Posted on 07/08/2008 10:36:27 AM PDT by meandog
Plummeting Reimbursement Rates Have Some Doctors Looking for a Way Out
By AUDREY GRAYSON ABC News Medical Unit
RSS For the past four years, Dr. Heather Tipsword has owned a family practice clinic that primarily treats Medicaid and Medicare patients in Oklahoma City. As many of her friends and family were looking forward to Fourth of July celebrations this past weekend, Tipsword was anxiously looking forward to another event altogether: Congress' meeting on the Monday after the holiday weekend to discuss some kind of fix to the scheduled 10.6 percent Medicare reimbursement cut.
For many doctors, low Medicare and Medicaid reimbursement rates are too much for their practices to bear. (ABC News Photo Illustration)To Tipsword, this round of Medicare reimbursement cuts, to become effective July 15, could make or break her family practice. (In many states, these cuts affect Medicaid too.)
"I have struggled to build up my practice, but my outlook gets worse each year," Tipsword said. "The current round of Medicare cuts -- which will cut my repayments, which are miniscule right now -- as well as increasing malpractice insurance coverage, despite an A+ rating, makes it less feasible for me to continue practice."
However, the meeting yielded no short-term fix for the problem, and by the end of the session it was clear that the 10.6 percent cut would likely go through anyway.
(Excerpt) Read more at abcnews.go.com ...
Government control of Prices doesn’t work?
Who knew!
Friederich Hayek
Milton Friedman
Etc.
I'm waiting for the first hospital to just bail out of Medicare/Medicaid altogether to be able to reduce costs to every other patient.
I don’t understand how anyone can know what health costs are so I am not sure if the Medicare/Medicaid issue is valid or not.
Case and point, I get statements from my insurance company where a doctor bills say $1000, but there is some discounting of say %650, so the doc gets paid $350 including my copay. So what does a procedure really cost, $1000 or $350? As long as I see this, I don’t know to believe anything the medical/pharmaceutical industry has to say.
The discount was supposed to be $650, not %650.
Just so everyone knows, whenever you hear about an ER closing, it is because of Medicaid, a government healthcare program.
By design, California’s medicaid system pays about 20 cents on the dollar of Medicare’s already paltry fees.
Most docs and hospitals tell me that they lose money on Medicaid and Medicare and make up the difference by charging private plans more.
If private plans go away, the rationing will hit very hard and you will hear the brakes screeching on growth in health staffing, for folks like nurses, etc.
So when you go to WalMart and the price on your foot massager says $500.00 and you pay the sales price of $9.99, what is YOUR true cost?
This makes me sick. Don’t believe it. I know a few doctors who deal with Medicare patients only, and together they recently purchased several parcels of land near the hospital on which they built HUGE medical buildings, including offices and surgical facilities. They are not hurting, not in any way, shape or form.
Can’t be... According to my elderly father, medicare is proof that government supplied healthcare is extremely efficient.
Do we really have to re-study why there were bread shortages in the Ukraine?
Any administered price system's distortions are compounded over time.
Medicare pays too much for some things, and not enough for others. Over time, you get more of what you overpay for, and less of what you underpay for.
Why do you think every hospital in America has a heart center, an orthopedic center, a cancer center, and a women's health program?
Why do you think hospital infection control programs are shrinking? Why do you think inpatient psychiatry is almost extinct?
For some MDs, Medicare is a license to print money, or even to build new buildings. For other MDs, it's ruination.
This will be the case of any government-run price regulation scheme - and it's AMAZING that there are so many people who, having lived through the 20th Century, don't know this already.
I believe they would lose their permit to operate if they did that.
“So when you go to WalMart and the price on your foot massager says $500.00 and you pay the sales price of $9.99, what is YOUR true cost?”
I am asking more about THE cost, not MY cost. A better example would be, the foot massager will cost someone paying cash $500 and will cost someone paying by VISA $9.99. The Government is coming in and saying we will use Discover and pay only $7.50. Obviously people are paying a wide range for the massager, but does anyone really know what the cost is?
Frankly, people would not need any insurance, except maybe major-medical if everyone got the discounts insurance companies get. No doubt, the system is screwed up.
Properly written TORT REFORM could reduce Insurance premiums 20% - 30%!!!!!!
(YES, for the Dr’s malpractice AND our Health Insurance!)
