Tuesday, May 29, 2012

Physicians and Patients beware!!! Across-the-board Medicare pay cut of 29.5% from taking effect in January



By Charles Fiegl, amednews staff. Posted July 18, 2011.

Medicare proposes a 50% cut for some imaging fees in 2012

Rates would be reduced for interpreting multiple advanced imaging scans performed on a patient during the same visit.

Washington -- As physicians try to stop an across-the-board Medicare pay cut of 29.5% from taking effect in January, the Centers for Medicare & Medicaid Services is proposing additional pay reductions for certain specialists and penalties for those who fail to prescribe electronically next year.

The proposed 2012 physician fee schedule released July 1 paints a gloomy picture for doctors participating in Medicare. CMS is required by statute to implement the across-the-board cut unless Congress steps in to prevent it. But the agency also would expand its multiple procedure payment reduction policy to physicians who interpret the results of certain advanced diagnostic imaging scans.

CMS already reduces what it pays for the technical component of the procedures when multiple scans are provided to the same patient on the same day. Now the agency is proposing to extend the reduction to the professional component, which would affect rates for the doctors interpreting the images. So a physician who interprets more than one MRI or CT scan taken of the same patient during the same visit, for instance, would see a 50% reduction in pay for interpreting the second and any subsequent scans.

The proposal extends a multiple procedure policy that already has been applied to certain surgical and therapy services, and CMS might not stop there. The agency has said that money that is saved by reducing rates for overvalued services helps boost pay for primary care and other services that it considers undervalued.

The latest imaging cut proposal prompted a strong reaction from radiologists. Many CMS pay revisions are first approved by Congress or recommended by a rate review panel convened by the AMA, but not in this case.

Doctors must e-prescribe at least 10 times in the first 6 months of 2012 to avoid a penalty in 2013.

"This is a bold attempt by CMS to reduce physician payments without specific authorizing legislation, and to usurp the function of the AMA Relative Value Update Committee without any supporting evidence," said John A. Patti, MD, chair of the American College of Radiology Board of Chancellors. "If this proposal is allowed to stand, eventually all physicians will be affected, and physicians will not be properly compensated for the work they do."

There are a number of examples of how the pay reductions would go too far, including complex cases where the patient is badly injured, Dr. Patti said. For instance, a physician would receive less pay for doing the same amount of work when interpreting separate CT scans of the head, neck, chest, abdomen and pelvis of a trauma patient.

"There is published evidence to support a payment reduction of 3% to 5%, but there is no evidence to support a reduction of 50%," he said.

Not every specialty that provides imaging services would be affected equally. The services that CMS plans to cut, for instance, are not commonly provided by cardiologists, said Brian Whitman, associate director of regulatory affairs for the American College of Cardiology. However, cardiologists are concerned that the agency will expand the policy to all diagnostic imaging, he said.

CMS does warn in the proposed fee schedule that physicians interpreting multiple x-rays and ultrasounds for the same patient visit may receive reduced payments, possibly starting in 2013. Diagnostic services offered by certain specialties, such as cardiology, also could see payment reductions when the technical component of a test is billed at the same time as another service.

The CMS proposal on imaging mirrors some of the advice of the Medicare Payment Advisory Commission. The AMA has disagreed with that approach and suggested the policy would compromise care.

A 29.5% Medicare pay cut for physicians is scheduled for January 2012.

The AMA is reviewing the 621-page proposed fee schedule, said AMA President Peter W. Carmel, MD. But statutory payment policy outlined in the rule shows Congress must act to fix a flawed pay system, he said.

"Many physicians are already struggling with inadequate Medicare payment rates and the ongoing threat of future cuts from the broken Medicare physician payment system," Dr. Carmel said.

The Association has recommended that CMS use its regulatory authority to review and revise the Medicare Economic Index used to calculate physician practice expenses. Revisions to the MEI could reduce the cost to Congress of a permanent replacement to the Medicare payment formula, Dr. Carmel said.

