Thursday, March 28, 2013

Physicians wise up, and they “NO” to patient’s “free” access to their Electronic Medical Records


In my opinion (and since it’s my blog that’s what you get) patients should not be given free access to their medical records! Why? Because there is a certain group of patients that would hang on every word and every diagnosis entered into the record. I could imagine a patient taking up an entire morning as they attempt to have their doctor to change a few words, so that they (the patient) could run over to the Social Security office, and get on DISABILITY. Physicians are busy enough without having to defend their trained medical opinion every time a malcontented patient is looking to bilk the system!

 

Electronic Health Records: Doctors Want to Keep Patients Out

The emergence of electronic medical records has left many patients wanting access to their own health information. But a new Accenture survey shows that many doctors don't think it's a good idea for patients to see their records.

By Jeffrey Kopman, Everyday Health Staff Writer



TUESDAY, March 26, 2013 — According to a new Harris Poll survey, conducted on behalf of the management consulting firm Accenture, less than one-third of U.S. doctors think patients should have full access to their own electronic health records.

As a patient, you may literally trust your doctor with your life, and the doctor-patient relationship relies on this level of trust. The  relationship should be one of give and take, even if the exchange is sometimes dominated by the professional.

So it may come as a surprise that 65 percent of docs believe their patients should have only limited access to their electronic health records, and 4 percent believe patients should have no access at all.

One thing is clear — patients believe electronic medical records improve their care. According to a 2011 survey, conducted by GfK Roper on behalf of Practice Fusion, a San Francisco-based electronic health record provider, 78 percent of patients whose doctors kept electronic medical records felt that their care improved.

"Patients want their healthcare to reflect the fact we're in the 21st century," said Ryan Howard, CEO of Practice Fusion. "They want to have prescriptions sent electronically, to receive email appointment reminders and to review past diagnoses and upcoming appointments online." 

“Several US health systems have proven that the benefits outweigh the risks in allowing patients open access to their medical records, and we expect this trend to continue,” said Mark Knicrehm, senior global managing director of Accenture Health, of the poll’s results.

While a majority of doctors in the Accenture survey wouldn’t trust patients with full access to their records,  81 percent said they wanted their patients to keep the records up to date, which may seem like a disconnect.

Primarily, though, the doctors are referring to updating personal information, not medical information. Almost all doctors polled think patients should update their own demographic information (95 percent), family history (88 percent), medications (86 percent), allergies (85 percent), and even some medical information, like new symptoms and self-administered test results (81 percent).

There seem to be few disadvantages to giving patients access to records and some real advantages, according to experts and commentators. So why do many doctors feel that their patients should not have full access to their electronic medical records? 

Stephen Baker, author of The Numerati blog, wrote that patient sensitivity may be to blame for doctors' unwillingness to share medical records.

“This would not be a problem if we, as a society, weren't so hypersensitive to 'hurtful' words, and eager to sue in cases of errors,” Baker stated on his blog

He used an example of a doctor speculating about his or her patient being the victim of abuse. While the patient might be offended on reading this information in their electronic medical record, the doctor might feel that it's important to document their observations. Baker concluded, “if we want the data, we should be ready to see and accept it, even when offensive. This openness would pay off richly.”

Thomas J. Vento, MD, a family doctor in private practice in Reisterstown, Md., sees the benefits of open access to medical records, because patients can help prevent medical errors.

"It’s a great idea to give your family doctor a copy to keep in his file, but it’s also very important to have your own copy of the health journal in case of a medical emergency," Dr. Vento said. "Being an active voice in health care is an integral part of getting the best care you can for yourself and your children."

After a 2012 study found that doctors failed to read many test results when patients were discharged from hospitals, experts claimed that electronic records could help "prevent important information from falling through cracks."

"[This] problem could be solved with electronic medical records that keep track of test results and alert doctors when the results have not been reviewed," said Gordon Schiff, MD, associate director of the Brigham Center for Patient Safety Research and Practice, at the time. "Patients also can play a role by keeping track of their tests and asking their doctor about the results."

