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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Phillipa on August 3, 2011, at 20:09:21
Seems they didn't cut medicaire but seem to be making the care impossible to get. Phillipa
From Medscape Medical News
Congress Passes Debt Deal; Could Reduce Medicare Payments
Robert LowesAuthors and Disclosures
August 2, 2011 With a 74 to 26 vote by the Senate today, a contentious Congress finally passed a bill that both shrinks federal spending and raises the $14.3 trillion federal debt ceiling, just in time to beat an August 2 deadline and avert a catastrophic government default.
The House did its part yesterday by approving the bill 269-161 in a grudging bipartisan vote, with Democrats unhappy that envisioned spending cuts topping $2 trillion were not accompanied by any tax increases, which Republicans vehemently opposed. Next comes the expected signature of President Barack Obama, who had crafted the measure with congressional leaders.
The agreement may calm the financial markets by maintaining the credit worthiness of Uncle Sam, but it is troubling physicians and hospital executives, who could see their Medicare reimbursements trimmed in the process. Those potential cuts would come at a time when providers already face other major Medicare reductions.
Physicians, for example, are scheduled for a 29.5% decrease on January 1, 2012, unless Congress intervenes. The bill passed today does not include a "doc fix" to the Medicare reimbursement crisis, disappointing organized medicine, which had lobbied for such a provision.
"It looks like a double cross," Jack Lewin, MD, chief executive officer of the American College of Cardiology (ACC), told Medscape Medical News. "Im sure doctors will feel frustrated when they find out (about the possible debt-deal cuts)."
The debt legislation lays out a serpentine path to an additional Medicare pay cut. It calls for an initial $917 billion in savings over 10 years by capping federal discretionary spending, meaning that mandatory entitlement programs such as Medicare and Social Security are off-limits. That move would permit a $900 billion increase in the debt ceiling.
Then, a special 12-member congressional committee must identify at least another $1.5 trillion in savings that Congress must enact by December 23, allowing a second debt-ceiling hike of $1.5 trillion. If Congress fails to chop at least $1.2 trillion from the budget through 2013, then Obama would be limited to a corresponding increase in the debt ceiling.
At the same time, failure to hit the $1.2 trillion savings target would trigger automatic cuts in both discretionary and mandatory programs, including Medicare, from 2013 through 2021. However, the Medicare cut could not exceed 2% in any given year.
A summary of the bill posted on the White House Web site explains that potential Medicare cuts would be "limited to the provider side."
No One Knows Where Medicare Provider Cuts Would Fall
The provider side has responded sourly to the debt-reduction legislation, decrying the prospect of more rate cuts as opposed to reimbursement relief.
"Physicians feel like theyve already been thrown under the bus," Dr. Lewin said about the new law. "Now [Congress] is backing up the bus over them."
Roland Goertz, MD, president of the American Academy of Family Physicians (AAFP), warned in a statement released yesterday that lower Medicare pay would cause many physicians to either close their practices or limit the number of Medicare patients they treat reducing access to care either way.
"The debt ceiling/deficit reduction plan...offers a potentially false promise to patients," said Dr. Goertz. "It guarantees benefits but, by ignoring Medicare physician payment issues, it potentially denies the actual medical care those benefits cover."
Richard Umbdenstock, president and chief executive officer of the American Hospital Association (AHA), makes a similar argument in calling for Congress to exempt Medicare from the debt-deal budget ax. "Cuts to Medicare funding for hospital care," Umbdenstock said in a press release yesterday, "could overload emergency rooms, shut down trauma units and reduce patient access to the latest treatments."
What dials up the anxiety factor further is that the bill passed by Congress today does not specify how automatic cuts would be applied to Medicare. The program consists of 4 parts Part A for hospitals, Part B for physicians, Part C for Medicare managed-care plans, and Part D for prescription drugs. Kevin Burke, director of government relations for the AAFP, told Medscape Medical News that Congress could trim each part equally, or confine the cut to just 1 or 2 parts.
The potential for Medicare provider cuts is not lost on Wall Street. Stocks for a number of publicly traded healthcare companies, including those that operate hospitals, fell sharply this morning.
AMA Still Lobbying for Elusive Doc Fix
For physicians, the bill is a far cry from an earlier debt-reduction proposal in Congress that would have protected their Medicare reimbursement. That proposal, authored by the bipartisan "Gang of Six" senators, called for voiding the 29.5% pay cut set for 2012 and scrapping the sustainable growth rate formula that triggered it. The Gang of Six would have offset the cost of this doc fix priced at $298 billion over 10 years with unspecified savings in Medicare. The AHA worried that hospital reimbursement would be sacrificed for the sake of physicians.
Organized medicine has not given up petitioning Congress for the elusive doc fix, which almost became a part of the 2010 healthcare reform law before Democrats erased it because of its high cost. In a statement released yesterday, Peter Carmel, MD, president of the American Medical Association, said his group anticipates that the 12-member congressional committee charged with finding budget savings would address the Medicare reimbursement crisis.
"Everyone agrees that a 30% cut in payments to those who care for Medicare patients would hurt seniors' access to the healthcare they need and deserve," said Dr. Carmel.
