Obamacare? No...no....no...The Fiscal Cliff will break the back of Health Care in The United States! (and will do it in only a few months!)

Here’s the take-away: On January 1^st – Physicians that accept Medicare will take a hit of 27% in Medicare Reimbursement! How can a Physician’s office, Health system, or Hospital keep the doors open with this loss of revenue? Can you say “We do not accept Medicare patients any longer”? If you can start... saying it! If you can’t....you better learn how!!!

27% Medicare Pay Cut For Doctors a Real Danger in The Fiscal Cliff

By Bruce Japsen

From Forbes    12/20/2012

Doctors face a 27 percent cut in payments from Medicare on Jan. 1. with Congress and the White House unable to come up with an agreement to avoid the so-called fiscal cliff -- or any other budgetary issues for that matter. (Photo credit: Wikipedia)

With Congress and the White House unable to come up with an agreement to avoid the so-called fiscal cliff — or any other budgetary issues for that matter — a major portion of pay for doctors from the Medicare program also hangs in the balance.

At issue is a permanent solution known as the “doc fix” for dramatic cuts to doctor payments from the Medicare health insurance program for the elderly under the so-called sustainable growth rate, or “SGR” formula. Without Congressional action, doctors face a cut in Medicare payments of nearly 27 percent on Jan. 1, 2013.

Move up http://i.forbesimg.com tMove down

Only short-term fixes – 15 of them in the last decade – have been passed as a stopgap measure to prevent major cuts in physician Medicare reimbursement. The payment formula came to be as part of the Balanced Budget Act of 1997 and has never been corrected permanently by Congress.

Unlike past years when Congress has headed off the Medicare fee cut, inaction in Washington lately on the fiscal cliff and for an entire year on the “doc fix” has the American Medical Association, the nation’s largest doctor group, and physicians across the country worried there will not even be a stopgap measure this time around.

“The threat is real,” AMA president Dr. Jeremy Lazarus said in an interview. “For physician practices, it is a terrifying situation.”

The Obama administration’s latest offer to avoid the fiscal cliff to U.S. House Speaker John Boehner and Republicans in Congress includes a repeal of the SGR, which could cost more than $240 billion. Here is a link to a Washington Post story on the repeal of the ‘doc fix.”

The GOP hasn’t warmed to White House proposals, which has many lobbies for doctors worried medical-care providers are going to take a financial hit this time.

Lazarus said doctors who treat Medicare patients face a significant amount of revenue loss. “You are talking anywhere from $10,000 or $15,000 up to $35,000 per physician,” Lazarus said.

The cut will also be immediate on Jan. 1 because the Obama administration has told doctors it will not delay processing of Medicare claims.

A Medicare fee cut could also impact insurance companies like Humana (HUM), Aetna (AET), UnitedHealth Group (UNH) and other private health insurers with large businesses providing benefits to seniors through Medicare Advantage plans. Such privately operated plans contract with Medicare to provide seniors health benefits.

A cut in doctor fees would also harm what the health plans can pay doctors and could also result in physicians fleeing health plan networks, physicians say. Already, one-third of physicians who treat Medicare patients are not accepting new patients, the AMA says, in part because they are unhappy with what the program pays them.

“We haven’t seen anything as of yet that will avert that cut on Jan. 1,” Lazarus said. “With a full year to stop this drastic cut, it is absolutely inexcusable that Congress has failed to act, leaving Medicare patients and physicians to deal with the consequences.”

 

 

Obamacare will make Medical Malpractice Lawyers very rich men!!

H/T NY Daily News

Without real Tort Reform Obamacare will cause our Medical System to go bankrupt! We all know that Trail Lawyers are Obama’s top political donors, so the chance of Obama pushing for Malpractice Reform will be ZERO!

Obamacare will fail without tort reform: Malpractice insurance costs are crippling medicine

By Dr. Michael Lavyne

Friday, November 19, 2010, 4:00 AM

I am what you call a successful neurosurgeon, and I have nothing against "socialized medicine" as such. Everybody deserves good health care. But I am nonetheless worried about President Obama's health care reform, because without tort reform as part of the package, it can't address the labor shortage we face in my specialty.

