![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Phillipa on April 13, 2011, at 22:06:51
Just received at l0:00pm seems a new medicaire and doctor cut that will end medicaire as we know it and docs costs to rise in 2012 by 29.5 % Anyone interpret? Phillipa
From Medscape Medical News
Deficit Reduction Plan to Implement Feared Cost-Control Tool
Robert LowesAuthors and Disclosures
Learn more April 13, 2011 The deficit-reduction plan unveiled by President Barack Obama today strengthens a cost-control tool in healthcare reform that organized medicine fears.The savings mechanism is the Independent Payment Advisory Board (IPAB). Under the Affordable Care Act (ACA), the IPAB will advise Congress on ways to curb the per capita growth of Medicare spending if it exceeds growth-rate targets set by the law.
If it does not implement IPAB recommendations, Congress must enact policies that save just as much, or else let the Department of Health and Human Services make the cuts.
The Medicare growth-rate target initially will be the average of the consumer price index (CPI) for urban residents and the CPI for medical costs. In 2018, the target changes to growth in the gross domestic product (GDP) plus 1%.
To wring more savings from Medicare, Obama proposes to lower the second spending target, triggering IPAB action to GDP growth plus 0.5% beginning in 2018. In addition, the IPAB would gain additional tools and enforcement mechanisms to control Medicare spending.
The greater role of the IPAB is part of a plan to reduce the federal deficit by $4 trillion over 13 years or less that Obama outlined in a speech at George Washington University.
End of Medicare "As We Know It"
Obama would hit those numbers with $3 in spending cuts and interest savings for every $1 in higher tax revenue, partly derived from ending Bush tax cuts for the wealthiest Americans. Obama said his prescription borrows from the recommendations of a bipartisan fiscal commission that he appointed last year, and incorporates $1 trillion already contained in his budget proposal for fiscal 2012, which begins October 1.
Obama laid out a different path toward a balanced budget than Rep. Paul Ryan (R-WI), the chair of the House Budget Committee, did last week. Under the Ryan proposal, federal outlays would decrease by $5.8 trillion over 10 years based on current spending policies.
The GOP plan achieves these savings partly by giving seniors who turn age 65 in 2022 and beyond a subsidy for buying healthcare coverage from private insurers, and turning federal contributions to state Medicaid programs into block grants.
Obama opposes the GOP "voucher" system, saying it would "end Medicare as we know it" and shift more costs from the federal government to seniors. He also argues that converting Medicaid into a block-grant program would leave it underfunded.
Hitting a Raw Nerve
Although Obama intends to preserve Medicare as an entitlement as opposed to a subsidy program, he nevertheless seeks to trim $340 billion from it over 10 years, which is on top of more than $400 billion in savings through 2019 that the ACA calls for. Some of the extra economizing involves improving patient safety, cutting unnecessary prescription drug outlays, and reducing waste and abuse that drives up costs.
None of those measures, however, is likely to hit a raw nerve in medical circles like the increased reliance on the 15-member IPAB to control Medicare spending.
Ever since the ACA was passed in 2009, organized medicine has sought to eliminate or drastically reshape this new entity, designed to function in a framework resembling the sustainable growth rate (SGR) formula for determining physician reimbursement in Medicare.
That formula sets an annual target for Medicare spending on physician services based on GDP growth, which also forms the basis for IPAB targets starting in 2018. If actual spending on physician services exceeds the target in a given year, reimbursement rates under the SGR formula must decrease the following year to make up the difference.
Organized medicine argues that the SGR formula is flawed because physician practice costs typically rise faster than the GDP. Every year since 2003, the SGR formula has triggered cuts to Medicare rates that Congress has subsequently postponed, causing them to pile up. As a result, physicians face a 29.5% reduction in 2012.
Obama's deficit-reduction plan allocates a "sufficient" amount of money to reform the SGR formula and avert this catastrophe but does not provide details on what this reform looks like.
In the meantime, the IPAB looms as a similar threat to physician compensation. Leaders of the American Medical Association and other medical societies contend that the IPAB could expose physicians to a double whammy by requiring pay cuts in addition to those mandated by the SGR formula.
"Strong Concerns"
In a written statement issued after Obama's speech today, American Medical Association Chairwoman Ardis Hoven, MD, said that her group has "strong concerns about the potential for automatic, across-the-board Medicare spending cuts because they are not consistent with meeting the medical needs of patients, which is our primary focus."
Medical societies also object to a group of unelected officials having so much power over physician reimbursement. And they consider it unfair that hospitals are spared IPAB cuts until 2019.
There are other restrictions that cause physicians to feel the brunt of IPAB spending decisions. The ACA prohibits the board from recommending any solutions that would reduce Medicare eligibility and benefits or increase costs borne by beneficiaries, including Part A and Part B premiums. In short, seniors avoid the IPAB axe just as hospitals do.
However, a senior White House official hinted during a not-for-attribution press briefing today that the IPAB might spread out the pain. When asked whether the various restrictions on IPAB cuts might disappear under the president's deficit-reduction plan, the official replied, "No, not all of them. I think the idea is there would be some expansion."