Dr. Lewin said he had wished and hoped that Congress would incorporate a doc fix in a grand debt-reduction deal, but not expected it to actually happen, given the composition of the Republican-controlled House. With the advent of Tea Party Republicans, he said, there is less of a consensus in the House to enact a doc fix.
"The Tea Party doesnt want to spend any money," he said. "They dont care if doctors stop seeing patients."
He said the ACC would urge the the 12-member congressional committee on debt reduction to return to the problem of Medicare reimbursement. However, instead of trying to tame runaway costs through "futile" price-control solutions such as the sustainable growth rate formula, the committee ought to introduce reforms to reward physicians for quality and efficiency. Such an indirect approach to cost control would have a better chance of succeeding, Dr. Lewin said.
Posted by Zyprexa on August 3, 2011, at 21:31:32
In reply to Health Reform + Reducing Meciaire Reembursements, posted by Phillipa on August 3, 2011, at 20:09:21
Leave it up to the Republicans to take away Medicare.
Posted by Phillipa on August 3, 2011, at 21:48:48
In reply to Re: Health Reform + Reducing Meciaire Reembursements, posted by Zyprexa on August 3, 2011, at 21:31:32
Zyprexa got any good links on health reform? Phillipa
Posted by jono_in_adelaide on August 3, 2011, at 22:20:46
In reply to Health Reform + Reducing Meciaire Reembursements, posted by Phillipa on August 3, 2011, at 20:09:21
Glad I live in Australia, atleast so far as medical care is concerned
Posted by mellow on August 4, 2011, at 17:10:05
In reply to Re: Health Reform + Reducing Meciaire Reembursements, posted by Zyprexa on August 3, 2011, at 21:31:32
I certainly don't want to throw the seniors out to the wolves, but if the government is going to offer Medicare as a benefit they either need to fund it correctly or kill it. At the hospital I work at we run massive deficits on Medicare. For every 1.00 we spend on a Medicare patient the government only pays us back .88 cents. So that .12 cents adds up on a long hospital stay. We are non profit but it is still hard to give state of the art care and pay good wages on those deficits.
The way hospitals make it up is by increasing the bills on privately insured patients who are seeing their out if pocket expense and their premiums go up every year. If the government stayed out of healthcare and let the market dictate price healthcare would be much cheaper. This would be the perfect situation. Medicare recipients, many on fixed incomes, would enter the market for insurance and the insurance companies would have to fight for their business by providing good cheap policies. This would help us all.
Right now the government has a printing press to back up it's insurance claims and they just give the doctors the finger when it comes time to pay up. They are screwing with competition when you take that into account because the private companies don't have the certainty of revenue that the government does. Also the government can pass legislation that changes the whole industry. This gives Medicare an advantage the private companies lack.
I really have no problem with Medicare but they need to pay up if they expect the industry to take care of all of the recipients. A 30% cut is brutal. Why not a 30% cut to the bloated defense budget. For all they are wasting in the middle east they could adequately fund Medicare and not screw up the healthcare industry. But the politicians want their cake and to eat it too. They need to choose.
mellow
Posted by floatingbridge on August 4, 2011, at 19:30:56
In reply to Health Reform + Reducing Meciaire Reembursements, posted by Phillipa on August 3, 2011, at 20:09:21
This first statement belongs on politics. Let's see how well I can manage this one.
I don't understand the logic of the Tea Party.
I am tired of the name Tea Party. Does it refer to Alice in Wonderland or the Revolution? I can't decide.
When I see what my insurance is billed for my services and my medication, I am continually stunned. I could never ever
pay that. Right now, we have insurance. My husband calls it the golden handcuffs.I also feel frustrated and angry knowing that, somehow, the general public is paying for my insurance, that good doctors
and hospitals are being low-balled, and hospitals, at least CA work in a deficit. In fact, in this state they are often hemorrhaging.I am, I suppose, if forced to declare, into socialized medicine.
I don't trust insurance companies and the free market to sort these things out.James M Cain, an odd-ball noir writer used insurance as a deeply imbedded plot device in some of his crime novels. Short version was that it was legalized gambling. All about
the odds. He discusses this directly in The Postman Always Rings Twice. It was written when insurance was nascent. Forget the film version. The observations of how this new idea of insurance was affecting the lives of people was axed to highlight the personal passions of the protagonists. Really, the unbridled greed of insurance and law organizations really
fueled that book. I guess that type of passion seems overlooked.If I have to run a sober budget at home, why can't the government manage? The US has an incredible military budget. Oddly enough, the soldiers on the ground are getting low-balled too. Their families have to pool resources to supplement their body armor and other items.
I certainly don't have answer.
Posted by bleauberry on August 4, 2011, at 19:41:22
In reply to Health Reform + Reducing Meciaire Reembursements, posted by Phillipa on August 3, 2011, at 20:09:21
The Tea Party doesnt want to spend any money," he said. "They dont care if doctors stop seeing patients."
That sentence, as well as most of the article, is outright false and ridiculous, as I see it. Easy trap to fall into, the way it is worded and phrased by those who have an agenda.
