Dear Congress: stop holding my patients hostage to you stupid pissing contests

This is it! I’m beyond fed up with you dickish behavior and your jerking me around. You want me to give up seeing Medicare patients then fine-you win. I quit. It’s not the pay cut per se as much as your constant political posturing. Do you think it’s funny to cut my pay and then rescind it 4 times in 6 months??? Would you like it if somebody did that to you? I understand that your vacations are oh so important. We wouldn’t want a little thing like doing your job to interrupt. You think that you can push and push and push and we’ll just roll over and take it because we took the Hippocratic oath. Well, I’ve tried and I’ve tried but I do’t think I can take it any more. Have fun telling the Medicare patients that there is nobody left in the county for them to see. If this thing isn’t fixed damn quick then I’m out.

Now for those who don’t have a clue what I’m ranting about-a little explanation. There’s this thing called the sustained growth rate (SGR) instituted in about 1997, that ties Medicare costs to GNP. However, Medicare costs have been rising faster than the GNP. Therefore, by some bizarre statute, there have to be cuts in physician reimbursement. Now Congress doesn’t want to cut physician payments since Medicare payments are already much lower than private insurance payments, but Congress also doesnt want to get off it’s collective ass and fix the problem. Therefore, for the past 13 years, Congress has kept postponing the cuts, while the amount needed to make up the deficit climbs and climbs. Each time Congress has put off the cuts for 6-18 months until this year. We’re at a 21.3% cut (soon to become 26%). (It might be germane to note that the average internal medicine practice overhead is close to 60% of gross, so that cutting gross revenues by 21% actually cuts profit-my salary- by more that 50%).

What has happened this year? Well let’s explain it this was. Let’s say you work for a big company and Congress is your boss. As of January 1, 2010, all employees are scheduled for a 21% pay cut unless they are deemed essential employees. Your boss ensures you that you are essential and will not undergo the cut. Here’s a timeline:

December 2009-Your boss tell you that you are essential and will not get a cut. He hasn’t had time to fill out the paperwork to make you an essential employee, but has talked to HR and they will continue your current pay until March 1.

March 1, 2010-The boss tell you that he hasn’t had time to address the problem but he will take care of it right away. Since he doesn’t want the company to do the extra paperwork of issuing a smaller paycheck and then correcting it, he has asked HR to hols the check for 10 business days until he can sort out the problem. He’s sure that this won’t inconventience you.

March 5, 2010-Your boss calls with good news. He hasn’t made you an essential employee but has gotten the big bosses to delay your cut until April 1. He issues your last check at the same rate, retroactive to March 1.

March 31, 2010-Your boss sends an e-mail. Sorry I couldn’t deal with your problem but I’m on Easter break until April 12. Got HR to hold your check another 10 business days, until April 14.

April 14, 2010-HR contacts you to ask if you have any updates from your boss, since your check, at the reduced rate, is due to be released tomorrow.

April 15, 2010-You call your boss who says that he hasn’t had time to get to it, but he has good news. He’s managed to get you an extension at the same salary until June 1. Meanwhile, he’s going to get right to work on putting you on that essential employee list.

May 28, 2010-You stop by your boss’ office for an update. He tells you that he’s been very busy and he’s leaving tonight for a Memorial Day vacation. He’ll be back on June 7. Meanwhile, HR has been instructed to hold your paycheck for 10 business days.

June 14, 2010-You call your boss to ask what is happening with your paycheck as HR can only hold it until June 15. He calls back to tell you that he has good news; HR has agreed to hold the paycheck until June 18.

June 18, 2010-Your boss tells you that he hasn’t had a chance to put you on the essential employees list, but has sent a memo to his boss asking if you can be kept on with a 2.2% raise for the next 6 months. He promises that if his boss approves this, he’ll try to get you on the essential employees list after his big project is done in November (coincidentally, it’s due on election day). Hr c ontacts you to tell you that they are sending out your check at the 21% pay cut and reminds you that all employees will be automatically cut another 5% at the end of the year unless they are exempted by their bosses.

June 21, 2010- Your boss tell you that he has talked to his boss, but his boss had wanted him to make a list of ALL essential employees, which your boss hasn’t done. He is refusing to delay your pay cut unless your boss comes up with the entire list.

June 23, 2010- Your boss tells you that he was sure that his boss would accept the 6 month delay. Frankly, he just doesn’t have the time or energy to deal with making this list, and he’s decided that he’s spent enough time on your situation and he has a lot of other important things to do. He assures you that he considers you an essential employee and that you should be exempt from the pay cut. He’s just going to wait for his boss to approve it.

