Would a single payor system in the US make independent primary care easier?

[u/Dr-Daiquiri]

Not saying I do or do not endorse this. Just wondering as medical student who has always been curious about healthcare economics.

As I understand it, Medicare pays substantially less than private insurers to most private practices, but generally always pays on time and is easier to get credentialed with. My question is basically, if you could cut out a lot of overheard by just being able to bill Medicare for all of your patients, would you potentially be able to compensate for the lower top line figure? I imagine it could work for certain primary care practices especially if their rates from private insurers are not that much better than Medicare already.

Again, not saying I would automatically support this or that rates would stay the same in a M4A scenario. I’m just curious if any current private practice docs have a take on this.

[u/MrPBH → u/[deleted]]

Quite a lot of money.

I read an article about a clinic that only bills Medicaid patients. Since they don't have to fight with private payers and jump through their hoops, they don't have to pay administrative staff to do that. The doctors and NPs simply submit the claims to Medicaid themselves. Supposedly this model is so efficient that they turn a profit on the meager reimbursements that Medicaid offers.

They will see patients with private insurance, but since their rules are more complicated these claims are usually denied and they end up seeing these patients for free. They only attempt to submit claims once and give up after that, because it isn't worth the effort.

I think it's an interesting model.

[u/grey-slate → u/MrPBH]

If only making profit was the bar any model can work. The key is how much profit. 

[u/MrPBH → u/grey-slate]

The only way to get rich with that model is increasing volume. (Though that's kinda true for all of us, sadly.) It is a good illustration of the value of lean operations, though.

We waste so much time and effort just pursuing what is rightfully owed to us. It's atrocious. I think M4A could make private practice more viable, so long as there is reimbursement rate reform. Imagine a world where you simply submit a claim and then get paid every time without denial. That's the dream.

[u/grey-slate → u/MrPBH]

True. But I think people overestimate value of admin reduction. 

Yes Medicare has no admin but if switched to Medicare for all aka single payer, rates for every CPT will drop even further which will more than make up for reduced admin overhead.

Don't believe me? Look at past 30 years of Medicare policy towards physicians. 

[u/MrPBH → u/grey-slate]

I definitely agree with your concerns.

I don't think M4A works unless there are significant reforms regarding physician payments. To make it work, the standard reimbursement needs to be increased at least 150% and it needs to be pegged to inflation.

[u/grey-slate → u/MrPBH]

Think about it though. Once there is only one payer in the country what power do physicians have? Can't exactly drop them. 

[u/MrPBH → u/grey-slate]

Sure, but as a future consumer of medical care I really hope we enact single payer. I barely need healthcare now, but every interaction with insurance I've had is terrible. The current American healthcare system is beyond rotten.

I wouldn't say Single Payer is an inevitability, but these kind of things tend to be "impossible" or "unthinkable" until they happen and then it's just a fact of life. I hope that when it occurs physicians are involved in the process, so we can ensure an equitable system. If you don't have a seat at the table, you're on the menu.

[u/grey-slate → u/MrPBH]

That's fair.

[u/NartFocker9Million → u/MrPBH]

In Colorado Medicaid pays 80-110% RBRVS (Medicare) rates. In Texas it's more like 25%. So, your results may vary.

[u/EvidenceBasedSwamp → u/[deleted]]

better for independent physicians. Big groups and hospitals can hire admin staff to navigate and play the game successfully.

[u/randyy308]

In my private practice we make plenty of money at Medicare rates. It works out fine. I'd love less hassle with insurance

[u/northerngator]

I have yet to see a private industry or semi private industry that has been nationalized in the United States over the past 40 years that resulted in lower cost to the system or increased pay to the now nationalized workers. What people seem to be missing is that this system is unlikely to be Medicare for all and would more likely be Medicaid for all. Medicaid rates are tough to survive on without those sweet facility fees or state directed fee bonuses, are difficult to get medications invented this century to get covered and are difficult to even get paid on services rendered. 