As doctors and medical institutions continue to switch to electronic medical records, and patients demand more access, the debate will continue: How much information should patients have access to?

Wednesday, March 27, 2013

Obamacare will increase insurance premiums, but physicians will not be reimbursed at higher rates...so where is the money going?


I have a question; If physicians are not being paid (reimbursed at higher rates for services)…Then who gets the extra money being forced into the system?

Study estimates Obamacare could raise individual claim costs 32 percent

 

Actuaries groups offers sobering look at the rising costs for individual insurance coverage plans under Obama health law

UPDATED 22:58 PM EDT, March 26, 2013 | BY John Solomon

One of the nation's premier experts in numbers has a tough diagnosis for President Barack Obama's health care law.

In a report that could prove a big political headache for the administration, the Society of Actuaries estimated Tuesday that insurers will have to pay out an average of 32 percent more for claims on individual health policies under the Affordable Care Act, a cost likely to be passed on to consumers.

While some areas will see declines in medical claims costs, the report predicts the majority of states will see double-digit increases in their individual health insurance markets, where people purchase coverage directly from insurers rather than get coverage from employers.

By 2017, the estimated increase would be 62 percent for California, about 80 percent in Ohio and Wisconsin, more than 20 percent for Florida and 67 percent for Maryland. Much of the reason for the higher claims costs is that sicker people are expected to join the pool, the report said.

The report did not make similar estimates for employer plans, the mainstay for workers and their families. That's because the primary impact of Obama's law is on people who don't have coverage through their jobs.

The report also predicts the law will reduce the number of Americans without health insurance from 16.6 percent to between as low as 6.6 percent after three years.

The Associated Press has a good summary of the debate the report generated. Here's what AP had to say:

The administration questions the design of the study, saying it focused only on one piece of the puzzle and ignored cost relief strategies in the law such as tax credits to help people afford premiums and special payments to insurers who attract an outsize share of the sick. The study also doesn't take into account the potential price-cutting effect of competition in new state insurance markets that will go live on Oct. 1, administration officials said.

At a White House briefing on Tuesday, Health and Human Services Secretary Kathleen Sebelius said some of what passes for health insurance today is so skimpy it can't be compared to the comprehensive coverage available under the law. "Some of these folks have very high catastrophic plans that don't pay for anything unless you get hit by a bus," she said. "They're really mortgage protection, not health insurance."

A prominent national expert, recently retired Medicare chief actuary Rick Foster, said the report does "a credible job" of estimating potential enrollment and costs under the law, "without trying to tilt the answers in any particular direction."

"Having said that," Foster added, "actuaries tend to be financially conservative, so the various assumptions might be more inclined to consider what might go wrong than to anticipate that everything will work beautifully." Actuaries use statistics and economic theory to make long-range cost projections for insurance and pension programs sponsored by businesses and government. The society is headquartered near Chicago.

Kristi Bohn, an actuary who worked on the study, acknowledged it did not attempt to estimate the effect of subsidies, insurer competition and other factors that could mitigate cost increases. She said the goal was to look at the underlying cost of medical care.

"Claims cost is the most important driver of health care premiums," she said.

"We don't see ourselves as a political organization," Bohn added. "We are trying to figure out what the situation at hand is."

On the plus side, the report found the law will cover more than 32 million currently uninsured Americans when fully phased in. And some states — including New York and Massachusetts — will see double-digit declines in costs for claims in the individual market.

Uncertainty over costs has been a major issue since the law passed three years ago, and remains so just months before a big push to cover the uninsured gets rolling Oct. 1. Middle-class households will be able to purchase subsidized private insurance in new marketplaces, while low-income people will be steered to Medicaid and other safety net programs. States are free to accept or reject a Medicaid expansion also offered under the law.

Obama has promised that the new law will bring costs down. That seems a stretch now. While the nation has been enjoying a lull in health care inflation the past few years, even some former administration advisers say a new round of cost-curbing legislation will be needed.

Bohn said the study overall presents a mixed picture.

