Doctor's say "NO" to Obamacare!

Sally Pipes, Contributor (I cover health policy as President of the Pacific Research Institute )

Op/Ed

Doctors Say Obamacare Is No Remedy for U.S. Health Woes

21 comments, 0 called-out

+ Comment now America’s doctors have conducted a full examination of the president’s health reform law — and their diagnosis of its effects on our healthcare system isn’t good.

Nearly two-thirds of doctors expect the quality of care in this country to decline, according to a new survey from consulting giant Deloitte. Just 27 percent think that the law will lower costs. And nearly seven of every 10 doctors believe that medicine is no longer attractive to America’s “best and brightest.”

Few people know more about our healthcare system than doctors working on the frontlines. Policymakers should pay heed to their indictment of Obamacare and revisit the disastrous law.

President Obama promised that his reform package would begin to stymie the out-of-control growth in the cost of American health care. He pledged $2,500 in health insurance savings for the typical American family.

But doctors don’t buy it. Only one quarter feel that Obamacare will reduce health insurance costs for consumers. Nine out of ten posit that insurers will raise premiums for employers and individuals.

They have good reason to doubt Obamacare’s cost-cutting potential. Healthcare spending is expected to reach $2.7 trillion this year — or about $1 of every $6 spent in our economy. By 2020, health spending will account for a full fifth of America’s GDP.

That increase is in large part thanks to Obamacare. Instead of relieving high insurance premiums, the nonpartisan Congressional Budget Office estimates that American families in the non-group market will see their premiums rise $2,100.

They’re already trending higher. According to the Kaiser Family Foundation, average family premiums in 2011 topped $15,000 — a 9 percent increase from 2010. Prior to Obamacare’s passage — from 2009 to 2010 — premiums went up just 3 percent.

In April 2010, Richard Foster, the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS), concluded that American spending on health care through 2019 would be $311 billion higher than if the law had never passed.

Even with all that additional money flowing through the system, doctors don’t think that the quality of care will improve. Half of all doctors believe that access to care will diminish because of hospital closures prompted by health reform.

Further, nearly 70 percent of doctors believe that long wait times will plague emergency rooms. A full 83 percent of physicians foresee increased wait times for primary care appointments.

That’s in large part because Obamacare is expected to extend government-subsidized insurance coverage to many folks — even as the supply of providers remains relatively constant.

The United States already faces a shortage of primary-care doctors. Medical schools today produce one such physician for every two our country needs. By 2019, the American Academy of Family Physicians warns that the United States will be short 40,000 doctors.

Expanding insurance coverage to millions more Americans won’t do much good if they can’t get doctor’s appointments. Physicians believe that their ability to provide quality care will be further strained by the law’s attempt to change the way they’re paid — from a fee-for-service basis to a vaguely defined system of paying doctors based on patient health and outcomes.

Nine out of ten physicians fear they will receive inadequate payments and endure higher administrative costs. Fewer than a quarter of doctors expect their paperwork requirements to ease up. Time spent wading though paperwork is also time no longer available for actually practicing medicine.

American doctors’ negative view of Obamacare is telling. Proponents of the law may claim that their griping is misplaced, but as Paul Keckley, Ph.D., the lead author of the report explains, “Understanding the view of the physician is fundamental to any attempt to change the health care model.”

In other words, if physicians aren’t on board with Obamacare, it won’t work. A law that hinders the practice of medicine, obstructs access to care, and costs Americans more is clearly not the right remedy for what ails us.

Sally C. Pipes is President, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute. Her next book — The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare (Regnery) — will be released in January 2012.

ObamaCare's Very Bad Year!

Paul Connor, The Daily Caller.

2011 was supposed to be a bad year for President Obama’s health care law, with House Republicans taking aim and federal lawsuits snaking their way through the judiciary. And although the House of Representatives has had limited success in dismantling the overhaul, key portions began to unravel all by themselves.

Here’s a look at the Patient Protection and Affordable Care Act’s year in review.

– Jan. 14: Kansas announces its intention to become the 26th state to file suit against the federal government to stop implementation of the health care overhaul.

– Jan. 19: The House of Representatives votes to repeal the health care law.

– Jan. 26: Illinois-based pharmaceutical company Abbott Labs cuts 1,900 jobs “in response to changes in the health-care industry, including U.S. health-care reform and the challenging regulatory environment.”

– Jan. 31: A second federal district judge rules that the law is unconstitutional.

