Health Care thoughts: Yes, No , Sorta, Kinda, Maybe
by Tom aka Rusty Rustbelt
Health Care: Yes, No , Sorta, Kinda, Maybe
Medicare rates for physicians have been, supposedly, regulated by the SGR* formula since 1998, but the formula is so wretched and lobbyists so strong the formula has been repeatedly postponed.
The Obama administration has been determined to do a one time catch up, which was scheduled to make an average cut of about 24% on December 1, 2010.
Congress has felt the heat from many different constituencies, but has been unable or unwilling to develop a new system.
The latest is the ” “Physician Payment and Therapy Relief Act of 2010.” Impressive title, but it is simply a one month reshuffling of some funds, a kick the can down the road strategy that just delays the inevitable.
This is no way to make policy.
*Sustainable Growth Rate
Tom–The internists and the family practitioners will end up eating a big loss when the Texas over-test and over-charge-em gang will make even more money. Maybe kicking the can down the road makes sense, considering the effect the low fees will have on the beneficiaries. NancyO
Spent most of this afternoon on conference calls with health care publishers and association managers.
Conspiracy theory – force as many physicians as possible to go to work for hospitals, thus paving the way for further bundling of payments and other payment innovations.
Funny thing, even if there is no conspiracy, it is working. The physicians are panicking and looking for integration deals.
30 days will put this on New Years, when Congress is not in session, so this gets dumped into the lap of the new Congress.
Likely Medicare will hold payments for the month of January, waiting to see what happens. That does wonders for cash flow.
What a mess.
Blue Cross Mass. has already lowered rates of reimbursement for mental health therapists, from about $89 to $72.50 per face to face hour (1990 rates?). So far I have also counted 5 reporting changes for 5 different clients…can charge difference in BC rate from own, cannot charge difference, rate ste still 89, patient submits bill and pays therapist after approved by Tx, Tx submits bill for approval, patient reports/measures own progress every 10 sessions or so (re-payment is based on ‘progress’ but too much and one is cured) for approval…one company, many policies.
One hour Tx, one plus hours paperwork, really messy criterion for progress.
The AP is reporting a one year deal (funded by fudging around some tax credits) to prevent the most draconian cuts. More in an hour or so.
another example of klutzy regulation
lowering rates gradually, giving them time to get used to the idea and make other plans, might work. just hitting them over the head with a 24% pay cut is going to arouse some opposition if not hysteria.
i suspect the problem is not that the rates are too high but that the treatments are too much too often.
on the other hand i get tired of doctors feeling sorry for themselves only making a million a year after all that education and expense.
If 35 years years I have never met a doctor who made $1M a year – heard of a few, but never met one, or even close.
I don’t think this policy was ever a serious attempt to control costs. It was a cynical attempt to control deficit projections (similar to the bush tax cut sunsets, and simpson-bowles deficit plan assumption that health spending will suddenly start increasing much slower for no stated reason).
If the law says we will drastically cut next year then “current law” budget projections show smaller deficits in the future.
But we can’t actually make those cuts because we aren’t really even trying to do much of anything to control costs so every year the law is changed so the cuts don’t happen.
The whole thing is a farce. Presumably it slightly increases costs due to the chaos it causes every year as the deadline approaches.
rusty
fair enough. but the point was not one million dollars exactly, but a lot more than most people make who worked just as hard and trained just as long.
Rusty:
What is the the reverse? How many doctors do you know who make median income? make $200,000 per year, make $500,000/year? My doctor visits range from $180 to $220. per visit. Are you saying this is valid?
dan:
What should the cost be?
Being one of the country’s leading experts on cost accounting in physician practices, it is damn expensive to provide that office visit, and Obamacare will make it more expensive.
It ain’t all profit.