Tort reform is crucial because it would curtail the threat of frivolous malpractice lawsuits, reward all patients who have been injured by medical mishaps, not just the wealthy with access to high-powered lawyers - and reduce the anxieties faced by young doctors going into medicine in the first place, especially those entering high-stakes fields like my own.

For example, I just operated on a 60-year old man who didn't even know his surgery was an emergency. He was losing motor function in his lower extremities due to severe spinal stenosis, and we were able to move quickly because we were free of insurance issues. But what if those insurance issues were paramount? What if somebody like me wasn't available, to anybody, because the supply of neurosurgeons had dried up - because the costs of letting them operate were too high? Would he still be walking?

Good doctors have always been in short supply; why worry especially about neurosurgery?

Only because spinal problems affect nearly 80% of our aging population: It's one of the most common reasons patients visit a primary care physician, right behind the yearly physical, the common cold, prenatal care and anxiety-related disorders. Baby boomers are about to overwhelm the system with demand for treatment of spinal problems - including surgery - at precisely the moment the supply of neurosurgeons able to treat them is dwindling.

How could this have happened? How could we have a labor shortage in one of the most lucrative, prestigious and desperately needed medical specialties?

One reason is the difficulty of getting certified, which makes sense. In May of 2009, the American Board of Neurological Surgeons certified 59 individuals as capable of tasks required of their specialty. But only about 30% of them, just 18 people, were ready to perform the surgeries that might solve the spinal problems of an aging population. The average age of these people was 37, they all carried loans from medical school and malpractice insurance premiums they faced were about $4.5 million a year if they settled in this state.

Thus we come to the second reason: the cost of malpractice insurance, which creates a very high cost of entry into this field. Unfortunately, the health care reforms of the Obama administration have done little to curb costs. These costs are imposed by hospital inefficiencies as unpoliced by government-run insurance plans and by the price of malpractice insurance undisciplined by tort reform.

I believe that tort reform is the key to reducing both kinds of cost, because the malignant threat of malpractice haunts the hospitals as well as the physicians. Without such reform, the choice for practicing neurosurgeons like me is between retirement and working 24/7 just to cover my insurance overhead. My premature retirement will reduce the supply of surgeons capable of dealing with the spinal problems of an aging population - and that supply is already short and getting shorter. Meanwhile, a few more board-certified surgeons a year won't meet the growing demand. The lines at your doctor's office could get long.

When Congress returns to consider the problem of health care, it must understand that without tort reform, neurosurgery of the kind I can provide to an aging population will be unavailable.

Lavyne is Clinical Professor of Neurological Surgery at Weill Cornell Medical College of Cornell University in New York City.

Obamacare....Physicians will be paid less, and pay higher taxes!

Obamacare

Health Care Reform: What Will It Mean for You in 2013?

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Many Physicians will face higher tax bills Jan. 1, 2013, as a result of four health care-reform law changes.
Here's a look at what's about to hit — unless Congress otherwise acts (and we know they won't)!

What's Coming Jan. 1

1. Limit on flexible spending account (FSA) contributions. Today, employers set their own caps on how much employees can contribute to these plans that let them use pretax money to pay for health care expenses. For 2013, the government will enforce a $2,500 limit per employee.

2. A new Medicare surtax on investment income. Until now, Medicare taxes have only applied to earned income. For 2013, taxpayers filing individually with wages and self-employment income above $200,000 ($250,000 for married couples filing jointly) will pay a 3.8% surtax on the lower of:

• Their net investment income — which includes interest, dividends, capital gains and other amounts.
• The amount of their modified adjusted gross income that is greater than $200,000 ($250,000 for married couples filing jointly).

3. An additional Medicare tax on wages and self-employment income for some. The existing Medicare payroll tax of 2.9% (of which 1.45% is paid by a taxpayer through payroll deductions) will be increased by 0.9% on wages or self-employment income that exceeds $200,000 for single and qualifying head of household and widow(er) filers ($250,000 for married couples filing jointly).

