(08-15-2020 01:25 PM)Hambone10 Wrote:  Not disagreeing with anything else you said... just felt compelled to add to this....

(08-15-2020 01:08 PM)OptimisticOwl Wrote:  

Quote: Or are you saying that, if Medicare reimbursed at the same rate in all areas, providers that currently operate on the city would relocate to rural areas?

I'll let the doctor clarify what he is saying, but what I am hearing is that equal reimbursements would eliminate the incentive for (1) new doctors to locate in big cities, and (2) rural doctors to pull up stakes and relocate to more urban centers.

My kidney specialist practiced here one day a week, then pulled up stakes and moved to College Station. Now I have to travel 40 miles to see a replacement specialist.

I will say this... If Medicaid paid the same for a GP to work in Boerne as they do in NYC, you might get a lot of docs at least working in Boerne long enough to pay off their debts and put money away for that Park Avenue spot.

It's not just about the reimbursement, but also about how and why you become a specialist.

One of the big problems with healthcare reimbursement vs other nations that is so often glossed over here (because there are no 'identical' patients) is that depending on your insurance, a cardiologist can get paid very well to give you bypass surgery. At what point is bypass surgery necessary? Would a stent work? There are so many details, it's really hard to compare apples:apples.

What we know is that if people get paid the same regardless of whether or not they do something (managed care), they're somewhat less likely to do it.... especially if they can simply see another patient and get paid more.... or as in your case, stop paying rent in Boerne and consolidate to a bigger town.

FTR, I don't recall if you're actually in or near Boerne... It's just an example and for some reason, I think of that part of the state when I think of you.

My doctor was already a specialist. No idea why he moved.

I live in the DFW metroplex, in one of the outlying counties. (we can out lie anybody you got...)

For personal reasons, I decline to give out further info, even to people I trust (and I certainly would trust you), but I have given a hint that nobody has picked up on...