ObamaCare - But WHO will Treat the Patients?
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:
- A Physician work component measuring time, skill, and intensity associated with the service provided. This accounts for 54.5%
- A practice related expense component that measures average practice expenses. 42.3%
- 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).
Ech 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
More by this Author
Who mail orders meat? Well apparently Omaha Steaks – a company that has been in business since 1917 – has a pretty fanatical mail order business. Omaha Steaks also operates a number of retail outlets...
This article discusses Audiophile (or close to it) quality speakers available to DRASTICALLY IMPROVE the listening experience for users of mobile devices, laptops, and computers.
Costco TV purchasing information: why buy a big screen TV from Costco? Find out if Amazon or Costco is the best place for you to buy your next big TV