So there we stand. The House passed a 18 month delay as part of a jobs bill in May. The Senate separated the physician compensation portion and passed a 6 month delay, since there weren’t enough votes to prevent a filibuster on the jobs portion. Pelosi has refused to have the House even consider the physician payment portion unless the rest of the jobs bill is considered with it, and Reid has decided to move on to other legislation. Meanwhile, our Medicare checks have been held 3 times in the past 3 months, and they are now being released at a 21% pay cut (effectively 50% of take home for me).

So, I’m sorry for the length of this rant, but I am fed up, pissed off, and generally all around mad about this. I don’t want to have to drop Medicare but I have no other choice. It’s not even so much the cut in reimbursement as the stress of dealing with this month by month. and by the interruption in my cash flow month after month. Strangely enough, my landlord doesn’t care about any of this; he just wants the Lease payment on time. My malpractice carrier doesn’t seem to care either. Not to mention my staff, who have this funny notion that I should continue their paychecks regardless of whether any money is coming in. Somebody should hold the Congress’ checks for 2 weeks and see how they pay their staffs.

P.S. Sorry for the errors-timed out before I could edit. Just pretend that I know grammar and spelling.

I know the feeling, coming from the other end, because I’m one of the long time unemployed whose benefits are going to be cut off unless the Senate passes the extension to the unemployment program. Unfortunately, it doesn’t seem like the Senate wants to do anything.

Aaaarrrrrrrgggghhh! The doctor is a psychobunny! :eek:

If they don’t do anything, then you can’t criticize them for something they did.

It isn’t the Senate that doesn’t want to do anything. It is 41% of the Senate that doesn’t want to do anything.

What are you complaining about? It works great in Canada.

Regards,
Shodan

I’m not quite sure I understand. Shouldn’t you be happy that they keep postponing the cuts?

Now that’s a good motherfucking rant.

You’re a retard.

The last postponement is expiring, so the official rates are going to drop dramatically.

Right, but up to now he’s been paid better than he otherwise would have. Right?

Trust me, I’m ecstatic that the keep postponing the cuts. The problem is that they are not fixing the underlying problem. Everybody agrees that the cuts are ridiculous. The House doesn’t want them. The Senate doesn’t want them. Everybody is in agreement that the current system where the cuts keep getting postponed over and over again but then the difference is made up by an increased cut the next time which will also get postponed is not working.

The problem is that instead of fixing the problem, which is the point of the delays, Congress just continues to postpone everything. This was not so bad when it was for 6 months at a time and they addressed the problem before time ran out. Now, however, they keep waiting until beyond the last minute, decide to hold the checks rather than pay them at the reduced rate, and finally after stalling and stalling and causing us to have to borrow money to meet expenses, they finally postpone for another month and then fail to meet that deadline.

Also, yes, I would have been paid less if the cuts had gone through every year since 1997. However, since the margin on Medicare is already razor thin, I would have stopped seeing Medicare patients long ago. Other insurances all pay better.

Ah yes, the old “my boys keep intentionally fucking up the system so that I can then gloat about how the system is broken!” drive by snark.

You have two problems:

  1. Those cuts were baked into the new health care plan to help it get a good CBO score. So if Congress rescinds them too soon after voting for the health care plan, it will look pretty transparent.

  2. There will not be a budget this year. Congress has decided it’s got more important things to do in a freaking recession than actually prepare a government budget so that people can plan, and they’re pushing it off until after the election, which means until the new year.

Real reason there won’t be a budget: The deficit numbers are going to skyrocket because reality never met with the Obama administration’s rosy growth projections (as all sane people knew they wouldn’t). It would be a bummer for the government to announce that the deficit will be 300 billion dollars higher right before an election. So, people who need to work under a real budget get screwed.

You think you’ve got it bad - NASA may have to close one of its research centers and lay everyone off, because it needs the promised funding increase to stay open, and the lack of a budget means it has to work with last year’s numbers.

Those who rely on government eventually discover that government is unreliable.

She sounds hawt!

-Joe

Actually it is the old “we can’t do anything because those fiendish Republicans have us out-numbered 41 to 59” excuse.

It’s pretty obvious that y’all can’t achieve anything of substance - can’t you at least come up with a better excuse?

Regards,
Shodan

Damn! He’s seen through our plan to distract the voters from our lack of substantial achievement by passing the most comprehensive health care reform legislation since the creation of Medicare.

The cuts are NOT in the new Health plan. In fact, a fix was put into the plan but was ditched because the Republicans objected.

Nah, I’ll just go with Shot From Guns.