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.”

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.

 

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

Physicians stop accepting insurance and government pay plans – Patients pay at point of care! Price of care goes down – Quality goes up!

I have often said “The cost of medical care has zero reflection upon what the patient can afford”! This new direction in patients digging into their own pockets to pay at point of care will drive down the cost of medicine!

Doctors dump health insurance plans, charge patients less

WICHITA, Kan., June 14 (UPI) --
A Kansas physician says he makes the same income and offers better quality care to his patients after he dumped all health insurance companies.

Thirty-two-year old family physician Doug Nunamaker of Wichita, Kan., said after five years of dealing with the red tape of health insurance companies and the high overhead for the staff he hired just to deal with paperwork, he switched to a system of charging his patients a monthly fee plus the price of an office visit or test, CNN/Money reported.

For example, under Nunamaker's membership plan -- also known as "concierge" medicine or "direct primary care" practices -- each patient pays a flat monthly fee to have unlimited access to the doctors and any medical service they can provide in the practice, such as stitches or an EKG.

For adults up to age 44, Nunamaker charges $50 a month, pediatric services are $10 a month, and for adults age 44 and older it costs $100 a month. Although Nunamaker calls the practice "cash-only," he accepts credit and debit cards for the fees and services.

Nunamaker and his partner negotiated deals for services outside the office. A cholesterol test costs the patient for $3, versus the $90 or more billed to insurance companies; an MRI can cost $400, compared with $2,000 or more billed to insurance companies.

The practice encourages patients and families to also carry some type of high-deductible health insurance plan in case of an emergency or serious illness requiring hospitalization, Nunamaker said.

Nunamaker said his annual salary is around $200,000, and he gets to spend more time with patients providing better care because he is not watching the clock and he gets to spend more time with this family.

Most of Nunamaker's clients are self-employed, small business owners, or small companies that found the monthly fee and the cost of the high-deductible plan was a cheaper option, CNN/Money reported.

Physicians are going Cash only (Charge and debit accepted), and everybody is a winner! Winner-winner-chicken dinner!!!

Psst! Hey Doc!….You want to treat and care for your patients….Do like this Physician! Get rid of the government and private healthcare insurances, and go CASH (or charge and debit cards)!


South Portland doctor stops accepting insurance, posts prices online
Posted By Jackie Farwell On May 27, 2013 (4:07 pm)

SOUTH PORTLAND, Maine — Dr. Michael Ciampi took a step this spring that many of his fellow physicians would describe as radical.

The family physician stopped accepting all forms of health insurance. In early 2013, Ciampi sent a letter to his patients informing them that he would no longer accept any kind of health coverage, both private and government-sponsored. Given that he was now asking patients to pay for his services out of pocket, he posted his prices on the practice’s website.

The change took effect April 1.

“It’s been almost unanimous that patients have expressed understanding at why I’m doing what I’m doing, although I’ve had many people leave the practice because they want to be covered by insurance, which is understandable,” Ciampi said.

Before the switch, Ciampi had about 2,000 patients. He lost several hundred, he said. Some patients with health coverage, faced with having to seek reimbursement themselves rather than through his office, bristled at the paperwork burden.

But the decision to do away with insurance allows Ciampi to practice medicine the way he sees fit, he said. Insurance companies no longer dictate how much he charges. He can offer discounts to patients struggling with their medical bills. He can make house calls.

“I’m freed up to do what I think is right for the patients,” Ciampi said. “If I’m providing them a service that they value, they can pay me, and we cut the insurance out as the middleman and cut out a lot of the expense.”

Ciampi expects more doctors will follow suit. Some may choose to run “concierge practices” in which patients pay to keep a doctor on retainer, he said.

Gordon Smith, a spokesman for the Maine Medical Association, wasn’t so sure, saying most patients either want to use the insurance they pay for or need to rely on Medicare and Medicaid.

Even with the loss of some patients, Ciampi expects his practice to perform just as well financially, if not better, than before he ditched insurance. The new approach will likely attract new patients who are self-employed, lack insurance or have high-deductible plans, he said, because Ciampi has slashed his prices.

“I’ve been able to cut my prices in half because my overhead will be so much less,” he said.

Before, Ciampi charged $160 for an office visit with an existing patient facing one or more complicated health problems. Now, he charges $75.

Patients with an earache or strep throat can spend $300 at their local hospital emergency room, or promptly get an appointment at his office and pay $50, he said.

Ciampi collects payment at the end of the visit, freeing him of the time and costs associated with sending bills, he said.

That time is crucial to Ciampi. When his patients come to his office, they see him, not a physician’s assistant or a nurse practitioner, he said.