In the proposed fee schedule, CMS said it would apply a similar approach used this year to implement Medicare electronic prescribing penalties in future years, meaning doctors must e-prescribe in 2012 to avoid a 1.5% penalty in 2013.

An eligible professional would need to report at least 10 e-prescribing transactions during the first six months of next year to avoid the penalty. However, CMS would allow physicians to report e-prescribing activity during any patient encounter in 2012. Current program policy limits eligible e-prescribing encounters to certain services, such as office visits.

Physicians who earn bonuses for e-prescribing this year would not be subject to the 2013 penalty. Doctors who earn bonuses for e-prescribing in 2012 also would not be penalized in 2014, when the pay cut rises to 2%.

Wednesday, May 23, 2012

More and more physicians are not accepting new Medicaid and Medicare patients (Can't afford it)!


More Doctors report they cannot afford to take new Medicaid and Medicare Patients!

By Caroline May - reporter for The Daily Caller.

H/T Daily Caller

Thirty-six percent of doctors say they are no longer accepting new Medicaid patients due in large part to declining reimbursements, a new national survey has found.

The survey of 2,232 physicians across all specialties conducted in late April by Jackson Healthcare in Atlanta — the fourth-largest health care staffing company in the U.S. — further found that broken down for specialty, 66 percent of dermatologists, 64 percent of endocrinologists, 58 percent of internists, 57 percent of physical medicine and rehabilitation doctors and 53 of adult psychiatrists said they are no longer able to take on more Medicaid patients.

Other specialties in the survey with a high percentage of doctors who reported stopping accepting Medicaid patients include orthopedic surgeons (50 percent), family practitioners (45 percent), gastroenterologists (47 percent), neurologists (43 percent), cardiologists (39 percent) and urologists (35 percent).

Currently 26 percent of physicians see no Medicaid patients at all, the survey reported.

According to the Kaiser Commission on Medicaid and the Uninsured, under the Patient Protection and Affordable Care Act (the constitutionality of which is currently under consideration at the Supreme Court), Medicaid enrollment could increase by 22.8 million by 2019.

According to Richard L. Jackson, chairman and CEO of Jackson Healthcare, the low reimbursement rate paired with the large influx of new Medicaid patients will be a problem.

“This is creating the perfect storm that will make it very difficult for the poor and elderly to access a doctor,” Jackson said. “Physicians say they just can’t afford to be part of a system that generates so many patients for so little compensation.”

The survey further noted that 17 percent of physicians said they could no longer afford to see new Medicare patients and 10 percent reported not seeing Medicare patients at all.

Sunday, May 13, 2012

Obama care is sickening patients, and making physicians poor!

H/T Town Hall
Physicians agree Obamacare is bad for the practice of medicine, and will shut down non-health system owned practices. Obamacare means bye-bye private practice, and hello employed practices. When Obamacare is struck down look for physician salaries and working conditions to increase!
Obamacare and The Supreme Court – the Clinical Perspective


Once again, everyone is talking about healthcare, largely thanks to the historic events which took place in the Supreme Court last week. The public has been showered with speculation about what will happen if the mandate is struck down, or if the entire law is overturned or if the law remains intact. Although this is a quintessential legal affair, it is curious that once again, those most closely enmeshed in the trappings of this conundrum- the physicians who deliver healthcare- don’t seem to have a voice, so as if to imply that they are insignificant bystanders.

Most physicians now agree that Obamacare will not help them care for patients any better than before its passage and will instead harm them. The architects of this law brilliantly front loaded it with “goodies” that make it popular with many Americans. Keeping “kids” on your health insurance until they are 26 or preventing insurance companies from dropping patients with pre-existing conditions can make people forget that the cost of a family health insurance policy has risen on average by $2100, not dropping $2500 as promised by President Obama. The promise of “free preventive health screenings” should concern everyone, because unfortunately, Americans will once again learn that there is no such thing as “free”. There is a cost attached to everything, especially healthcare.

