Monday, July 22, 2013

Physicians promised a 73% increase in Medicaid reimbursement…That’s a good one! I t will never happen!


So here it is…seven months since physicians were promised an increase in the Medicaid reimbursement…..and nothing. But…physicians have seen an increase in Medicaid patients, and still are receiving the lower Medicaid reimbursement! I might remind you that this Medicaid pay rate does not even come close to covering the physicians cost! And it will only get worse!

Obamacare's 73% Medicaid Pay Raise For Doctors Is Delayed

3/15/2013 @ 8:43AM Forbes

Bruce Japsen, Contributor

A huge pay raise promised under the Affordable Care Act for primary care doctors who treat the nation’s poor covered by Medicaid health insurance is nearly three months behind schedule and may take another three months before it kicks in, state Medicaid directors say.

Under the health law, a primary care doctor – a family physician, a pediatrician or an internist – who treats a Medicaid patient will see their reimbursement rise to the level of the Medicare health insurance program for the elderly for scores of primary care services.  Doctors do have to apply to their state Medicaid programs and meet certain criteria in part proving that they have historically treated certain numbers of Medicaid patients.

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Though the pay increase will vary because Medicaid rates differ from state to state, the average pay increase will be about 73 percent given Medicare last year paid on average 66 percent of what Medicare pays for certain primary care services, according to a Henry J. Kaiser Family Foundation study.  Doctors in some states could see payment increases of 100 percent or more.

The idea behind the pay increase, which is funded by federal dollars for two years, is to get more doctors to accept Medicaid patients and prevent other physicians from dropping out of a government program that hasn’t been well funded.  Amid a primary care doctor shortage, eligible patients will need all of the doctors they can get given the health law expands Medicaid coverage to millions more Americans effective Jan. 1, 2014 for participating states.

Because Medicaid is funded via a match of funds from states and the federal government, cash-strapped states that have cut from their programs in also lost federal dollars, allowing payment rates to fall far behind.

“The purpose of the increase in Medicaid physician fees for primary care is to encourage greater Medicaid participation among physicians as the program expands in 2014 and demand for care increases,” the Kaiser report said. “If the enhanced payment rates succeed in increasing physician participation and beneficiary access as intended, interest in extending the higher Medicaid rates beyond 2014 is likely to be high.”

But the Obama administration says the checks will eventually reach doctors and payments will be retroactive to Jan. 1 of this year so physicians who are approved to participate in their states will get what they are due.

“The Medicaid enhanced payments for primary care physician fee was made possible by the Affordable Care Act and is in full effect for calendar years 2013 and 2014,” a spokesman for the Centers for Medicare & Medicaid Services says. “States are moving quickly to implement the higher payment and a number of states have already submitted State Plan Amendments (SPAs) which will permit federal funding to flow to states for the increases.  In addition to submitting the required SPAs, states are also in the process of reprogramming their claims processing systems to pay at the appropriate, higher rates.  CMS has made it very clear that states must make enhanced payments to eligible providers retroactive to January 1, 2013.”

Exactly how federal dollars will be doled out to doctors is unclear in part because an increasing number of states in recent years don’t pay physicians on a fee-for-service basis.

Many doctors are paid bundled rates by health plans like Humana (HUM), Amerigroup, a subsidiary of Wellpoint (WLP), Aetna (AET) or UnitedHealth Group (UNH) or physicians may be employees and are therefore paid through their clinic, practice or other entity, complicating the rollout of the pay increase.  Therefore, the payments for services aren’t necessarily apples to apples comparison when it comes to paying the same as Medicare rates.

“How you do this in a managed care environment is the big challenge,”  Matt Solo, executive director of the National Association of Medicaid Directors said in an interview.  “It is not at all clear.”

Solo estimates the money might not reach doctors until late in the second quarter of this year, which would be by June 30.

“The money will flow,” Solo said. “It will eventually flow.”

Meanwhile, doctor groups wait patiently for their funds.

“It is vital that Medicaid receive sufficient funding to support an adequate network of caring physicians and maintain its purpose as a social safety net,” said Dr. Jeremy A. Lazarus, AMA president. “New federal funds authorized for primary care payment increases by the Affordable Care Act are an important step in the right direction to encourage more physician participation in the Medicaid program. The AMA and other physician organizations have urged state Medicaid programs and governors to move forward with filing the necessary paperwork with the federal government so that increased Medicaid payments can be paid to eligible primary care physicians.”

