Need Information for TownHall Meeting Re: Physician compensation in Health Care Bill

8/6/2009 | rlmorel

[rlmorel]

I am going to try to attend a TownHall meeting today, and there was another thread on FR with an article from a Pediatric Opthamologist who stated that physicians will be paid the same amound of money regardless of specialty. (Thread is at: http://www.freerepublic.com/focus/f-news/2309412/posts)

That seemed patently absurd to me, but I downloaded the document is is written with such legalistic obfuscation that I was unable to find the provision on this aspect.

Can anyone help? Has anyone taken the time to comb through this POS legislation and come across this?

[rlmorel]

This is an issue I wanted to ask at the meeting, because I think the concept of Physician compensation is key. Health Care is a hugely human intensive business.

Currently, physician billets are filled (albeit with a long lag, sometimes on the order of many years) on the basis of what attracts young doctors into various specialties including what it pays, offset by the difficulty of learning a specialty and the risk involved. If it were an easy specialty and they didn't need a million dollar malpractice policy, everyone would be brain surgeons. But the factors weed it out. If we remove the financial incentive, why would someone be a brain surgeon, a high stress, high risk, high call specialty when they could be a dermatologist with normal working hours and no call?

[bboop]

I heard that last night too — a guy next to us at the restaurant whose doctor friends were up in arms because ‘doctors would all be paid the same, regardless if they were a GP or a specialist.’

I’d love to hear doctors making a stink about this.

[bobsatwork]

Try this (page 241): Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service This monstrosity is so complex I can't say with certainty what it all means, but this could be interpreted to mean pay leveling.

[loveliberty2]

The Association of American Physicians & Surgeons has been fighting the effort to impose socialized medicine since 1943. Much information can be gleaned here:

[loveliberty2]

Sorry, that should have been here

[combat_boots]

Try these:

“PG 239 Line 14-24 Government will reduce physician services for Medicaid.

PG 241 Line 6-8 Doctors, doesn’t matter what specialty you have, you’ll all be paid the same.

PG236 L22-25, 237 L1-3 National rate of uninsured defined by Census.

PG 239 Line 10-12 Medicare DSH payments will be increased.

PG 238-249 Line 1121 Doctors-Government mandates your growth, costs, value, services, & income.

PG 253 Line 10-18 Government sets value of Dr’s time, prof judg, etc. Literally value of humans.

PG 313 Line 9-14 Government MANDATES Health Services providers will state ownership, invest, & compensation arrangements.

PG 317 Line 13-20 PROHIBITION on ownership/investment. Government tells Drs. what/how much they can own.

PG 318-319 Government is mandating how hospitals & physicians conduct business & investments.

PG 429 Lines 13-25 The Government will specify which Doctors can write an end of life order.

Pgs 797-800 SEC. 1744 PAYMENTS for grad medical education. The government will now control Drs education.”

Note:
This is not the exact language.

[84rules]

"Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service."

Actually, it is the subsections below this sentence that levels out the pay between doctors regardless of their specialty.

Those subsections deal with establishing conversion factors for "each service category." It essentially amends Subsection (d)(1) of section 1848 of the Social Security Act (42 U.S.C. 1395w-4) which governs how phyicians are to be paid for their services.

[84rules]

You can download HR3200 from here:

HR3200

[rlmorel]

Thanks...I already got it from Jeff Head (who has a great page with a variety of links on it)

And...thanks for your service. Wish we DID have the USMC out there fighting this...it would be no contest!

[rlmorel]

Excellent link! Thank you, that did have some very pertinent info.

I am trying to find stuff that is contained in the bill that I can quote and make some sense of, and this is helping.

[Dudoight]

Doctors, it does not matter what specialty you have; you will all be paid the same. “Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.’’ Sec. 1121 page 241, lines 6-8

The Government “validates work relative units” (sets value of doctor’s time, professional judgment, methods, etc., defining the value of humans). “The Secretary shall establish a process to validate relative value units under the fee schedule under subsection (b). 10 ‘‘(ii) COMPONENTS AND ELEMENTS OF WORK.—The process described in clause (i) may include validation of work elements (such as time, mental effort and professional judgment, technical skill and physical effort, and stress due to risk) involved with furnishing a service and may include validation of the pre, post, and intra-service components of work.” Sec. 1122 page 253, lines 6-18

http://beltoftruth.wordpress.com/2009/08/05/hr-3200-obama-health-care-plan-update-4-especially-for-doctors/

[Cletus.D.Yokel]

Service categories established under this paragraph shall apply without regard to the specialty of the physician furnishing the service.

What this tells me is, that if you have a skin disorder, you might end up seeing a podiatrist or proctologist if that who is available. They will then be paid at the pre-determined rate of a dermatologist.

[Jeff Head]

See this:

HERE ON FR

Read the sick quotes from the architect of this Obama Care plan and chief advisor to the president.

The read post 38 and get into the deep thinking of these people. They want to control and make life and death decisions for all of us.