4. Higher hurdle for deducting medical expenses. Currently, out-of-pocket medical costs only are deductible to the extent they exceed 7.5% of your adjusted gross income. For 2013, that hurdle will rise to 10%. But if you're 65 or older, that threshold remains frozen at 7.5% through 2016.

Please ask the AMA how Obamacare will benefit physicians?

Physicians paid less under Obamacare, and if a patient suffer because hospitals will be forced to block re-admissions!

Obamacare decreases Physician salaries, increase wait time to see a physician, and will force patients to find a new way to receive care.

7 things that scare your doctor with ObamaCare on the horizon

By Dr. Sreedhar Potarazu

Published December 05, 2012

FoxNews.com

As the Affordable Care Act is in full swing, there’s a lot of apprehension and perhaps, sometimes, enthusiasm about what is truly in store for the medical profession.

The last time you visited your doctor you may have noticed that he or she was more apprehensive, cautious, and yes, maybe more overwhelmed. The fact of the matter is that the health care profession is undergoing the most significant renovation to ever happened in the history of the United States.

Here are many things that keep many doctors awake at night:

1. A new wave of new patients.
Now that insurance companies must accept people with pre-existing conditions, and dependents under the age of 26, there is a new floodgate that has opened, which will bring more people into the system to see a primary care physician. In addition, many states will be expanding their Medicaid rosters, which will also introduce a greater volume of patients all competing for a limited number of physicians.

The projected shortage in primary care physicians between now and the year 2020 is expected to exceed 90,000 by some estimates, which means we have a real supply and demand issue. Either physicians will have to extend their hours and see more patients, or patients will have to wait longer to get an appointment.

2. The paycheck could start shrinking.
Although one would think that a rise in patient volume would correlate into higher income, reimbursements for many specialties could, in fact, be reduced under ObamaCare. There are proposed cuts of almost $718 billion out of Medicare, which will be based on reduced reimbursements and reduction in fraud and waste in the health care system. There is no question that there is room for improvement in reducing the number of unnecessary or duplicate tests being done, but the real concern for doctors is a lot of these decisions will be made by IPAB, the Independent Payment Advisory Board, which will dictate the standards.

3. The wonders of technology.
Every physician is now required to implement an electronic medical record as a means of standardizing information gathering and sharing in the health care industry. This is a good idea. The problem is that in order for a physician to effectively implement a new system, they need to cancel patients for a few months in order to accommodate the transition in learning, which in turn, creates a backlog.

There is, of course, the cost of implementing a new system that will eat into the profits a doctor already earns (and is potentially diminishing). Doctors may even need to hire newly skilled staff to manage these systems and convert their manual records to an electronic one. Technology is important, but the road to success will be rocky.

4. Decreased face time.
With a increasing volume of patients and increased demands on technology and reduced reimbursement, what might ultimately happen is that patients spend less time with their doctor - less than even the average seven minutes. The domino effect from here is that patients get less questions answered, and doctors are more exposed to missing things in the process. In addition, there is the likelihood this could lead to more tests being ordered because there is simply no time to take a good history that is often the crux of an accurate diagnosis.

5. Staying connected.
A major part of the new delivery system is accountable care organizations, which are designed to improve coordination between doctors, hospitals, patients and care takers. Many doctors will soon be reimbursed through a bundled fee for the services that are delivered for an individual for all of the doctors responsible. It will now be critical that doctors are able to understand what tests and evaluations were done before and after a patient’s visit in order to best be able to coordinate care.

6. Hospitals are punished if discharged patients must be re-admitted.

Hospitals will be penalized if patients come back within a certain period of time, and it will be very important for them to be able to communicate with the primary care doctors to make sure the patient complies with their appointments, medications and any other care.

7. The doctor-patient relationship.
As insurance companies try to get more market share, many of them are buying up doctors' practices and aligning themselves with hospitals to create a monopoly. This is not very different from the days of managed care. Most of us are used to physician choice, and there is nothing more special than the relationship with our doctor. The trend remains that with future consolidation of the market, many doctors could be excluded from certain networks , and you may no longer be able to see the doctor of your choice.
The years 2013 and 2014 will be big years for the health care profession and the next time you visit your doctor, you might put these points into perspective, as this might ultimately impact the future of your care.

