Monday, March 26, 2012

Undoing Obamacare! What's in it for Physicians!


By: Carrie Lukas is the managing director of the Independent Women’s Forum

Obamacare isn’t just bad policy; it’s also a lost opportunity to advance positive health-care reforms. This is a critical point for the public to understand as the Supreme Court considers Obamacare’s constitutionality, and as we begin a presidential election in which the future of the health-care system will be a central issue.

The debate isn’t between Obamacare and the status quo. No one thinks our current system is optimal. It’s inefficient and costly, it encourages the over-consumption of care, and it unfairly disadvantages those who don’t receive insurance through their employer. The question is which direction we should go. Should we follow Obamacare’s path of greater government control or find a different way to encourage greater efficiency, control costs, and improve outcomes?

If Obamacare is struck down or repealed, policymakers should move quickly to reform our health-care system in a way that returns the control of resources to individuals and creates a more competitive health-insurance marketplace. For starters, they should equalize the tax treatment of individual and employer-sponsored health insurance.

But to really reform our medical system, policymakers will have to tackle Medicare, because it shapes the medical system as a whole. Congressman Paul Ryan and Senator Ron Wyden have laid out a blueprint reforming Medicare that would be a giant leap in the right direction.

Let’s hope that Obamacare is quickly laid to rest so we can begin the important national conversation about these next steps.
The second article you should read follows:

— Thomas P. Miller is resident fellow at the American Enterprise Institute.

Repealing Obamacare is necessary to preserve individual liberty, maintain limited government, improve health care, and restore economic growth. Prospects for doing so hinge on a half-dozen key battle fronts, and success thereafter hinges on several, if not all, of them.

Legal: The Supreme Court could overturn the entire Affordable Care Act later this year as unconstitutional. That’s possible, but not likely. But even a partial victory — simply nullifying the individual mandate — would unravel the political glue that holds this unwieldy and unworkable law together. Congress would have to fix or replace whatever remained.

Political: It will take a new president to sign any law to repeal Obamacare, let alone replace it with better health policy. This November’s elections also will determine whether Obamacare opponents regain working control of the Senate.

Legislative: Fully repealing the entire health-care law would require 60 votes in the Senate. But a budget-reconciliation measure could remove its essential features (“debone it”) with only a narrow majority in both houses of Congress.

Administrative: Obamacare’s complex wiring for implementation could short-circuit on its own and threaten to crash most of the health-care system. Many states are refusing to submit to federal command and control. Imaginary structures and lab experiments (health exchanges, real-time income information, Washington-created “innovations”) won’t be ready for prime time. By necessity, we will have to build something else that is effective, cheaper, and sustainable.

More appealing alternatives: The time to fill in a “replace” agenda is long overdue. Good Ideas Exist, but they need to move from the imaginary to the practical stage and hang together as a whole.

Timing: Repeal-and-replace needs to happen before new subsidy dollars under Obamacare start flowing to millions of Americans in 2014. Our future health and prosperity can’t afford further doses of toxic medicine for another four years.


Monday, March 19, 2012

More and More American Physicians oppose Obamacare!

From Rasmussen Reports.

Seems as Americans and Physicians learn more about Obamacare the more they do not like it!


Monday, March 19, 2012
The U.S. Supreme Court will hear arguments on the constitutionality of the national health care law next week, and the number of voters who Strongly Support the law’s repeal is now at an eight-month high.
The latest Rasmussen Reports national telephone survey of Likely U.S. Voters shows that 56% at least somewhat favor repeal of the health care law, including 46% who Strongly Favor it. Thirty-nine percent (39%) oppose repeal, with 29% who are Strongly Opposed. (To see survey question wording, click here.)
The survey of 1,000 Likely Voters was conducted on March 17-18, 2012 by Rasmussen Reports. The margin of sampling error is +/- 3 percentage points with a 95% level of confidence. Field work for all Rasmussen Reports surveys is conducted by Pulse Opion Research, LLC.

Monday, March 12, 2012

Obamacare means the patient will not see the underpaid overworked Physician!


By MikeNV from the Hubpages.
Where are all the Doctors?

If you don’t pay the Doctors a “Market Rate” they will NOT perform the services. ObamaCare will have disastrous results for seniors and the poor. The very people the plan is supposed to help will be hurt the most.

