Posted on 08/18/2009 12:25:02 PM PDT by CWW
Medicare Advantage plans often pay less than half what Medicare allows. The insurance companies are subsidized by the Fed Govt. So where is that money going?
I have been wondering about that too.
Why does no one talk about the wholly preventable disease of AIDS and instead talk incessantly about obesity which is merely a contributory factor to heart disease and diabetes.
Average cost of AIDS lifetime == $330,000
“Who told him this? Given his confusion between Medicaid and Medicare, how much weight can be given to this unwarranted conclusion?
The doctor is talking about Medicaid. The better comparison is Medicare. “
Doctor Pollard has no “confusion” between Mcare and Mcaid. That’s absurd.
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“Medicaid is needs based , run BY THE STATES
On this basis, not sure how relevant this doctor’s experiences are.”
His experience is totally relevant. Mcaid is a mess all over. Feds kick in funds to the states for it.
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“Now he switches to Medicare discussion, without , apparently , being aware of the significance of this switch.”
Of course he knows the difference between the two. This commentary is ABSURD!
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“So, how do all those bad systems like France and England maintain sufficient levels of specialty doctors?”
THEY DON’T. They get foreign medical graduates and have chronic doctor shortages.
The AIDS crowd might be a group under which the fire should be fanned
The comments to the article contain some excellent replies. Here’s a good one...
Posted by: Jim Strong
Aug 06, 01:58 AM
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As parts of the 1987 Omnibus Budget Reconciliation Act implemented in 1991, it was neither anticipated or followed by the media and was hardly dealt with by the medical community when draconian cuts appeared Jan 1991. The Medicare effects were MAJOR reimbursement reductions for the surgical specialties, and slight increases for Family Practitioners and Internists. All major surgical specialties were cut significantly, and the cuts remained in place with insignificant modification to this day. In Colorado in 1990, the anesthesiology reimbursement was $32 a point, slightly below BC/BS discounted rates. In Jan 1991 it suddenly dropped 50% to $16 a point and a further reduction was experienced with the ‘base’ points defined by Medicare in addition to time were also marginalized downward in addition to the unit values. In some practices, the cuts amounted to 65% or more depending on what types of cases were in ones practice for Medicare. The rates of 1991 are the SAME rates today in Colorado, and also in Washington.
Of the $16 allowed by Medicare for the last 18 years, Medicare pays 80% x $16 = $12.80 and the patient or the secondary insurance pays $$3.20. An hour of anesthesia service is 4 units, or $64 for 1991 to the present. Prior to 1991 it had been $128 an hour allowed. Medicare pays about $51.20 an hour and the patient or the secondary carrier pays the remaining $12.80 allowed. Currently in WA state, anesthesiologists make their living on the private insurance reimbursements which themselves are usually heavily discounted from the normal fees.
Today, an average point charge for a private practice anesthesiologist is $70 a point, and in parts of WY is around $90 a point....private ins. carriers usually heavily discount this. It takes about 4 Medicare cases to provide the same dollar reimbursement as one private insurance case on average. If a MD has mostly Medicare anesthesia cases, he will not have enough cases or hours in the practical day to desire to remain in practice. At $70 a point, the Medicare allowable is $16 (if collected including the 20% not covered by Mediacare)....a 77% lower reimbursement from an average fee in the state of WA for a Medicare case.
Aside from anesthesia, one of the heaviest hit dating from 1991 with no relief, other specialties have had similar experiences.
The loss of Medicare income from 1991 in the surgical subspecialties more than covers the lost income relative to the income not available for those pesky rising malpractice premiums. REPLACE MD REIMBURSEMENTS FROM MEDICARE TO 1990 LEVELS, AND THE SURGICAL MALPRACTICE FINANCIAL CRISIS DISAPPEARS.....DISAPPEARS!!! The crisis can be explained for the most part by the lost income from the Medicare cuts of 1991! The biggest culprit in generation of the physician difficulty of paying for malpractice insurance is the Democrat Congress of 1987 and the surgical specialties Medicare cuts implemented in 1991 which remain essentially in place today. A handful of states had slightly higher anesthesia reimbursements (suspect the large voting states NY, CA, TX and FL to be the ones), and I recently received notification that states in the $20 per point range were being lowered soon to the $16 already discussed.
