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The Medicare can has been kicked forward for the past 50 years and now, somehow, it's all Obama's fault. .
Well, I certainly don't blame Obama for Medicare. I actually support government health care for the retired. They paid into the system, and the elderly deserve to be cared for. I feel the same for the TRULY disabled. This should exist. I am just addressing your point implying that Medicare is so overwhelmingly successful. No. It's ballooned into the unimaginable and can barely be paid for WHILE STILL not paying providers well. So...it costs too much but no one is getting paid well and it did not take population expansion into account. WTF kind of system is that?
But who is to blame for the new ridiculous CMS guidelines? Have you seen this new bundling thing?
Or how about the fun fun of an entire visit not getting paid for because we don't check the right box on the new 2 midnight form or document a foley protocol correctly?
..............When one looks back on the creation of Medicare in the 60's, the AMA made it clear that the entire medical system would immediately collapse under the weight of seniors seeking medical care. And yet. that did not happen, did it...............
No, you are right, Medicare merely kicked off a cost/price spiral in medical care that, five decades later, is threatening to bankrupt the nation.
The argument for Medicare in the 60's was that our senior citizens were spending 12% (gasp!) of their incomes on health care. Now, trillions and trillions of dollars later, our senior citizens are spending 17% of their incomes on health care.
Medicare as we know it is unsustainable and is dead as a doornail, and everyone knows it. The only question is whether the government will make the hard decisions with death panels, or individuals will make their own hard decisions with vouchers.
Now we face Obamacare, evidently too complicated to even be implemented, with its sacrifice of married people for the benefit of singles, successfully self-employed for the uninsured, and the young for the old....all while failing miserably in its attempt to both insure the uninsured and provide actual care to those on the bottom rungs of society.
Medicare was created back in the mid 60's when the retirement population was a few million, within the next 10 years there will be about 77 million seniors who will qualify for medicare, yes, it will collapse under it's own weight. The population growth with in the United States has been declining since the 70's, it is the population of taxpayers that support medicare, it has already reach a point that expenditures exceed income, what do you think will happen within the next 10 years. Medicare will not be able to pay its bills and doctors and hospitals will refuse to accept Medicare.
Former President Harry Truman was the first Medicare enrollee. He never paid a dime into the system and he had the means to pay for his own healthcare, out of pocket, given the relative primitiveness of medical services almost 50 years ago. If one had a heart attack, they typically died and did not receive surgery or hospitalization, let alone a heart transplant. By 1970, there were more than 20 million seniors enrolled in Medicare, just 5 years after inception and most of them never paid a cent towards it.
Since the inception of Medicare, longevity has increased by about 20%. And then there's the baby boom, the first generation to have paid into Medicare their entire working lives, in effect, paying for the prior generations and medical innovations. It was never enough and shortfalls became deficit spends. The Medicare payroll tax rate has remained constant since 1986, despite that the oldest of the baby boom was destined to turn 65 in 2010, come hell or high water.
Medicare was originally designed to pay hospitals their actual costs, regardless of efficiency. Beginning about 15 years ago and onwards, Medicare and private insurers increasing conjoined hospital efficiencies and outcomes with payments. Increased attention has been paid to reductions in waste, fraud and abuse.
Medicare is the largest insurer in the U.S. and it operates at the lowest administrative cost of any insurer.
Cheney, at age 71, got his new $1 million heart paid for by government despite having a net worth of $90 million.
Your clinic hasn't contracted with which insurer??? BCBS? United Health Care? Humana?
These insurance companies are all selling insurance on the ACA website? Your client purchased an insurance policy from an insurance company. The insurance company simply listed the plan on the ACA website. If your clinic had previously negotiated a contract with the insurer, presumably that contract is still in place.
No, that is not true.
Many of these "new products" listed on the exchanges under the umbrella of "Blue Cross", "United", "Coventry", "Cigna", ect... are NEW PRODUCTS which have different
a. copays
b. premiums
c. physician reimbursement
d. hospital reimbursement
e. providers
We are currently contracted with different Blue Cross Products (there are several) with different coverages and rates. The new products listed on the exchanges are NEW PRODUCTS. Our office manager informed me (after our surprise yesterday) that we have not entered into contracts with many of these products, as the reimbursement is too low.
As you have noted, Kaiser is the "800 lb gorilla" in CA. However, many providers declined plans through the exchanges there, as the rates were too low. What did these plans do? Many increased the rates back to the "old levels". This, of course, will result in higher premiums with the next calendar year.
It sounds like the dictator is telling you who you must serve.
It sounds like the insurer made a mistake.
Government has no control over or knowledge of the providers supplied by private insurers.
