Posted on 02/15/2014 10:16:02 AM PST by SeekAndFind
For me and many other doctors like me, taking care of you has never been about the money. I have always considered it an honor and a privilege to be allowed personal entrance into the private world of your mind and your body. It is very satisfying for me to be able to offer my medical knowledge and experience to help you, my patient. This is why no matter how much or how little you or your insurance company pay me to see you, I will continue to do so. I will not abandon you because the reimbursement I get for your office visit is constantly diminishing or because I will soon get a bundled or quality-of-care payment rather than a fee for the service. No matter what the insurance scheme, I will struggle to lower office overhead to compensate for continued loss of income.
But Obamacare may not allow me to continue taking care of you, no matter how altruistic I am. The real problem with Obamacares narrow networks on the state exchanges is not doctors like me dropping out; it is insurers deciding not to add us to their new networks in the first place. Dont get me wrong. No doctor in his or her right mind is eager to accept the reduced fees that Obamacare offers, and there is every reason to believe that the new policies will cut our reimbursements to the bone. But the reason that I dont participate in the individual markets GHI, HIP, or Empire Blue Cross plans is that these insurers have decided not to include my universitys network of doctors.
The cost of keeping us connected to our patients is far too rich for Obamacares blood. And for those insurers, like Oxford, United, and Aetna, that do include me via my university plan, I worry that these networks wont include the orthopedist or kidney specialist or brain surgeon I am used to referring to, further jeopardizing my patients quality of health care. Can you imagine searching unsuccessfully for a brain surgeon to remove a growing tumor? This is the hideous future of the state exchanges: limited care provided by limited networks of physicians. Remember the capitated HMOs of the 1990s? Obamacare is a reprise of this failed model. The word capitated should really be decapitated.
The individual market is just a taste of the future the same problems are sure to surface when the Obamacare business exchanges are up and running. And as businesses drop employees health coverage or make them part-time, so that more individuals resort to the state exchanges, the numbers of patients who are used to seeing me but no longer can will increase dramatically.
Many of my fellow physicians are concerned that as Obamacare collapses without the good doctors to support it, the government will have no choice but to mandate that all doctors participate. There is already a precedent for this. With Medicare and Medicaid, you are either all the way in or all the way out. There is no middle ground. As a participating Medicare provider, I cannot refuse to see a Medicare patient, though I can certainly delay an elective visit when my office schedule is full. An AMA survey in 2010 found that 17 percent of doctors were restricting the number of Medicare patients in their practice. Can you blame them? With reimbursements falling and restrictions rising for performing complex procedures on elderly patients with multiple medical problems, what doctor would rush to see them?
Many of my brethren feel that the same problem will soon exist for Obamacare. This is many doctors worst nightmare. You see, Obamacare is a multi-headed beast it involves too many insurers for such an across-the-board mandate to be effective or workable. Recently, I decided to drop out of an insurance network that was paying me only $25 per visit and was refusing to pay for flu vaccines.
I cant imagine losing the right to drop out of a bad insurance network any more than I can imagine what would happen if the new Obamacare insurances could be forced to include the best doctors.
The health-insurance situation is bad enough without adding any more mandates.
Marc Siegel, M.D., is an associate professor of medicine at the NYU Langone Medical Center and medical director of the centers Doctor Radio. He is a member of the Fox News Medical A Team and the author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health.
I quit when medicine was placed under State
control some years ago, said Dr. Hendricks.
Do you know what it takes to perform a brain
operation? Do you know the kind of skill it
demands, and the years of passionate,
merciless, excruciating devotion that go to acquire that skill? That was what I could not
place at the disposal of men whose sole
qualification to rule me was their capacity to
spout the fraudulent generalities that got them
elected to the privilege of enforcing their wishes
at the point of a gun. I would not let them dictate the purpose for which my years of study
had been spent, or the conditions of my work, or
my choice of patients, or the amount of my
reward. I observed that in all the discussions
that preceded the enslavement of medicine,
men discussed everythingexcept the desires of the doctors. Men considered only the
welfare of the patients, with no thought for
those who were to provide it. That a doctor
should have any right, desire or choice in the
matter, was regarded as irrelevant selfishness;
his is not to choose, they said, but to serve. That a mans willing to work under compulsion
is too dangerous a brute to entrust with a job in
the stockyardsnever occurred to those who
proposed to help the sick by making life
impossible for the healthy. I have often
wondered at the smugness at which people assert their right to enslave me, to control my
work, to force my will, to violate my conscience,
to stifle my mindyet what is it they expect to
depend on, when they lie on an operating table
under my hands? Their moral code has taught
them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I
have withdrawn. Let them discover the kind of
doctors that their system will now produce. Let
them discover, in their operating rooms and
hospital wards, that it is not safe to place their
lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man
who resents itand still less safe, if he is the
sort who doesnt.