– Feb. 2: All 47 Republican senators vote to repeal the Affordable Care Act, but the measure fails.

– Feb. 16: Health and Human Services Secretary Kathleen Sebelius testifies before the Senate Finance Committee and admits that the CLASS Act, a key portion of the law that was touted as a $70 billion savings, is “totally unsustainable.” But not to worry: Sebelius says her department has the authority to rework the legislation to make CLASS tenable.

– Feb. 18: The House votes to block federal funding to implement the Affordable Care Act. The Congressional Budget Office also estimates that repealing the law would add $210 billion to the combined federal deficits from 2012 to 2021.

– Feb. 22: A federal judge tosses a lawsuit claiming that the Affordable Care Act violates the liberties of those who choose to rely on God to protect and heal them instead of buying health insurance.

– March 3: The House votes to end an unpopular tax paperwork-filing requirement for businesses tucked into the health care law.

– March 23: The law turns one year old. On the same day, the House Committee on Energy and Commerce finds that the temporary Early Retirement Reinsurance Program will spend its allotted $5 billion far earlier than its Jan. 1, 2014 expiration date.

– March 30: The CBO estimates that health care reform will cost $1.1 trillion, an increase of $90 billion from its February estimate.

– May 17: The Daily Caller reports that 20 percent of new waivers from the law have gone to gourmet restaurants, nightclubs and fancy hotels in former House Speaker Nancy Pelosi’s district.

– June 8: A McKinsey & Company survey of over 1,300 private sector employers found that 30 percent of employers would definitely or probably stop offering insurance to their employees after the law is implemented in 2014.

– June 18: HHS announces that it is axing waivers from the law.

– June 21: A glitch in the law, discovered after Obama signed it, would allow middle-class Americans to get subsidized health care intended for poor people, the Associated Press reports. Medicare’s chief actuary says the policy “doesn’t make sense.”

– June 29: In the face of a constitutional challenge, the Sixth Circuit Court of Appeals rules in favor of the law.

– July 18: An Employment Policies Institute report finds that the Affordable Care Act would incentivize employees to switch to a government-subsidized insurance exchange even if employers were to continue their health care coverage, costing taxpayers “significant[ly].”

– July 19: The bipartisan “gang of six” puts forward a debt-reduction plan that would repeal the CLASS Act.

– Aug. 1: HHS issues a regulation requiring all group health insurance plans to cover FDA-approved “contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.”

– Aug. 12: The Eleventh Circuit Court of Appeals rules that the law’s individual health insurance mandate is unconstitutional.

– Sept. 8: The Fourth Circuit Court of Appeals rejects a pair of challenges to the law on procedural grounds. It does not rule on the law’s constitutionality.

– Sept. 15: A bicameral Republican report accuses Democratic supporters of the health care law of recklessness for promoting the CLASS Act despite knowing that the program would eventually blow up the budget.

– Oct. 5: The signatures of about 1.6 million petitioners pressing for the repeal of the Affordable Care Act are delivered to Capitol Hill at a press conference.

– Oct. 13: A federal inspector general finds that the IRS is having trouble collecting the 10-percent federal tanning tax established by the law.

– Oct. 14: HHS completes its 19-month review of the CLASS Act, determining that “we do not have a path to move forward,” Sebelius says. CLASS remains on the books, but the administration essentially gives up on it.

– Nov. 4: Tennessee Rep. Phil Roe and 23 Republican colleagues send a letter to IRS Commissioner Douglas Shulman objecting to a new IRS rule authorizing subsidies for participants in the yet-to-be-created federal health care exchange program. They argue that the agency is seeking to rewrite legislation, something it is not allowed to do. Conservative experts say the IRS rules are covering up a glitch in the original law that provides subsidies for people enrolled in state exchanges, but not federal exchanges. Shulman does not agree with their analysis.

– Nov. 9: The National Federation of Independent Business releases a report saying that in 2012 the law’s new health insurance tax will reduce private sector jobs by between 125,000 and 249,000.

– Nov. 10: The Beckett Fund for Religious Liberty announces it is suing HHS on behalf of Belmont Abbey College, a Catholic educational institution. The lawsuit claims the Aug. 1 regulation violates the college’s teaching on contraception, sterilization and abortion.

– Nov. 14: The Supreme Court agrees to hear arguments on the Affordable Care Act.

