/2009/12/23/news/economy/healthcare_doctors_in_prison/index.htm? postversion=2009122718. Barbara Kram's post on www.DotMed.com can be read at: www.dotmed.com/news/story/11948.)