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So you know that survey you get in the mail after a hospital stay or an outpatient diagnostic test? The one that ask you questions like, "Were you treated politely?" and "Were snacks available without having to ask for them?" Due to requirements in the new Obamacare federal health regulations, Medicare money for hospitals will to some degree be tied to patient satisfaction scores -- most of which will come from those post-encounter surveys. Check out this nice video from msnbc.
Showing posts with label Obamacare. Show all posts
Showing posts with label Obamacare. Show all posts
Sunday, November 27, 2011
Saturday, November 26, 2011
blogtalkradio: We're moving our audio feeds!
As part of our new website upgrade we are migrating our audio feeds to blogtalkradio! Check out this new audio player and let us know what you think. We thought we would profile one of our favorite shows. This is the audio version of an interview with Congressman Dr. Michael Burgess as he talks about his book "Doctor in the House."
Listen to internet radio with docdano on Blog Talk Radio
Tuesday, May 10, 2011
Doctor in the House: an interview with author Congressman Michael Burgess, M.D.
When Dr. Michael Burgess gave up delivering babies in favor of kissing them, most physicians thought he was crazy.
After reliving the September 11th World Trade Center nightmare in his head for weeks, the successful obstetrician decided to run for Congress in his Republican district of North Texas against the well-funded and well-named son of then Majority Leader Dick Armey.
Not only did Burgess win, but he has quickly become the thought leader of American medicine in the United States Congress.
In his new best-selling book, Congressman Dr. Burgess retells the story of his first years in the House of Representatives where another nightmare unfolded: the Democratic creation of Obamacare.
His work is entitled Doctor In The House and it contains the prescription necessary to heal the ills of American health care.
In this blog we engage in a spirited discussion with Dr. Burgess. Let us know what you think.
Saturday, March 12, 2011
"docdano. com Live" Protesting in Wisconsin: Is Obamacare at the root of the debate?
I spoke last night to a group of young physicians at a venue across the street from the Wisconsin State Capitol at the height of the protest against the state government.
Amid the drum beats and screams of union organizers chanting how workers' rights would be eternally devastated because of the loss of collective bargaining, I lectured to a group of resident physicians on the benefits that await patients with the explosion in health care technology.
The root of the problem centers around a state, like almost all in the country, that is saddled with loss of tax revenues due to the downturn in the economy. This has resulted in massive budget deficits and hard choices.
Many states including Wisconsin have ushered in a flurry of Republicans who ran on campaigns of no new taxes, the need to cut waste and spending, and more state's rights.
So that's what the Republican Governor did from day one in office.
He first attempted to limit spending on education to trim the budget, but because of collective bargaining the negotiation of this type of decrease in the state spending was not palatable to the unions.
It didn't matter, really, because the Republicans had the votes to pass it anyway.
But instead of voting on this budgetary issue, the Democrats chose to flee to the land of Obama in Illinois to prevent the state legislature from reaching the critical number of votes to make a quorum.
For three weeks this stalled the debate and decision on the issue, until the Republicans decided to pull out the budget issues (which require the quorum) and vote instead on non-budgetary items - like collective bargaining.
So this lead to more protests.
I literally visited with hundreds of people in Wisconsin over the past week and different opinions abound from every direction.
Clearly if you are a member of the "haves" then you have no desire to give up a benefit.
That's normal.
One person told me that his daughter is a unionized teacher and she pays a whopping $23 a month for health care insurance with no deductible. Even if you factor in that there might be some requirements for her to see certain physicians in network or limitations on formulary and specialist access, this is still a bargain.
He went on tell me that the Governor's proposal would have raised this to $123 per month. I don't know if these numbers are accurate, but the change in benefit structure certainly spurred part of the protest that had national attention.
If you've read this blog before, you know that I'm not a fan of the Obamacare bill. And I think you are seeing in Wisconsin one end of the spectrum of the problems with the bill.
Let me show you why.
To pay for the extra benefits offered under the bill (like no pre-existing illness exclusion, limitations on the right of rescission of insurance if you're too sick to be in the plan, or extended coverage for children), then there will have to be either more money (read tax dollars or higher premiums) or a decline in benefits for those that are members of the "haves."
It's really that simple.
State governments who have been charged with implementing many of the provisions of the federal health care bill don't have the ability to print money or sell treasury bonds. Their only source of revenue is tax dollars.
A significant part of Obama's plan was to provide health insurance for "all Americans." And, unfortunately, a large number of the uninsured were to be covered with the under funded, limited access Medicaid system -- much of which is paid for by the states.
Finding revenue for Medicaid means that other state funded services - like education, or health benefits for teachers - have to be cut and shifted.
That is the only possible way to fund insurance for the "have nots."
I've been derided for one of my statements in the past, but I stand by it: the Obamacare health regulation was the largest transfer of wealth in American history.
So the union supported President now finds himself supporting the union backed protesters who are fighting against changes in state government that would be used to pay for the health care bill that he (and the unions) supported.
Wisconsin is only a microcosm of what is happening in every state that is now grappling with implementing the federal health legislation in a time of budget crisis.
It is an expensive bill, and now we are starting to pay the price.
I'm a big fan of expanding health care access and coverage for the "have nots." A country like the United States should be ashamed for having citizens that don't have access to quality health care. I'm just not a supporter of the big, expensive, inefficient and over-reaching federal health care bill that was passed last year.