Posted by mtdewcmu on April 13, 2011, at 23:25:57
In reply to Obama New Health Care Cuts Please Read + Comment, posted by Phillipa on April 13, 2011, at 22:06:51
I don't know why that story is written in such a scary tone. Probably to get people to read it.
I think that IPAB is going to be modeled after the British government's NICE agency, which determines which treatments are helpful enough to justify having the NHS pay for them. Drug companies and especially device makers try to get FDA approval for incredibly expensive drugs and devices that barely have any benefit to the patient, but Medicare and insurers wind up having to pay for them. So it's like a scam to get money out of Medicare. With a government agency doing cost-benefit analyses, they can refuse to pay for extraordinarily expensive and marginally helpful treatments, which could save Medicare a lot of money. Only the drug companies and device makers should be afraid of IPAB, and possibly some doctors that have been abusing the rules to get more money. Doctors feel that reimbursement rates are not sufficient for an office visit, so they order tests that aren't necessary but Medicare pays a lot for, to increase their income. If Medicare goes on paying for anything and everything, it will literally bankrupt the government. Somebody had to do something. Paul Ryan and the Republicans want to end Medicare and give seniors some money toward buying private insurance. There would be no guarantee that it would be enough to cover a plan that is equivalent to Medicare. And in fact, the idea is to give seniors less than what they'd get through Medicare to save the government money, and if that's not enough to buy insurance, too bad. Obama is trying to do the right thing and make Medicare solvent without destroying it, by cutting out waste. But some people prefer to believe that Obama is planning to euthanize seniors to save money. If you believe that, then I have some beachfront property I'd like to sell you in New Mexico. But it's impossible to have a rational debate in this country anymore.
Posted by hyperfocus on April 14, 2011, at 0:55:10
In reply to Obama New Health Care Cuts Please Read + Comment, posted by Phillipa on April 13, 2011, at 22:06:51
Basically the plan is to tie Medicaire spending to growth of the economy even more and if spending exceeds that fraction then this new IPAB board must make cuts, which ultimately means physicians have to accept less reimbursement. The govt's argument is that this will trim wasteful and unnecessary medical spending. The doctors are saying this is unfair because medical costs grow faster than the economy, that they're already forced to take cuts through the SGR mechanism, and that this non-medical IPAB board has no right to make recommendations on medical matters.
So, basically, there's going to be less paid to doctors through Medicaire in the future. And the doctors are angry about it. Nothing new here.
Posted by mtdewcmu on April 14, 2011, at 9:37:48
In reply to Obama New Health Care Cuts Please Read + Comment, posted by Phillipa on April 13, 2011, at 22:06:51
I suggest reading Paul Krugman's column if you want to stay abreast of Medicare issues. He doesn't hide the fact that he leans liberal, but he is an esteemed professor of economics at Princeton (and he's won the Nobel Prize for economics). I don't think his biases creep in when he is writing about his specialty. In other areas, perhaps. But I believe he tells it straight on economics.
Posted by Phillipa on April 14, 2011, at 13:09:29
In reply to Re: Obama New Health Care Cuts Please Read + Comment, posted by mtdewcmu on April 14, 2011, at 9:37:48
Thanks guys being a recipient of medicaire as now 65 only gives me a bit of money so cut out meds maybe I should take but can't afford. I met a lady that said no more colonoscopies before all this after age 72 so in a way no cancers could be found at least intestinal so in a way I feel that's a form of euthenasia. Now I'm looking for reassurance no fighting so any positive stuff for the benefit of seniors like me I really need to hear. Thanks Phillipa
Posted by mtdewcmu on April 14, 2011, at 14:29:38
In reply to Re: Obama New Health Care Cuts Please Read + Comment, posted by Phillipa on April 14, 2011, at 13:09:29
> Thanks guys being a recipient of medicaire as now 65 only gives me a bit of money so cut out meds maybe I should take but can't afford. I met a lady that said no more colonoscopies before all this after age 72 so in a way no cancers could be found at least intestinal so in a way I feel that's a form of euthenasia. Now I'm looking for reassurance no fighting so any positive stuff for the benefit of seniors like me I really need to hear. Thanks Phillipa
I hadn't heard about the colonoscopies, but they must mean routine colonoscopies. If you had an indication for one, I know you would get it.
What are your chances of getting colon cancer, anyway? Probably not enough to let it bother you.
Posted by mtdewcmu on April 14, 2011, at 14:43:35
In reply to Re: Obama New Health Care Cuts Please Read + Comment, posted by Phillipa on April 14, 2011, at 13:09:29
I don't mean to sound uncaring, but when doctors make those recommendations about routine screening, they make them primarily with the patient's best interests at heart. Opinions about routine cancer screening seem to be becoming more negative, because they lead to a lot of false positives. There are far more false positives than true positives, and a false positive can mean a lot of anxiety and intrusive procedures for nothing.