My doctor bailed on Medicare about a yr ago. There are big signs all over her office. We had a chat and I was curious I asked her why. She said they owe her about $80k and it takes them forever to pay. She got tired of messing with them.
I know several former doctors who are now ‘guests’ of the state who did the same thing.
The unrealistic zero sum expectations placed on doctors for excellent healthcare, coupled with $200,000+ medical schools bills, and $100,000 year malpractice insurance, maze-like rules for reimbursement, coupled with 10% yearly reimbursements for care = Doctors quitting.
A friend who is a pediatrician is pulled out of all insurance companies as a provider and is going to 100% cash practice.
She will see less patients but the cash paying patients get more 1 on 1 care. Her overhead is less by getting rid of insurance clerks.
Nobody would take their car to a mechanic who couldn't tell you what a repair would cost or who couldn't give you a parts/labor billing breakdown for a repair, yet we routinely take ourselves in for any number of diagnostic and/or repair procedures in complete ignorance of who's being charged what for what and who's getting that money.
AH! Socialism Sucks!
and thats what
The Demorats Want!
VOTE DEMORAT IF YOU ARE BRAINDEAD!
I was in health care for 25 years, the last 12 in durable medical equipment (DME). MEDICAID reimbursed less than cost on many frequently ordered devices or set filing rules in such a cock-eyed fashion so as to make it impossible to file in time for payment.
MEDICARE reimbursement varies from state. Why is the payment for the exact same item 30 to 50% higher in California and 200 - 300% in Puerto Rico than Mississippi? The cost of the equipment is the same and other cost are in line.
The real source of rising healthcare costs are 2 fold; government involvement and trial lawyers.
You are talking about fraud there. No way you get rich on medicare/aid legally.
Um, you really need to know more about what you’re talking about before you make that kind of statement. General practioners are being squeezed and put into a major vice by current medical payment plans put forth by the government and private insurance.
Surgeons and other specialists are doing well, namely because payments to them are at a much higher rate than to GPs.
But you’re having GPs coming out making 110k per year with 250k debts from schooling alone. Overhead and office staff are an additional expense, as is malpractice insurance. This is after they spent 3 or more years slaving away at 80-hours per week on 40k pay.
Several things need to happen, and one of these no doubt is a shifting of funds from specialists to primary care docs.
I’m going to be honest: I laugh at the idea that GPs could afford to buy huge medical buildings next to a hospital. And to add on to that, they’re not building surgical suites as GPs, either.
There are nurses who are making far more than doctors these days and with less schooling and training on top of it. Thing is, they’re working in anesthesia.
My doc is a cash practice also. He gives an invoice so you can submit for insurance reimbursement, but since his cash fees are lower than the copay we’d pay, it’s a moot point. He also has this handy thing on the back of the invoice: it’s a list, in real English, of all the services and procedures he offers, with their cash price listed next to them. No surprises. I love it.
“A friend who is a pediatrician is pulled out of all insurance companies as a provider and is going to 100% cash practice. She will see less patients but the cash paying patients get more 1 on 1 care. Her overhead is less by getting rid of insurance clerks.”
I know a lot of psychiatrists are going this route, as well: completely cash payments.
They spend far more time with their patients when the insurance companies and medicare stopped paying for psychotherapy. Right now, doctors are being forced into seeing increasing numbers of patients to make up for reimbursements cuts. It’s not satisfying to the doctors or the patients.
Primary care is really getting screwed over in this country.
That’s because Medicare and Medicaid PAY. Lots of patients just refuse to pay anything. But Medicare and Medicaid can barely cover Malpractice Insurance in many cases.
Here's an idea, hows about a hefty cut in the salary and benefit package of every federal employee, (excluding members of the military), with the resulting savings applied to covering these proposed medicaid and medicare cuts. Or, kick out the illegal aliens and used the money saved that we've been wasting on them to cover the shortfall.
Illegal aliens make up about 40% of the uninsured in this country. They also access the ER for primary care, which means they’re racking up some pretty giant charges.
The sad reality is also that they’re over-represented in our trauma centers: in part because they’re often involved in manual labor and in part because of their tendencies to drink and drive. There were definitely nights when I was on trauma where half of our patients were Mexicans, and I don’t live anywhere near the border.