Let's face it: the bill cost the taxpayers almost $1 trillion.
The payment for the bill is due now.
And lest you think that non-government workers will get a free ride and this is just an issue for state employees - it will filter down to every American.
As health plans shift to include the new benefits, pay the taxes and fees that are now required by the IRS, and see declining membership due to employees shifting to government subsidized insurance products there will no doubt either be an increase in your health care premiums or a reduction in your benefits.
The problem is that for many insured Americans there is no union to fight for your corporate benefits.
It will be left up to you.
One Wisconsin young man told me that maybe the Republicans should have left Congress when the health care bill was passed.
I reminded him that democracy doesn't work this way. We elect people to represent us and sometimes we win, and sometimes we lose.
I think the Obamacare bill is failure, but I believe strongly that we can keep what's good and fix what's broken. We just have to continue the debate, make compromises, and yes, probably make some sacrifices.
So it probably won't be the last protest I'll attend. Maybe next time I'll get to carry a sign...I'm not much of a drum beater.
- Posted using BlogPress from my iPad
Amid the drum beats and screams of union organizers chanting how workers' rights would be eternally devastated because of the loss of collective bargaining, I lectured to a group of resident physicians on the benefits that await patients with the explosion in health care technology.
The root of the problem centers around a state, like almost all in the country, that is saddled with loss of tax revenues due to the downturn in the economy. This has resulted in massive budget deficits and hard choices.
Many states including Wisconsin have ushered in a flurry of Republicans who ran on campaigns of no new taxes, the need to cut waste and spending, and more state's rights.
So that's what the Republican Governor did from day one in office.
He first attempted to limit spending on education to trim the budget, but because of collective bargaining the negotiation of this type of decrease in the state spending was not palatable to the unions.
It didn't matter, really, because the Republicans had the votes to pass it anyway.
But instead of voting on this budgetary issue, the Democrats chose to flee to the land of Obama in Illinois to prevent the state legislature from reaching the critical number of votes to make a quorum.
For three weeks this stalled the debate and decision on the issue, until the Republicans decided to pull out the budget issues (which require the quorum) and vote instead on non-budgetary items - like collective bargaining.
So this lead to more protests.
I literally visited with hundreds of people in Wisconsin over the past week and different opinions abound from every direction.
Clearly if you are a member of the "haves" then you have no desire to give up a benefit.
That's normal.
One person told me that his daughter is a unionized teacher and she pays a whopping $23 a month for health care insurance with no deductible. Even if you factor in that there might be some requirements for her to see certain physicians in network or limitations on formulary and specialist access, this is still a bargain.
He went on tell me that the Governor's proposal would have raised this to $123 per month. I don't know if these numbers are accurate, but the change in benefit structure certainly spurred part of the protest that had national attention.
If you've read this blog before, you know that I'm not a fan of the Obamacare bill. And I think you are seeing in Wisconsin one end of the spectrum of the problems with the bill.
Let me show you why.
To pay for the extra benefits offered under the bill (like no pre-existing illness exclusion, limitations on the right of rescission of insurance if you're too sick to be in the plan, or extended coverage for children), then there will have to be either more money (read tax dollars or higher premiums) or a decline in benefits for those that are members of the "haves."
It's really that simple.
State governments who have been charged with implementing many of the provisions of the federal health care bill don't have the ability to print money or sell treasury bonds. Their only source of revenue is tax dollars.
A significant part of Obama's plan was to provide health insurance for "all Americans." And, unfortunately, a large number of the uninsured were to be covered with the under funded, limited access Medicaid system -- much of which is paid for by the states.
Finding revenue for Medicaid means that other state funded services - like education, or health benefits for teachers - have to be cut and shifted.
That is the only possible way to fund insurance for the "have nots."
I've been derided for one of my statements in the past, but I stand by it: the Obamacare health regulation was the largest transfer of wealth in American history.
So the union supported President now finds himself supporting the union backed protesters who are fighting against changes in state government that would be used to pay for the health care bill that he (and the unions) supported.
Wisconsin is only a microcosm of what is happening in every state that is now grappling with implementing the federal health legislation in a time of budget crisis.
It is an expensive bill, and now we are starting to pay the price.
I'm a big fan of expanding health care access and coverage for the "have nots." A country like the United States should be ashamed for having citizens that don't have access to quality health care. I'm just not a supporter of the big, expensive, inefficient and over-reaching federal health care bill that was passed last year.
Let's face it: the bill cost the taxpayers almost $1 trillion.
The payment for the bill is due now.
And lest you think that non-government workers will get a free ride and this is just an issue for state employees - it will filter down to every American.
As health plans shift to include the new benefits, pay the taxes and fees that are now required by the IRS, and see declining membership due to employees shifting to government subsidized insurance products there will no doubt either be an increase in your health care premiums or a reduction in your benefits.
The problem is that for many insured Americans there is no union to fight for your corporate benefits.
It will be left up to you.
One Wisconsin young man told me that maybe the Republicans should have left Congress when the health care bill was passed.
I reminded him that democracy doesn't work this way. We elect people to represent us and sometimes we win, and sometimes we lose.