Posted by mellow on April 14, 2011, at 15:34:03
In reply to Obama New Health Care Cuts Please Read + Comment, posted by Phillipa on April 13, 2011, at 22:06:51
The reason this is concerning to many health agencies is because MC is are starting balloon payments. I work in a hospital and have spoken with our executives. If someone comes in to the ER with a heart attack and it is determined that they have congestive heart failure, there is a set rate we will get paid to treat that patient. The federal government now has algorithms for what tests and how many days you need to keep said patient. If you use more resources than that to make the patient better...oh well you aren't getting paid anymore than the standard payment for that diagnostic code.
Lets says that patient is a whimp and goes home and is a little constipated and then calls 911 because they swear they are having another heart attack. They end up coming back to us for two days to take a laxative and take x rays. And those services go under the original payment. Who do you think pays for the ambulance ride?
I'm not saying I don't think MC is beneficial. In fact it is critical in the lives of our seniors, but it has gotten so beyond that in scope and our population has gotten so lazy in regards to our own health and wellness that wonderful health organizations like the hospital I work for are just going to go out of business. We lost 80 million last year in services that weren't reimbursed. Whats 2011 going to be like? Can you imagine being a doctor who works 10-12 hour days and have your salary shrink every year when MC makes cuts? I know several who are in this exact situation.
mellow
Posted by mtdewcmu on April 14, 2011, at 16:29:00
In reply to Re: Obama New Health Care Cuts Please Read + Comment, posted by mellow on April 14, 2011, at 15:34:03
> The reason this is concerning to many health agencies is because MC is are starting balloon ...
There is a fine line between being generous with reimbursements and creating perverse incentives for fraud, waste, and abuse. No doubt the government will make some mistakes, but you have to give them credit for walking this tightrope while trying to do right by patients and not go bankrupt. There is no simple solution. This dilemma exists in all the industrialized countries. I have hope that the government will make corrections as problems arise. No one obviously wants hospitals to go out of business. I guess I'm just an optimist in this regard.
> Lets says that patient is a whimp and goes home and is a little constipated and then calls 911 because they swear they are having another heart
Again, they are trying to create the right incentives for hospitals. It's too easy to do tests that aren't really necessary and bill Medicare. (Plus they want to see hospitals put a higher priority on avoidable mistakes.) If the fraud, waste, and abuse are minimized, there will be more money available for all the honest care providers.
>
> I'm not saying I don't think MC is beneficial. In fact it is critical in the lives of our seniors, but it has gotten so beyond that in scope and our population has gotten so lazy in
The health care law passed in 2010 has a lot of fixes built in to it for Medicare's systemic problems. It is our best hope to save Medicare. I don't mean to preach, but there is just so much doom and gloom. If nothing is done now, there will end up being a crisis and the fixes may be worse.I worked in a hospital for several years, too, and I would not want to see all the new paperwork and annoyance of having the boss be _even_more_ worked up about preventable mistakes. But that's just how it goes.
Posted by Phillipa on April 14, 2011, at 19:24:04
In reply to Re: Obama New Health Care Cuts Please Read + Comment, posted by mtdewcmu on April 14, 2011, at 16:29:00
Medicare is also Disability Insurance for those that are really sick what happens to them? I see one of the problems as the GP or internist now barely does anything but care for a sore throat maybe. If it's thyroid here at least it's refer to an endo, if break a bone which bone as there is a special doc for the foot, arms, hands, etc. Why can't the internist treat these things themselves? As my husband calls it it's refer as like a buddy system for some docs. Phillipa
Posted by Willful on April 22, 2011, at 22:59:13
In reply to Re: Obama New Health Care Cuts Please Read + Comment, posted by Phillipa on April 14, 2011, at 13:09:29
This woman who supposedly told you that colonoscopies aren't covered by medicare could not be more misinformed. Or maybe you didn't understand what she was saying. In fact the opposite is true-- medicare is covering MORE not less of the cost of colonoscopies-- ie 100%.
As follows:
"Beginning 1 January 2011....Colonoscopies and other colorectal cancer screening will be done at no charge to beneficiaries. Medicare also will pay the full cost of an annual wellness visit. Beneficiaries won't have to pay any amount out of pocket for preventive services that are highly recommended by the U.S. Preventive Services Task Force, such as mammograms. Medicare is also authorized under the health reform law to offer incentives for beneficiaries to complete "behavior modification" programs that could teach them how to eat better and exercise more...Beginning 1 January 2011, that will change. Colonoscopies and other colorectal cancer screening will be done at no charge to beneficiaries. Medicare also will pay the full cost of an annual wellness visit. Beneficiaries won't have to pay any amount out of pocket for preventive services that are highly recommended by the U.S. Preventive Services Task Force, such as mammograms. Medicare is also authorized under the health reform law to offer incentives for beneficiaries to complete "behavior modification" programs that could teach them how to eat better and exercise more."
This would seem to be a result of the new Health Reform laws-- about which you have posted so much negative information and of which have complained so greatly. Until January 2011 and this new reform, which you don't like, medicare patients had to pay 20% of the costs of these tests.
Maybe Phillipa you would be better off if you didn't listen to everybody and tried to check out the facts.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.