It is not the Tea Party cutting anything. They aren't even an official organization like Dems or Repubs. They are just millions of regular people who are sick and tired of Washington fraud and negligence in handling my money.
The cuts are from the negotiations, so both Dems and Repubs are to blame.
This is such an old but trustworthy scare tactic to convince you that you cannot live on your own without uncle sam holding your hand.
There are billions if not trillions of dollars of waste on really ridiculous programs, grants, and duplication of services, extravagant offices, million dollar limosines....I mean, come on, there is so much stuff to cut without hurting anyone....except themselves....which is why they don't do it. Instead they cut where it should not be cut. Medicare can be fixed better than ever without any cutting of anything except washington's negligence in handling other people's money.
I am not of the Tea Party. But I can say, I am for anyone who happens to feel like the Pilgrims who were willing to die in order to stop taxation without representation and to have a small limited government that everyone should have equal opportunity to strive (or not) for prosperity and happiness. That just happens to be the Tea Party basically.
One example. Any successful private business management company that took over the Medicare system would probably be able to run it twice or three times better than it currently is, on the existing budget. Washington is so much waste, they are willing to cut aid to those who need it the most in order save their own rearends.
Posted by Phillipa on August 4, 2011, at 19:54:52
In reply to Re: Health Reform + Reducing Meciaire Reembursements, posted by bleauberry on August 4, 2011, at 19:41:22
Blue you hit the nail on the head that is exactly what's going on. All the Washington Senators, Reps etc are getting soooo much money and taking what we contributed to the system while working. I pay for my medicaire monthly out of retirement check and also have to pay for another policy to pay for what medicaire doesn't pay. With a deductable. And then the private insurance for dental. When I worked at one time in ICU I had to leave and this was long before this when the docs would ask who had the best insurance as they needed a ventilator so those with low income taken off. Made me sick. And it's appalling to cut the funds to doctors. When nursing a lot of Canadian RN's worked here as the system didn't work there. They earned their money and returned to their country. Bear in mind this was about 20 years ago. I worked paid my dues into the system I earned my mediciare. No pulling the plug on me. As for hospitals losing money too many illegals paying nothing. And those with no insurance using the ER for non emergencies a cold. Just my perspective. No quick fix. Phillipa
Posted by floatingbridge on August 4, 2011, at 21:22:08
In reply to Re: Health Reform + Reducing Meciaire Reembursements, posted by bleauberry on August 4, 2011, at 19:41:22
Running healthcare along a healthy business model seems great.
What is a healthy business model? Sustainability. Fiscal sobriety. Responsibility. When it comes to healthcare however, and I guess a few other things, I like the model of being a brother's keeper. In a fiscally sound manner.
Not everyone agrees with this I understand.
I do not think the Tea Party is made up of individuals who are like Pilgrims. Pilgrims no longer exist. Besides, historically, they were a heterogenous lot. They were deeply divided about their dealings with the locals for starters. They ran heretics out of town or worse.
For me, the sentence about the Tea Party was inflammatory because it is reductive. That given, I find the allusion with in the name Tea Party vexing.
My post, once again, is more suited to the politics board :-/.
Posted by floatingbridge on August 4, 2011, at 21:26:17
In reply to Re: Health Reform + Reducing Meciaire Reembursements » bleauberry, posted by Phillipa on August 4, 2011, at 19:54:52
Phillipa, it is very unjust. Paying into a system without even being able to opt out, then the rules change. I'm sorry. I don't know hat to say....
> Blue you hit the nail on the head that is exactly what's going on. All the Washington Senators, Reps etc are getting soooo much money and taking what we contributed to the system while working. I pay for my medicaire monthly out of retirement check and also have to pay for another policy to pay for what medicaire doesn't pay. With a deductable. And then the private insurance for dental. When I worked at one time in ICU I had to leave and this was long before this when the docs would ask who had the best insurance as they needed a ventilator so those with low income taken off. Made me sick. And it's appalling to cut the funds to doctors. When nursing a lot of Canadian RN's worked here as the system didn't work there. They earned their money and returned to their country. Bear in mind this was about 20 years ago. I worked paid my dues into the system I earned my mediciare. No pulling the plug on me. As for hospitals losing money too many illegals paying nothing. And those with no insurance using the ER for non emergencies a cold. Just my perspective. No quick fix. Phillipa
Posted by sigismund on August 4, 2011, at 22:58:18
In reply to Re: Health Reform + Reducing Meciaire Reembursements, posted by floatingbridge on August 4, 2011, at 21:22:08
The people who oppose government spending on health and education are the same people who were in favour of the wars of choice.
Posted by Phillipa on August 4, 2011, at 23:37:32
In reply to Re: Health Reform + Reducing Meciaire Reembursements, posted by sigismund on August 4, 2011, at 22:58:18
True Sigi. We need choices I thought we voted guess not. PJ
Posted by Zyprexa on August 12, 2011, at 3:55:55
In reply to Re: Health Reform + Reducing Meciaire Reembursements » Zyprexa, posted by Phillipa on August 3, 2011, at 21:48:48
http://www.healthcare.gov/law/provisions/billofright/patient_bill_of_rights.html
This is the end of the thread.
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