By MikeNV from the Hubpages.
Where are all the Doctors?
If you don’t pay the
Doctors a “Market Rate” they will NOT perform the services. ObamaCare will have
disastrous results for seniors and the poor. The very people the plan is
supposed to help will be hurt the most.
Studies by the
American Medical Association (AMA) and the Center for Studying Health System
Change (HSC) suggest that further cuts might impede access to doctors and
reduce the quality of seniors' care. According to a survey by the AMA, many
physicians already limit seniors' access to their services. Almost 30 percent
of physicians limit the number of new Medicare patients they will accept - or
do not accept Medicare patients at all. Low physician reimbursement rates may
also reduce the quality of medical services seniors receive. For instance, the
AMA found that physicians in general have reduced the time they spend with each
patient. Nationally, approximately two-thirds of physicians surveyed (65.2
percent) either spend less time with patients during a visit or squeeze more
visits into each workday. Many are also referring difficult cases to other
physicians or specialists rather than caring for the patients themselves. None
of these actions are in patients' best interest. – NationalCenter for Policy
Analysis (2002)
This study was done in
2002, and the consensus was clear. Doctors are walking away from Medicare
patients and fast! Now under ObamaCare they are proposing another 20% cut in
Physician Pay. If you are poor or elderly and dependent on Government Health Care you are in for a very sad and rude
awakening. You may not be able to find a specialist willing to treat you. While
Obama is off to his $4,000 a night Hawaiian Get-away Americans are left with a
bewildering cost laden albatross that will only drive the stake into the hearts
of the elderly and poor.
What would you do if
your boss walked into your office today and told you that they were cutting
your pay by 20%?
Would that go over
well with you? Probably not. But that is exactly what is going to happen to
Medicare Reimbursements under Obama Care.
The Congressional
Budget Office predicts the bill will reduce deficits by $130 billion over the
next 10 years, an estimate that assumes lawmakers carry through on hundreds of
billions of dollars in planned cuts to insurance companies and doctors,
hospitals and others who treat Medicare patients.
There is some real
cockeyed logic in the “savings” statement. “Assuming”… when has the Government
ever cut costs on anything? How does adding $1 Trillion in costs result in $130
Billion in savings?
Do you see any logic
in creating a health care plan that penalizes Doctors who are already
undercompensated by Medicare? What Doctor in their right mind is going to see
any patient after they find out they have Medicare? And for those few that do
what kind of “care”do you think their patients will receive? This is just
insane to even suggest. Doctors are people and why should they bear the burden,
while the insurance companies pile on the profits?
Providing health care
insurance for 39 million aged and disabled persons, Medicare cost an estimated
$222 billion in 2000, a 3% decline over 1999.Of this $222 billion, $33.1
billion (15%) was spent on physician services.Medicare has two parts: Parts A
(hospital insurance) and B (medical insurance). Part A is financed primarily by
payroll taxes (1.45% of a wage paid by employer combined with 1.45% paid by
employee) and is premium free for nearly all beneficiaries. Approximately 25%
of Part B is financed by monthly premiums ($50 per month) paid by beneficiaries
and the remainder from general federal revenues.
This results in per
insured cost of $5,692 of which the insured pays $600 per year. If the insured
is hospitalized they pay $792 up front and if the stay extends beyond 60 days
they are responsible for $198 per day, and $396 per day after day 90.
Realistically long term hospital stays are not very common.
Part B of Medicare for
medical insurance is a 80/20 copay where the insured is responsible for 20% of
the costs of physician visits.
This is just
background information so you can see that there is really nothing special
about Medicare. A 65 year old seeking private health insurance would easily pay
this amount.
Physician Payment
Under Medicare
This is where Medicare
gets messy. Physician services are based on a fee schedule, GPCI, and a
national dollar conversion factor. The fee schedule is based on “relative
value”. The fee has 3 components:
1.
A Physician work
component measuring time, skill, and intensity associated with the service
provided. This accounts for 54.5%
2.
