(2) Each CPT is also assigned a value for work, practice, and malpractice. The biggest difference is that there are *2* values for the practice value, depending on whether the CPT procedure was performed in a doctor’s office or in a hospital. Physicians are paid less for performing a procedure in a hospital because they don’t have to cover the overhead of the hospital, whereas they have to cover the overhead of running their own office.

(3) To get the value payable to a physician for a particular CPT, you multiply the CPT-based Work value by the State-based (or more correctly, GPCI-based) Work value. To this, you add the product of the CPT-based Practice (either office or hospital, depending on where the procedure was performed) value and the GPCI-based Work value. Then, you add the product of the CPT-based Malpractice value and the GPCI-based Malpractice value.

(4) This you’re done? Not quite. There’s a multiplier that is set yearly by CMS. Changing this value changes physician reimbursement across the board. You take the final value you calculated in (3), above, and multiply it by the current multiplier. That gets you to what the physician gets paid for performing a procedure on you.

Now, back to your original question: why physicians are paid less in rural areas. In rural states, to generalize a bit, the Work, Practice, AND Malpractice figures are lower than in more urban areas, mostly having to do with the cost of labor, the cost of real estate, the cost of living, and the cost of malpractice insurance. Lower Work, Practice, and Malpractice figures lead to lower end results in the monstrous calculations I detailed above. Simple, no? Now you know why your doctor’s office has 5 office personnel per physician, when, back in the old days, the physician had a nurse who also handled the paperwork. You also know why fully 15% of all of the money spent on healthcare in the US goes towards the administration of healthcare, and not actually providing healthcare. It’s a damned shame.

This is what happens when Pelosi is to the right of her district, and Reid is to the left of his.

Given the demographics of her district, she must be a squarely liberal Congresswoman.

The truth is that Medicare does pay less in rural areas, but expenses are less too, and there is no place in the country where you couldn’t run a profitable hospital or clinic with Medicare+5% rates.

Could you elaborate as to why expenses are less in rural areas, and if you feel that doctor compensation should also be lower in those areas in light of the fact that there is such a physician drain in the rural areas?

Medicare part E is clever but doesn’t quite hit the high note that a progressive, nation-changing program might convey. ObamaCare alludes to the lofty potential of sweeping reform but it is not yet understood just what ObamaCare means. If there could be a more proactive name, something with cache’ that might propel promotion and acceptance in a sound bite.

Proactive Medicare? Pro-Medicare? How about something simple but provocative…

ProCare!

http://www.youtube.com/watch?v=MoHF_7lZx_8

Risks are assessed using formulas to determine which plans end up with lower risk populations, which end up with higher risk populations. Those that have lower risk pools pay into a fund that compensates plans with higher risk populations.

http://findarticles.com/p/articles/mi_m0795/is_n2_v16/ai_16863015/

In plain English: “govt negotiates prices for all private and public insurance, thereby lowering administrative costs and creating an equal playing field. It shares a lot with a single payer system, but allows for more private ownership”

Neither idea is predicated on the existence of the public option, neither precludes it; both would help to contain cost.

Stock should be taken now as to who has impeded progress and highest on the list is Obama. His lack of support for the PO while others did all the work warrants that he should be punished come the next election. It would be a travesty to reward this miscreant by allowing him to share in the hard work of others who had to overcome his efforts to derail the PO. A challenge from Sherrod Brown or some equally deserving candidate should get the support of those on the left.

Obama is a pretentious patronizing spewer of platitudes incapable of working hard at anything. He is basically an inept wingbag and we should not have to suffer this clown any further.

Does anyone know much about the nuts and bolts of the House/Senate conference that will produce the final bill? I’m curious as to how things actually work in conference.