The Senate decided to close debate on the “doc fix”, setting the stage for the death spiral of Medicare. Already paying below market rates, expect that a substantial number of physicians walk away, as they face a river of red ink from practices being asked to work for free (or less).
June 17, 2010 — In a last-minute shock to physicians, the Senate voted today against postponing a scheduled 21% reduction in Medicare reimbursement to physicians and other health providers.
A compromise proposed by Sen. Max Baucus (D-MT) was defeated largely along party lines, with no Republican support. The compromise was put forward after the Senate had rejected a $140 billion finance package yesterday that would have delayed the cut in Medicare payments to physicians until 2012, along with measures to extend unemployment benefits and provide $24 billion to states to cope with their Medicaid programs.
continue reading »
|
Posted by
Vijay Goel, M.D. |
Categories:
payment,
risk |
Congratulations to new Massachusetts Senator Scott Brown. We saw health care concerns drive the election of a Republican in the bluest of states.
Yet, most people want health care to be reformed…its not that we don’t want change…its that the current approach to ObamaCare looks to lock out change and lock in an insurance model that people can neither comprehend nor afford nor trust. As Albert Einstein once remarked, “Insanity is doing the same thing over and over again and expecting different results.”
So what is the right model for health reform? My humble suggestion is that our nation yearns for Health Assurance, not just Health Insurance. What does that mean?
continue reading »
If “Health Reform” as presently constructed gets passed, what happens? Would love to hear what you think.
Have you visited a MinuteClinic or other retail health clinic? This approach to health care is transparent (prices clearly posted and generally cheaper than physician visits), convenient (located in a pharmacy or other retailer), and customer-friendly (walk-in appointments easy to find).
So why are these clinics, which customers love, struggling?
The answer is surprisingly simple: Medicare (and by proxy, other health insurers) have created a payment system that starves innovators because:
- they can’t charge more for providing better service
- there’s no reward for customers who select a cheaper service
- they can’t even bill customers for innovations that achieve better results and reduce the need for further services
continue reading »
Doctor Availability Declining with Cuts (via Health Care BS)
Are Primary Care Physicians (PCPs) finally willing to say no to the Fee for Service Medicare approach that has destroyed their practices and profession?
The Mayo Clinic in Arrowhead, Arizona fires a shot across the bow, by informing patients that they will no longer accept Medicare for their primary care doctor visits as of Jan 1 (via Dr. Wes and AZcentral.com)
The discrepancy between what Medicare pays and our cost of providing care acutely impacts the sustainability of our primary care practice. Medicare reimbursements do not cover our actual costs of providing care, and therefore we have recently had to make some difficult decisions that will impact the Arrowhead Family Medicine practice.
continue reading »
Was struck today that I have heard very little about the role of Medigap in the current health insurance debate…despite massive discussion of Medicare, Medicare Advantage, payment reform…etc. In addition, it highlights how difficult it is to sort through the tangled web of money and influence…not sure how much I believe it, but its certainly food for thought.
This thought was triggered by Michelle Milkin’s post on AARP’s dependance on royalties from selling sponsored insurance plans:
A Hill source summed it up for me this way: “AARP has endorsed a huge reduction in funding of Medicare Advantage, which touches over 10 million middle-lower income seniors. If Medicare Advantage funding is reduced, and seniors are forced out of the program, they become potential buyers of the heavily-promoted and very profitable Medicare Supplement program sponsored by AARP (MediGap is 70% of AARP’s annual income). Medicare Supplement is a huge source of revenue to AARP. At a minimum, AARP should be required to disclose this every time they discuss Medicare Advantage.
continue reading »
Sustainable health reform requires a solid foundation…unfortunately the proposals we’re seeing out of Washington create a more elaborate house of cards, as we continue to create an elaborate health care ponzi scheme. The House that built Medicare has already saddled our country with Trillions in unfunded liabilities. The proposals we see look to continue to reward a medical-industrial complex that creates and manages diseases rather than focusing on optimizing the health of people.
So what are the criteria of a sustainable health system? continue reading »
David Goldhill’s piece highlights a personal journey of disbelief around how health care and hospitals work today in his essay, How American Health Care Killed My Father – The Atlantic (September 2009) .
For those who haven’t seen it, its a terrific read, and highlighted by David Brooks as the first thing he would ask President Obama to do in preparation for his health care speech. An excerpt below:
continue reading »
Gold Plated Wheelchairs
Does low administrative cost or pooled purchasing lead you to the best values? When it comes to government purchasing, the results are surprisingly bad– the Medicare fee schedule rate for medical supplies can multiples higher than the cash price an individual can command. HHS’s Inspector General, Daniel Levinson, gives us the shocking details in his report on Power Wheelchair Acquisition Costs for the Medicare program (via CNN.com)
The Executive Summary is a fascinating rebuke of Congress’ ability to remove pork from the Medicare program, driving up costs for both taxpayers and beneficiaries. It also is a cry for help for a Medicare Administrator to take the steps required to appropriately run the government’s payor– we’ve missed the leadership a Mark McClellan can provide in the role (there hasn’t been a Senate-confirmed Medicare head since 2006). Is this the future of a govenment plan focused on minimizing administration?
Medicare’s fee schedule amounts are based on manufacturer-suggested retail prices. They include reimbursement for the power wheelchair acquisition cost and services performed in conjunction with providing the wheelchair, such as assembling and delivering it and educating the beneficiary about its use. Prior Office of Inspector General (OIG) reviews have found that consumers can buy power wheelchairs for lower prices than Medicare and its beneficiaries. In May 2006, the Centers for Medicare & Medicaid Services (CMS) proposed a revised methodology for setting new fee schedule amounts that would not rely upon manufacturer-suggested retail prices and is responsive to the market. As of May 2009, CMS had not finalized this proposal.
continue reading »