I think the Obamacare bill is failure, but I believe strongly that we can keep what's good and fix what's broken. We just have to continue the debate, make compromises, and yes, probably make some sacrifices.
So it probably won't be the last protest I'll attend. Maybe next time I'll get to carry a sign...I'm not much of a drum beater.
- Posted using BlogPress from my iPad
Location:State Capitol, Madison, Wisconsin
Tuesday, February 22, 2011
Re-bamacare: Is health care reform now a problem for Republicans?
The public relations nightmare for the Obama administration's health care plan last year now seems to be a problem for the Republicans.
Republican lawmakers have long wanted more intense reforms of insurance laws that purport to stream line the system, lower cost, and cut out redundancy.
Of course the concern for patients is that the only sure fire way to lower health care costs is to restrict access and therefore lower utilization.
Patient advocates have long been skeptical of Republican promoted health care (read: insurance reforms) because below the surface the bills seem to be reminiscent of old war style cronyism: pandering to the insurance companies and corporate medicine.
True or not, that's not the purpose of my discussion today. This is more about the table turning anti-Obamacare public sentiment that is now being carefully redirected toward these Republican proposals.
Particularly in state legislatures where lawmakers are now struggling to balance state budges with escalating deficits, every possible revenue source or cost cutting move is being critically examined.
On the surface many of these ideas seem plausible -- directly employee physicians so that their prescribing and ordering habits can be controlled.
Given that the most expensive piece of medical equipment in America right now is the pen, this would seem to be on target.
Limit tests or procedures, force the use of quality guidelines and metrics, cross share lab to prevent redundancy, and put physicians smack in the middle of a care management team to increase quality and value for patients.
And to make more money for the corporate entities involved.
The problem is not whether something like these rules need to be implemented -- they do -- the problem is that absent proper oversight and restraint the slippery slope of profits and revenue would suggest that patients might get the short end of the stick.
Just imagine if your physician was told to use a certain drug, a certain provider for a procedure or diagnostic test, a particular institution for your surgery -- your choice would be gone as would that of the physician.
Now certainly we are all going to have give up some health care decision freedom as we move to limit the exponential rise in health care expenditures.
But patients and physicians need the opportunity for some autonomy in the doctor-patient relationship.
Whether it is contractural protections against wrongful termination, protections against adverse hospital decisions, prohibitions against forced admissions, or whistleblower protections, physicians need to maintain some degree of separation from the unintended consequences of corporate America.
Patients need this as well.
What's been fascinating to watch is that in multiple states where Republicans are using the budget shortfall as a steam roller to clear a path for any proposal that seems to save money, the health care changes related to employment and insurance reform seem to be hitting a snag.
Dubbed "____-bamacare" depending on the lawmaker in question, use of this phrase immediately conjures up negative sentiment not only among the public but also among fellow Republicans who might not be so forward educated on the benefits at stake.
This is particularly evident in Texas where Lieutenant Governor David Dewhurst is seeing push back on his proposals to expand corporate control of health care.
From visiting with hundreds of patients its clear that monkeying with anything to do with a patient's health care choices, particularly now in this post-Obamacare sensitivity, is a risky move.
It is likely that good proposals will also potentially fall on the sword with our President's plan.
Patients seem to be tired of government intervention in health care. They recognize the need for changes in the cost, but they are still not convinced that government or big business is in the best position to make these decisions.
They are probably right.
- Posted using BlogPress from my iPad
Republican lawmakers have long wanted more intense reforms of insurance laws that purport to stream line the system, lower cost, and cut out redundancy.
Of course the concern for patients is that the only sure fire way to lower health care costs is to restrict access and therefore lower utilization.
Patient advocates have long been skeptical of Republican promoted health care (read: insurance reforms) because below the surface the bills seem to be reminiscent of old war style cronyism: pandering to the insurance companies and corporate medicine.
True or not, that's not the purpose of my discussion today. This is more about the table turning anti-Obamacare public sentiment that is now being carefully redirected toward these Republican proposals.
Particularly in state legislatures where lawmakers are now struggling to balance state budges with escalating deficits, every possible revenue source or cost cutting move is being critically examined.
On the surface many of these ideas seem plausible -- directly employee physicians so that their prescribing and ordering habits can be controlled.
Given that the most expensive piece of medical equipment in America right now is the pen, this would seem to be on target.
Limit tests or procedures, force the use of quality guidelines and metrics, cross share lab to prevent redundancy, and put physicians smack in the middle of a care management team to increase quality and value for patients.
And to make more money for the corporate entities involved.
The problem is not whether something like these rules need to be implemented -- they do -- the problem is that absent proper oversight and restraint the slippery slope of profits and revenue would suggest that patients might get the short end of the stick.
Just imagine if your physician was told to use a certain drug, a certain provider for a procedure or diagnostic test, a particular institution for your surgery -- your choice would be gone as would that of the physician.
Now certainly we are all going to have give up some health care decision freedom as we move to limit the exponential rise in health care expenditures.
But patients and physicians need the opportunity for some autonomy in the doctor-patient relationship.
Whether it is contractural protections against wrongful termination, protections against adverse hospital decisions, prohibitions against forced admissions, or whistleblower protections, physicians need to maintain some degree of separation from the unintended consequences of corporate America.
Patients need this as well.
