Posted on 07/06/2013 7:21:46 AM PDT by Kaslin
You should care a lot about how health reform will affect your doctor. The reason: it will also affect you.
Here's what's happening: hospitals are merging and they are acquiring doctors. In the process, they are making the market less competitive, gaming third-party payment formulas and doing other things that make our health insurance premiums and our taxes higher than they otherwise would be.
None of this is the result of any plan the administration ever announced, however. What did the Obama administration intend to happen? The clearest explanation of their vision of health reform comes from Harvard Medical School Professor Atul Gawande, who thinks that medicine should be more like engineering — with all doctors following the same script, rather than exercising their individual judgments:
This can no longer be a profession of craftsmen individually brewing plans for whatever patient comes through the door. We have to be more like engineers building a mechanism whose parts actually fit together, whose workings are ever more finely tuned and tweaked for ever better performance in providing aid and comfort to human beings.
Karen Davis, president of the Commonwealth Fund, explains what this will mean for the organization of medical practice:
The legislation also includes physician payment reforms that encourage physicians, hospitals, and other providers to join together to form accountable care organizations [ACOs] to gain efficiencies and improve quality of care. Those that meet quality-of-care targets and reduce costs relative to a spending benchmark can share in the savings they generate for Medicare.
To assist in this effort, millions of dollars have been spent on pilot programs and demonstration projects to find about "what works" so the ACOs can go copy them. We've had demonstration projects for coordinated care, integrated care, medical homes, electronic medical records, pay-for-performance and just about every other faddish idea. Unfortunately, the Congressional Budget Office has found in three separate reports that that none of this is working (see here, here and here.)
When I say that none of these techniques work, what I really mean is that projects designed, approved and paid for by the demand side for the market aren't working. Many of these techniques actually do work when they are instituted by entrepreneurs on the supply side. But these innovations have nothing to do with ObamaCare. They are happening in spite of ObamaCare.
[Oops, there was one demo project that actually worked and worked well. The government is shutting it down.]
Meanwhile, more than half the doctors are working for hospitals and other institutions, rather than working in private practice. And hospitals are using their new doctor employees to get more money out of Medicare. Even the Medicare Payment Advisory Commission (MedPac), the federal agency responsible for overseeing Medicare fees, has noticed — although belatedly — that hospitals can charge Medicare more for the same services than doctors can charge if they bill Medicare as an independent practitioner. As reported in The New York Times:
Medicare pays $58 for a 15-minute visit to a doctor's office and 70 percent more — $98.70 — for the same consultation in the outpatient department of a hospital. The patient also pays more: $24.68, rather than $14.50.
Likewise, the commission said, when a Medicare beneficiary receives a certain type of echocardiogram in a doctor’s office, the government and the patient together pay a total of $188. They pay more than twice as much — $452 — for the same test in the outpatient department of a hospital. (The test is used to evaluate the functioning of the heart.)
…From 2010 to 2011, the commission said, the number of echocardiograms provided to Medicare beneficiaries in doctors' offices declined by 6 percent, but the number in hospital outpatient clinics increased by nearly 18 percent.
On the positive side, a major unintended consequence of health reform is the boost to consumer directed health care. In the health insurance exchanges, the cheapest plans are going to have deductibles of $5,000 or more. And lots and lots of people are going to choose the cheapest plans. Avik Roy reports that employers are going for Health Savings Accounts (or Health Reimbursement Arrangements) in a big way. Bottom line: millions of patients are going to be buying care with their own money, rather than with a third-party payer's money.
I'm sure this thought is causing heartburn for those on the left who view high deductible plans as "under-insurance." But this development is viewed as opportunity by health care entrepreneurs.
One study is predicting that the number of walk-in clinics is going to double in the next few years. The Obama administration doesn't like them because they are not part of integrated care/coordinated care/medical homes/etc., etc., etc. Even so, they are doing what the ACOs are unlikely to do: lowering costs, increasing quality and improving access to care.
Amerika can bend over and kiss their rears goodbye, ya think?
during the harvest, they will help cut sugar cane, I suppose.
Insurance only works financially if it covers unplanned for and unpredictable situations. It's about evaluating risk.
Why should I have to have insurance to pay for some old guy's Viagra and some fatty's diet counseling? Etc
But will the Health Savings Account help you if you become terribly sick and need hospitalized care? If I were younger, I might consider it, but if one gets cancer, that $5,000 deductible won’t seem like much.
The simple fact of the amount of money being stolen from Medicare to support the ObamaCare train wreck should scare the living hell out of seniors.
This is truly the “Disposal Senior Citizen Act” among other things.
It also proves the total ineptness of the GOP in not getting that one fact out far and wide.