– Nov. 16: Forty-seven percent of Americans favor repeal of the law, Gallup finds.

– Nov. 29: Massachusetts Democratic Rep. Barney Frank joins the effort to repeal the Independent Payment Advisory Board, a key portion of the law that would “recommend levels at which Medicare recipients, including seniors, can be reimbursed for health care expenses.”

– Nov. 30: The House energy committee votes to repeal the CLASS Act.

– Dec. 15: The Obama administration announces that the number of young uninsured Americans has fallen by 2.5 million, attributing it to his law’s provision permitting young adults to stay on their parents’ health care plans until age 26.

– Dec. 18: Health care experts doubt that the federal insurance exchange program will be fully operational by the Jan. 1, 2014 deadline, since many states have refused to implement the state exchange program, the Washington Post reports.

– Dec. 19: The Supreme Court announces it will hear an unprecedented week’s worth of arguments in March 2012 to determine whether the health care overhaul law is constitutional.

Medicare plans to cut reimbursements by 27% in 2012

Doctors facing 27% cut in their Medicare fees

Arizona Daily Star | Posted: Tuesday, November 29, 2011 12:00 am

WASHINGTON - Politicians of both parties outdo each other vying for the approval of seniors, but their inability to compromise on the federal budget has put Medicare in the crosshairs again.

Unless Congress acts before Jan. 1, doctors face a 27 percent cut in their fees for treating Medicare patients. That could undermine health care for millions of elderly and disabled beneficiaries.

Last year around the holidays doctors were looking at a cut of about 20 percent.

The cuts are the consequence of a 1990s budget law that failed to control spending but never got repealed. Congress passes a temporary fix each time, only to grow the size of reductions required next time around. The supercommittee's breakdown leaves the so-called "doc fix" unresolved with time running out.

A thousand miles away in Harlan, Iowa, Dr. Don Klitgaard is trying to contain his frustration.

"I don't see how primary care doctors could take anywhere near like a 27 percent pay cut and continue to function," said Klitgaard, a family physician at a local medical center. "I assume there's going to be a temporary fix, because the health care system is going to implode without it."

Medicare patients account for about 45 percent of the visits to his clinic. Klitgaard said the irony is that he and his colleagues have been making improvements, keeping closer tabs on those with chronic illnesses in the hopes of avoiding needless hospitalizations. While that can save money for Medicare, it requires considerable upfront investment from the medical practice.

"The threat of a huge cut makes it very difficult to continue down this road," said Klitgaard, adding "it's almost comical" lawmakers would let the situation get so far out of hand.

Physian's Pay may increase, Maybe!

Doctors to see slight salary increases in 2012

October 18, 2011 | Stephanie Bouchard, Associate Editor

PHILADELPHIA – Doctors can expect to see salary increases in 2012 but they’ll be smaller than those in 2011 says a physician compensation survey released this week by global consulting firm, the Hay Group. In 2011, physician salaries increased by 2.7 percent but expectations are that in 2012 they'll increase only by 2.5 percent.

The size of the salary increases is impacted by organization-specific things such as the salary increases provided to other employees, and, more importantly, reimbursements, said Jim Otto, senior principal in Hay Group’s healthcare practice. “The primary influences on these increases are likely to be flat or minimal increase in reimbursement for services rendered and flat or minimal increase in actual services rendered that result in reimbursement,” he said.

Doctors working in group-based practices are expected to see pay increases of 3.2 percent in 2012 but hospital-based doctors are only expected to see increases of 2.5 percent. More specifically, physician specialists working in hospitals may expect an increase of 2.4 percent and those in group practices may expect a 4.5 percent increase. Primary care doctors in hospitals may expect a 2.9 percent salary increase in 2012 while their peers working in group practices may expect a 3.3 percent increase.

The differences in salary increases between hospital-based and group-based doctors are likely the result of three things, Otto said: group income from ancillary services that are part of a practice’s business lines and which are not part of a hospital-employed physician’s compensation; sharing in profit after expenses for physician owners, which is also not part of a hospital-employed physician’s compensation; and employed physician increases being influenced by budget and salary increases for the other employees of the hospital.

With the demand for primary care physicians up, it’s not as surprising that they are expected to have larger salary increases than specialists in 2012. “The expected increases to primary care physicians is a reflection of the importance of their role in the healthcare reform environment – for example, accountable for integrated patient care models – the increase in reimbursement that is being paid by insurance companies and the government for primary care services, and the decreasing reimbursement for other specialists,” Otto said. “This does not mean that the pay differences that you see in the market between primary care physicians and specialists will evaporate quickly, but over time these differences are expected to shrink.”

