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To: ExxonPatrolUs
using a round number, basically this is how it works as it is now...

Diagnostic Laparoscopy = $1000

No Insurance, you pay $1000

top tier insurance like Blue Cross says,
Yeah it's worth $1000 but we give you so much business that you will take an adjustment of $150 and a write off of $100 and we'll pay you $750

Medicare says,
We don't think it's worth $1000, we only think it's worth $750 but, since we give you so much business you will take an adjustment of $150 and a write off of $100 and we'll pay you $500

Medicaid says,
We don't care what it costs, because we give you so much business we'll give you $250 or you can't treat Medicaid patients anymore.

now, cut that number and see how many Doc's will STILL treat them...

7 posted on 12/01/2012 9:24:29 AM PST by Chode (American Hedonist - *DTOM* -ww- NO Pity for the LAZY)
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To: Chode
:Medicaid says, We don't care what it costs, because we give you so much business we'll give you $250 or you can't treat Medicaid patients anymore."

Being sarcastic of course, say the good doctor can do two procedures in one hour of actual work time, At the Medicaid rate of $250 per procedure as in the example, that good doctor would be paid $500 per hour by the program with the lowest reimbursement rate. Just something to think about.

10 posted on 12/01/2012 9:39:23 AM PST by buckalfa (Nabob of Negativity)
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To: Chode

Physicians would be penalized for ordering unnecessary tests and procedures for their patients under the plan. But the cost of the permanent doc fix would be high — as much as $300 billion.

Two points - one, beware when the government decides what an “unnecessary” test and procedure is. When it’s the payor who decided this instead of the physician and patient rationing of care will follow and, already is with Medicare. Currently the govt. panel has announced that doctors should not do any mammograms on women for screening for breast cancer prior to age 50... unfortunately there are a lot of women with breast cancer prior to that age that will go undetected !! Also they have determined that doctors should not screen for prostate cancer...and of course that learned panel had no urologists, nor oncologists !!

Two — doctors offices are no different that any other business. They must cover expenses and turn some profit to stay in business... the profit margin in caring for a medicare patient currently is negligible to nil and when the feds cut reimbursements further doctors have two choices...refuse to see medicare patients, or close the doors...the number opting out right now is high...it will skyrocket if congress doesn’t fix this before implementation. If you have a doctor that is seeing you and taking your medicare...do not move, do not change doctors...and thank your lucky stars..and his/her office!


13 posted on 12/01/2012 9:46:23 AM PST by Froggie
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