I would like to say that I am late posting this AM because I was hoping that I would have a reply from my recent open letter to the powers that be in Trenton.
If anyone thinks that the concept of state socialism is the answer to all problems they have another guess, coming.One aspect that I would focus on is the health care reform. It is probable that it is going to be one of the greatest calamities
We have become a society that is dependent on "entitlements". The government is going to give us everything.
Remember that there is an old adage that you can get what you pay for, nut that you never get something for nothing. The reformers of health care are promising state of art care to the public; indeed to everyone without any reservation. That of course is a lot of bull.
Quality of care is depended on the availability and the use of quality resources. All of which costs money. The costs however is going to be met by reducing payments to a level that the health care professional can no longer survive and make a decent living.
With the increase in the paper work especially in affecting the primary care physician's office overhead, it is important that reimbursement match the rise in cost of living. I will not go into specifics but I am sure that it is obvious that the number of front office employees have doubled or even tripled in the past decade.
It is becoming difficult for a small one or two doctor practice to survive. Larger groups reduce costs by employing nurse practitioners and/or Physicians Assistants, who assume most of the hands on care relegating the MD to decision makers. The loss of personal relationships is detrimental to good health care. The patient used to be a "person " not a case number.
Unfortunately, Health Care has become a business, not a profession.. Both the government with rules and regulations and the insurance carriers with their restrictions, limitations and controls have contributed to this change. Those that pay the bill are determining what physician and which hospital you can use. The public accepts this as a way of life.
To reduce the costs of the technical resources there will be increasingly strict restrictions on the availability to the patient. Nowadays whether for Medicare or a private insurance plan or HMO the doctor must write out and send a separate documentation for each procedure declaring why it was necessary for the patient well-being. Even for the simple blood test and/or a chest x-ray the physician must fill out what amounts to a requisition for the procedure. For MRI's and some referrals permission must be received from the carrier. Add to the fact that the requirements from various insurance carriers and the various government plans are not consistent so that they have to be met individually. All this is requires a dedicated employee's time.
Moreover, the decisions in 99% of the time are not made by your doctor or even a company "approver" supposedly a nurse who can negate a physician's plan of care for a patient. Yes there are supposedly a plan for appeals and review but the system makes that difficult.
For years all carriers have used a book of tables drawn up years ago by actuaries based on an artificially created system of DRGs (Diagnostic Related Groups) that determine reimbursement for hospital based on a maximum length of stay. If it were for 5 days and the patient stayed six days or left after 3 days, the hospital would receive the same dollar amount. This would encourage early discharges. If the hospital could maintain "hot beds" its cash flow would increase and it could survive on contracts with insurers that cut reimbursement.
Whether it is true or not I don not know. I have however been told that one area hospital has instituted a performance bonus system in which the physician gets points (Dollars?) for each day remaining that the patient is discharged before the DRG limit. If true and I think it is creditable, I find that morally and ethically dishonest and that any physician participating should be censured.
Although reimbursement from Medicare especially to specialists has risen over the years it has not kept pace with the COL. This reprint is from a on line source, "Mediscape"
Editor's note: Later in the evening on November 18, the Senate passed its bill postponing a 23% cut in Medicare reimbursement to physicians from December 1 to January 1.
November 18, 2010 — House Democrats introduced legislation today that would postpone a 23% cut in Medicare reimbursement for physicians set for December 1 until January 1, 2012, and instead boost rates by 1% in the meantime.
Meanwhile, Sen. Max Baucus (D-MT), the chair of the Senate Finance Committee, and Sen. Chuck Grassley (R-IA), the committee’s ranking Republican member, unveiled a 2-part plan that also would spare physicians the massive pay cut for 13 months.
Under the senators’ bipartisan agreement, the Senate would delay the December 1 pay cut until January 1, and in the meantime craft another extension for the rest of 2011. The 1-month delay would be paid for with savings achieved elsewhere in the Medicare program. The financing for the longer extension has yet to be worked out.
Brendan Daly, a spokesperson for House Speaker Nancy Pelosi (D-CA), told Medscape Medical News that the House would consider the 1-month Senate extension on November 29. The timing on the 13-month House bill has yet to be determined, Daly said.
Organized medicine has warned that if the 23% pay cut takes effect, many physicians will close their doors to new Medicare patients and even drop out of the federal program. To make matters worse, another Medicare cut of roughly 2% is scheduled for January 1.
Bipartisan Lip Service for Permanent Fix, Clash Over Financing
Organized medicine, along with the Obama administration, supports delaying the Medicare pay cut until 2012 — the so-called 13-month fix — as a way to buy Congress more time to devise a permanent solution to the Medicare reimbursement crisis. At its heart is the sustainable growth rate (SGR) formula that Congress created in 1997 to help control Medicare spending. The formula sets a target for annual Medicare expenditures on physician services based partly on growth in the gross domestic product. If actual spending in 1 year tops the target, Medicare is supposed to reduce physician reimbursement the following year to recoup the difference.
The American Medical Association and other medical societies argue that the formula is defective because physician practice expenses grow at a faster pace than the gross domestic product. They support replacing the SGR formula with one more squarely based on the Medicare Economic Index, which measures inflation in physician practice costs.
The SGR formula has triggered pay cuts every year going back to 2003, but Congress has postponed each one. However, the difference between targeted and actual spending accumulates from year to year, meaning the cuts keep getting bigger.
The notion of a permanent doc fix attracts lip service from both parties, but only a delay reaction.
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