I will post at least three more documents
relating to my concerns about
health care and the impact of the affordable Health Care Act. None of this is
to be construed as an indictment of neither the Obama administration nor an up
to blog for Mitt Romney. I will discuss the so-called Romney alternate to the
affordable health care act in a subsequent blog.
Instead in the previous blog and this one I am attempting to
express my concerns upon the impact of the act upon delivery of quality care to
all Americans.
Articles II: Section 8 of the Constitution which defines
Congress’s powers does not specifically give it the right to mandate health care
for the citizens. Amendment X would suggest that that night could only be
exercised by the state however amendment XIV [civil rights] states that “no
state shall make or enforce any law which shall abridge the privileges or
immunities of citizens of the United States”.
I note these quotes from the Constitution because they have
the potentiality of making the mandatory provisions of the health care act
illegal and unconstitutional. However, that is that problem at this point. I
have apparently been told that the health care act not cost us anymore and that
there would be no increase in taxes.
THE DOCTOR,
However there are
various fines and penalties in the law some of which are designed to circumvent
the contention that there is no mandate to buy insurance. Starting in 2014 and
rising every year there is a penalty which will be adjusted for inflation at
thousand and 15 failure to buy health insurance.
This June the Supreme Court determined that those penalties
are indeed a tax, and therefore the mandate to buy health insurance is
perfectly legal under the Congress’s powers of taxation.
Nonetheless, the “penalty” for not being insured is less
than any possible insurance premiums and those who are healthy may risk the
possibility of their needs health care and just pay the penalty. This penalty of
course rises from 1% of income 2014 two $2085 per family were 2.5% of income
whichever is higher in 2016. Of course those low income to do not have to file
a tax return, never the surgeon religious groups are those of a supreme that
would exceed 8% of the family income are not subject to this penalty.
The new health care act also has surtax on Medicare for
those whose income is over $200,000 single or if married $250,000 which will be
amounting to 0.9% earn income plus a new 3.8% tax portion of capital gains and
dividends. That is a top of the 1.45% that is mandatory to be taken out of
their wages.
I am not going into the mandates forcing employers to
provide health insurance.
There is no estimation on the cost and high premiums that
will face the present day insured population.
THE DOCTOR
Let us turn to the other aspects of the Medicare laws and
the affordable health care act which I feel will have a negative effect upon
the delivery of health care. Aside from the fact that I Medicare payments are
determined by two dictated overall known as SGR [Medicare sustainable growth
rate] to control spending ties Medicare reimbursement into the growth of the
GNP; the intent is to reduce or reimbursement to the providers are.. Because
you know it’s every year this is been below the rate of inflation there has
been objection from the medical profession so that the changes recommended have
been abolished by congressional act. Instead at the end of 2012 827% cut in
Medicare part payments scheduled to go into effect on March 1, 2013. Undoubtedly,
that will be begin the gated because of enforce responsibility great number of
physicians will either refused to accept Medicare patients or entirely leave
the profession.
On top of this threat to the practice of medicine; Medicare
has instituted a set of requirements which if followed by physicians for the
first couple of years includes small increases in reimbursement but if not
instituted will end up with a reduction in reimbursement. They are electronic
prescription writing, the electronic medical records, and something cool physician’s
quality reporting system which requires doctors to report certain activities or
data specific to patient encounters.
Initially there is a bonus of 0.5% physician’s total
Medicare charges for the year 2012 to be paid by2016. There were supposedly
additional bonuses payable for 2000 and on through 2014 after which only
penalties will be in play. Those penalties are of course reduction in
reimbursement I which can be up to 2%.electronic prescription transmission, 3%
for not having electronic medical records and 2% for failure of the PQRS.
There are exemptions to the electronic prescription law as
follows:
“In November 2011, the Centers for Medicare & Medicaid Services
(CMS) released the final regulation on the 2013 Medicare e-prescribing penalty
program. The penalty for not successfully participating in the program
or not filing for an exemption on time is a 1.5 percent payment
reduction for all Medicare claims based on the 2013 fee schedule amounts during
the year.
Avoiding the 2013 Medicare e-prescribing penalty
Physicians and other eligible professionals who meet the following
criteria will not be subject to the 2013
Medicare e-prescribing penalty. If you meet one of the following
criteria, you will automatically be excluded from the penalty and no action is
required on your part:
• You are
not an MD, DO, Podiatrist, Nurse Practitioner, or Physician Assistant as of
June 30,
2012.
• Office visits and other
services listed in the CMS e-prescribing measure specifications represent less
than 10 percent of your allowed Medicare Part B charges in the first six months
of 2012 (January 1, 2012 through June 30, 2012) (Link to CMS’ measure specifications
at: https://www.cms.gov/ERxIncentive/06_E-Prescribing_Measure.asp#TopOfPage and
click on
2012 eRx Measure Specifications, Release Notes, and Claims-Based
Reporting Principles [ZIP
475KB]).
• Less than 100 of your claims
for Medicare Part B patient services contain visit and service codes that fall
within the e-prescribing measure specifications for dates of service between
January 1,
2012 and June 30, 2012.
In addition, if a physician (MD, DO) or eligible professional
(podiatrist, nurse practitioner, physician assistant) has already taken one of
the actions described below, the 2013 e-prescribing penalty will not apply:
• You e-prescribed using a
qualifying e-prescribing system or certified electronic health record (EHR) and
submitted 10 or more e-prescribing codes (G8553) on your Medicare Part B claim
forms from January 1, 2012 and June 30, 2012, and the claims were received and
processed by CMS by no later than July 31, 2012.
o Note: Unlike the e-prescribing
incentive program and the 2012 e-prescribing penalty program, to avoid an
e-prescribing penalty in 2013, you do not have to tie the electronic
prescription to a qualifying visit or service when you report on 10 e-scripts
during the first six months of 2012. As long as you e-prescribed for a Medicare
patient you treated, you can report the G8553 code on the Medicare Part B claim
on any Medicare service or visit you rendered for your patient.
• You do not have prescribing privileges and
you reported the G-code, G8644, at least one time on a Medicare Part B claim
prior to June 30, 2012.”
What a mess! Government and lawyers can never do anything
simple. As a result the physician has to
be constantly on guard against inadvertent failure to comply with these laws to
avoid financial penalties. None of the laws improve health care; they are just
figments of imagination in the minds of those individuals who considers themselves
experts, but have no practical concept.
When I started I noted that I was concerned with the quality
of health care that we are going to see. I have not said anything about the
hospitals, the availability of procedures and restrictions on what may be
important tests. More about this later.
If we are not throes of Sandy there will be a continuation
tomorrow.