Most doctors might think it reasonable if everyone had healthcare insurance, but that is not what Obamacare is about. The essence of this law is that every American must purchase a health insurance policy that the Federal government approves of. That means that the government defines what is in the policy, what will be covered and what will not, and who will be allowed to deliver that care and under what circumstances.

The legal argument that has become the foundation for the defense of the individual mandate is that there is cost shifting, which is created when uninsured individuals show up in the emergency room for care. The contention is that we all pay for this, and that universal coverage will put an end to this problem.

The irony is that Obamacare itself is an elaborate cost shifting scheme. It shifts $500B out of Medicare to pay for the 159 new federal bureaucracies that have been created under this law. The 80 million people who are going to be put on Medicaid will shift costs to the 50% of Americans who still pay taxes and will absorb the healthcare costs of those who pay nothing. Obamacare is an income redistribution scheme.

The tenor of the proceedings in the Supreme Court last week creates hope amongst physicians that Obamacare will be overturned. Anything short of that will fail to halt the events currently underway that are eroding the foundations of the medical profession. Built into Obamacare is reduced compensation for physicians, increased regulation, unrealistic demands, and no relief from medical liability abuse.

All actions always have consequences- whether intended or unintended. The result of Obamacare will be less doctors working, which means that the guarantee of increased access to healthcare is a false promise. Your insurance card will only provide a place in line. It means that the Patient Centered Outcomes Research Institute will decide what treatment you will get. It means that the Secretary of Health and Human Services will tell your doctor how to practice medicine.

On this current path, the private practice of healthcare will disappear within the next 10 years, as physicians sell their practices to hospitals, afraid that they can no longer afford to stay in business. More than 50% of doctors now work for hospitals. Obamacare suspends antitrust regulations so that hospitals can consolidate doctors’ practices into a single entity- an accountable care organization (ACO). Under such an arrangement, the doctors work for the ACO and not for the patients.

There already are rumblings coming from Washington suggesting that physician licensure needs to be nationalized in an attempt to compel doctors to see patients on Medicare and Medicaid and avert the mass exodus that is expected when reimbursement rates are slashed in the coming years.

Most doctors still believe that there is some hope for them and for their patients. This would require a Republican President, Senate and House of Representatives, and a repeal of Obamacare. The prospect of a helping hand from the Supreme Court is something that was not counted upon, but which would be most welcome.

Dr. Hal Scherz is the founder and president of Docs4PatientCare and organization of physicians dedicated to protecting the doctor patient relationship

Monday, May 7, 2012

Physicians for Healthcare Savings Accounts! Physicians should embrace Health Savings Accounts!


Health savings accounts should replace Obamacare, and let the market replace the today’s system. Good physicians could charge more, and not so good Doctor’s would have to ask for less. The free market makes the cream rise to the top in both results, and charges. Physicians would like the system because collections would rise to near 100% (if you exclude Medicare and Medicaid), and that’s a good thing!

  

AMA Offers Health Savings Accounts for Physicians

From the Louisiana Medical News



By: BY SHARON H. FITZGERALD


The American Medical Association (AMA) is helping physicians take advantage of the savings and flexibility of health savings accounts (HSAs).

The newest offering from the AMA Insurance Agency is an alternative to traditional health insurance for both personal and practice health protection needs.

"The AMA, largely through its advocacy efforts, was a major player in getting HSAs their legs in January 2004. Then, when HSAs actually became a viable product, since the AMA is such an advocate of patient choice in healthcare, we thought, 'Why wouldn't we want to do that for physicians, since it's good for everybody?' " Christopher Burke, president of AMA Insurance Agency, recalled. The agency is an AMA wholly-owned subsidiary, founded in 1988 with a portfolio that has grown dramatically through the years. Today, the agency partners with approved major carriers to offer physicians disability, long-term care, Medicare supplements, a Medicare-approved prescription drug plan and a host of other health offerings, plus insurance in other categories such as life insurance and property and casualty.