Studies by the American Medical Association (AMA) and the Center for Studying Health System Change (HSC) suggest that further cuts might impede access to doctors and reduce the quality of seniors' care. According to a survey by the AMA, many physicians already limit seniors' access to their services. Almost 30 percent of physicians limit the number of new Medicare patients they will accept - or do not accept Medicare patients at all. Low physician reimbursement rates may also reduce the quality of medical services seniors receive. For instance, the AMA found that physicians in general have reduced the time they spend with each patient. Nationally, approximately two-thirds of physicians surveyed (65.2 percent) either spend less time with patients during a visit or squeeze more visits into each workday. Many are also referring difficult cases to other physicians or specialists rather than caring for the patients themselves. None of these actions are in patients' best interest. – NationalCenter for Policy Analysis (2002)

This study was done in 2002, and the consensus was clear. Doctors are walking away from Medicare patients and fast! Now under ObamaCare they are proposing another 20% cut in Physician Pay. If you are poor or elderly and dependent on Government Health Care you are in for a very sad and rude awakening. You may not be able to find a specialist willing to treat you. While Obama is off to his $4,000 a night Hawaiian Get-away Americans are left with a bewildering cost laden albatross that will only drive the stake into the hearts of the elderly and poor.

What would you do if your boss walked into your office today and told you that they were cutting your pay by 20%?

Would that go over well with you? Probably not. But that is exactly what is going to happen to Medicare Reimbursements under Obama Care.

The Congressional Budget Office predicts the bill will reduce deficits by $130 billion over the next 10 years, an estimate that assumes lawmakers carry through on hundreds of billions of dollars in planned cuts to insurance companies and doctors, hospitals and others who treat Medicare patients.

There is some real cockeyed logic in the “savings” statement. “Assuming”… when has the Government ever cut costs on anything? How does adding $1 Trillion in costs result in $130 Billion in savings?

Do you see any logic in creating a health care plan that penalizes Doctors who are already undercompensated by Medicare? What Doctor in their right mind is going to see any patient after they find out they have Medicare? And for those few that do what kind of “care”do you think their patients will receive? This is just insane to even suggest. Doctors are people and why should they bear the burden, while the insurance companies pile on the profits?

Providing health care insurance for 39 million aged and disabled persons, Medicare cost an estimated $222 billion in 2000, a 3% decline over 1999.Of this $222 billion, $33.1 billion (15%) was spent on physician services.Medicare has two parts: Parts A (hospital insurance) and B (medical insurance). Part A is financed primarily by payroll taxes (1.45% of a wage paid by employer combined with 1.45% paid by employee) and is premium free for nearly all beneficiaries. Approximately 25% of Part B is financed by monthly premiums ($50 per month) paid by beneficiaries and the remainder from general federal revenues.

This results in per insured cost of $5,692 of which the insured pays $600 per year. If the insured is hospitalized they pay $792 up front and if the stay extends beyond 60 days they are responsible for $198 per day, and $396 per day after day 90. Realistically long term hospital stays are not very common.

Part B of Medicare for medical insurance is a 80/20 copay where the insured is responsible for 20% of the costs of physician visits.

This is just background information so you can see that there is really nothing special about Medicare. A 65 year old seeking private health insurance would easily pay this amount.

Physician Payment Under Medicare

This is where Medicare gets messy. Physician services are based on a fee schedule, GPCI, and a national dollar conversion factor. The fee schedule is based on “relative value”. The fee has 3 components:

1.    A Physician work component measuring time, skill, and intensity associated with the service provided. This accounts for 54.5%

2.    A practice related expense component that measures average practice expenses. 42.3%

3.    Malpractice expense component that reflects average insurance cost. 3.2%

The general formula for determining total RVUs is: [work RVU x work GPCI] + [practice expense RVU x practice expense GPCI] + [malpractice RVU x malpractice GPCI] = total RVU; payment = total RVU x conversion factor ($38.2581 for 2001).

Each physician service corresponds to a CPT code. There are approximately 9000 numbers, each of which corresponds to a specific physician service. The AMA developed the CPT code and secured a copyright for its protection. (Recently the contract under which the AMA licenses use of the CPT to the government has been placed under scrutiny.) Both the development and subsequent updating of the CPT codes and the RVUs assigned to that code are conducted by the AMA partnered with the CMS.

