Feeds:
Posts
Comments

Posts Tagged ‘socialized medicine’

As of April 1, 2015, CMS stopped payments to doctors for Medicare beneficiaries. As of April 13, CMS announced that it would begin processing claims, as required by law, but at an average 21% reduction across the board. The net effect for many physicians offices is that certain services, such as injections and medications are now being reimbursed by CMS less than the wholesale cost to the providers. Quite obviously, those treatments are no longer going to be offered to Medicare patients.

This is the long predicted adverse and unintended consequence of a poorly designed law known as SGR, past almost 2 decades ago but only now being implemented as of April 1. While the Congress has past by part ascending supported legislation to fix the problem, the United States Senate went on an extended Easter vacation for 2 weeks in yet another shocking demonstration of dysfunctional government.

The rationing of of healthcare to the Medicare population has begun in earnest.

-Dr. Casscells, Director

Center for Healthcare Policy

From Reuters, April 15:

“Congress on Tuesday approved a bill to repair the formula for reimbursing Medicare physicians, marking a rare bipartisan achievement just in time to head off a 21 percent cut in the doctors’ pay.

The bill would replace a 1990s formula that linked Medicare doctor pay to economic growth, with a new formula more focused on quality of care. It also would require means-testing of Medicare beneficiaries so higher income people pay higher premiums.

One of the government’s largest social safety net programs, Medicare is health insurance that serves 54 million elderly and disabled people.

The old formula for paying Medicare doctors has been a problem for years as health care costs outpaced economic growth. Congress had repeatedly addressed the problem with a long series of temporary “doc fix” patches. The new formula is intended to be a lasting change.

The federal government warned Congress last week that it must act before April 15 or thousands of Medicare doctors nationwide would face a 21 percent pay cut under the old reimbursement formula.

The measure passed the House overwhelmingly in March but because it expands the federal deficit, it was greeted skeptically by deficit hawks in the Senate.

They labeled the bill irresponsible because it would add an estimated $141 billion to the U.S. debt over the next 10 years, according to the Congressional Budget Office (CBO).”

What does this mean for healthcare, particularly for the elderly? For the longest time, Congress has been forced to pass the annual “doc fix” because they decided the way to “cut spending” on Medicare was not to means-test the program, ensure that only qualified persons were using the program, and ensure that actual spending was kept under control, they decided to cut the reimbursement to healthcare providers.

Medicare and Medicaid pay far below what a provider can get from a health insurance company or from a fee-based service. This is why patients who use these services consistently have trouble getting great care.

Consider this hypothetical scenario: a general practitioner owns a small clinic. He generally expects to earn $100 an hour for his own salary and for his business. A Medicare or Medicaid patient walks in and he realizes that to spend an hour on this patient will net him only $25 per patient. He has, for argument’s sake, one hour right now. Given the low reimbursement, instead of charging two patients $50 each for a half hour each, he needs to see four patients an hour at $25 in order to earn his income. The doctor must now¬† choose: give less time to the Medicare patients, or accept a lower fee per hour.

There are those who will say the doctor is “greedy” if he doesn’t accept the fee cut, and point to the Hippocratic Oath and the part which says, “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.” This will be used to say they should consider it a privilege to help their fellow human being, even if the doctor derives no benefit from doing so.

Let’s remember that doctors are people too; they have families, bills, expenses, debt, and other obligations like everyone else. Pretty much every doctor would agree that treating patients without regard to difference or ability to pay is fundamental, which is why many doctors perform charity care for the poor. However, this attitude that doctor should be lucky to treat people is arrogant, and usually put forth by non-providers who think they are entitled to things.

Thus, the problem with the fix is that every single year this charade happens: Congress ‘patches up’ the gap, to stave off already-harsh cuts to reimbursements for providers, who can make more money if they don’t treat Medicare and Medicaid patients, and have the benefit of not having the wrath of government on them if they err in filing paperwork (they feel the hassle of dealing with the insurance companies, but at least the insurance companies can’t give out fines or prison sentences for paperwork filing violations or ‘over-billing’ scenarios).

CRI, together with the Medical Society of Delaware, are the only Delaware organizations advocating for physician and patient driven health care, in opposition to socialized medicine. We want to see the power of healthcare decisions shift towards  the patients and their immediate providers, as well as the immediate costs. Doing this will mean a big step forward in getting healthcare costs under control and improve quality by encouraging innovations and cost-lowering for providers to offer patients. We see this in other sectors of our economy, so why not healthcare?

Read Full Post »