What's been fascinating to watch is that in multiple states where Republicans are using the budget shortfall as a steam roller to clear a path for any proposal that seems to save money, the health care changes related to employment and insurance reform seem to be hitting a snag.
Dubbed "____-bamacare" depending on the lawmaker in question, use of this phrase immediately conjures up negative sentiment not only among the public but also among fellow Republicans who might not be so forward educated on the benefits at stake.
This is particularly evident in Texas where Lieutenant Governor David Dewhurst is seeing push back on his proposals to expand corporate control of health care.
From visiting with hundreds of patients its clear that monkeying with anything to do with a patient's health care choices, particularly now in this post-Obamacare sensitivity, is a risky move.
It is likely that good proposals will also potentially fall on the sword with our President's plan.
Patients seem to be tired of government intervention in health care. They recognize the need for changes in the cost, but they are still not convinced that government or big business is in the best position to make these decisions.
They are probably right.
- Posted using BlogPress from my iPad
Location:Jacksonville, Florida
Monday, December 20, 2010
Conversation with a Health Care Leader: the past and future of health reform with Dr. Susan Rudd Bailey
Today we talked with Susan Rudd Bailey, MD who is the President of the nation's largest state medical society about the genesis of federal health reform and what she expects for the future. This nationally known leader of the Texas Medical Association is candid in her discussion of the role that physicians and patients play in determining the ultimate outcome of the recent federal health regulation. She also discusses the implications of the flawed funding mechanism for Medicare -- the so called "SGR".
Thursday, December 16, 2010
Is Obamacare unconstitutional?
Is Obamacare unconstitutional? That's the question we address today on docdano.com. Darren Whitehurst and Dan Finch from the Texas Medical Association join us today to discuss the Virginia federal judge ruling that the health reform bill is unconstitutional. What does it mean? And what effect is it going to have on the upcoming session of Congress?
Friday, December 3, 2010
The Health Care Cold War: Will ACO's Bring Down The Wall?
Although there are no sounds of B-52's flying at low altitudes above the hospital, there are salvos nonetheless between the partners in health care as the positioning of providers in the ACO marketplace starts to crystallize.
ACO's, or accountable care organizations, are the product of one of the Obamacare beta solutions for controlling health care costs and improving outcomes.
My friend Dan Finch at the Texas Medical Association compared them to unicorns: no one's ever seen one but you'll recognize it when you do.
I'm not sure he's completely correct, there are a few of these organizations forming around the country. One in Chicago offers to produce great data on the utility of the delivery mechanism though the jury is still out on whether it will net positive results for patients.
These new entities can be formed really by anyone -- that is, anyone brave enough to pioneer the business model. The risks are great because of the capital requirements to protect the integrity of the captitated payment system which is really the heart of the organization.
Capitation is an ugly word in health care financing probably because of the almost unanimous negative consequences of the insurance models funded in this manner in the 90's.
Everyone then left with a bad taste in their mouth.
Insurance companies couldn't rein in physicians and hospitals to control costs and patients never bought into the model that prevented them from using a infinite amount of resources in their own health care.
So why would it be different now?
The argument is mostly supported not by the change in patient expectations or the robust IT infrastructure that we have in this century, but rather by the necessity to control costs. That argument unfortunately will drive the business principles that formulate these new organizations.
The definition of a "cold war" must include the word "protectionism." Certainly the world saw the escalation in missile batteries and nuclear warheads until Reagan was successful in "tearing down that wall."
But, pardon the reckless use of the 1988-presidential-debate line: Mr. Obama you are no Reagan.
Why am I so pessimistic these ACO's will find a place in this market space?
First is the lack of a unified national standard concerning our information technology infrastructure. There is currently no data sharing among providers outside of their own controlled groups (you can thank another federal stature for the difficulty here: read HIPPA).
And although a standard can be created and implemented, there is still the fact that many of the ground war health care practitioners (the primary care physicians) are still not active users of this technology. Current estimates put this at somewhere around 30% tops.
And with the cost of implementation of an electronic health record setup in a physician's office near $40K it will be some time before we see widespread adoption of EMR's.
Then there is the issue of exactly what we will measure to insure that quality care is being delivered. These so called "measures" of quality are still undergoing national debate and peer review. They're close to getting the numbers right. The question is whether physicians and patients will buy in.
And finally there is the nasty issue of "gain sharing." This is where you reward the parties for achieving the goals of delivering high quality care in an efficient manner.
Paying physicians is particularly difficult because of a myriad of other federal statues relating to anti-trust and kick back regulations.
Some groups, particularly hospitals, believe that the answer to this issue is direct employment of physicians. But this business model is challenging in that not only must a hospital control the diverse interests of a multi-specialty group of physicians, but it also has to morph the health care of individual patients to fit a cost savings model.
Both of these groups are not historically responsive to direction by a third party.
Then you have the difficult problem that hospitals are funded by actually admitting patients and providing care. In the ACO model the profits only come from keeping patient's healthy and OUT OF THE HOSPITAL.
Now sure, business models can change. But hospitals will have to recognize and be able to adapt to this change in a swift and controlled manner to insure that they remain profitable and can continue their mission.
Oh lest I forget one other very important party to the ACO equation: the people who pay for health care services.
