The Sad Case of the Patient Protection and Affordable Care Act

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

'adding all these people' is what should happen. In just about every other civilized country all these people would have been in the system to begin with..

Which to a sensible person means you actually have a plan for how to integrate them, no?

The problem is we have a system that is not focused on prevention

yes, very much so, yet look at what happens when we try to introduce some incentives.

The carrot: our health insurance plan gives people $100 every six months if they go to they gym three times a week. that works pretty well.

the stick: people who engage in unhealthy habits should pay more. It's common practice for smokers to have higher rates than non-smokers, for example, yet try to have the obese pay a higher premium or lose weight and listen to the outrage! in CT the governor wanted to implement a plan by which people who work for the state actually take the prescription drugs for 4 common conditions or else pay more for their health coverage and it was a huge controversy. (the conditions were high cholesterol, high blood pressure, COPD, and diabetes). It's my understanding that all of these conditions are well-controlled with medication; physicians who presumably have on-going contact with their patients prescribe them, yet people resist taking them anyway? Why shouldn't they pay more when they don't?

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Just an incredibly sensible thought. And of course will be totally ignored by the powers that be.

I dunno, the messiah dictator might take it seriously. After all, he doesn't have to please anyone any longer.

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

ok. we need more primary care physicians. I call mine and its a 3 - 6 month wait. why dont the insurance companies pay more for primary care, thus driving more $$$, hence more doctors into this field? in the long run they would probably shell out less $$$s than they do for specialists.

The other side of the coin is to pare down the payments for the procedures that specialists perform. That has happened-ophthalmologists get paid far less for cataract surgery now than they did years ago. But the problem is that there seem to always be newer more expensive procedures developed-or variations of old ones that are reimbursed differently and the beat goes on.

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

You know what really irks me about all of these arguments... people can point the fingers at physicians requiring unnecessary tests, or pharmaceuticals overcharging for meds, or insurance companies not providing services, yet no one has the balls to go after the sheeple that can't take care of themselves. If you screw up, that doesn't mean I am to pay for you. Pay for your own stupidity, DAMMIT!

Just an incredibly sensible thought. And of course will be totally ignored by the powers that be.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

You know what really irks me about all of these arguments... people can point the fingers at physicians requiring unnecessary tests, or pharmaceuticals overcharging for meds, or insurance companies not providing services, yet no one has the balls to go after the sheeple that can't take care of themselves. If you screw up, that doesn't mean I am to pay for you. Pay for your own stupidity, DAMMIT!

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

ok. we need more primary care physicians. I call mine and its a 3 - 6 month wait. why dont the insurance companies pay more for primary care, thus driving more $$$, hence more doctors into this field? in the long run they would probably shell out less $$$s than they do for specialists.

In Mass the board that determines reimbursement has 2 primary care MDs and 26 specialists on it. You probably do not need a road map.

[huskyfan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

ok. we need more primary care physicians. I call mine and its a 3 - 6 month wait. why dont the insurance companies pay more for primary care, thus driving more $$$, hence more doctors into this field? in the long run they would probably shell out less $$$s than they do for specialists.

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

YES! Exactly. Many physicians are retiring now rather than deal with the incremental extra reporting requirements under PPACA, while you simultaneously add lots of new patients to the system. Result: longer wait times.

It's only news to Rover apparently and he is so good at denial I imagine he is singing at the top of his lungs right now with his fingers stuck firmly in his ears.

Hello- Reality is we have had a large aging population of people that have not been able to get care and are now visible because they can afford to get care. To act like the law created need is silly. 'adding all these people' is what should happen. In just about every other civilized country all these people would have been in the system to begin with.

The problem is we have a system that is not focused on prevention and does not financially reward the people we now are relying on to handle the overall management of the patient. No one thought to listen to the medical people who were saying there are not enough providers to manage the volume. People continued to go into the more lucrative specialties. We have some parts of the system saying there won't be enough MDs and trying to ramp up NPs and PAs to fill this gap with initatiives to do so. Another part is actively trying to exclude PAs and NPs from the system all together and barring that trying to put in place rules that will be so restrictive it will drive us out of the system (the practices won't be reimbursed at a level that makes it worth their while if they hire us).

We continue to tolerate a system that is driven by profit with CEOs that make the gross product of several small countries no matter what their performance. We continue to tolerate unqualified people making decisions to deny treatment and testing and think that is OK as long as the gov't isn't in control of the criteria.

MDs were retiring in large numbers before this bill. Numbers of hospitals were also decreasing. The system has been breaking for a long time. Demand for resources has been increasing with our aging population. Instead of looking at how to decrease cost in a reasonable way we let the 'market' drive our thought process. The market does not have a medical degree and is not motivted to decrease their profits. Lobbyist for the pharma companies have no reason to want to decrease medication cost. Insurance companies do not want to put out for prevention.

[unofan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

YES! Exactly. Many physicians are retiring now rather than deal with the incremental extra reporting requirements under PPACA, while you simultaneously add lots of new patients to the system. Result: longer wait times.

It's only news to Rover apparently and he is so good at denial I imagine he is singing at the top of his lungs right now with his fingers stuck firmly in his ears.

The problem there is a shortage of doctors, which is itself primarily a result of the shortage of medical schools (which, unlike law schools, are generally not money makers for universities) and available spots within said schools.

Or are you really arguing that having more people covered by insurance/health coverage is a bad thing because more people will then seek medical services?