Millions of now-uninsured people will be covered as the market for directly purchased insurance more than doubles with the help of government subsidies. The study found that market will grow to more than 25 million people. But costs will rise because spending on sicker people and other high-cost groups will overwhelm an influx of younger, healthier people into the program.

Some of the higher-cost cases will come from existing state high-risk insurance pools. Those people will now be able to get coverage in the individual insurance market, since insurance companies will no longer be able to turn them down. Other people will end up buying their own plans because their employers cancel coverage. While some of these individuals might save money for themselves, they will end up raising costs for others.

Part the reason for the wide disparities in the study is that states have different populations and insurance rules. In the relatively small number of states where insurers were already restricted from charging higher rates to older, sicker people, the cost impact is less.

"States are starting from different starting points, and they are all getting closer to one another," said Bohn.

The study also did not model the likely patchwork results from some states accepting the law's Medicaid expansion while others reject it. It presented estimates for two hypothetical scenarios in which all states either accept or reject the expansion.

Larry Levitt, an insurance expert with the nonpartisan Kaiser Family Foundation, reviewed the report and said the actuaries need to answer more questions.

"I'd generally characterize it as providing useful background information, but I don't think it's complete enough to be treated as a projection," Levitt said. The conclusion that employers with sicker workers would drop coverage is "speculative," he said.

Another caveat: The Society of Actuaries contracted Optum, a subsidiary of UnitedHealth Group, to do the number-crunching that drives the report. United also owns the nation's largest health insurance company. Bohn said the study reflects the professional conclusions of the society, not Optum or its parent company.

___

AP White House Correspondent Julie Pace contributed to this report.

 

Monday, March 25, 2013

Obamacare closes Pittsburgh Area OB/GYN ward! So is starts....


Granted the demographics have changed, and this area of Pennsylvania has seen a decline in the younger population, but there still is enough to keep the OB ward open. Problem is that hospitals must anticipate budgets, and Obamacare is wreaking havoc on the budget forecasting process.

Southwestern Pa. hospital to stop baby deliveries

WINDBER, Pa. (AP) — A southwestern Pennsylvania hospital will stop delivering babies after March 31 because its obstetricians are either leaving or refocusing their practices, and because hospital officials believe they can't afford it based on projected reimbursements under looming federal health care reforms.

The Windber Medical Center, about 60 miles southeast of Pittsburgh, is losing two obstetricians and two others are shifting their focus more to gynecology.

Hospital officials say the population of women of child-bearing age is dropping and that the number of births the hospital would be called upon to perform isn't enough for it to provide the service in the face of lower reimbursements under the federal Affordable Care Act.

The hospital delivered about 200 babies each year since restarting its obstetrics program in 2005.

Officials aren't sure how many jobs will be lost.

Friday, March 22, 2013

Obamacare demoralizes physicians, and causes many early Doctor retirements!


Of course doctors would want to retire! Twenty years ago the “bean counters” started to take over medicine. The Bureaucrats saw the money, so they came-a-running! Mean whilst… Doctors were doing what they were born to do…make sick people better and well patients stay that way! So now physicians are being squeezed from every direction, and the OUT Door is the last best option!
 
More Docs Plan to Retire Early

Six in 10 physicians said it is likely many of their colleagues will retire earlier than planned in the next 1 to 3 years.

By David Pittman, Washington Correspondent, MedPage Today

WASHINGTON — THURSDAY, March 21, 2013 (MedPage Today) — Most physicians have a pessimistic outlook on the future of medicine, citing eroding autonomy and falling income, a survey of more than 600 doctors found.

Six in 10 physicians (62 percent) said it is likely many of their colleagues will retire earlier than planned in the next 1 to 3 years, a survey from Deloitte Center for Health Solutions found. That perception is uniform across age, gender, and specialty, it said.

Another 55 percent of surveyed doctors believe others will scale back hours because of the way medicine is changing, but the survey didn't elaborate greatly on how it was changing. Three-quarters think the best and brightest may not consider a career in medicine, although that is an increase from the 2011 survey result of 69 percent.

