tag:blogger.com,1999:blog-18943510.post6774104793288033135..comments2023-08-21T02:57:37.362-05:00Comments on Dr. Wes: The End of Delayed GratificationDrWeshttp://www.blogger.com/profile/17438019699222125477noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-18943510.post-11621406748842968582007-11-26T16:44:00.000-06:002007-11-26T16:44:00.000-06:00anonymous, I have not infact said that time shoul...anonymous, I have not infact said that time should be valued the same.<BR/><BR/>Read it again.<BR/><BR/>Specialty medicne should be paid at a higher rate.<BR/><BR/>However the gap in reimbursment is striking and the reimbursment of primary care is affected directly be the reimbursment of specialty care by way of the fixed pot of money called Medicare Part B, through the LOSE-LOSE system of RVU.<The Happy Hospitalisthttps://www.blogger.com/profile/14392872203166584371noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-13856285251327146032007-11-25T23:22:00.000-06:002007-11-25T23:22:00.000-06:00I fail to see your reasoning that all time spent s...I fail to see your reasoning that all time spent should be valued the same, which seems to be where you are going. This is a common conceit of primary care doctors, who seem to divide work neatly into things that involve thinking and things that don't but presumably involve something else. I have yet to see a skillful surgeon who wasn't showing some evidence of thinking as he was doing surgery. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-18943510.post-68926735153904401102007-11-25T14:04:00.000-06:002007-11-25T14:04:00.000-06:00Interesting commentary between the two of you-- an...Interesting commentary between the two of you-- and indicative of why we're in the mess we are.<BR/><BR/>RVUs set top-down are arbitrary and based on a lot of justification factors that have nothing to do with real demand. In the rest of society, demand, ability to pay, and pricing elasticity create a range of choices that market forces allow to survive or not. If the public won't pay for a GI Anonymoushttps://www.blogger.com/profile/03214069880720585895noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-89675696650849630852007-11-22T20:50:00.000-06:002007-11-22T20:50:00.000-06:00Happy-I agree. We're singin' pretty much the same...Happy-<BR/><BR/>I agree. We're singin' pretty much the same tune, just different harmonies...<BR/><BR/>Have a great Thanksgiving...DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-74739858658655345282007-11-22T10:03:00.000-06:002007-11-22T10:03:00.000-06:00Wes I had a response but somehow it didn't get th...Wes I had a response but somehow it didn't get through the system. So I will try again and explain my position.<BR/><BR/>I have never maintained that specialists and primary care should be reimbursed at the same rate. The thing that matters is the gap in reimbursment will drive a resident determination on going into primary care or specialty care. Right now that gap is striking. And the The Happy Hospitalisthttps://www.blogger.com/profile/14392872203166584371noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-56102350520234054262007-11-22T00:39:00.000-06:002007-11-22T00:39:00.000-06:00"happy" h-What value do we extend to advanced degr..."happy" h-<BR/><BR/>What value do we extend to advanced degrees and specialization and the costs inherent to that training? Should that expertise be worth the same minute-for-minute as a generalist? Certainly this is not the case in other business models. But I am more intrigued about this:<BR/><BR/>Isn't this perfect? What a great detractor: getting different specialists and generalists to DrWeshttps://www.blogger.com/profile/17438019699222125477noreply@blogger.comtag:blogger.com,1999:blog-18943510.post-9981269627819366762007-11-21T20:24:00.000-06:002007-11-21T20:24:00.000-06:00Wes, you bring up some good points, but it is all ...Wes, you bring up some good points, but it is all relative in nature. From my blog:<BR/><BR/>http://thehappyhospitalist.blogspot.com/2007/11/red-hot-hospitalists-and-exiting-that.html<BR/><BR/>The average screening colonoscopy takes 13.5 minutes to do. In 1992 that colonoscopy was "worth" 8.48 RVU's. A level 3 (the most common) office visit by a primary care physician was worth 1.0 RVU's. An The Happy Hospitalisthttps://www.blogger.com/profile/14392872203166584371noreply@blogger.com