You hit the nail right on the head my FRiend. I would only add to what you are saying that once you’re in the Medicare/Medicaid “mill” business in addition to migrating to services which pay better, there is a huge incentive to “Turn the Crank”. Move patients in the in door and out the out door. These can be either real patients or Chicago voter type patients. But in either case, the emphasis becomes quantity and not quality. This has been going on for a VERY long time. At least to back in the 1970’s.
I refuse to believe it! Facts won’t stop me from providing a crappy service to the American people! Tax the rich! Universal Health Care!
Shrug Atlas, shrug! What will we do when there are no more doctors? How many people will die before mamma guv’mint butts out? Has anyone noticed that waiting lists for surgeries are growing longer? And this is before any ‘real’ socialization.
bttt
It's a game the insurance companies play.
If I charge $1000, they pay $350. If I charge $350, they pay 35% of that.
Every once in a while, a patient without insurance wants to pay cash up front and asks what the fee is. I always tell them that the fee is irrelevant, I call up my billing agent and instruct her to give the patient the insurance company rate. If not, the responsible cash-paying patient is getting ripped off by the games that insurance companies pay.
Medicare is, at least, a fixed commodity. Unfortunately, for some things, a doctor's overhead to provide the service may be higher than what Medicare pays.
They are probably engaged in fraudulent billing, collecting payment from the government/taxpayers for thousands of office visits and procedures that never happened.
The problem though is that most hospitals and nursing homes have a very high medicaid/medicare ratio to private insurance. I would guess at least 95%...maybe higher... are government funded. They complain about government funding but most would probably go belly up without it.
Yep.
Insurance companies swing lower costs for guaranteed volume, and that is the basis for your claim.
I used to write medical billing, and the underlying root of all evils here is government involvement which skews the free market dynamic, and has done so since the magic date of 1964, when health care costs became disconnected from reality for political gain.
Nobody would take their car to a mechanic who couldn't tell you what a repair would cost or who couldn't give you a parts/labor billing breakdown for a repair, yet we routinely take ourselves in for any number of diagnostic and/or repair procedures in complete ignorance of who's being charged what for what and who's getting that money.
You're almost there. Transparency won't mean squat unless people are directly paying something. One qualification for your mechanic is reasonable feedback on what it will cost you for the repair. Now let's say instead, you paid only a nominal/or no fee for the auto repairs - most people will no longer care what the "real" price of the repair. Transparency is now irrelevant to your goal - getting your car repaired. In fact, when there is only a nominal cost, many will ask the mechanic to "double check things" and for the heck of it, rotate the tires, too. This is the daily social economics of today's medicine. Notice how it also destroys the fabric/cohesiveness of the nation, as individuals are often placed in a dilemna of short term/individual preferences versus "what's best for the 'system'"/long-term. Few of us would actually advise people to choose the latter over the former (in fact, there is a whole political philosophy founded upon choosing this way, and it is called Libertarianism - just joking, it was my cheap shot of the night). Few who want are actually willing to sacrifice, or at least, it is becoming rarer.
bump
The final step is to move "health insurance" back to being an actual insurance policy, not a "benefit" policy. You buy fire insurance for your house to protect yourself against catastrophic loss, not because you expect to have a fire. But you expect to pay for routine household repairs yourself. Medicine is no different. And yes, as we age we should expect to pay more for medical costs than when we are young just like an old car tends to need more repair work than a new car.
Along the same line, I think the private insurance discount is similar to the Medicare discount. Does that mean, that the docs will also stop accepting private insurance payments?
Hardly a news story. This continued reduction of real reimbursement for doctors (and other "providers") by Medicare and Medicaid has been going on for decades now.
The low reimbursements from Medicaid caused the large majority of private medical practices not to deal with poor patients, and led to the phenomenon of "Medicaid mills"; these practices catering to the poor require huge volumes of patients in order to make up for the very low government payments.
With Medicare, the declines in government compensation to "providers" have been slower, though persistent. It is now not uncommon for practices to "drop out" of Medicare and only accept patients on a private contracting basis. These paractices, however, are bound by law not to accept reimbursement from Medicaire for any patients whatsoever. So while "dropping out" of Medicare has enabled some practices to keep up with fees on patients willing to pay more for services, these practices run the risk of losing a good percentage of the their Medicare patients unwilling to pay their own way.
Instead they should drive UPS Trucks
P.S. The average medical school debt is now in excess of $250K. The numbers should be revised accordingly.
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