"Physicians recognize 'the new normal' will necessitate major changes in the profession that require them to practice in different settings as part of a larger organization that uses technologies and team-based models for consumer (patient) care," the survey's findings stated.

About two-thirds of the survey responders said they believe physicians and hospitals will become more integrated in coming years. In the last 2 years, 31 percent moved into a larger practice, results found. Nearly eight in 10 believe midlevel providers will play a larger role in directing primary care.

Four in 10 doctors reported their take-home pay decreased from 2011 to 2012, and more than half said the pay cut was 10 percent or less, according to Deloitte. Among physicians reporting a pay cut, four in 10 blame the Affordable Care Act (ACA), and 48 percent of all doctors believed their income would drop again in 2012 as a result of the health reform law.

Other findings:

·        26 percent believe Medicare's sustainable growth rate formula will be repealed in the next 1 to 3 years

·        One in 10 believe medical liability reform will pass Congress in the next 1 to 3 years

·        A quarter of physicians would place new or additional limits on accepting Medicare patients if there were payment changes

·        55 percent of physicians believe the hospital-doctor relationship will suffer as admitting privileges are put at risk to comply with hospital standards of meaningful use

·        31 percent gave the U.S. healthcare system a favorable grade of "A or B" compared with 35 percent in 2011

Despite those pessimistic views, seven of 10 said they were satisfied about practicing medicine, although that number was lower for primary care providers and higher for younger age groups, the survey found. Dissatisfaction was attributed toward less time with patients, long hours, and dealing with Medicare, Medicaid, and government regulations.

Speaking of the ACA, fewer physicians (38 percent in 2012) believe the ACA is a step in the wrong direction compared with 44 percent in 2011. The number who think the law is a good place to start remained the same.

Two-thirds of physicians in the Deloitte survey say they use an electronic health record (EHR) that meets meaningful use stage 1 requirements, but that number has been lower in other surveys. Three in 5 respondents were satisfied with their EHR.

Deloitte mailed the survey to more than 20,000 physicians selected from the American Medical Association's master file. Just 613 returned completed surveys, giving a margin of error of 3.9 percent at the 0.95 confidence level.

 
 
 
 
 
 
 
 
 
 
 

Tuesday, March 19, 2013

The Veterans Administration stop doing, the Army stopped doing, but Obamacare is now going to do it! Group appointments! Get ready for horrible care!


The Veterans Administration and The Department of Defense tried this back in the 1980s. It didn’t work! Patients will not keep the appointments once they figure out they are part of an audience all vying for The Doctor’s affection!

 

Group Appointments With Doctors: When Three Isn't A Crowd

More doctors are holding appointments with multiple patients, a trend some say may help ease a forecasted shortage of physicians.

By Michelle Andrews, Kaiser Health News

TUESDAY, March 19, 2013 (Kaiser Health News) — When visiting the doctor, there may be strength in numbers.

In recent years, a growing number of doctors have begun holding group appointments — seeing up to a dozen patients with similar medical concerns all at once. Advocates of the approach say such visits allow doctors to treat more patients, spend more time with them (even if not one-on-one), increase appointment availability and improve health outcomes.

Some see group appointments as a way to ease looming physician shortages. According to a study published in December, meeting the country's health-care needs will require nearly 52,000 additional primary-care physicians by 2025. More than 8,000 of that total will be needed for the more than 27 million people newly insured under the Affordable Care Act.

"With Obamacare, we're going to get a lot of previously uninsured people coming into the system, and the question will be 'How are we going to service these people well?' " says Edward Noffsinger, who has developed group-visit models and consults with providers on their implementation. With that approach, "doctors can be more efficient and patients can have more time with their doctors."

Some of the most successful shared appointments bring together patients with the same chronic condition, such as diabetes or heart disease. For example, in a diabetes group visit, a doctor might ask everyone to remove their shoes so he can examine their feet for sores or signs of infection, among other things. A typical session lasts up to two hours. In addition to answering questions and examining patients, the doctor often leads a discussion, often assisted by a nurse.