Physician-related charges are submitted directly to the Medicare carrier. Physicians who accept Medicare recipients have two choices: to accept or reject an assignment from Medicare

See if You can Follow Along with This Scenario

Hypothetically, Patient A makes three office visits this year at $50 per visit. Medicare will only pay for $40 per office visit. If Dr. B accepts the assignment, he/she will bill Patient A $80 for the first two office visits. On the third office visit, Dr. B will bill the Medicare carrier for $40. The Medicare carrier will then send Dr. B a check for $16 (80% of $20 [$20 being the amount over the $100 annual deductible]) and Patient A will be liable for the remainder. If Dr. B does not accept the assignment, Medicare's allowable charges will be 5% less than for participating physicians. In this case, Medicare would only allow for $38 (95% of $40) per office visit. Moreover, Dr. B cannot bill Patient A more than $43.70 (115% of $38) for the office visit even though his/her usual charge is $50. Thus, for the first two office visits, Patient A would pay Dr. B directly. On the third office visit, after recognized annual charges now at $114 ($38 x 3), Patient A would receive a check for $11.20 (80% of $14) from Medicare and would be personally liable for the remainder (total bill up to $131.10 [$43.70 x 3]). Any subsequent physician services used by Patient A during that year would be charged at a rate of 115% above the allowable Medicare service-related charge, with Medicare paying 80% of the charge.

Do you seriously think Doctors are going to put themselves through the expense of hiring staff to follow up on these ridiculously low payments? They would spend more money on Staff than they would be reimbursed for by Medicare. And how are patients supposed to keep track of all this? It’s hard enough to sort through the numbers when you are healthy, nearly impossible when ill. Remember these are senior citizens dealing with this mass of paperwork.

The reality is the system of insurance both private and through Medicare is so complex, time consuming and full of potential for error that medical costs are being eaten by administrative costs at the expense of both Doctors and the Insured. It’s no wonder that many specialists with a reputation in their field have simply chosen not to accept any form of insurance. They will bill and you can submit to your own insurer, but they will not accept the burden of staffing an office to deal with these administrative complexities.

When you cut the Doctors pay, but keep in place an overly complex system of Medicare Requirements what you are doing is effectively shifting the Best Doctors out of the system. I pity anyone who has to deal with Doctors who are willing to accept Medicare.

Obamacare is only going to make the availability to quality health care worse, much worse.

I worked for a couple of years for a Medical Insurance company. I’ve seen the Administrative Overhead first hand from the inside out. People want to give Team Obama a pat on the back or they want to bash him for his spend, spend, spend philosophy. Neither is going to fix anything... and this current "Health Care Reform" Bill is only going to drive up cost and drive down Physician availability.

The Health Care System is overly burdened by Administration and for those who are praising this latest disastrous health care bill… enjoy your socialized medicine.

People with money will continue to pay out of pocket for real health care while you wait in the “I hope I can find a Doctor who is willing to see me line”. Good luck with that.

Some source materials: Medscape.com

Monday, March 5, 2012

Obamacare means 15% to 20% lower incomes for Physicians!


How ObamaCare Will Affect Your Doctor

Expect longer waits for appointments as physicians get pinched on reimbursements.

By Scott Gottlieb

At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.

Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.

Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage.

The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty.

Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan.

Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals.

The 60% of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. But it also includes tens of thousands of primary-care doctors, the very physicians the Obama administration says need the most help.

Doctors will consolidate into larger practices to spread overhead costs, and they'll cram more patients into tight schedules to make up in volume what's lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists.

Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice.

These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves.

So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy.

But while Medicare has stumbled with these efforts, private health plans have made notable progress on similar payment reforms. Private plans are more likely to lead payment reform efforts because they have more motivation than Medicare to use pay as a way to achieve better outcomes.

Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level.

Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care; or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes.

There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients.

Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans.

There are also measures available that could fix structural flaws in our delivery system and make coverage more affordable without top-down controls set in Washington. The surest way to intensify flaws in the delivery of health care is to extend a Medicare-like "public option" into more corners of the private market. More government control of doctors and their reimbursement schemes will only create more problems.

Dr. Gottlieb, a former official at the Centers for Medicare and Medicaid Services, is a fellow at the American Enterprise Institute and a practicing internist. He's partner to a firm that invests in health-care companies .