Whether these ACO's are created as a hospital-based entity or along the traditional insurance model, at the end of the day both the government and American business expect to pay less for health care services in the future.
So for the ACO model to be successful it actually has to have a declining net revenue line.
It is this money line that has everyone so concerned and lining up to protect their own interests.
Hospitals are arguing for a hospital-centric model so they can control the dollar at the end of the day. Physicians are either jumping on board with the hospital groups or they are lobbying for measures to protect their private practice.
Patient groups are seeing that there could be limitations on both who they can see for care and where they can go. This loss of autonomy in the doctor-patient relationship will be very hard for most patients to swallow.
Insurance companies and business groups don't trust hospitals, physicians, or patients to work to control costs in the health care economy. So they are lobbying for strong protective measures to insure that ACO's don't get out of the normal reserve requirements to sell an insurance product.
ACO's hold the promise of ending the cold war.
If all of the parties could work together on a fair and balanced model that puts the patient first in the decision making process, it could offer an opportunity for success.
But for now all of the parties are building up their arms to protect their own interests, or they are being overwhelmed by a well funded adversary.
Virtually every hospital is "creating an ACO" and physician's practices are being gobbled up health care systems.
I applaud the idea of collaboration and use of IT to improve the health experience for patients. Today, though, I'm not too confident that the current attempt at tearing down the wall will work.
- Posted using BlogPress from my iPad
ACO's, or accountable care organizations, are the product of one of the Obamacare beta solutions for controlling health care costs and improving outcomes.
My friend Dan Finch at the Texas Medical Association compared them to unicorns: no one's ever seen one but you'll recognize it when you do.
I'm not sure he's completely correct, there are a few of these organizations forming around the country. One in Chicago offers to produce great data on the utility of the delivery mechanism though the jury is still out on whether it will net positive results for patients.
These new entities can be formed really by anyone -- that is, anyone brave enough to pioneer the business model. The risks are great because of the capital requirements to protect the integrity of the captitated payment system which is really the heart of the organization.
Capitation is an ugly word in health care financing probably because of the almost unanimous negative consequences of the insurance models funded in this manner in the 90's.
Everyone then left with a bad taste in their mouth.
Insurance companies couldn't rein in physicians and hospitals to control costs and patients never bought into the model that prevented them from using a infinite amount of resources in their own health care.
So why would it be different now?
The argument is mostly supported not by the change in patient expectations or the robust IT infrastructure that we have in this century, but rather by the necessity to control costs. That argument unfortunately will drive the business principles that formulate these new organizations.
The definition of a "cold war" must include the word "protectionism." Certainly the world saw the escalation in missile batteries and nuclear warheads until Reagan was successful in "tearing down that wall."
But, pardon the reckless use of the 1988-presidential-debate line: Mr. Obama you are no Reagan.
Why am I so pessimistic these ACO's will find a place in this market space?
First is the lack of a unified national standard concerning our information technology infrastructure. There is currently no data sharing among providers outside of their own controlled groups (you can thank another federal stature for the difficulty here: read HIPPA).
And although a standard can be created and implemented, there is still the fact that many of the ground war health care practitioners (the primary care physicians) are still not active users of this technology. Current estimates put this at somewhere around 30% tops.
And with the cost of implementation of an electronic health record setup in a physician's office near $40K it will be some time before we see widespread adoption of EMR's.
Then there is the issue of exactly what we will measure to insure that quality care is being delivered. These so called "measures" of quality are still undergoing national debate and peer review. They're close to getting the numbers right. The question is whether physicians and patients will buy in.
And finally there is the nasty issue of "gain sharing." This is where you reward the parties for achieving the goals of delivering high quality care in an efficient manner.
Paying physicians is particularly difficult because of a myriad of other federal statues relating to anti-trust and kick back regulations.
Some groups, particularly hospitals, believe that the answer to this issue is direct employment of physicians. But this business model is challenging in that not only must a hospital control the diverse interests of a multi-specialty group of physicians, but it also has to morph the health care of individual patients to fit a cost savings model.
Both of these groups are not historically responsive to direction by a third party.
Then you have the difficult problem that hospitals are funded by actually admitting patients and providing care. In the ACO model the profits only come from keeping patient's healthy and OUT OF THE HOSPITAL.
Now sure, business models can change. But hospitals will have to recognize and be able to adapt to this change in a swift and controlled manner to insure that they remain profitable and can continue their mission.
Oh lest I forget one other very important party to the ACO equation: the people who pay for health care services.
Whether these ACO's are created as a hospital-based entity or along the traditional insurance model, at the end of the day both the government and American business expect to pay less for health care services in the future.
So for the ACO model to be successful it actually has to have a declining net revenue line.
It is this money line that has everyone so concerned and lining up to protect their own interests.
Hospitals are arguing for a hospital-centric model so they can control the dollar at the end of the day. Physicians are either jumping on board with the hospital groups or they are lobbying for measures to protect their private practice.
Patient groups are seeing that there could be limitations on both who they can see for care and where they can go. This loss of autonomy in the doctor-patient relationship will be very hard for most patients to swallow.
Insurance companies and business groups don't trust hospitals, physicians, or patients to work to control costs in the health care economy. So they are lobbying for strong protective measures to insure that ACO's don't get out of the normal reserve requirements to sell an insurance product.