Insurance typically covers a group appointment just as it would an individual appointment; there is no change in the co-pay amount. Insurers generally focus on the level of care provided rather than where it's provided or how many people are in the room, Noffsinger says.

Some patients say there are advantages to the group setting. "Patients like the diversity of issues discussed," Noffsinger says. "And they like getting 2 hours with their doctor."

Patients sign an agreement promising not to disclose what they discuss at the meeting. Although some patients are initially hesitant about the approach, doctors say their shyness generally evaporates quickly.

"We tell people, 'You don't have to say anything,' " says Edward Shahady, medical director of the Diabetes Master Clinician Program at the Florida Academy of Family Physicians Foundation in Jacksonville. Shahady trains medical residents and physicians to conduct group visits with diabetes patients. "But give them 10 minutes, and they're talking about their sex lives."

Though group appointments may allow doctors to increase the number of patients they see and thereby boost their income, many doctors are uncomfortable with the concept, experts say, because they're used to taking a more authoritative approach with patients rather than facilitating a discussion with them.

According to the American Academy of Family Physicians, 12.7 percent of family physicians conducted group visits in 2010, up from 5.7 percent in 2005.

Some studies have found that group visits can improve health outcomes. In an Italian trial that randomly assigned more than 800 Type 2 diabetes patients to either group or individual care, the group patients had lower blood glucose, blood pressure, cholesterol and BMI levels after four years than the patients receiving individual care.

Doctors say patients may learn more from each other than they do from physicians. "Patients really want to hear what others patients are experiencing, " Shahady says.

Jake Padilla of Westminster, Colo., participated in his first group visit more than a decade ago, shortly after he had heart bypass surgery.

Padilla, now 67, continued to attend group appointments geared to primary-care patients' concerns for years after that at the Kaiser Permanente outpatient clinic near his home. (Kaiser Health News is not affiliated with Kaiser Permanente.) He usually went once a month or so, and the members of the group constantly changed.

One woman who attended the group was 102 years old, he remembers. Fellow patients wanted to know how she managed to live that long. One of her secrets, she said, was deep breathing. Padilla has since used that advice when his blood pressure gets out of control.

But group visits aren't for everyone. Padilla's wife, Tedi, went to one meeting with him and never went back.

"She said she didn't have time to sit there and listen to all those patients," he says.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

 

Tuesday, March 12, 2013

Obamacare forces physician salaries down while pitting doctors against administrators, and patients against both!


Obamacare pits doctor against doctor, and doctor against Healthcare administrator, and patient against all of them (and each other), and ...you get the point!
 
Doctors vs. Obamacare: Can your physician simply ‘opt-out’?

Photo: The Washington Times


Adam Frederic Dorin, M.D., MBA

SAN DIEGO, January 17, 2012 — The destruction of quality in the American medical system will not result from one isolated event. Neither the ‘Affordable Care Act’, its restricted pay to physicians, nor even rationed care will immediately tip the scales toward a subpar medical system. Rather, the turn for the worse will take effect as several pieces of the Obamacare puzzle are set into motion over the next few years.

One piece of this puzzle likely to work against the success of Obamacare will be the creation of local managed care ‘medical homes’ called ‘Accountable Care Organizations’ or ACOs. These little fifedoms controlled by local medical community powerbrokers will pit physician against physician, with only hospital administrators and local medical society ‘leaders’ profiting above the fray.

The other piece will be efforts by the government to force physicians to participate in Medicare and Obamacare plans. These Obamacare components raise serious questions as to whether doctors have any rights in the President’s vision for the future of American medicine.

As one astute physician noted to me recently, “doctors in practice need an ‘out’ to protect themselves against the upcoming tsunami.” What he was referring to are forces behind the scenes today attempting to eliminate any obstacles to Obamacare’s future success. Since the new law’s ability to deliver care to tens of millions of additional patients rests on its ability to cut costs, both Medicare and Obamacare reimbursement to doctors will be low.