Dr. Sreedhar Potarazu

Obamacare: physicians have a big pay cut - States do not want to expand Medicaid and get stuck with the bill!

Physicians will have a huge pay cut! States will have to pay for the increase in Medicaid costs.....Ah....where will they get the money?

 

H/T PNJ.com

WASHINGTON — It’s health care brinksmanship, with hundreds of billions of dollars and the well-being of millions of people at stake.

President Barack Obama’s health care law expands Medicaid, the federal-state health program for low-income people, but cost-wary states must decide whether to take the deal.

Turn it down, and governor’s risk coming off as callous toward their neediest residents. Not to mention the likely second-guessing for walking away from a pot of federal dollars estimated at nearly $1 trillion nationally over a decade.

If the Obama administration were to compromise, say by sweetening the offer to woo a reluctant state, such as Florida has been under Gov. Rick Scott, it would face immediate demands from 49 others for similar deals that could run up the tab by tens of billions of dollars.

As state legislatures look ahead to their 2013 sessions, the calculating and the lobbying have already begun.

Conservative opponents of the health care law are leaning on lawmakers to turn down the Medicaid money. Hospitals, doctors groups, advocates for the poor, and some business associations are pressing them to accept it.

“Here’s the big thing: The state does not want to expand Medicaid and get stuck with the bill,” said Dr. Bill Hazel, Virginia’s health secretary.

Medicaid covers nearly 60 million low-income and disabled people but differs significantly from state to state. Under the health care law, Medicaid would be expanded on Jan. 1, 2014, to cover people making up to 138 percent of the federal poverty line, or about $15,400 a year for an individual.

In Florida, where Scott says he is rethinking his opposition, the state could end up saving money through the Medicaid expansion, said Joan Alker, executive director of the Georgetown University Center for Children and Families, which studied the financing.

The reason is Florida would spend less on a state program for people with catastrophic medical bills.

Florida has an estimated 3,952,000 uninsured residents. Alabama, which has no plans to expand Medicaid, has 696,000 uninsured residents.

About half the 30 million people gaining coverage under the law would do so through Medicaid. Most of the new beneficiaries would be childless adults, but about 2.7 million would be parents with children at home. The federal government would pay the full cost of the first three years of the expansion, gradually phasing down to a 90 percent share.

The Supreme Court said states can turn down the Medicaid expansion. But if a state does so, many of its poorest residents would have no other way to get health insurance.

The subsidized private coverage also available under Obama’s law is only for people making more than the poverty level, $11,170 for an individual. For the poor, Medicaid is the only option.

So far, eight states have said they will turn down the expansion, while 13 states plus the District of Columbia have indicated they will accept it. The eight declining are Alabama, Georgia, Louisiana, Maine, Mississippi, Oklahoma, South Carolina, and Texas.

Nearly 2.8 million people would remain uninsured in those states, according to Urban Institute estimates, with Texas alone accounting for close to half the total.

Health and Human Services Secretary Kathleen Sebelius says states can take all the time they need to decide. They can even sign up for the first three years of the expansion and dropping out later.

But she hasn’t answered the one question that many states have: Would the Obama administration allow them to expand Medicaid just part way, taking in only people below the poverty line?

That means other low-income people currently eligible would be covered entirely on the federal government’s dime, and they would be getting private coverage, which is costlier than Medicaid.

 

Obamacare puts the squeeze on Hospitals, the uninsured, and Physicians!

By Ben Shapiro in Breitbart

Missouri Republicans are fighting back against the imposition of Obamacare, stating that costs to the state far outweigh any potential benefits of the program. Obamacare wants states to expand their Medicaid rolls, with the state eventually picking up a significant portion of the tab; at the outset, though, for each state dollar spent on Medicaid expansion, the federal government will pick up $19.

Hospitals are claiming they want the Medicaid expansion, but state lawmakers say there just isn’t money available. The hospitals have been put between a rock and a hard place, since Obamacare phases out funding for hospitals that serve low-income, uninsured patients in an attempt to force the state to pay for it.


