Here is an example of a part of the first bill that I broke down:
NOTE: DON’T LET THE LEGISLATIVE GOBBLEDY_GOOK SHOWN BELOW SCARE YOU AWAY FROM READING THIS POST: I PUT IT THERE FOR A SPECIFIC REASON)
I was trying to figure out what is going to happen with physician compensation because I heard from a physician that all specialties, brain surgeons and dermatologists, will be paid the same. So, I tried to look through it, and in the process stumbled across how they plan to reduce both payment AND availability of imaging resources (such as CT, MR, etc.)
This is pissing me off, and really, it is beginning to make me burn. Look at how this thing is written. I copied the section below right out of the document. Look further down for my explanation if you are interested.
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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
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•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-
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1 tion, shall apply to services furnished on or after January
2 1,
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The following two paragraphs below show what the BULL$HIT above boils down to in normal english, and what it actually MEANS. This just steams me.
“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 Association of American Physicians and Surgeons (at this link: http://www.aapsonline.org/ this is an organization that advocates for physicians, not like the AMA which is advocating for liberalism) these sections above up to a reduction of 4.3 billion dollars a year in money to be paid for imaging. If someone interprets that some different way, please let me know...but if you bring in 45 million more people and reduce the money you pay...gee whiz, what is the end result?
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.
And, they were bashing the insurance companies for not explaining everything and having hidden clauses.
“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.”
And yet, you are reading it and painstakingly deciphering their BS legalese which is incomprehensible at first/second/third glance.
You’re doing it...keep going!
Stop reading their BS whenever you begin to sense utter confusion or disorientation but save your notes. Post those notes here on FR.
You’re a brave one and I appreciate your efforts. :)
They plan to tax pacemakers, hearing aids, porcelain teeth and more....... someone better wake up a lot of seniors before it’s too late.