A basic tenet of Obamacare is to force doctors to take untenable cuts in pay, all the while absorbing overbearing new regulations and mandates with little or no personal recourse. Proponents of the Obamacare law know that they can suffer concessions made in Washington, D.C. as long as the doctors delivering the majority of medical care in towns all across this land are made to heel to the new law’s demands in the end.

Some on the political left have conjured up schemes to tie physician state licensure to participation in Medicare and Obamacare. Others have taken solace in the notion that the regional ACOs themselves will be able to quash any doctor rebellions by simply using their control of the purse strings to withhold or limit how much local money each doctor will be paid for his services.

Unbeknownst to most people in or out of the healthcare arena, however, are the legal options available to physicians to either never enroll in Medicare or to voluntarily withdraw their participation in the government’s plan. The legal nuances of the doctor-Medicare relationship may shed light on options available to physicians to skirt inclusion in Obamacare if the law’s enforcers decide to use a heavy hand in mandating their participation.

Quoting a memorandum by the California Medical Association’s Solo/Small Group Practice Forum delegation on January 9, 2012, physicians became aware of a “bulletin circulated by the American Medical Association [referencing] an email authored by an unidentified Center for Medicare and Medicaid (CMS) employee who stated that a non-enrolled physician who treats Medicare beneficiaries must either involuntarily enroll in Medicare or else provide medical care free of charge. Apparently some embrace conscription of physicians and believe that the federal government can require physicians to work for free.”

The real challenge for physicians today is that they lack true representation by the American Medical Association (AMA). Since the AMA’s membership represents only about 15% of practicing community doctors in America, and since the AMA lost 12,000 member doctors in 2010 alone (and are expected to have lost at least that amount in the year 2011), the AMA has a real credibility problem with the nation’s physicians.

Furthermore, since the AMA publically signed on as a supporter of the Patient Protection and Affordable Care Act (PPACA) with only the implicit blessing of their limited membership, and many local and state AMA-affiliated medical societies remained eerily quiet during and after the contentious health care reform debates, the vast majority of doctors feel the organization betrayed them. America’s doctors need true representation to the public and to their elected representatives. Without proper representation, doctors are looking for ways to simply opt-out of all government health care plans.

Organizations like America’s Medical Society (AMS) have sprung up in the aftermath Obamacare’s passage to help physicians preserve and grow their independent practice of medicine. They believe that doctors have the right to privately contract with patients for their medical treatment.

Patients can seek reimbursement from Medicare by completing form CMS-1490S, which contains the following instructions: “Doctors, providers, and suppliers are required to submit claims to Medicare when providing covered services. You can reduce your out-of-pocket expense by seeing a doctor or supplier that is enrolled in Medicare and bills Medicare for the services provided.” See: https://www.cms.gov/cmsforms/downloads/cms1490s-english-instructions-DME.pdf

Such wording on an official Medicare form, promulgated by the Center for Medicare and Medicaid Services (CMS) would lead one to believe that a patient may seek treatment from a non-enrolled physician and may also pay ‘out-of-pocket’ for at least part of their medical care. This would seem to contradict the AMA email referenced above.

In the case Stewart v. Sullivan (816F.Supp. 281,282 283; D.N.J. 1992), Lois Copeland, M.D., a Medicare nonparticipating physician, filed a lawsuit challenging Medicare’s prohibition against charging Medicare beneficiaries more than the government’s stated limit. The court noted that penalties described in Social Security Act 1848(g)(4)(A) require proof of over-charges on a “repeated basis,” and in a “knowing and willful manner.” Although the court ruled that they did not find any infringement on private contracting, the case was dismissed.

Many physicians, feeling isolated and in fear of losing their practices due to severe cuts in reimbursement under Obamacare, are looking for remedies under the law to simply not participate, disenroll, or limit their involvement with the Medicare program. Many would like to continue to see patients by making private arrangements and/or by simply giving free care, but on their terms without unwieldy and unnecessary government regulations imposed by such participation.

Here are three potential approaches to understanding how physicians may resist Medicare and, by extension, Obamacare participation:

Physician enrollment in Medicare is voluntary. Sec.1866. [42 U.S.C. 1395cc] (a)(1) states a provider is “qualified to participate and eligible to receive payments from the government if s/he files with the Secretary” an agreement (i.e., voluntarily completes form CMS-855).

