Posted on 07/10/2012 10:20:23 AM PDT by maggiesnotebook
This week, the Center for Medicare & Medicaid Services (CMS) released a "proposed" rule updating what Doctors and Hospitals will be paid under ObamaCare. The Medicare Physician Fee Schedule (MPFS) ushers-in changes to the "Physician Quality Reporting System," and makes changes to the "Physician Value-Based Payment Modifier." Considering that Obama and Democrats in Congress cut $500 Billion from Medicare, I would love to hear Physicians weigh-in on this "proposed rule."
Under the MPFS, a relative value is assigned to each of more than 7,000 types of services to capture the amount of work, the direct and indirect (overhead) practice expenses, and the malpractice expenses typically involved in furnishing the service. The higher the number of relative value units (RVUs) assigned to a service, the higher the payment. The RVUs for a particular service are multiplied by a fixed-dollar conversion factor and a geographic adjustment factor to determine the payment amount for each service.If I read the announcement correctly, Physicians interest rates deducted for equipment costs and writing-off equipment "maturity" will be reduced by 3% to 5%.
There will be reductions in "Multiple Procedure Payments."
More preventative measures will be paid for, known as Medicare Telehealth Services:
These include: annual alcohol misuse screening, brief behavioral counseling for alcohol misuse, annual face-to-face intensive behavioral therapy for cardiovascular disease, annual depression screening, behavioral counseling for obesity, and semi-annual high intensity behavioral counseling to prevent sexually transmitted infections. In addition, CMS is proposing to add alcohol and/or substance abuse assessment and intervention services to the list of Medicare telehealth services for CY 2013.Getting inside your head (as a part of "Middle Class Tax Relief):
Under the proposal, therapists will be required to include new codes and modifiers on claims for therapy services that will not affect payment, but will convey information about patients’ functional limitations at the outset of therapy, periodically throughout therapy, and at discharge from therapy. Information on therapist-established patient goals will also be collected under this proposal.The entire document is The entire document is here and contains far more than represented above. Comments from Physicians are welcome. Tell us what all this means, please.
But dear doctor...Don’t worry. This is temporary. We will adjust the penalty in the year ahead....first we’ll double it, then we’ll triple it and pretty soon it will be bigger than the Medicare shaft....
No sympathy for doctors who bought into this scam but interesting to see how fast the central planners are instituting their rules even to the inclusion of “Malpractice” fees associated with each type of procedure.
Governments have proven through out recorded history how completely inept they are running things unless they can use force. Central planners always fail and it is only a matter of time and how much damage is done before this will fail.
No sympathy for doctors who bought into this scam but interesting to see how fast the central planners are instituting their rules even to the inclusion of “Malpractice” fees associated with each type of procedure.
Seems quite apparent lawyers created this bill to assure they get their take right off the top and do not risk losing any of their income stream.
Governments have proven through out recorded history how completely inept they are running things unless they can use force. Central planners always fail and it is only a matter of time and how much damage is done before this will fail.
Call this what it is - stiff the doctor.
Long-term response - Doctor takes early retirement, young student in pre-med undergraduate study changes field, young doctors in residency training move to Switzerland, or Costa Rica, or the Phillipines, and attract “medical tourist” treatment programs.
Physician’s assistants soon follow footsteps of doctors. Nurse practitioners become first-line delivery of medical services.
Doctor-patient ratio becomes about one per 10,000.
Yup. There is an army of Birkenstock-wearing, unionized nurse practitioner “providers” who will happily work for a government salary of $75,000 a year or so. They will deliver your morphine and tenderly hold your hand as you die of something doctors could easily cure, but is now deemed too expensive on some utilization clerk’s spreadsheet.
At least 50% of the physicians in the U.S. should close their practices. When the Medicare crowd and the Medicaid crowd have their services cut off, they’ll be beating their Congressmen with their canes. This entire fiasco would be repealed pronto.
Medicare’s own actuary projects that under Obamacare, physician payments under Medicare eventually will be 74% lower than the rates paid by private health insurers. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/2012TRAlternativeScenario.pdf
Of course, long before that happens, providers will flee Medicare patients in droves, leaving them on their own (as Medicaid patients do right now) to find a provider. Typically this will take the form of care in an emergency room or community health center. Granny won’t be happy.
The real interesting thing to watch will be doctors who go solely to a cash private practice model. No Medicare, Medicaid, other health plans or insurance.
Some who already do this have figured that their overhead is so low, they can charge their patients 50% less.
The big problem, malpractice insurance, can be dealt with at the state level by limiting lawsuits to “actual damages” only, not punitive damages or attorney fees.
Of course, long before that happens, providers will flee Medicare patients in droves, leaving them on their own (as Medicaid patients do right now) to find a provider.
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Sometimes change is good ,, a poor relative of mine on Medicaid needed a cancerous kidney removed (nephrectomy) ... if it was me it would have been a painful rib breaking surgery ,,, however since the payout was smaller there was only one doctor who would operate on her ,, he also happens to be the ONLY doctor that does it laproscopically in our area,, making both the surgery and the recovery very speedy..
Your poor relative is fortunate. As a general proposition, paying 40-50% less than market rates isn’t the best strategy for getting good value for the money, which is why we would do well to fundamentally overhaul Medicaid.
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