Tuesday, July 9, 2013

Canadians run to America for Medical Care. Americans eyeing the Caribbean for their health needs


So when Obamacare “hits”, and most physicians see a huge decrease in their earnings, and there are long waits for service, and quality decreases, and consumer costs and taxes go through the roof…..Where will Americans go? Hello Caribbean!


Report: Thousands fled Canadian health system in 2012

9:38 PM 07/08/2013    Michael Bastasch

Thousands of Canadians continue to flee the country to seek medical treatment abroad, with the United States a common destination.

An estimated 42,173 Canadians left their homeland in 2012 to seek medical treatment elsewhere. This is a decrease from the 46,159 Canadians who fled the country in 2011 for medical treatment.

“In some cases, these patients needed to leave Canada due to a lack of available resources or a lack of appropriate procedure/technology,” according to a report by the Fraser Institute — a free-market Canadian think tank. “In others, their departure will have been driven by a desire to return more quickly to their lives, to seek out superior quality care, or perhaps to save their own lives or avoid the risk of disability.”

While the number of Canadians looking abroad for health solutions is still significant, it’s unclear whether or not the drop in the number leaving is related to the implementation of the Affordable Care Act in the U.S.

“While a number of external factors may have led to a decline in the number of Canadians seeking care abroad, wait times for care in Canada also improved a little in 2012 both for specialist consultations and treatment,” Nadeem Esmail, Fraser’s director of health policy studies, told The Daily Caller News Foundation in an email.

The Fraser Institute asks doctors across Canada every year about what percentage of their patients got non-emergency care outside the country in the last 12 months. Those numbers are then averaged for each medical specialty and combined with the number of actual medical treatments performed in each province.

While the total number of fleeing Canadians decreased, some provinces saw increases in the number of patients leaving Canada.

Fraser reports: “Increases between 2011 and 2012 in the estimated number of patients going outside Canada for treatment were seen in Saskatchewan (from 1,221 to 1,380), Quebec (4,600 to 6,308), New Brunswick (526 to 997), and Newfoundland and Labrador (433 to 649).”

One reason for these departures is the long waits imposed on patients by national health planners. The median wait time for treatment after consulting a specialist fell last year to 9.3 weeks. Wait times increased in seven Canadian provinces and only fell in three — Saskatchewan, Manitoba, and Ontario.

The largest group of patients who fled Canada in 2012 — 4,594 — were those in the “ophthalmology” category. An ophthalmologist is a specialist for medical and surgical eye problems.

Thousands also left the country looking for “general surgery,” “orthopedic surgery” as well as for gynecological and urological treatments or procedures.

 

Tuesday, July 2, 2013

33% percent of all Internal Medicine and Family Medicine residency training programs are not producing graduates seeking rural medicine practice. That’s a huge problem!


33% percent of all Internal Medicine and Family Medicine residency training programs are not producing graduates seeking rural medicine practice. That’s a huge problem!

U.S. producing 'abysmally low' number of primary care doctors

UPI 06 15 2013

WASHINGTON, June 15 (UPI) --
Despite a shortage of U.S. primary care doctors, less than 25 percent of new doctors go into this field, and fewer still work in rural areas, researchers say.

Lead study author Dr. Candice Chen, an assistant research professor of the George Washington University School of Public Health and Health Services, said the study also found only 4.8 percent of the new primary care physicians set up shop in rural areas.

"If residency programs do not ramp up the training of these physicians the shortage in primary care, especially in remote areas, will get worse," Chen said in a statement. "The study's findings raise questions about whether federally funded graduate medical education institutions are meeting the nation's need for more primary care physicians."

Chen and colleagues studied the career paths of 8,977 physicians who had graduated from 759 medical residency sites from 2006-08. Three to five years after the program ended, the researchers found 25.2 percent of the physicians worked as primary care doctors, although this number almost certainly was an overestimate because it included graduates who practiced as hospitalists, Chen said.

In addition, the researchers found 198 out of 759 institutions produced no rural physicians at all during the study period.

Currently, the United States is producing primary care physicians at rates that are "abysmally low," Chen said.

U.S. producing 'abysmally low' number of primary care doctors