“If more doctors were able to do this, that would be real health care reform,” he said. “That’s when we’d see the cost of medicine truly go down.”

Why Physicians are better than Nurse Practitioners (and Physician Assistants

The big difference between Physicians and Nurse practitioners (and Physician Assistants) is NPs really do not stay with a practice for any period of time. They are a transient (I am speaking in general) work force. Most NPs, and PAs only stay practices for a short period of time, and then on to the next practice. Physicians sign contracts, and become part of the community, and act in a manner that will grow a practice.

Then there is the education and training. We all know the time and sacrifice a would-be physician puts into becoming a practicing doctor. Although the NP and PA have a rigorous training program the difference is vast.

I want to see a doctor, get diagnosed, and treated. There is a place for NPs and PAs, but playing Doctor is not a THAT place!

Nurse Practitioners Playing Doctor More Often

May 27, 2013 4:45 AM EDT

With Obamacare on the horizon and a growing shortage of primary-care physicians rising fast, nurses could fill the void. But, ask Daniela Drake, MD, are they good enough?

When I was 36 weeks pregnant, my nurse practitioner told me I had a urinary tract infection and prescribed an antibiotic. I didn’t have symptoms, so I didn’t believe her. But it was Friday at 4:30 and I got the feeling that she was in a hurry. “You increase your risk of miscarriage if you don’t treat,” she said as she dashed off a prescription.

Dr. Rebecca Parker looks at a list of patients in the emergency room of Chicago's Advocate Trinity Hospital. Emergency rooms, the only choice for patients who can't find care elsewhere, may grow even more crowded as newly insured patients will visit ERs for both real emergencies and problems that could be handled more cheaply in doctor's offices. (Kiichiro Sato/AP)

At a follow-up appointment three days later, the doctor discovered that this urinary tract infection was not an infection at all, but preeclampsia—a condition that can cause stillbirth and affects the mother’s brain and kidneys. I was losing massive amounts of protein in the urine, which the nurse interpreted as an infection. But I didn’t just have failing kidneys, I also had neurologic symptoms.  I was obviously trembling and confused.  The nurse missed it. The doctor didn’t.  I was rushed into a caesarian-section and delivered a healthy baby girl.  But if my follow up appointment had been a few days later, I might have had a seizure and died.

Despite my personal experience with one nurse’s questionable competence, as a physician, I welcome nurses into the ranks of primary-care providers. It’s not because I think they’re so caring (mine seemed to care more about going home); it’s not because I think they’re so excellent (see above)—it’s because there are simply too few primary care doctors to meet demand. During the next few years, thanks to President Obama’s Affordable Care Act, some 36 million newly insured patients will flood into the healthcare market. By 2015, according to the Association of American Medical Colleges, the United States is expected to have a shortfall of 62,000 physicians—and during subsequent years that shortfall will only get worse.

Due in part to the impending shortage, the Institute of Medicine (IOM) proposed that nurse practitioners provide primary care to bridge the gap in physician coverage. But the concern is—given my experience and that of other patients—will it work? Are nurses good enough?

Certainly nurses believe they are fully up to the task. Last week, The New England Journal of Medicine published a study stating that nurses believe they should have the same privileges and pay as physicians. Nurses also believe they will provide better and safer care. Not just good care. Not equal care. Better care. Safer care.

Doctors, of course, would disagree. Even though a well-respected meta-analysis has shown no appreciable differences in health outcomes between doctors and nurses, many physicians worry that nurses may overlook serious illness. It certainly happened to me. But I would argue that that’s the nature of medical care. After all, doctors are famous for making mistakes.  I can easily imagine my story flipped on its head:  A harried and exhausted doctor dismisses the twitching, overweight pregnant lady--who would be saved three days later by the nurse who had the time and energy to care.

What’s really happening is that American physicians are over-trained for run-of-the-mill primary care. Of course nurses can do it. I sometimes joke that a properly motivated high-school student could do it with a smartphone and a checklist. The current standard of care is medicine-by-protocol. The work is ceaseless and routine to the point of tedium—and almost half of primary care physicians are burnt out. Nurses are probably quite justified in criticizing what they see. But that doesn’t help physicians accept them.

Especially since, generally speaking, a lot of doctors are still chafing from the treatment they received at the hands of these nurses during residency training.

The rancor between our two professions is heightened by an obvious bias towards nurses in the media.  It makes a good story to portray nurses as victims of unfair, bloviating physicians. Doctors Doubt Nurses Skills, Survey Finds  trumpeted one of many similar headlines reporting this NEJM study. But that headline could have also easily lamented: Nurses Doubt Doctors Abilities, Resent Salaries.