A non-enrolled physician has equal protections and due process rights under laws that prohibit the federal government from demanding a physician either serve (enroll in) Medicare or give free medical care to Medicare beneficiaries.

Some would say the US Constitution, Amendment Thirteen, protects every American from “conscription” in that:

“Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States …”

Section 1842(i)(2) does not restrict a physician to only two choices: “participating” or “non-participating.” Sec.1842. [42 U.S.C. 1395u] (i)(2) clearly states “The term … nonparticipating physician refers … to a physician who … is not a participating physician … (as defined in subsection (h)(1))” Sec. 1842(i)(2) is a conditional statement: if non-participating, then not participating.

But physicians obviously have more than two possible relationships with Medicare including “opted out,” never enrolled, voluntarily terminated, or employed by a Medicare Advantage IPA/HMO.

Section 1848(g)(4)(A) explains how a physician who is enrolled in Medicare should submit bills under Part B; it does not mandate every physician who is non-enrolled into enrollment, thus triggering mandatory claims submission. Section 1848(g)(4)(A) does not grant the federal government authority to press physicians into service (enrollment).

So what about patient reimbursement by Medicare? Can a patient pay his/her doctor and then seek reimbursement from Medicare? Most physicians will agree to bill the government, but if they don’t does this mean they must give free medical care to Medicare beneficiaries?

Healthcare attorney Andrew L. Schlafly wrote the following: “… even if the federal government attempted to assert control over payments by patients to disenrolled physicians, courts may well hold that it is unconstitutional for government to interfere with payments made by Medicare enrolled patients for services rendered by physicians who have disenrolled. We are unaware of a court case establishing or forbidding this option. Government may prefer not to test its authority over disenrolled physicians rather than risk a new precedent against its power.”

Later this year, the Supreme Court will decide on the merits of the Affordable Care Act’s individual mandate requiring all Americans to either participate in Obamacare or pay a penalty; then, the country will face challenges to other vexing issues associated with this legislation. Will a change in leadership at the White House and the Senate result in an outright repeal of the law? Will such a repeal automatically stop the regional, community-based ACOs dead in their tracks, as Obamacare foes hope? Will physicians be threatened and mandated to participate in Medicare and other government-sponsored health insurance plans regardless of the law’s fate?

Health insurance is an important and vital component of a free-market society. The question remains, should government mandate coverage? Obamacare mandates participation, additional fees, over a hundred new government agencies, and layers of additional bureaucracy, but fails to include rules to allow insurance entities to compete across state lines; it also lacks tort reform to lessen the costly and widely denounced practice of defensive medicine to ward off frivolous lawsuits.

It seems the question is not one of intent in criticizing the new health care law, but rather one of content. Obamacare gets it wrong at almost every turn. Instead of finding tax-credits and other incentives to help doctors care for the uninsured, it imposes paternalistic, over-bearing, and anti-competitive pressures to coerce providers of care to see more patients for less under unfavorable conditions.

Obamacare opponents are not against healthcare for all; nor are they against government-sponsored health insurance. What they find troubling is the notion that the government wants to control every minute detail of the medical care delivered between a doctor and a patient.

In the end, Americans will not abandon independent, physician-directed medical care centered around the core doctor-patient relationship. In the match up of Doctors vs. Obamacare, physicians have already opted-out—in due time, this reality will become more and more obvious.

Doctor Dorin is a Hopkins-trained, board-certified anesthesiologist, practicing in a large group in San Diego. He is a small business owner, a Commander in the US Navy Reserves, and the Founder/President of America’s Medical Society, Inc., (AMS) a non-profit corporation created to serve and educate physicians and the general public in matters of national health-care reform and medical politics.

Tuesday, March 5, 2013

Academia attacks physicians and physician salaries...What a joke!