Other findings from the physician compensation survey include:

• When determining base pay structure, 50 percent of organizations set physician pay on an individual basis, 28 percent establish formal salary ranges, 18 percent use market rates and 1 percent use step-rate progression.
• The prevalence of annual incentive plans decreased slightly among all physician participants in 2011.
• Measures for determining incentive payouts continue to be dominated by quality and patient satisfaction.

Follow HFN associate editor Stephanie Bouchard on Twitter @SBouchardHFN.

Physician Salaries - Towns and Cities; Size does matter!

How does Town Size and Population Affect Physician Salary?

By Andrea Santiago, About.com Guide

Question: How does Town Size and Population Affect Physician Salary?

A reader, who is a future physician, posed some questions about physician salary as it relates to the size of the community in terms of population. Do physicians earn more in small towns or large cities, and why?

Answer: In discussing physician compensation, the use of the term "salary" can be misleading, since many physicians are not employed, nor are they paid a base salary. Most physicians (more than 50%) are in business for themselves, owning a private practice in full or in part, as opposed to being employed by a hospital or group. Even for physicians who are employed, their compensation is controlled by many geographic, economic, and demographic factors, such as managed care and insurance reimbursements, which are set by third party organizations and government regulations.

According to the Medical Group Management Association (MGMA) which conducts extensive annual surveys and analysis of physician compensation, most physicians earn more money in communities which are well under one million in population. In many specialties, the highest earners are found in towns of 50,000 to 250,000 in size, according the the MGMA statistics.

This disparity in compensation is due to several factors:

Competition: In smaller to mid-sized communities, competition from other physicians is not as prevalent as in larger metropolitan areas, which tend to become “over-doctored” due to the tendency of doctors to flock to large cities due to family ties or perceived benefits of working in a larger city.

Reimbursements: Reimbursements from insurance companies tend to be higher in small- to mid-sized communities. Therefore, a physician in a big city and a physician in a small town could see the exact same amount and type of patients, and do the same amount of work, and each physician could be reimbursed completely different amounts based on the rates in their area, and often it’s the small-town doc that comes out ahead.

Overhead costs: Typically, costs of practicing as a physician, such as malpractice insurance, and office space, are higher in larger cities. This is because larger cities tend to be more litigious environments than smaller communities, and frequent lawsuits drive up the cost of malpractice insurance further.

Examples of high-earning physician specialties in smaller towns:

Orthopedic Surgeons These surgeons earn the most in towns of 50,000 or less, typically. For example, according to the MGMA Physician Compensation and Production Report of 2009, orthopedic surgeons in the smallest towns earn a median annual income of $502,195, and only $474,359 annually in in metro areas larger than one million people in size. Their median income decreases further in towns with a population of 250,000-1,000,000, to about $393,402.

Gastroenterologists in smaller towns (under 50,000) earn an average of $467,927. Those physicians in towns of 50,000 to 250,000 earn $452,195 on average, which is a whopping 22% more than their counterparts in major metro areas (over one million population), who earn $370,673 annually on average.

Dermatologists earn the most in towns of 50,000-250,000 with a median income of about $395,159. In major metropolitan areas, dermatologists earn about $50,000 less than that, with a median annual income of $340,317 in cities with a population over one million. In towns under 50,000 in size, derms earn $356,624, according to the MGMA 2009 Physician Compensation and Production Survey.

Cardiologists in small to mid-sized towns earn anywhere from 17% to over 25% more than those in major metro areas. Those increased earnings can equate to a difference of nearly $150,000 annually for some cardiologists in smaller communities! Interventional cardiologists see the most dramatic effects of town size on income, for example, with median earnings of $609,041 in small towns (under 50,000 people), and $462,820 in major metro areas (over one million people).

Above are just a few examples. The list goes on, but these are a few of the most dramatic examples. Not every specialty sees such a significant difference, but nearly every specialty sees a gain in compensation in smaller towns, particularly those in the lucrative range of 50,000 to 250,000 in population, which are the highest paying locations for most specialties. As an added bonus, in addition to earning more money each year, physicians in smaller communities get more for their money, obtaining additional savings and improved financial situations for doctors who practice in small or mid-sized communities.