1)Increase in the federal income tax rate
Sure, be a team player. Pick up that extra uncovered shift on the schedule. But don’t pick up too many, because the max federal tax rate is going to go up…probably to 39%. Especially for you really hardworking stiffs making more than $250K per year, it’s time to start doing the math before you work too hard and end up giving most of that extra shift to Uncle Sam.
Better think twice about buying those Thin Mints from the next door neighbor’s kid, or giving to the YMCA, United Way or any other charity. Why, because the amount of that contribution that you could deduct from your federal income taxes is going to go down, probably from 42 to 29 cents on the dollar. So much for give until it hurts, now it’s give until you bleed.
“What the heck is bundling?” you ask. Bundling is going to be one of the key strategies to reduce federal expenditures on healthcare in the upcoming years. Here’s how this special trick is going to work. Instead of the government paying for each portion of a patient’s care (i.e. Hospital charge, radiologist charge, emergency physician charge during a single ED visit) the feds are going to come up with a single payment for an “episode of care”. They are then going to come up with a single payment (which you can bet is going to be less than the current sum of the parts), and then they are going to give it to one entity (probably the hospital). It will then be up to all of the participants to somehow divide the total payment. Gee, I wonder if the hospitals will just be nice and treat the ED docs as well as their radiologists, surgeons, cardiologists, hospitalists and every other specialty that will stake a claim for the money the hospital receives. This is where those years of schmoozing your hospital CEO and CFO will pay off. Oh, you haven’t been doing that? Too bad! Back of the line for you.
After 30 years of letting the insurers, hospitals, and pharmaceutical companies skim all the profits in healthcare while physicians were getting, at best 0-1% updates from Medicare, I’m not convinced that the AMA is really who I want representing me in the big healthcare debate. And now we’re supposed to believe that because the insurers, hospitals, big pharma and the AMA sent some flowery, Kumbaya, “we’re all in this together” letter to the President, docs aren’t still going to get the short end of the stick (or dollar in this case)? Haven’t those same for-profit groups been shafting docs all along? Why should they play nice now?
5)Tort Reform? Don’t hold your breath
Haven’t heard much talk about that in the healthcare reform debate, now have you? Probably not going to either. No, tort reform won’t be a big player in the healthcare debate, due in no small part to the historically friendly relationship between the powerful trial lawyer lobby and the democratic party. What we’ll get instead of a discussion of tort reform is a discussion about “more effective medicine.” That’s right, the federal government is going to do effectiveness research and tell us doctors what the “right” thing to do is, or at least what they will pay you for. But don’t worry, you probably won’t be immune from being sued even if you follow that standard.
Well, now that I’ve been a little ray of sunshine in your day, I’ll just leave you with a little quote so that you can go cry into your N95 mask when you go see the next patient with Swine/Avian/Gorilla Flu.In the words of the immortal Jack Nicholson as Marine Colonel Jessep: “You can’t handle the truth!” The truth is that emergency physicians do stand their post 24/7/365. We stand tall every day, night, weekend and holiday despite being puked on, spit on, and sworn at. And yet, the future of our specialty now rests in the hands of a few Washington bureaucrats who believe they know how to run the entire healthcare system from the Capitol steps. God help us all.