My state's BCBS has a legacy MD search function. In the small print, it says that plan participation is subject to change and encourages verification before receiving services. Most medical practices in my neck of the woods verify insurance before accepting appointments and have been doing so for a long, long time.
Government has no control over or knowledge of the providers supplied by private insurers.
My state's BCBS has a legacy MD search function. In the small print, it says that plan participation is subject to change and encourages verification before receiving services. Most medical practices in my neck of the woods verify insurance before accepting appointments and have been doing so for a long, long time.
Yeah,so?
How's that going to help Joe Blow after he has already picked a plan that told him his doctor was participating and he calls for an appointment or shows up as a walk in and finds he can't see him?
Yeah,so?
How's that going to help Joe Blow after he has already picked a plan that told him his doctor was participating and he calls for an appointment or shows up as a walk in and finds he can't see him?
What I do before buying a plan is call the docs I like and make sure they are taking it.
The Medicare can has been kicked forward for the past 50 years and now, somehow, it's all Obama's fault. There is some irony in the party that was quick to call ACA a death panel now seeks to eliminate Medicare and instead give vouchers to seniors to buy healthcare insurance in the private market.
The reason Medicare was created was because insurers refused to insure the elderly. It's one thing for insurers to write supplemental policies to pay some of what Medicare does not. It's a whole new ball game to be the primary insurer.
MD shortage is a regional thing. Some areas are underserved. Others, not so much. Medicare pays a flat fee to MDs based on diagnostic codes no different than how insurers pay, albeit the rates are different. Medicare also pays the MD a fixed percentage of the cost of any prescriptions they write. The higher the price of the med, the more the MD makes. Maybe some MDs over prescribe to make more. MD and hospital fraud occurs.
Medical care is rationed everywhere. In the U.S. it's rationed based on one's ability to insure themselves and the quality of the insurance plan or pay out of pocket at the point of service.
Where do you get your information?
1. When Medicare started, the reimbursement to physicians was very good. Thus physicians accepted it. Now the reimbursement is low, therefore there are many who do not accept medicare.
2. Obamacare products are starting out with low reimbursement. Why would anyone sign on for those plans?
3. Medicare does have regional differences in reimbursement. However, the most efficient, low cost areas are reimbursed the worst! Therefore, very high cost, inefficient systems are paid more.
4. Our state ranks #1 in quality for medicare. Our state also has the lowest reimbursement for medicare. We are punished for quality and efficiency.
5. MONEY FOR PRESCRIPTIONS FROM MEDICARE??? Where the heck did you get that? That is absolutely false. No physician is paid "extra money" for prescriptions!
6. When you are a medicare provider, you accept medicare rates and cannot "balance bill" with the patient's supplement- that is illegal.
Gee.................. I really wish #5 was true. Wouldn't that be great?!
The reimbursement for plans sold on the exchanges is not the same as our contracted rates- not even close. The "list" was of current Blue Cross providers; however, the exchange plan is far from the Blue Cross product and has much lower reimbursement. Will we accept that plan? Most definately not.
Let us say that the "business side" of Obamacare proceeds, the website works, and it obtains additional funding via taxation. Even with that, with many plans providing lower reimbursement to providers, who is going to see those patients? Health insurance is somewhat worthless when few, if any, will provide healthcare when you need it.
We will not be "picking up new patients" by being on the provider list, as we will not be providers. Our community is pretty well to do with patients having very good health insurance and reimbursement contracts to providers. Why in the world would we accept poorly reimbursing plan patients when we are already busy enough with good plans?
Those good plans are likely large group healthcare plans subsidized by employers. Such plans began certifying their compliance with ACA as early as 2013 and are doing so for 2014. Individual plans represent only 5 % of the insured market. The individual plan market has always been the dark side of the healthcare insurance market. Reportedly, 40% of the individual healthcare plan market was sub prime in those states that allowed garbage insurance to be sold to naïve consumers often times via late night TV or via the internet.
Despite this, a segment within the GOP seeks to eliminate employer sponsored group healthcare plans. They seek to create and impose a new tax on the value of the employer's contribution to the cost of the policy. On average, that cost is in the neighborhood of $18,000 a year per employee... This segment of the GOP seeks to drive people into the individual market for healthcare insurance. They dangle the carrot from a stick that when employers no longer are expected to subsidize employee insurance , maybe you can finally get a raise out of your employer. How likely is it that employers are going to grant employees making $50K a year a 30% raise?
Large group healthcare plans cost insurers, hospitals and medical practices substantially less than individual plans to administer. Large group healthcare plans generally have 3 flavors, PPO, HMO and EPO. Conversely, the options were unlimited within the individual market.
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