What a joke of a study! Does this article even address the hours worked by a Physician? Does it take into account the $250K in student loans the average U.S. trained physician will be saddled with prior to seeing their first patient? Then there is the fact that many physicians will not be finished with their training until they are into their 30s.

Take an accounted that graduates college at 22, and becomes a CPA by 25. This accountant will make upwards of $750k before a doctor makes their first buck!

OK…Now check this out…Every quote in this story is from “Academia”! So you have these pointed head professors walking around campus with nothing to do except dump on the earnings of U.S.  motivated and driven physicians! Let’s all talk about the cost of a college education in the U.S. While we are it lets see about the workday of the tenured University professor. Don’t get me started on the cost of an education because of the way way way way over paid tenured professors!

 

Sky-high salaries, costly hips boost US health costs

Compared with five other countries, America is tops in docs' income, fees, study finds

By Linda Carroll

msnbc.com contributor

updated 9/8/2011 9:05:48 AM

High doctors’ salaries and climbing fees may be the major reasons that health care costs are so much steeper in the United States than in other developed countries, a new study concludes.

Don't miss these Health stories Columbia University researchers compared payments to primary care doctors and orthopedic surgeons from six developed countries: Australia, Canada, France, Germany, the United Kingdom — and the United States.  After scrutinizing the data, they found that both groups of US physicians were making much more money than their foreign counterparts.

In part that’s because procedures like hip replacements cost so much more in the US, said the study’s lead author Miriam J. Laugesen, an assistant professor of health policy and management at the Mailman School of Public Health at Columbia University.  In part it’s because physicians are just paid better here, she added.

On average, primary care physicians in the United States received $186,582 in pretax income a year, compared with $95,585 in France and $92,844 in Australia. When it came to orthopedic surgeons, there was a similar disparity, with US surgeons taking in an average of $442,450 a year, compared with $154,380 in France, $208,634 in Canada and $324,138 in the UK.

“With the recession we have right now, there are a lot of questions about whether physician fees can continue to go up at the pace they have,” Laugesen said. “We can’t say what is the right amount to pay. But we can certainly shed some light on what is going on.”

A similar trend was seen in specific procedures. Hip replacements, for instance, cost almost twice as much in the US as they do in foreign countries: When a private insurer paid, the US cost was $3,996. That’s compared to $1,943 in Australia and $2,160 in the UK, for example. The disparity wasn’t as sharp when there was a public payor, but the US still led the pack with an average payment of $1,634 vs. $652 in Canada, $1,046 in Australia and $1,181 in the UK.

Experts said the study contributed important data to the ongoing health-care debate.  “I think that it’s clear that something is broken in our health care system,” said Daniel Polsky, a professor of medicine and health care management at the Perelman School of Medicine and the Wharton School, both at the University of Pennsylvania. “A lot of people think that to fix it we need to do less care — that we’re just doing too much. What this study suggests is that it’s not about how much we’re doing, but about how much we’re paying for what we’re doing.”

The new data provide a window on something shown by earlier studies: as much as 70 percent of health care costs are due to salaries of health care workers, said Jonathan P. Weiner, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

“This suggests we don’t have the right balance,” Weiner said. “This is a time when 40 to 50 million Americans are without health insurance.”

Beyond that, Weiner said, the study underscores the inequity between specialist salaries and those of primary care physicians.

So how did we get to where we are?

“In part it’s due to our cultural acceptance of paying a lot for health care,” said Meredith Rosenthal, a professor of health economics and policy at the Harvard School of Public Health. “Physicians incomes are way above the median. They’re in the top 5 percent.”

As for primary care physicians’ complaints about the disparity between their incomes and those of specialists, Rosenthal said, it’s all just a matter of perspective.

“On the one hand, primary care physicians make a lot more than the average American, but they make a lot less then dermatologists,” she explained. “So the primary care physicians see themselves as relatively impoverished because of their position relative to the dermatologist — not relative to the average working guy.”

But ultimately, Americans need to look at these numbers and think about what they mean, Rosenthal said.

“We’re willing to pay physicians so much because we value health care so much,” she explained. “But, physicians are making five times the median income. Is that what we really want?”