A practice related
expense component that measures average practice expenses. 42.3%
3.
Malpractice expense
component that reflects average insurance cost. 3.2%
The general formula
for determining total RVUs is: [work RVU x work GPCI] + [practice expense RVU x
practice expense GPCI] + [malpractice RVU x malpractice GPCI] = total RVU;
payment = total RVU x conversion factor ($38.2581 for 2001).
Each physician service
corresponds to a CPT code. There are approximately 9000 numbers, each of which
corresponds to a specific physician service. The AMA developed the CPT code and
secured a copyright for its protection. (Recently the contract under which the
AMA licenses use of the CPT to the government has been placed under scrutiny.)
Both the development and subsequent updating of the CPT codes and the RVUs
assigned to that code are conducted by the AMA partnered with the CMS.
Physician-related
charges are submitted directly to the Medicare carrier. Physicians who accept
Medicare recipients have two choices: to accept or reject an assignment from
Medicare
See
if You can Follow Along with This Scenario
Hypothetically,
Patient A makes three office visits this year at $50 per visit. Medicare will
only pay for $40 per office visit. If Dr. B accepts the assignment, he/she will
bill Patient A $80 for the first two office visits. On the third office visit,
Dr. B will bill the Medicare carrier for $40. The Medicare carrier will then
send Dr. B a check for $16 (80% of $20 [$20 being the amount over the $100
annual deductible]) and Patient A will be liable for the remainder. If Dr. B
does not accept the assignment, Medicare's allowable charges will be 5% less
than for participating physicians. In this case, Medicare would only allow for
$38 (95% of $40) per office visit.
Moreover, Dr. B cannot bill Patient A more than $43.70 (115% of $38) for the
office visit even though his/her usual charge is $50. Thus, for the first two
office visits, Patient A would pay Dr. B directly. On the third office visit,
after recognized annual charges now at $114 ($38 x 3), Patient A would receive
a check for $11.20 (80% of $14) from Medicare and would be personally liable
for the remainder (total bill up to $131.10 [$43.70 x 3]). Any subsequent
physician services used by Patient A during that year would be charged at a
rate of 115% above the allowable Medicare service-related charge, with Medicare
paying 80% of the charge.
Do
you seriously think Doctors are going to put themselves through the expense of
hiring staff to follow up on these ridiculously low payments? They would spend more money on Staff than they
would be reimbursed for by Medicare. And how are patients supposed to keep
track of all this? It’s hard enough to sort through the numbers when you are
healthy, nearly impossible when ill. Remember these are senior citizens dealing
with this mass of paperwork.
The
reality is the system of insurance both private and through Medicare is so
complex, time consuming and full of potential for error that medical costs are
being eaten by administrative costs at the expense of both Doctors and the
Insured. It’s no wonder that
many specialists with a reputation in their field have simply chosen not to
accept any form of insurance. They will bill and you can submit to your own
insurer, but they will not accept the burden of staffing an office to deal with
these administrative complexities.
When you cut the
Doctors pay, but keep in place an overly complex system of Medicare
Requirements what you are doing is effectively shifting the Best Doctors out of
the system. I pity anyone who has to deal with Doctors who are willing to accept
Medicare.
Obamacare is only
going to make the availability to quality health care worse, much worse.
I worked for a couple
of years for a Medical Insurance company. I’ve seen the Administrative Overhead
first hand from the inside out. People want to give Team Obama a pat on the
back or they want to bash him for his spend, spend, spend philosophy. Neither
is going to fix anything... and this current "Health Care Reform"
Bill is only going to drive up cost and drive down Physician availability.
The Health Care System
is overly burdened by Administration and for those who are praising this latest
disastrous health care bill… enjoy your socialized medicine.
People with money will
continue to pay out of pocket for real health care while you wait in the “I
hope I can find a Doctor who is willing to see me line”. Good luck with that.
Some source materials:
Medscape.com
No comments:
Post a Comment