This media bias has a corrosive effect on our dialogue—and this doesn’t help us get to a much-needed solution—because in some ways nurses and doctors aren’t all that far apart. A closer look at the NEJM study shows a startling amount of agreement. Most doctors and nurses agree that nurse practitioners can improve access to care. Moreover, an astounding 20 percent to 25 percent of doctors actually agree that nurses will provide safer, better and more cost-effective care.

Even I, despite my near-death experience, esteem nurse practitioners highly. I’ve found them pleasant, competent and collaborative. I am, however, troubled by the nursing conceit that they’re superior to physicians. That vanity certainly will create a lot of resistance amongst many doctors. And I wonder how their high self-regard will affect their ability to practice medicine. Even most nurses agree that the best providers are the least arrogant. Great clinicians continually develop their craft by learning from nutritionists, naturopaths, acupuncturists, as well as nurses.  Indeed, if we’re going to improve outcomes, our healthcare system needs to find a way to fully encompass these different perspectives.

In the end, however, we don’t have time to fight. Obamacare finally goes into effect next year and the medical system will need more providers to serve the newly insured. With fewer young physicians opting to go into primary care, many believe that in the future only nurses will be providing this basic entry-level care. After all, it’s an extremely demanding and largely unappreciated job. So unappreciated that even nurses think they can do it. And at this point, it’s pretty clear that they can.

 

PHYSICIANS SALARIES ARE TOO HIGH! YOU MUST BE CRAZY!

Note to the author of these article: You are a Veterans Administration Primary Care clinic FP. What do you see…maybe 10 patients a day? Go get a real job, then talk about what a hard working physician should be paid! Oh yeah buddy….while your writing about the pay differentials in Canadian, Australian and British physician when compared to U.s. Physicians you left out one very important point…..The cost of college, med school, and the low pay of the U.s. resident and fellow! British, canadian, and australians pay a very low cost (in dollars and pounds) to become Medical doctors. the average U.S. physician is saddled with $250 in med and undergraduate loans. chew on that….

Pharma & Healthcare

|8/21/2012 @ 1:53PM |22,964 views

It's Physician Pay, Stupid!

Peter Ubel, Contributor

In 2006, health-care expenditures in the U.S. rose 6%, a rate of growth significantly higher than inflation and one that, if sustained, would lead to a doubling in health-care spending in a mere dozen years.  Some of that extra spending was a function of more doctors doing more things to more people—an increasing number of hip replacements, for example, for senior citizens hobbled by degenerative joints; more diabetes and blood pressure treatments too, for all the increasingly obese people in the country whose health is threatened by cardiovascular disease.

But according to a Price Waterhouse Coopers analysis, 75% of that growth was a result not of an increase in the volume of medical interventions but, instead, an increase in their price.

People like me who obsess about our nation’s crippling medical expenses often focus on reducing unnecessary medical tests and procedures.  The folks at Dartmouth, who run the Dartmouth Atlas, correctly worry about unjustifiable variations in the use of medical procedures, with some regions of the country two or three times more likely to, say, perform C-sections than other areas.  This medically unjustifiable variation in the intensity of care, we are told, points us toward potentially vast savings.  If we can figure out how to identify unnecessary C-sections for example—or tonsillectomies or hip replacements—we can dramatically reduce health-care spending.

But overlooked in all this talk about unnecessary procedures is the unnecessarily high cost of most procedures.

Why does hip replacement in the United States cost $4,000, while costing less than half that amount in Australia, hardly a medical backwater?  Why does such an operation cost six times as much in the United States as it does in Canada?

The price of medical services is significantly higher in the United States than other parts of the world.  Primary care physicians in the United States make $186,000 per year on average versus $131,000 in Germany.  Orthopedic surgeon pay ranges from a high of $442,000 in the United States, to $324,000 in the UK, to a relatively parsimonious $187,000 per year in Australia, that according to analysis by the United Health Group Foundation.

I realize that questioning physician income will raise the ire of many physicians.  As a primary care physician myself, I have long felt that we non-proceduralists are underpaid, in comparison to our sub-specialty peers.  And no doubt, buried in the average primary care income of $186,000 per year in the U.S. are way too many hard working general pediatricians making closer to $80,000 per year.  But even highly paid doctors won’t like what I’m saying.  I expect my orthopedic surgeon colleagues will recoil at the thought that they, with all their advanced training, aren’t worth what we pay them.

But the fact remains that U.S. health-care expenses are bankrupting our country.  And there is no way to control these expenses without limiting physician pay.