[joecct]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Fish-Most of my cohorts have indeed retired or are considering it precisely for that reason. Jenny and I are losing all our personal physicians-and honestly we no longer have a primary care physician at all. If we did not have the medical training ourselves, we would not know who to see for anything.

My son's insurance would not pay an ER claim because he did not have (could not find) a primary care physician.

Guess we're headed to concierge (for the more well off) or clinics. Stinks?

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

http://gma.yahoo.com/doc-shortage-co...ws-health.html (from that hotbed of conservative values, ABC News):




Great, now everyone has insurance, and no one new to the system can find a primary care physician. Isn't that what once was called "throwing the baby out with the bathwater" ?

ABC is the provider of news for CNY Talk Radio, the alternative station (i.e. not the wallbanger or golfer).

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

YES! Exactly. Many physicians are retiring now rather than deal with the incremental extra reporting requirements under PPACA, while you simultaneously add lots of new patients to the system. Result: longer wait times.

It's only news to Rover apparently and he is so good at denial I imagine he is singing at the top of his lungs right now with his fingers stuck firmly in his ears.

Fish-Most of my cohorts have indeed retired or are considering it precisely for that reason. Jenny and I are losing all our personal physicians-and honestly we no longer have a primary care physician at all. If we did not have the medical training ourselves, we would not know who to see for anything.

[DrDemento]

Re: The Sad Case of the Patient Protection and Affordable Care Act

This isn't news. It isn't even old news. Specialists get paid sig more and have way less responsibility in the current system. The primary care people are getting more and more responsibility and no renumeration to go with it. Mass had an immediate shortage that persists in primary care. If a practice is any good it rarely is open to new patients in our area.

Until they start paying the primary practice for all the things they think we should do this will persist. Why does an ENT's med asst get paid 250 to irrigate and ear and we get 80$? Our reimbursement for care is not as high as the specialist. Top that with all the punishments the insurance companies heap on us if the patient is non-compliant and we practically pay to take care of the pt. See various rants in this and previous threads

Was not going to join the chat but Les always makes me do some thinking. Why do we have this wide differencial in remuneration for physicians? Who made up the numbers and who decided what each tiny little thing we did got paid for and how much? Who assigned codes for everything and who decided what the remuneration was for each carefully coded item? Did practicing physicians cause this situation or even play a big part in it? Anyone with medical practice experience will tell you how ridiculous this entire system of coding and reimbursement is. Even trying to figure out how to do this properly and adhere to the coding guidelines often causes an office to hire someone just for that purpose. And then once you have it down pat, stupid as it may be, they change it and you have to learn all new codes and their uses.

From personal experience-whoever devised this wonderful system decided that i should be reimbursed more for taking off a benign tiny growth on the face than I received for doing a much more complicated excision of a cancer on the chest(which also necessitated far more time and expertise and careful follow up visits).

Doctors are not stupid people (except when it comes to investing and perhaps politics) So they quickly figured that you could spend a morning as a gastroenterologist doing a series of expensively reimbursed procedures (endoscopies, colonoscopies, etc) at their local outpatient surgical facility and collect a tidy sum of money versus spending all day in the office with patients taking medical histories, doing physical exams, and prescribing and counseling and collect 1/10th or less in revenue. Now, what would you choose? 3 hours performing 6 of these 20-30 minute procedures at a couple thousand each or spending all day seeing 40 patients in the office at perhaps $50 a piece? I used gastroenterology as an example but the same thing virtually happens with almost any specialty. The things that the coding system rewards are the things that the doctors are going to try to do more often-sometimes even when they are not needed.

Primary care physicians usually do not have that luxury-most of what they do is see a patient, take a history, perform a physical examination, and then either counsel or prescribe. But all of that takes considerable time and because the coding only allows the entire time as an office visit (between level 1 and 5 in value depending on all sorts of factors that make very little sense-since often they do not reflect the seriousness of the problem). Who, beside the truly devoted, would ever make the choice to enter the field of primary practice medicine when they had the choice to work less hours, see less people, perform more procedures and receive an incredibly larger amount of money for doing it?

I do not dare suggest that I have the solution to this problem. But certainly having these decisions about reimbursement left to people who have no clue about the practice of medicine. Or to people who have a financial interest in these decisions (insurance companies, the government, etc) just has not worked. Way back in the old days-before all of this coding and reimbursement being based on criteria that make little sense-specialists still made a better living than primary care physicians. That was probably the case ever since the age of specialization began. But the differential was not nearly as great. When I graduated medical school-40+ years ago-about 1/2 our graduating class intended to be primary physicians. If i was able to go back further perhaps that figure would have even been higher. Today, the number who even consider it has dwindled to a minute percentage.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

This isn't news. .... Mass had an immediate shortage that persists in primary care. If a practice is any good it rarely is open to new patients in our area.

YES! Exactly. Many physicians are retiring now rather than deal with the incremental extra reporting requirements under PPACA, while you simultaneously add lots of new patients to the system. Result: longer wait times.

It's only news to Rover apparently and he is so good at denial I imagine he is singing at the top of his lungs right now with his fingers stuck firmly in his ears.

[joecct]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Status of exchanges in the states: http://healthreform.kff.org/state-ex...iles-page.aspx
HHS Draft regs: http://cciio.cms.gov/resources/files...nt05162012.pdf