Pravda - Please first understand that everything that I have posted from a medical standpoint is not "woe is me", but instead, look out "all of us" as I am...and will be a patient in the future medical system. Most of my postings have been out of concern for all patients in the future as it relates to ACCESS to QUALITY PHYSICIANS.

Practicing medicine is very gratifying....most of the time, but has gotten FAR more complex from an administrative and paperwork standpoint. In orthopaedics, the greatest compliment that we can get is "Hey doc, I hope I don't have to see you again.....OH didn't mean it that way....you know what I mean." Given the current recession, the work is somewhat recession proof - not entirely - but much more than other professions. Fifteen to 20 years ago a physician could dictate a pretty cryptic office note, but enough to remind himself what the status is and what to expect at the next visit (3-4 line dictations). Today, with Medicare coding and documentation requirements, this type of dictation is considered "FRAUD". The patients are being seen and treated, but because the note did not have all of the "bullet points" required, it is assumed that the "work was not done". Medicare has an entire division that travels the country looking for this type of "FRAUD". Give me a break!! This documentation nightmare (the need to write and proof a mini term paper for each office visit) is the reason that I started a medical (EMR) software company.

With regard to Medicare payments, my grey-haired senior partners made considerably more money 20 years ago when Medicare was in the early stages. This is the generation with second homes. I am 45 and most of the people my age or younger don't come close to considering owing a second home...or paying cash for much of anything. More likely, my generation has a MAXED OUT HELOC on their first home. Because our income is predictable and "recession proof", banks have always loved doing business with physicians, especially the younger ones because we like to think that we can live like our grey-haired senior partners.

Anyway, as I said, the paperwork requirements for the practice of medicine have significantly changed and Medicare reimbursement has been slowly decreased year-over-year for more than 10 years running. The Medicare charges that you see have not been inflated over time, because this would do no good; (We know what Medicare will pay). Also, the charges have not been decreased.....I guess because the assumption may be that Medicare would say "Oh look, the MD has lowered his fee so let's lower our reimbursement as well" Medicare payments TODAY are at a level for most services that are break even at best. Private pay insurance has a better margin and is the mechanism by which we keep our doors open and continue to provide the PUBLIC SERVICE of treating Medicare patients. You may have seen situations where groups limit the number of Medicare appointment slots and/or don't see Medicare at all. We are at a tipping point with this, and if rates fall further, groups will have no choice but to OPT OUT.

Sorry to editorialize. To answer your last 2 questions - NO Medicare is not going broke because of the fee level that they are paying physicians. Scope....Yes. Administrative costs....H3LL yes. Answer...who knows....just squeeze a different turnip. Between falling Medicare rates and raising malpractice insurance premiums, not much left in this one. On the malpractice front, I have had two frivilous suits in 14 years. In both cases I treated the patient as I would hope someone would treat my mother. Neither had merit and were dropped. With that history, I still paid 105K in insurance last year, and I hear that tort reform "isn't really needed" in this healthcare reform. $#%&#!!. It should be the foundation! Defensive medicine (ordering tests that your educated gut feeling tells you really isn't needed) costs BILLIONS annually. BUT, if we don't order the test, you know who will ask..."Well Doctor....didn't you think about.......".

FWIW.

jc