[rlmorel]

This is pissing me off, and really, it is beginning to make me burn. Look at how this thing is written:

***************************************
***************************************
SEC. 1147. PAYMENT FOR IMAGING SERVICES.
10 (a) ADJUSTMENT IN PRACTICE EXPENSE TO RE11
FLECT HIGHER PRESUMED UTILIZATION.—Section 1848
12 of the Social Security Act (42 U.S.C. 1395w) is amend13
ed—
14 (1) in subsection (b)(4)—
15 (A) in subparagraph (B), by striking ‘‘sub16
paragraph (A)’’ and inserting ‘‘this paragraph’’;
17 and
18 (B) by adding at the end the following new
19 subparagraph:
20 ‘‘(C) ADJUSTMENT IN PRACTICE EXPENSE
21 TO REFLECT HIGHER PRESUMED UTILIZA22
TION.—In computing the number of practice
23 expense relative value units under subsection
24 (c)(2)(C)(ii) with respect to advanced diagnostic
25 imaging services (as defined in section
VerDate Nov 24 2008 23:22 Jul 14, 2009 Jkt 079200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6201 E:\BILLS\H3200.IH H3200 jlentini on DSKJ8SOYB1PROD with BILLS
274
•HR 3200 IH
1 1834(e)(1)(B)), the Secretary shall adjust such
2 number of units so it reflects a 75 percent
3 (rather than 50 percent) presumed rate of utili4
zation of imaging equipment.’’; and
5 (2) in subsection (c)(2)(B)(v)(II), by inserting
6 ‘‘AND OTHER PROVISIONS’’ after ‘‘OPD PAYMENT
7 CAP’’.
8 (b) ADJUSTMENT IN TECHNICAL COMPONENT ‘‘DIS9
COUNT’’ ON SINGLE-SESSION IMAGING TO CONSECUTIVE
10 BODY PARTS.—Section 1848(b)(4) of such Act is further
11 amended by adding at the end the following new subpara12
graph:
13 ‘‘(D) ADJUSTMENT IN TECHNICAL COMPO14
NENT DISCOUNT ON SINGLE-SESSION IMAGING
15 INVOLVING CONSECUTIVE BODY PARTS.—The
16 Secretary shall increase the reduction in ex17
penditures attributable to the multiple proce18
dure payment reduction applicable to the tech19
nical component for imaging under the final
20 rule published by the Secretary in the Federal
21 Register on November 21, 2005 (part 405 of
22 title 42, Code of Federal Regulations) from 25
23 percent to 50 percent.’’.
24 (c) EFFECTIVE DATE.—Except as otherwise pro25
vided, this section, and the amendments made by this sec-
VerDate Nov 24 2008 03:06 Jul 15, 2009 Jkt 079200 PO 00000 Frm 00274 Fmt 6652 Sfmt 6201 E:\BILLS\H3200.IH H3200 jlentini on DSKJ8SOYB1PROD with BILLS
275
•HR 3200 IH
1 tion, shall apply to services furnished on or after January
2 1,
***************************************
***************************************

THIS is what it actually boils down to (my condensing):

“SEC. 1147. PAYMENT FOR IMAGING SERVICES.
ADJUSTMENT IN PRACTICE EXPENSE TO REFLECT HIGHER PRESUMED UTILIZATION
In computing the number of practice expense relative value units under subsection the Secretary shall adjust such number of units so it reflects a 75 percent (rather than 50 percent) presumed rate of utilization of imaging equipment.”

(I am no expert on this, but downloading a Powerpoint Presentation, and looking around at various critiques of the way practice expense is calculated, INCREASING the presumed rate of utilization drives DOWN the amount of money you get paid. I am a genius. I assumed that, but figured I better check it out...)
END RESULT: LESS MONEY FOR IMAGING, FEWER SERVICES OFFERED.

“Section 1848
ADJUSTMENT IN TECHNICAL COMPONENT DISCOUNT ON SINGLE-SESSION IMAGING INVOLVING CONSECUTIVE BODY PARTS.
The Secretary shall increase the reduction in expenditures attributable to the multiple procedure payment reduction applicable to the technical component for imaging from 25 percent to 50 percent.”

(What this means is that from now on, if you do a CT of the Abdomen AND a CT of the pelvis without moving the patient, you now get paid 50% less rather than 25% less. This is huge, and just one example of how they are going to cut billions of dollars a year in costs. The scumbags will say with a straight face that they aren’t rationing, but if you don’t get paid for the service, you either don’t do the service, or you go broke)
END RESULT: LESS MONEY FOR IMAGING, FEWER SERVICES OFFERED.

According to the AAPS link someone provided above (Great link!) This section adds up to a reduction of 4.3 billion dollars a year. If someone interprets that some different way, please let me know...

Now, I wasn’t born yesterday, and I know why they are doing this, but this is our healthcare we are talking about, and they have deliberately tried to bury as much of it in incomprehensible legalese as they can get it. It made me madder and madder as I tried to go through it.

THEY DON’T WANT ANYONE TO READ AND UNDERSTAND THIS.