For the new HSA coverage, the AMA agency partners with First HorizonSM Msaver, Inc. Msaver has had a long history of offering medical savings accounts (MSAs), the first generation of such tax-saving accounts for healthcare. When First Horizon acquired Msaver in 2005, it brought to the table "the savings component and the technology platform that the bank provides to make it easy for people to deposit into the account, get the account set up, take money out to pay for qualified expenses and track those expenses," Burke explained. "The banking experience, I think, is really what's making this much more viable for people today." He explained that the AMA agency's role to provide physicians with "a little bit more of a concierge service," while taking advantage of First Horizon Msavers' expertise in the HSA field.

HSAs were created in Medicare legislation signed into law by President Bush on Dec. 8, 2003. They took effect in January 2004, replacing MSAs with a program offering additional tax advantages.

"When the tax code changed, the government really began to embrace HSAs as a way to self-direct healthcare choices, and they wanted to provide tax incentives for people to begin experimenting with this as a concept," Burke said.

To launch an HSA, the insured must already be covered by a high-deductible health plan which insures against catastrophe. First Horizon Insurance Services, an affiliate of First Horizon Msaver, offers the high-deductible health plans from several highly rated insurance companies.

Contributions into the tax-deferred HSA account are used to pay qualified medical expenses, and the HSA takes the form of a tax-exempt trust or custodial account for tax purposes. What's interesting is that some qualified expenses of an HSA — all tax-free — are not typically covered by traditional health insurance plans, such as dental, vision, orthodontics, prescription drugs and long-term care. Unused funds in an HSA can roll over from year to year, earning interest on a tax-free basis.

Both individuals and employers may set up and fund an HSA, and contributions can be made on a pretax or tax-deductible basis. HSAs offer flexibility and portability because even if the employer also contributes to an individual's HSA, the employee owns the account and can take it with him or her should employment cease. HSAs can be for one person or for families.

Burke said he believes HSAs offer particular advantages to physicians, their families, their associates and employees, and their practices' bottom lines. "Physicians are already dealing with this fabric of healthcare. Physicians obviously are providing quality, cost-effective care to themselves and their families and very often to their practice associates and their families," he said, surmising that routine healthcare within a practice is handled very cost-effectively.

"Why wouldn't you want to tailor your medical insurance program to that care experience? So you've got a program permitting people to save money on a tax advantage by creating a savings account for routine care, and if they don't spend it, it remains in there as a tax-deferred benefit that they can spend in future years or just save," he said. "Then you've got the high-deductible health plan that is there for any serious, unforeseen, major medical problem that protects you from personal bankruptcy, so it's an interesting combination."

Burke said the AMA Insurance Agency is starting to see more physicians offer HSAs as an employee benefit option while also offering a traditional health plan.

"An HSA may not be for everybody. It's a new concept, so it tends to be a little scary for some folks who are very used to traditional base plans. You don't want to force your associates into it, but you may be able to ease them into it via this sort of a combination plan," he explained.

About 150 HSA policies were written by the AMA agency in the last few months of 2006, "but we have not yet taken the huge step into the group practice environment," Burke said.

"We just began this fall to pilot a few programs to do that," he said. "We've seen some concepts that we've put out there begin to work. Typically within the group practice, it's going to be a matter of connecting with an insurance agent who's already working with that group practice and talking with that individual, because they trust that person for their health insurance needs. It's pretty difficult for us sitting here in Chicago to coach physician practices, especially with their group practice managers, unless you're face to face. So we began to experiment with some in-the-field experience this fall, and we'll see where that goes. But I think it's a really, very interesting program for practices, especially as they're being squeezed with their financials."

The first step, Burke said, is acquiring the high-deductible health plan, which then makes the physicians eligible for the HSA.

"I think doctors are starting to embrace it more as a concept for them and their practices as its really taken root and become a viable product on these banking platforms," he said.