That is the entire Obamacare agenda. By forcing hospitals to care for people who are low-income, the federal government hopes to leverage the states. If the states refuse, the federal government cuts off funding but retains the regulations, forcing hospitals into bankruptcy. Then Democrats can claim that the private system has failed to provide for those needy folks, and enact a public option.

Canadian Physicians must be Board Eligible or Board Certified to practice in the U.S.

Canadian Physicians seeking to practice in the U.S. have several boxes to check. The most important is the one that enable the Canadian trained physician to be American Board Eligible and Board Certified. Every hospital, health system, and other health care organization will only work with BE/BC physicians. Period! For reimbursement reasons all physicians must be BE/BC or insurance companies are not paying the bill.

So how can a Canadian trained physician become BE/BC, and able find a job in the U.S.

State licenses:

For a physician who has been trained in Canada, getting any State license should not be a concern. They are not considered to be a foreign medical grad. Take PA for instance; The PA licensing board should not have a concern with Canadian training.

American Boarded:

For a physician to have completed their Canadian training and to be eligible to sit for their American Boards. To be eligible to sit for the American Board of Medical Specialties, they must have been a member of the Royal College of Physicians and Surgeons of Canada. This will qualify him to apply for certification with the American Boards.

Obamacare will not work! One - there is no malpractice reform! Two: U.S. Military must be kept as the worlds top military (Canada for example has a weak military, and they are happy to have it that way)!

Even as far back as 2006 the Canadian system was failing, but nothing has been done to fix it. Infact, today we see Physicians in Canada are paid less, and see lower amounts of patients. ObamaCare has American heading straight to the Canadian system, but it will fail in America (patients will suffer!). TWO BIG REASONS:

1) America spends 4 times as much in GDP that works out to $7,110,000,000/yr. Canada spends just 1.4% of it’s GDP on defense (hey why spend on defense when you (Canada) have a 500lb Gorilla (U.S. Military) protecting you.

2) The American legal system makes it’s best living in Malpractice lawsuits. Yep, the Trail Lawyers donate more money than any other lobbying group, and the Dems get all that money. There is tort reform in Canada with caps in place. Only in Texas will you find Malpractice Tort reform. The malpractice lawyers are ripping the system-off blind!

Canada's Private Clinics Surge as Public System Falters

By CLIFFORD KRAUSS

Published: February 28, 2006

VANCOUVER, British Columbia, Feb. 23 — The Cambie Surgery Center, Canada's most prominent private hospital, may be considered a rogue enterprise.

Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients would wait months or even years before receiving treatment.

But no one is about to arrest Dr. Brian Day, who is president and medical director of the center, or any of the 120 doctors who work there. Public hospitals are sending him growing numbers of patients they are too busy to treat, and his center is advertising that patients do not have to wait to replace their aching knees.

The country's publicly financed health insurance system — frequently described as the third rail of its political system and a core value of its national identity — is gradually breaking down. Private clinics are opening around the country by an estimated one a week, and private insurance companies are about to find a gold mine.

Dr. Day, for instance, is planning to open more private hospitals, first in Toronto and Ottawa, then in Montreal, Calgary and Edmonton. Ontario provincial officials are already threatening stiff fines. Dr. Day says he is eager to see them in court.

"We've taken the position that the law is illegal," Dr. Day, 59, says. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years."

Dr. Day may be a rebel (he keeps a photograph of himself with Fidel Castro behind his desk), but he appears to be on top of a new wave in Canada's health care future. He is poised to become the president of the Canadian Medical Association next year, and his profitable Vancouver hospital is serving as a model for medical entrepreneurs in several provinces.

Canada remains the only industrialized country that outlaws privately financed purchases of core medical services. Prime Minister Stephen Harper and other politicians remain reluctant to openly propose sweeping changes even though costs for the national and provincial governments are exploding and some cancer patients are waiting months for diagnostic tests and treatment.

But a Supreme Court ruling last June — it found that a Quebec provincial ban on private health insurance was unconstitutional when patients were suffering and even dying on waiting lists — appears to have become a turning point for the entire country.

"The prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services," the court ruled.