ACO's hold the promise of ending the cold war.
If all of the parties could work together on a fair and balanced model that puts the patient first in the decision making process, it could offer an opportunity for success.
But for now all of the parties are building up their arms to protect their own interests, or they are being overwhelmed by a well funded adversary.
Virtually every hospital is "creating an ACO" and physician's practices are being gobbled up health care systems.
I applaud the idea of collaboration and use of IT to improve the health experience for patients. Today, though, I'm not too confident that the current attempt at tearing down the wall will work.
- Posted using BlogPress from my iPad
Location:Quito, Ecuador
Monday, November 15, 2010
Doctors and Medicare Cuts
Just a quick note on a great article from the Washington Post on the impending Medicare cuts:
"Washington Post Article"
It fits in well with our blog posts this week,
Dan
- Posted using BlogPress from my iPad
"Washington Post Article"
It fits in well with our blog posts this week,
Dan
- Posted using BlogPress from my iPad
Location:Dallas, Texas
Friday, November 12, 2010
Is the government telling me if I can see my doctor?
Medicare was touted as the social entitlement program that would forever change health care access for our seniors.
But is it becoming the biggest challenge to seeing the doctor of your choice?
For the first time in the almost 50 years of the program more and more Medicare recipients are facing the challenge of finding a doctor who will take their government sponsored insurance.
Sure, there have recently been problems with the over 65 finding primary care physicians. But these PCP's can be hard for any insurance class of patient to find, though much harder for patients with plans that pay 40 percent of current market rates.
As you have seen from my recent blog posts, we are facing a rapidly approaching meltdown of our Medicare system. With no substantial reimbursement increases since 1997, an expanding older population, and medical costs that are outpacing the rate of growth of GDP, more and more physicians and other health care providers are exiting the market space.
But the current state of affairs is about more than money. A whole lot more.
You see money won't necessarily buy you access to your physician if you are a Medicare patient.
For most capitalist oriented folks this doesn't make sense. This land of milk and honey we call America was built on one's ability to buy anything -- including access. Whether it be to the halls of Congress or the waiting rooms of medical specialists, the rich (or even the middle class) in the United States have always been given the golden ticket for access if they could afford it.
But current Medicare rules don't allow for the normal business relationships that have built the rest of our economy.
This stems from the limited participating agreements that physicians are forced to agree with if they desire to see Medicare patients. And, for laws that restrict the payment of benefits to seniors if they see physicians that aren't a part of the Medicare program.
Physicians are really given only two choices if they want to get paid for seeing a Medicare patient. They can either agree to be "participating" where they are paid directly by the government for delivering care, or "non-participating" where they agree to see an over 65 patient but the payment is paid to the patient and the physician is then responsible for collecting the fee.
If a physician "opts out," that is, decides to not be a part of the program at all ("par" or "non-par"), then they can see a Medicare patient only if a complicated set of constantly renewed contracts are completed.
But here's the catch: the patient cannot receive any reimbursement from the government for the cost of the care.
That's right, as a Medicare patient you lose your benefits from the federal government entitlement program if you enter into a contract with a physician who is not part of the system. You won't even get reimbursed for what Medicare would have paid if the physician was a program provider.
Now honestly this has never been much of a problem: most physicians participated in the program and very few were "non-par", much less opted out. A big impediment to even testing the water of opting out has been the mandatory two year waiting period that physicians must survive before they are allowed to rejoin the system.
That was until the post-Obamacare age we live in now.
Funding the Medicare system has become laughable with a recurrent litany of temporary fixes that now provide only a month-to-month operating budget for the program.
It is this uncertainty combined with the decline in overall revenue that is driving physicians to opt out of the program and into the world of direct contracting.
Is it fair for the federal government to get a free ride on the backs of American seniors by no longer being responsible for providing health care dollars?
If you are an entitled Medicare recipient and you see a physician of your choosing who might not be a part of the system, why shouldn't you at least be able to get reimbursed for your out of pocket costs to the limits of the allowable Medicare charge?
So I guess the answer to the question is, that for now, the government is not "telling patients they can't see the doctor of their choice" but they are telling them that they aren't going to pay for it.
As we move forward into the Republican controlled Congress, and free market capitalism begins to rein supreme, we are almost certain to see challenges to the current status quo. Not only will patients begin to demand the right to see the physician of their choice, Republicans may see changes in the law as a way to limit growth of the program and curb the government's responsibility for cost increases.
Of course, with these rights patients risk a higher amount of out-of-pocket costs.
It's unclear if the political winds will blow to enhance the laws surrounding direct contracting -- loosening the restrictions on physicians from offering these deals and for patients electing to sign up -- but it is almost certain to be a part of the discussion very soon.
Follow this story as we chronicle the debate on www.docdano.com.
- Posted using BlogPress from my iPad
But is it becoming the biggest challenge to seeing the doctor of your choice?
For the first time in the almost 50 years of the program more and more Medicare recipients are facing the challenge of finding a doctor who will take their government sponsored insurance.
Sure, there have recently been problems with the over 65 finding primary care physicians. But these PCP's can be hard for any insurance class of patient to find, though much harder for patients with plans that pay 40 percent of current market rates.