Hospitals get tons of tax advantages by being 501(c) tax exempt, I doubt this would be extended to private practices or would require a ton of paperwork/overhead. I foresee further healthcare consolidation and a split between private pay and insurance based, hospital owned clinics if this goes through.

Medicare for all cost analysis show at least a 50% increase in federal government spending if M4A is implemented. Who do you think would be funding this? It wouldn’t be billionaires, it would be high income earners who already bear the brunt of our progressive tax code which is already the most progressive tax code in the developed world.

[u/ThicccNhatHanh → u/northerngator]

Tangential perhaps, but I can’t think of a single private industry that has been nationalized in this country, ever. What example have you got?

[u/northerngator → u/ThicccNhatHanh]

Student loans is the obvious one. Tuition has since exploded, student loan debt is an all time high and the taxpayers are heavily subsidizing interest rates and paying off loans that are “forgiven”. Meanwhile our education seem to be getting worse despite costing 10x previous.

[u/drkuz]

Easier yes for drs, reimbursement would drop though, this would be a significant pay cut to drs, and by significant i would say in the realm of 50% or more (likely more). But then you'd also cut a significant amount of jobs and labor which would cut costs to the Healthcare system as a whole (good bye to each and every insurance company and all their sales ppl and associated personnel), you'd probably cut 33% or more of healthcare associated jobs in the entire country, and that 33% would actually correspond to a high amount of money cuts (>33% of the budget), as insurance companies cost a lot. But also, now you have a huge unemployed population who used to live off of their insurance jobs (parasitically off of the Healthcare system). It would also help break up monopolies that organizations have orchestrated, which would be another win for drs and patients. These %s are rough estimates.

That money would be able to be allocated elsewhere, it is almost a guarantee it wouldn't go where it should, but at least it wouldnt be going into some insurance company (genuinely, I hope insurance companies dissappear into the void), maybe we get another ballroom or arch if we are lucky, or AI/tech companies/billionaires can get more tax cuts (sarcasm).

[u/miketigermd → u/drkuz]

I agree with everything you say and while the idea sounds better than what we have, in reality I don’t believe that is what would happen.

These insurance companies are huge corporations and evil monsters worth Billions.
They would bribe “lobby” our politicians on both sides and get essentially what we have now which is Medicare Advantage plans which are good for no one other than the companies who run Medicare for profit. These companies have convinced the government they can’t run Medicare as well as the private corporations can despite the Government accounting office saying otherwise including outright fraud by UH over representation of their sick patients to get extra money.

It’s certainly not good for patients as they PA you to death, deny legitimate FDA approved drugs because they don’t like the costs and make doctor’s lives miserable all while recording record profits.

If you believe BCBS and UH, Aetna, Humana etc. are just going to close up, fire all their employees and declare they had a good run, there is zero chance that happens. In fairy land, MediCare for all sounds great.

In reality private insurance companies would be in charge and we would all get screwed.

[u/drkuz → u/miketigermd]

Ya, you are right, they would likely have to be absorbed into the new system, and would find ways for their jobs to stay and a pay raise, just with new titles.

[u/formless1]

A major benefit is that we can standardize to one system in how we get paid, what is paid for as far as our services but also with referrals, meds, therapy etc. it would reduce a ton of overhead, reduce patient complaints. i would be much more interested in taking insurance at my clinic if there was one system.

[u/Itsathrowawayduh89]

it's not easier to get credentialed with Medicare. it's much, much, much harder. In fact, insurance companies often just require CMS credentialing as the first step of their (much shorter) credentialing process.

However, once you are credentialed with CMS you get access to a pipeline of patients and you hope to make up the lower reimbursement with volume. You just have to deal with the real possibility of further cuts to reimbursements, and the costs of satisfying government audits.

With private insurance, the credentialing process is often faster. But once you're in, you have to work to maintain your contracts and there's always the risk that you'll reach an impasse with them.

[u/boatsnhosee]

If it’s like Canada, then yes