In response, the Quebec premier, Jean Charest, proposed this month to allow private hospitals to subcontract hip, knee and cataract surgery to private clinics when patients are unable to be treated quickly enough under the public system. The premiers of British Columbia and Alberta have suggested they will go much further to encourage private health services and insurance in legislation they plan to propose in the next few months.

Private doctors across the country are not waiting for changes in the law, figuring provincial governments will not try to stop them only to face more test cases in the Supreme Court.

One Vancouver-based company started a large for-profit family medical clinic specializing in screening and preventive medicine here last November. It is planning to set up three similar clinics — in Toronto, Ottawa and London, Ontario — next summer and nine more in several other cities by the end of 2007. Private diagnostic clinics offering MRI procedures are opening around the country.

Canadian leaders continue to reject the largely market-driven American system, with its powerful private insurance companies and 40 million people left uninsured, as they look to European mixed public-private health insurance and delivery systems.

"Why are we so afraid to look at mixed health care delivery models when other states in Europe and around the world have used them to produce better results for patients at a lower cost to taxpayers?" the premier of British Columbia, Gordon Campbell, asked in a speech two weeks ago.

While proponents of private clinics say they will shorten waiting lists and quicken service at public institutions, critics warn that they will drain the public system of doctors and nurses. Canada has a national doctor shortage already, with 1.4 million people in the province of Ontario alone without the services of a family doctor.

"If anesthetists go to work in a private clinic," Manitoba's health minister, Tim Sale, argued recently, "the work that they were doing in the public sector is spread among fewer and fewer people."

But most Canadians agree that current wait times are not acceptable.

The median wait time between a referral by a family doctor and an appointment with a specialist has increased to 8.3 weeks last year from 3.7 weeks in 1993, according to a recent study by The Fraser Institute, a conservative research group. Meanwhile the median wait between an appointment with a specialist and treatment has increased to 9.4 weeks from 5.6 weeks over the same period.

Average wait times between referral by a family doctor and treatment range from 5.5 weeks for oncology to 40 weeks for orthopedic surgery, according to the study.

Last December, provincial health ministers unveiled new targets for cutting wait times, including four weeks for radiation therapy for cancer patients beginning when doctors consider them ready for treatment and 26 weeks for hip replacements.

But few experts think that will stop the trend toward privatization.

Dr. Day's hospital here opened in 1996 with 30 doctors and three operating rooms, treating mostly police officers, members of the military and worker's compensation clients, who are still allowed to seek treatment outside the public insurance system. It took several years to turn a profit.

Today the center is twice its original size and has yearly revenue of more than $8 million, mostly from perfectly legal procedures.

Over the last 18 months, the hospital has been under contract by overburdened local hospitals to perform knee, spine and gynecological operations on more than 1,000 patients.

 

Medicaid is growing, and Physician earnings are dropping! Health systems are now only receiving 16 cents on every dollar $ billed!

Record 70.4 Million Enrolled in Medicaid in 2011: 1 Out of Every 5 Americans

By Matt Cover

November 9, 2012

 

 

(CNSNews.com) – A record 70.4 million people were enrolled in the Medicaid health care program for the poor in fiscal year 2011, according to government figures provided to CNSNews.com.
That figure equals about 22 percent of the population, which means there was one person on Medicaid for every 5 Americans in 2011.
The record number of Medicaid enrollees in 2011 – the earliest year for which figures are available – is a count of all persons enrolled in Medicaid for any part of that year, providing the fullest and most accurate count of the size of the entitlement program. (The federal fiscal year in 2011 ran from Oct. 1, 2010 to Sept. 30, 2011.)
Figures provided to CNSNews.com by the Centers for Medicare and Medicaid Services (CMS), the agency that oversees the two health care entitlements, reveal an ever-expanding Medicaid program. From 2005 to 2011, total enrollees grew by more than 10 million people, going from 60.1 million in 2005 to 70.4 million in 2011.
Medicaid is the joint federal-state health care program for the poor that allows states to extend coverage beyond those who are in poverty. Recently, the ObamaCare health reform law expanded Medicaid eligibility to those living on 133 percent of the federal poverty level.
The poverty level annual income for a family of four is $23,000 – 133 percent of that, in terms of annual income for a family of four, would be $30,590.
That expansion does not go into effect until 2014, however, and therefore does not affect the continued growth trend. Nor does it contribute to the record 70.4 million Americans enrolled in Medicaid.