As you have seen from my recent blog posts, we are facing a rapidly approaching meltdown of our Medicare system. With no substantial reimbursement increases since 1997, an expanding older population, and medical costs that are outpacing the rate of growth of GDP, more and more physicians and other health care providers are exiting the market space.
But the current state of affairs is about more than money. A whole lot more.
You see money won't necessarily buy you access to your physician if you are a Medicare patient.
For most capitalist oriented folks this doesn't make sense. This land of milk and honey we call America was built on one's ability to buy anything -- including access. Whether it be to the halls of Congress or the waiting rooms of medical specialists, the rich (or even the middle class) in the United States have always been given the golden ticket for access if they could afford it.
But current Medicare rules don't allow for the normal business relationships that have built the rest of our economy.
This stems from the limited participating agreements that physicians are forced to agree with if they desire to see Medicare patients. And, for laws that restrict the payment of benefits to seniors if they see physicians that aren't a part of the Medicare program.
Physicians are really given only two choices if they want to get paid for seeing a Medicare patient. They can either agree to be "participating" where they are paid directly by the government for delivering care, or "non-participating" where they agree to see an over 65 patient but the payment is paid to the patient and the physician is then responsible for collecting the fee.
If a physician "opts out," that is, decides to not be a part of the program at all ("par" or "non-par"), then they can see a Medicare patient only if a complicated set of constantly renewed contracts are completed.
But here's the catch: the patient cannot receive any reimbursement from the government for the cost of the care.
That's right, as a Medicare patient you lose your benefits from the federal government entitlement program if you enter into a contract with a physician who is not part of the system. You won't even get reimbursed for what Medicare would have paid if the physician was a program provider.
Now honestly this has never been much of a problem: most physicians participated in the program and very few were "non-par", much less opted out. A big impediment to even testing the water of opting out has been the mandatory two year waiting period that physicians must survive before they are allowed to rejoin the system.
That was until the post-Obamacare age we live in now.
Funding the Medicare system has become laughable with a recurrent litany of temporary fixes that now provide only a month-to-month operating budget for the program.
It is this uncertainty combined with the decline in overall revenue that is driving physicians to opt out of the program and into the world of direct contracting.
Is it fair for the federal government to get a free ride on the backs of American seniors by no longer being responsible for providing health care dollars?
If you are an entitled Medicare recipient and you see a physician of your choosing who might not be a part of the system, why shouldn't you at least be able to get reimbursed for your out of pocket costs to the limits of the allowable Medicare charge?
So I guess the answer to the question is, that for now, the government is not "telling patients they can't see the doctor of their choice" but they are telling them that they aren't going to pay for it.
As we move forward into the Republican controlled Congress, and free market capitalism begins to rein supreme, we are almost certain to see challenges to the current status quo. Not only will patients begin to demand the right to see the physician of their choice, Republicans may see changes in the law as a way to limit growth of the program and curb the government's responsibility for cost increases.
Of course, with these rights patients risk a higher amount of out-of-pocket costs.
It's unclear if the political winds will blow to enhance the laws surrounding direct contracting -- loosening the restrictions on physicians from offering these deals and for patients electing to sign up -- but it is almost certain to be a part of the discussion very soon.
Follow this story as we chronicle the debate on www.docdano.com.
- Posted using BlogPress from my iPad
Saturday, October 30, 2010
Mortgage meltdown or medicine meltdown?
As we enter the final phases of the election cycle you can get a good idea of the spoils of big government just by looking at the rhetoric in the campaign.
Clearly, one issue is dominating the election this fall: the economy, and more specifically the lack of jobs.
So I would like to pose a few questions and ideas on just how government actually performs in creating economic growth and in kick starting job growth. I don't necessarily have the answers, but I'm real good at asking questions.
Did government assisted mortgages help the economy? Certainly by artificially lowering mortgage rates and the creation of investor owned, government back sub-prime mortgage equities, the federal system of assistance in home buying has become the norm.
But given the meltdown in the mortgage industry, did we do a service to Americans by putting people in homes they couldn't afford? Flipping houses became the source for a evening cable television show and the folly of many particularly young home buyers.
As liquidity in the mortgage market disappeared so did the dreams and savings of many Americans -- including those that had invested in the "government" back equities of Fannie Mae and Freddie Mac.
Is government funded healthcare going to be beneficial for our country in the long term? Just like mortgages, are we going to put our country into a health system they can't afford?
Out current federal health legislation creates "coverage" for 85% of our citizens, but does nothing to promote access to care or an improvement in health care choices.
The latter is particularly concerning.
Regardless of the life style choices one makes, there is a guarantee of coverage. There certainly needed to be an improvement in health care services for the uninsured, and there needed to be some limitations on the growth in spending, but wouldn't it have been better to put incentives on the user?
The real question becomes: will we be facing a health care meltdown just like the mortgage industry? As the requirements for health care services rise, there being no limitations on cost, and no impediments to limiting health care decisions, can the system continue to function?
The biggest concern here is whether physicians and other health care industry providers (pharmaceutical companies, insurance companies, hospitals) can continue to function in an economic environment of continued declining reimbursement for services.
This is especially true given the proposed 23%+ cut in Medicare rates next month with more to follow in January.
Will there be a decline in health care liquidity?