An average anesthesia practice wil have over 50% Medicare, Medicaid, and ‘Community Health Plans’ (Mecicaid, again). By Obamas’ and the Dems intention to eliminate all private insurance, essentially all private practice surgical specialists unsalaried by hospitals or govt. or research facilities will probably be forced out of practice with the loss of private insurance...that is hundreds of thousands of US MDs......this has not been attended to by anyone with real numbers. NO PHYSICIAN LOSS ENVIRONMENTAL MEDICAL IMPACT STUDY HAS BEEN MENTIONED, PROPOSED, OR CONSIDERED to DATE. In the year 2000, my business accountant gave me data that showed I spent 75% of my time on the Medicare, Caid cases which provided 15% of my income...private insurance, mostly discounted by about 35%, provided 85% of my income for only 25% of my time. My total income represented the national quoted average of about$25o,000 for full time practice with a lot of call (3 call schedules during any week)...about 60-70 hours a week by recollection.
Medicare Part B, since 1965, has provided 100% of all residency (training funding and departmental support) for ALL specialists in the US. Furthermore, I think it was 2000 or 2001, ALL specialties training slots in ALL training institutions, non-military, were reduced by 25% with no change since. That is correct, a reduction of specialist MDs trained in the US was cut by a fourth a few years ago. A pilot program was run in NY for one year, and implemented nationally the next year. A shortage of anesthesiologists has been a problem for the last few years.
Summary: the Fed Govt. trains all specialists, has controlled their numbers totally, and is responsible for the shortages of same occurring now. The Congress is the main culprit in the difficulty of MDs to pay their malpractice premiums and augmentation fo the Malpractice Crisis due to the heavy reduction of Medicare reimbursement dating to a specific year, 1991, and will be responsible for the complete destruction of MD private practice and hundreds of thousands of MDs, whom Obamas’ National Service Program will probably demand work for free after their practices are destroyed. These topics have been dealt with in the past, but only in low circulation medical specialist journals in a fragmented and often misdirected way in that I have never seen an article relating the figures to the cuts of 1991 and their tracks to the present.
http://comments.americanthinker.com/read/42323/384747.html
I agree.
Thanks for the ping!
Say, for example, that the allowed reimbursement is $16 a point for a private MD service...this actual for one specialty in most states. This is the ‘allowed’ fee. Medicare will pay 80% of the ‘allowed’ fee, the $16...Medicare will send $12.80 to the MD. The balance of $3.20 is paid by the Medicare patient or by his secondary insurance, whatever it may be that he has purchased. It is a Federal criminal act for the patient or the doctor to deviate from the schedule in any way.
In WA state, in the referred to specialty, an average MD charge is $68 a point. The total allowed to receive is $16...16/68 is a 76% discount on the MDs standard fee before ANY practice overhead costs are taken out. All over the US, this is a private MDs imposed Federal tax right off the top in effect, placing MDs, due to Medicare and Caid writeoffs in the 65% tax bracket on their labor time. They are, and have been, especially since the cuts of 1991, the highest taxed people in the US.
Additional comment. One specialist in my state says he was apprised by his billing company on the state of his medical practice and time in surgery. He said his practice showed 75% of his time in the OR was for Medicaid and Medicare (similar low reimbursements)...’coupon’ cases...this 75% of his total time in the OR for the year yielded only 15% of his income. Private insurance and heavily discounted preferred provider and managed care discounted contracts yielded 85% of his income and only accounted for 25% of his time. What a way to be in business...govt considers MD private practice 100% business, not ‘medical practice’.
Thank you. You call it a tax. I call it price controls. I believe you can opt out of Mcare and then you can charge the patient what you want.
What I am saying is that some of the Mcare Advantage plans pay much worse than Medicare. I never see this information anywhere.
The basic Mcare Adv plan costs the basic Mcare premium est $94.00. Aetna pays doctors approximately what Mcare allows. UHC (which took over Oxford) and AARP pay less than half what Mcare allows. Both have the same premium. This information is not out there in the public. UHC and AARP pocket that extra money.
The only part of the Obama plan I agree with is eliminating govt funding of Mcare Advantage.
If a MD opts out of Medicare, he is capped at 115% OF THE ALLOWABLE, and because the increase is so small, and the billing so additionally costly, few choose the option. Either way, the reimbursement will not support them in private practice.
That’s not correct.
There are three Medicare options —
1. Participating = must bill Medicare, 100% of allowable
2. Non-Participating = must bill Medicare, 115% of allowable
3. Opt Out = you can NOT bill Medicare but you can charge whatever you want
Thanks.
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