 

According to CMS statistics, Medicaid has been growing rapidly since 2008, going from 62.8 million total enrollees to 70.4 million in 2011. Prior to 2008, Medicaid rolls had remained relatively stable, going from 60.1 million in 2005 to just 60.9 million in 2007.
While Medicaid rolls would be expected to rise during a recession, as they did in 2008 and 2009, the last recession ended in June 2009 and Medicaid rolls have expanded faster than during the 2005-2008 period. Medicaid rolls have grown by 5.2 million Americans since 2009 – when the recession ended and the economy began to grow again slightly.
Despite a period of modest gains in employment and economic growth, Medicaid rolls have grown to their record high of 70.4 million Americans.

Under Obamacare physicians are just another Assembly Line Healthcare worker! Obamacare shuts down private practices!

by Dr. Susan Berry8 Nov 2012

With the re-election of President Barack Obama, the Affordable Care Act's regulations will continue to roll out through 2014.

There will be new rules for how the states and the federal government will run the new health insurance “exchanges.” Insurance companies will have their rules regarding premiums they can charge and the customers they will be required to sign up, regardless of medical history. As for individual Americans, we will be required to present evidence of a “government-defined” health insurance plan to the IRS when we file our tax returns.
But, what about doctors, specifically those who own their own practices? Doctor-owned practices are places where health care is provided, but they are also small businesses, operated by small-business owners and entrepreneurs, the doctors themselves.
Doctors who own their own practices have the same costs as other small businesses: rent or mortgage, staff salaries and benefits, utilities, computers, equipment, furniture, etc. As small businesses that have suffered along with others under the first Obama administration, there is no reason yet to believe they won’t suffer more under the second, particularly when Obama and the Democrats want to increase taxes on those who make $250,000 or more. For those health care providers who have practices with many employees, the issue of the ObamaCare employer mandate to provide health insurance for them is another factor of the decision regarding whether a practice is sustainable.
For health providers who rely on health insurance as third party payers, lower reimbursement rates over the years have greatly impacted small business practices. Most Americans would never accept a job in which their prospective employer told them they would get paid less and less each year they work for the business. Yet, health providers agree to this all the time in the system we have had prior to the era of ObamaCare, a system that is equally dysfunctional.
As a result of lowered Medicare reimbursements, for example, more doctors will now be denying care to our seniors. The $716 billion that ObamaCare steals from Medicare is the reimbursement funding that is supposed to have gone to Medicare providers. Gone with the re-election of Obama.
For those health providers who are “fee for service,” meaning that patients pay them directly for services without insurance as another intervening element of the transaction, the Obama economic decline has led to high unemployment and, consequently, less customers who can pay fees. Health providers who are small business owners have experienced significant drops in income and the reality that they must pay for office expenses with what would have been personal income. Mental health providers are often in this category, having left insurance-based practices because of the extremely low reimbursement rates by health insurance companies in this specialty area.
Doctoral level mental health providers could once have a successful business because many patients preferred to pay them privately to protect themselves from having a mental health diagnosis on their health insurance records. However, with so many Americans out of work, many fee-for-service practices are barely surviving. With the new rules and regulations of ObamaCare, most will close.
The fact is that the costs of complying with all the ObamaCare regulations makes it difficult to sustain doctor-owned practices. With the government now mandating that doctors use electronic records, so that information is easier to share, the costs to implement the requirements will belong to health providers.
Under ObamaCare, many, if not most, doctors will be forced into hospital employment or Accountable Care Organizations (ACO). That means they will no longer be their own bosses, no longer make the decisions about their individual practices and, consequently, no longer have the same level of responsibility for the health care that is delivered. As we have seen in most bureaucratic systems that are reliant upon the government in some way, the buck always stops someplace higher up.
Perhaps some doctors will like being a “company man or woman,” because they won’t have to worry about complying with all the new ObamaCare regulations and administrative issues in their own practices. Instead, they can just show up, treat healthcare problems, collect a salary, and let someone else worry about the business end of it.
Like other small businesses, doctor-owned businesses are facing a forceful blow. Health care business owners can either spend all the money and time required to comply with ObamaCare -- money and time taken away from their personal incomes and further investment in their business practices -- or close up shop and become just another health care worker on the assembly line that is life.