Dr Hendricks, “Atlas Shrugged”
The other problem with self pay and high deductible patients is once they are seen by a physician, they are yours for 30 days, the amount of time it takes to fire them. There is a bunch of scenarios for this situation.
1. A patient pays for the first visit, then makes another appt for a different new problem the next week. The patient cannot afford the second visit, but the doc has to see them anyway because they can be charged by their medical board for abandonment if they refuse the second visit.
2. It is hard to quote an accurate price for the visit. The patient may have a much more complicated medical history, and the cost of the visit becomes much higher than initially quoted. Then, you have an angry patient screaming in the waiting room about their bill.
I think for the future, that patients may have to post some sort of bond, or bank a deposit in order to be accepted by a physician. It may something along the lines of $500 deposit that always needs to be fully funded by the patient as long as they are a patient of that practice.
That all over America almost every individual covered under Obamacare has become a high deductible patient. As soon as the small employer groups move over to ACA plans over the next year or so huge numbers of patients will be high deductible patients. In some areas nearly everyone will be a high deductible patient.
Doctors and hospitals will have to deal with that situation, and be ready to improve their billing procedures and face a lot of unhappy customers, as well as being able to withstand the loss of a lot of income. A lot of the careful arranged up-coding, facilities charges, etc. that insurance companies have swallowed as a necessary cost of doing business won't be so easy to get past the cash strapped patients who are seeing the bills first hand.
The pricing pressure the providers face may actually help reign in the rising cost of healthcare. But it won't be easy to be in the medical business.
Most docs have a fee schedule. With the high deductible plans, they can charge their actual fee instead of taking an insurance discount. I call that a win. They are going to have to figure out a way- like posting a deposit - before they see a patient. They are a business, not a charity.
Good luck making doctors do Anything they don’t want to do!
The government won’t have to make people become doctors. They’ll just import more from Nigeria and Somalia etc.
This article says he can’t refuse care to a medicare patient. The next sentence he says doctors are refusing to treat medicare patients. Huh?
-PJ
Not if they are in-network for the insurance company. All of the deals I have seen require the provider to only bill the patient the balance after the insurance discount is taken.
Also it looks like at least here in NH a provider cannot seek more from the patient than the amount they are willing to take for the same procedure from an insurance company. The providers still bill for their fee, and few patients know the law, but were one to sue a patient in an attempt to collect I am sure their attorney would know the law.
Providers may find the large increase in patients with high deductible plans to be financially challenging, since they will be exposed to more collections risk than they were with insurance plans with low deductibles.
would anyone be surprised?
A year or two later, NRO will support it
Yup. I will walk away from my career and training before I become a government lackey.
Invaders with questionable medical degrees and not enough knowledge of English to be totally effective will fill those slots.
Another problem is that if "it's covered" people will make appointments when they don't need them and there will be those who make appointments and don't keep them, clogging scheduling and leaving doctors and dentists with idle time.
They can make it like the military and say that only those in the service can perform those tasks and hold those licenses.
Ultimately the government lackeys have the docs by the ba**s. They can deny your license to practice if you don’t agree to...(fill in the blanks). We closed our 15 doctor practice a few years ago, sold the buildings and retired several years earlier than planned because of the looming nobamacare. To hell with these marxist asses. We’re enjoying every
moment of retirement.
I’m not sure I buy that. People don’t always do what a doctor recommends for other reasons besides not being able to pay for it.
And why would a doctor be liable for a patient declining a specific treatment? He can’t force someone to have surgery, and MRI etc. How could he be liable for people not doing it?
You’ve raised some excellent points.
“Then, you have an angry patient screaming in the waiting room about their bill.”
Now, in this situation, if you do really have an unhinged and disruptive patent, you don’t have an obligation to treat them electively, no matter what the board may think. If a patient is perceived as a threat to a staff member that would be consistent with a prident lay person standard, the patient can be discharged mediately. The key is documentation, that’s why doctors need a camera system to cover these incidents. A clinic does have an obligation to protect its employees from threatening patients.
With all that’s coming down with 0-care, we’re going to see a lot more crazy behavior.
Thanks Army Air Corps
The list, Ping
Let me know if you would like to be on or off the ping list
You will not believe what is happening in health care. Patients have sued hospitals because they did not make followup arrangements for patients post hospitalization, even though they were given the names and phone numbers to call their primary care physician. Now, hospitals have to make all the arrangements, because somehow the patients are unable to dial the phome number. This increases hospital costs in overhead to do something the patient should be doing .
If a doctor recommends a treatment, you can get sued by not trying to help the patient obtain that treatment.
That was back when [pre 2008]we were governed under the directives in the Constitution. Before a majority of those that voted said, via their votes, that they wanted a muslim to be their master. Before they said, again ,via their votes, that they wished to sell their souls and birthright to the muslim for a bowl of Government stew.
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