As a retired Mechanical Engineer, I reject that statement. That should read: Planning commission regulations. Engineers are not necessarily confined to strict regulations. Engineering innovations make for better and less expensive products.
Good Hunting... from Varmint Al
Atul Gawande is someone who does NOT understand engineering. I have seen the cookie cutter, cut and paste approach applied blindly (as in one size fits all), and IT DOES NOT WORK! While their may be similarities between applications, each application must be examined to determine where the engineering solution may need find tuning specific for that application. The same applies to medicine, or any other field based in science and technology.
Disclosure statement - I am a licensed professional engineer.
Engineering, at its core, is the art of taking a set of requirements and producing a compliant solution - with the elegance embedded in the simplicity.
It has already caused him to sell his practice to a massive health care conglomerate and become an “employee”. One step closer to walking out the door into retirement once his employment agreement expires. After all, he has already cashed out.
TOTAL, TOTAL, TOTAL, TOTAL, TOTAL, TOTAL, TOTAL, TOTAL, TOTAL, TOTAL, TOTAL.
Get the nominations process OUT of the hands of The GOP Establishment, and take the early Primaries OUT of The North East or it will never change.
Routine life saving screening tests like mammograms and PSA tests will be done only every other year because according to government bean counters it makes no difference. Breast and prostate cancer deaths will increase as a result because these cancers will be more advanced when detected. This has been the experience in the UK where breast cancer deaths have increased well beyond the rates in other countries.
Worst of all will be the rationing of care with government mandated treatment standards. The very young and the elderly will be routinely denied care. Case in point that 10 year old girl recently needing a lung transplant. Had the bureaucrats prevailed she would be dead simply because she didn't meet the guidelines.
I hope doctors retire early if they are able to do so. I hope people suffer. Maybe...just maybe people will be awakened to the LIB tyranny being forced upon us.
It will NEVER happen. Liberals accept NO responsibility for any of the actions they have hoisted upon this republic.
They blame others for their very existence.
Actually, no: such procedures are responsible for a remarkably small share of the improvement. Roughly half of the decline has come from reductions in risk factors like high cholesterol and high blood pressure, both of which are treated by relatively cheap medicines. And much of the remaining decline is thanks to ridiculously inexpensive treatments like aspirin, heparin, ACE inhibitors, and beta- blockers.*"
Obamacare focuses on making the more expensive, less effective technologies less available and/or cheaper -- while doing little, if anything to make cheap, effective treatments more readily available or more commonly utilized. (Stopping smoking, dieting and exercising -- walking instead of driving -- have a net negative cost.) While colonoscopies, mammograms, PSA screening and expensive miracle-cancer treatments can certainly be proven to be effective, it's much more difficult to prove that they are cost effective. (Just to be clear -- I don't have any trouble with the idea of it costing $100,000 for me to live one month longer -- just so long as it's your $100,000, not mine!)
Lungs are the hardest organs to transplant. The adult lungs had to be shaved to fit the child, causing them to be handled excessively, and most of the time end up being compromised. Something that has not been widely talked about is that, the first tx did not go well, and Sarah's body rejected the transplant, and three days later she had to have another million dollar set of lungs that were not healthy. This procedure was only a band aid fix for her and some adult with small children to raise is dead.
But delaying the employer mandate by a year? Hey! No problem.
My GP is 53...he says he’s retiring. He had a private practice with a group of other doctors, but they’ve been acquired by one of the large healthcare corporations. But he has no desire to practice medicine that way, so he says he’s retiring.
Recently our insurance (United) and one of the healthcare conglomerates in our area could not come to an agreement and we went for approximately 3 months without being able to see any doctor that was part of that corporation unless we wanted to pay private pay. But the doctors weren’t allowed to lower their rates (even if they take lower rates from most insurance companies and Medicare)...they had to charge the full rate.
I was in the process of changing neurologists, mine had left town to work for a pharmaceutical, and I had set up an appt. with the new neuro who happened to be in the group that was squabbling with the insurance company. I inquired about the cost of a new patient visit, if I were to private pay...$495 and they wouldn’t lower it for private pay, because that’s what they charge the insurance companies and to charge less was against the law...but the insurance companies, because of their contract pay much less than that per their contract.
I also found out at that time that 90% of the neuros in our city had signed with the healthcare conglomerate...so I just went without a neuro for a few months (I have MS) and fortunately didn’t have any crisis during hat time...if I had, I’d have had to either use the ER or my GP would have had to handle it...only problem, it takes me 6 weeks to get in to see the GP, so I imagine his NP would have had to handle it.
I just look for more and more problems like this as Obamacare takes effect.
Doctor? What doctor?
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