Specialists are quietly under fire in the new proposed health care bill. In it, the most highly paid doctors are asked to take a 5% pay cut, which is even more formidable than it sounds since Medicare dollars are worth 83 cents on the private dollar. When these figures are collated, it amounts to a pay cut of roughly 20% for specialists under the new health care bill.

The devil is in the details. According to a recent article in the Wall Street Journal:

    “Beginning in 2015, Medicare would rank doctors against their peers based on how much they cost the program—and then automatically cut all payments by 5% to anyone who falls into the 90th percentile or above.”  The War on Specialists, WSJ October 6th, 2009

This formula automatically penalizes specialists, as it is they that will invariably fall into the 90th percentile of that formula. Specialists become specialists for a variety of reasons, not least of which is the potential for a higher income. If their wages are stripped towards parity with general practitioners, will specialists still want to be specialists?

The common theory running through the health care bill is that the high costs of specialists will be defrayed if patients have better and more frequent access to general practitioners. However, the above formula simply penalizes specialists for doing what they do disregarding any other measures that have been put in place.

In addition, the health care plan goes after diagnostic tests. Echocardiograms and catheterizations have been reduced by 42% and 24% respectively. These diagnostic tests are vital to understanding what is going on with patients and their discouragement through the health care bill is a misplaced effort to trim costs. Cancer doctors are hit especially hard through slices to the CT and MRI pie, both of which are vital tools in cancer diagnosis and treatment. Payments for antitumor radiation therapy will fall off by up to 44%.

While the cuts referenced don’t actually cut any spending, they definitely shift the money from one area to another. In its quest to make the specialist less of a driving force to the patient than the general practitioner, the health care bill is cutting too close to the bone where specialists and their diagnostic equipment are concerned.

Pfizer has been hit with a $2.3 Billion settlement for off-label marketing claims that promote uses of over a dozen of its products that are not FDA-approved for that particular use. The settlement’s sheer size is enough to scare away pharmaceutical companies from pursuing or continuing similar practices, which any physician can tell you have become all too common in the industry. Of particular concern were Pfizer’s marketing claims about Bextra, which was removed from the market in 2005 in response to concerns about its safety. A portion of the money goes to resolve whistle-blower lawsuits that triggered the findings that led to the settlement and a portion of it will go to state Medicaid programs.

The settlement is the largest that the Department of Justice has ever garnered in a healthcare case, and it is a clear signal that there will be more to follow if the healthcare industry doesn’t start policing itself more effectively. The negative news for the healthcare industry in the wake of this settlement is that even healthcare organizations that have a stellar reputation will have to now defend it in their marketing.
 
Assistant Attorney General Tony West and HHS Secretary Kathleen Sebelius have publicly stated that the settlement is punitive and it is meant to show that the government is dedicated to rooting out and punishing healthcare fraud. The question that we must ask ourselves as health care professionals in the wake of this lawsuit is how our marketing measures up. Are we or our organizations engaging in practices that could be construed as dishonest? There is no arguing that the optics of similar marketing techniques are now appearing badly. It may actually be wise to retool our marketing to the honest practices that our organizations engage in, such as honest fee estimates, giving back to the community, and our own codes of ethics.
 
Hiring an outside agency to reevaluate your marketing practices may be the best way to retool your brand and message. Internal interests could be blinding you to how your message appears to the outside, especially when your organization is so close to the subject matter. There are many agencies that specialize in healthcare marketing, and chances are good that your public relations department already knows their names. Whatever you do, keep the message honest and forthright.

Obama’s stimulus bill has earmarked $200 Million for various health care professionals that spend two years at National Health Service Corps sites to repay their student loans. 3300 awards are being made to people who are working in underserved areas or that are treating the underinsured. This action is proof that the government is willing to stimulate the health care profession in rural and areas that are less desirable for physicians to live in. In order to qualify for the loan repayments, primary-care physicians, dentists, and mental health professionals have to commit to a service of two years with the Corps.

The new funds are supposed to stimulate the number of doctors. Proponents of the plan are hoping to swell the numbers of the Corps by 100% with the loan repayment offer.

If you are a physician just getting out of college or residency, you may want to consider joining the National Health Service Corps or moving to a rural area. There are often bonuses similar to the one being offered under the stimulus plan for doing so. Simply contact a physician recruiting agency or local health care organizations for more information, and of course sign up with the National Health Service Corps if you are interested in the loan repayment offer.

There are other benefits to living in rural areas, including a low cost of living. This will make it easy for you to save money towards a family or whatever future plans you may have. Add to that the low stress environment usually offered in a rural health care setting, and you have an idyllic work setting for the new physician.