Physicians and other health care providers may find themselves in a situation much like the mortgage industry: servicing consumers with health care services they and the government really can't afford.
I guess the real question is will there be a foreclosure on your new sub-prime health coverage?
- Posted using BlogPress from my iPad
Clearly, one issue is dominating the election this fall: the economy, and more specifically the lack of jobs.
So I would like to pose a few questions and ideas on just how government actually performs in creating economic growth and in kick starting job growth. I don't necessarily have the answers, but I'm real good at asking questions.
Did government assisted mortgages help the economy? Certainly by artificially lowering mortgage rates and the creation of investor owned, government back sub-prime mortgage equities, the federal system of assistance in home buying has become the norm.
But given the meltdown in the mortgage industry, did we do a service to Americans by putting people in homes they couldn't afford? Flipping houses became the source for a evening cable television show and the folly of many particularly young home buyers.
As liquidity in the mortgage market disappeared so did the dreams and savings of many Americans -- including those that had invested in the "government" back equities of Fannie Mae and Freddie Mac.
Is government funded healthcare going to be beneficial for our country in the long term? Just like mortgages, are we going to put our country into a health system they can't afford?
Out current federal health legislation creates "coverage" for 85% of our citizens, but does nothing to promote access to care or an improvement in health care choices.
The latter is particularly concerning.
Regardless of the life style choices one makes, there is a guarantee of coverage. There certainly needed to be an improvement in health care services for the uninsured, and there needed to be some limitations on the growth in spending, but wouldn't it have been better to put incentives on the user?
The real question becomes: will we be facing a health care meltdown just like the mortgage industry? As the requirements for health care services rise, there being no limitations on cost, and no impediments to limiting health care decisions, can the system continue to function?
The biggest concern here is whether physicians and other health care industry providers (pharmaceutical companies, insurance companies, hospitals) can continue to function in an economic environment of continued declining reimbursement for services.
This is especially true given the proposed 23%+ cut in Medicare rates next month with more to follow in January.
Will there be a decline in health care liquidity?
Physicians and other health care providers may find themselves in a situation much like the mortgage industry: servicing consumers with health care services they and the government really can't afford.
I guess the real question is will there be a foreclosure on your new sub-prime health coverage?
- Posted using BlogPress from my iPad
Friday, October 8, 2010
Is Obamacare in critical condition?
Check out this CNBC video from the Kudlow Report asking the question: is Obamacare heading for a repeal?
Sunday, October 3, 2010
Obamacare - You want fries with that?
A recent article in the Wall Street Journal and the followup editorial concerning McDonald's decision to consider ending health care coverage for its work force has sparked controversy.
But it is a very compelling message.
Obamacare, or more correctly, the new federal health legislation passed in the spring by the Democratic Congress, promised to "keep your current health coverage intact."
But as the law goes into effect, it is confirming what we pundits have been screaming from the beginning: it will impact everyone in America.
Read: everyone. From the uninsured (which hopefully will see expanded coverage but still be challenged with with limited access) to tax payers to small business and yes, to physicians, everyone will see an impact.
And it will vary from the potential double digit increases on private indemnity insurance for those 25 year old new entrepreneurs to the seemingly bizarre requirement that small business owners will now have to issue thousands of additional 1099 forms to virtually every vendor they purchase products or services from.
So for McDonald's to be considering eliminating health care coverage may not come as a surprise. Now before my faithful readers start sending me emails about "how these were minimum benefit plans" and "these workers deserve better care," let me preempt you.
McDonald's offers ground level employment for thousands of young people -- and many part time workers. So for them to be offering any health care benefits to begin with was extraordinary.
And now to have them being forced to either enrich the plan with added benefits and cost, or abandon their current entry level health benefit structure is an example of how they too will be impacted by the legislation.
But for all the bad that has been said about the federal health regulations, the most chilling concern that I have is that at the end of the day despite the super-sized money and new statues that have been created -- we may not see an improvement in the access and quality of care.
There is no value meal here.
But it is a very compelling message.
Obamacare, or more correctly, the new federal health legislation passed in the spring by the Democratic Congress, promised to "keep your current health coverage intact."
But as the law goes into effect, it is confirming what we pundits have been screaming from the beginning: it will impact everyone in America.
Read: everyone. From the uninsured (which hopefully will see expanded coverage but still be challenged with with limited access) to tax payers to small business and yes, to physicians, everyone will see an impact.
And it will vary from the potential double digit increases on private indemnity insurance for those 25 year old new entrepreneurs to the seemingly bizarre requirement that small business owners will now have to issue thousands of additional 1099 forms to virtually every vendor they purchase products or services from.
So for McDonald's to be considering eliminating health care coverage may not come as a surprise. Now before my faithful readers start sending me emails about "how these were minimum benefit plans" and "these workers deserve better care," let me preempt you.
McDonald's offers ground level employment for thousands of young people -- and many part time workers. So for them to be offering any health care benefits to begin with was extraordinary.
And now to have them being forced to either enrich the plan with added benefits and cost, or abandon their current entry level health benefit structure is an example of how they too will be impacted by the legislation.
But for all the bad that has been said about the federal health regulations, the most chilling concern that I have is that at the end of the day despite the super-sized money and new statues that have been created -- we may not see an improvement in the access and quality of care.
There is no value meal here.
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