Posts Tagged ‘medicare reimbursement’

In all this talk about Syria, we Americans may be forgetting that the biggest public policy shift in our lifetime is about to take place. The Affordable Care Act is rolling out on October 1st, whether Kerry manages to corral Syria’s chemical arsenal or not. Even though employers of 50 or more get a one year delay to implement a health insurance plan for their companies, and smokers get a one year reprieve from being charged more than non-smokers, Obamacare is scheduled to debut on time with:

“…health exchanges (marketplaces), community-rated health plans, tax credit subsidies, individual insurance requirements, prohibiting annual and lifetime limits on coverage, requiring insurers to accept all applicants without regard to their health status (pre-existing conditions) and limiting how much more they can charge them…” http://www.kevinmd.com/blog/2013/08/delays-pose-big-problem-obamacare.html

What a monumental effort, making health insurance available for all just when we qualify for Medicare! Then I heard about thousands of hospital workers being laid off in TN, and naturally asked Bob what’s up. After all, we Boomers are just the beginning of a tsunami of health-related consumers to wash ashore; how could our country possibly be laying off medical personnel? Of course the easy answer is to blame the government, Obama and all his caring, that’s what the GOP would like us to believe.

Actually, hospitals across the country are massively laying off workers for a few reasons. One big one is the sequester – you remember that courtesy of the Tea Party. Our budget was cut by 1.2 Trillion, that’s trillion with a “T.”  Since nobody on The Hill could find a way to stop The Sequester, Moody had this to say: “…sequestration is expected to lower the revenues of hospitals, physicians, and other health care providers by $11 billion in 2013.” That’s Billion with a “B.”

Medicare under from budget sequestration could “exacerbate an already challenging operating environment for not-for-profit hospitals” that are facing “low revenue growth” from government and private insurers, Moody’s Investors Service said this week. The sequester involves about $1 trillion in across-the-board spending cuts, including a 2% reduction to all Medicare reimbursement rates, that took effect on April 1. http://www.advisory.com/Daily-Briefing/2013/04/10/Moody-Sequester-Medicare-cuts-threaten-hospitals

And the funny thing is, well it’s not really funny, but if you happen to live in a red state, with a governor who said thanks but no thanks to the Affordable Care Act, well the chances are that your favorite nurse, or physical therapist, or doctor may not be there is undeniable. http://www.wkrn.com/story/22942014/laid-off-workers-rally-outside-vanderbilt

You decide, is this job loss due to a bill that gives all Americans access to health care? Or is it due to an intractable Congress?DB_medicaid_map



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I’m not a doctor. But I play the MDW (medical doctor’s wife) role now and then. Usually this fact doesn’t even come up, because when it does I have seen the change come over a person’s face. There is a slight leaning toward deferential, there is a wall erected, it gets in the way of things. One consequence of the MDW degree (and now the MDM, medical doctor’s mom) is that over the years, other people view me as having more medical knowledge in general, which is not true. I may be able to say “Homonomoushemianopsia” but it doesn’t mean I know all there is to know about it.

One thing I do know about is how intransigent this Congress has been, and I heard Bob say recently that Medicare reimbursement is taking a big hit in January. Then I heard that my brother’s primary care doctor stopped taking Medicare patients. So I set out to investigate. Now let’s just assume because it’s true, that ER physicians are a separate breed altogether. They donate almost 30% of their work to the poor. Overall, almost a third of patients who end up in the ER don’t have any insurance and are indigent. Can you think of any other business that writes off a third of their work? Emergency Medicine docs are the social safety net of our society.

But a Family Practice or Primary Care doc, he/she has spent the same amount of time being educated: 4 years of college, 4 years of med school, 3 years of residency and sometimes more when they get another fellowship. And now they are being asked to take a pay cut of 27% from Medicare. Around $168,000 is the average salary of your PC doc. A doctor’s income in a private practice is:
A – plus, what he/she takes in (payments)
B – minus expenses or overhead (staff, office space, electricity, malpractice, equipment).
Overhead runs on average 60% of a doc’s practice to about $259,000. It’s guns and butter, pretty basic economics. They are being asked to take a 65% cut in their salary because while their Medicare payments shrink by 27% their overhead costs will stay the same, or go up.

Are you still with me? If so, please consider letting your legislators know this has to come up for a vote before the holidays. http://capwiz.com/usdr/issues/alert/?alertid=57348501&queueid=%5Bcapwiz%3Aqueue_id%5D


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