Medicaid verse Medicare, and Obamacare closing access and hospitals!

Record 70.4 Million Enrolled in Medicaid in 2011: 1 Out of Every 5 Americans By Matt Cover November 9, 2012   (CNSNews.com) – A record 70.4 million people were enrolled in the Medicaid health care program for the poor in fiscal year 2011, according to government figures provided to CNSNews.com. That figure equals about 22 percent of the population, which means there was one person on Medicaid for every 5 Americans in 2011. The record number of Medicaid enrollees in 2011 – the earliest year for which figures are available – is a count of all persons enrolled in Medicaid for any part of that year, providing the fullest and most accurate count of the size of the entitlement program. (The federal fiscal year in 2011 ran from Oct. 1, 2010 to Sept. 30, 2011.) Figures provided to CNSNews.com by the Centers for Medicare and Medicaid Services (CMS), the agency that oversees the two health care entitlements, reveal an ever-expanding Medicaid program. From 2005 to 2011, total enrollees grew by more than 10 million people, going from 60.1 million in 2005 to 70.4 million in 2011. Medicaid is the joint federal-state health care program for the poor that allows states to extend coverage beyond those who are in poverty. Recently, the ObamaCare health reform law expanded Medicaid eligibility to those living on 133 percent of the federal poverty level. The poverty level annual income for a family of four is $23,000 – 133 percent of that, in terms of annual income for a family of four, would be $30,590. That expansion does not go into effect until 2014, however, and therefore does not affect the continued growth trend. Nor does it contribute to the record 70.4 million Americans enrolled in Medicaid.   According to CMS statistics, Medicaid has been growing rapidly since 2008, going from 62.8 million total enrollees to 70.4 million in 2011. Prior to 2008, Medicaid rolls had remained relatively stable, going from 60.1 million in 2005 to just 60.9 million in 2007. While Medicaid rolls would be expected to rise during a recession, as they did in 2008 and 2009, the last recession ended in June 2009 and Medicaid rolls have expanded faster than during the 2005-2008 period. Medicaid rolls have grown by 5.2 million Americans since 2009 – when the recession ended and the economy began to grow again slightly. Despite a period of modest gains in employment and economic growth, Medicaid rolls have grown to their record high of 70.4 million Americans.Medicare reimbursement is already low, and Obamacare will decrease this reimbursement rate by another 15% to 40%. The effect will be many physicians and health systems will limit their number of Medicare patients seen. Worse yet…health systems will be forced to drop Medicare patients! A second effect will be hospitals located in areas populated by a high percentages of Medicare patients then be forced to shut their doors (close)!   Then there is Medicaid! Just check out how badly Medicaid pays physicians and hospitals for services rendered:
How much each state pays doctors for Medicaid primary care services compared to Medicare rates.
State	Pct. of Medicare Rates
AL	70%
AK	125%
AZ	86%
AR	69%
CA	43%
CO	77%
CT	72%
DE	98%
DC	94%
FL	50%
GA	70%
HI	59%
ID	91%
IL	53%
IN	55%
IA	76%
KS	82%
KY	72%
LA	76%
ME	64%
MD	74%
MA	70%
MI	51%
MN	47%
MS	90%
MO	57%
MT	102%
NE	76%
NV	71%
NH	62%
NJ	50%
NM	85%
NY	51%
NC	86%
ND	141%
OH	60%
OK	95%
OR	74%
PA	56%
RI	33%
SC	79%
SD	76%
TX	62%
UT	66%
VT	83%
VA	75%
WA	72%
WV	71%
WI	61%
WY	104%
US Avg.	61%
Source: The Urban Institute, 2010 figures.