Tag: "doctors"

More Reasons Why Doctors Do Not Participate in Medicaid

doctor-xray-2This blog has many entries discussing how few doctors participate in Medicaid, the joint state-federal healthcare program for low-income people that ObamaCare expands. One reason is that fees are too low to induce doctors to participate. But even if doctors are willing to accept low fees, they find that Medicaid is the worst payer in their practices:

  • Medicaid programs have the highest number of days to collect payment (days accounts receivable): All payer average = 26 days; Medicaid average = 44 days.
  • Medicaid programs have the highest denial rate: All Payer average = 6.8%; Medicaid average = 18.5%.
  • Medicaid programs have the lowest transparency in electronic explanation of payment and adjudication of claims (electronic remittance advice): All Payer average = 95%, Medicaid average = 89.4%.

Primary-Care Physicians Earn Only 20 Percent of What They Charge

If $180,000.00 is 20% of the total reimbursement, then a PCP brings in $900,000.00 a year. Therein lays the misconception that doctors are overpaid, but remember: the doctor does not pocket that total. At a patient load of 7,200 patients that is $125.00 for a 15 minute appointment. This is great pay. But remember also that 80% of that total goes to pay the staff salaries and benefits, rent, utilities, as well as such government mandated programs like Electronic Medical Records and all other costs needed to keep a business running. (The InsureBlog)

Government Handouts for Electronic Health Records: Standards Lowered to Ensure Money Keeps Flowing

We recently noted that, halfway through the year, only four hospitals and 50 physicians have achieved the federal government’s goals for “meaningful use” of electronic health records (EHRS). The federal government has a goal of spending $30 billion to induce hospitals and physicians to adopt EHRs, and it still has about $8 billion to spend. In order to ensure the money keeps flowing, standards have been lowered:

The new rule, released May 20 and slated to be published in the Federal Register May 23, would enable providers to use the 2011 edition of certified electronic health record technology for Stage 1 or Stage 2 in 2014. They would have the option to attest to the 2013 definition of Meaningful Use core and menu items and use the 2013 definition of clinical quality measures. (FierceHealth EMR)

So, hospitals and physician practices which received handouts in previous years are pretty much guaranteed to receive a handout this year, just by resubmitting the old paperwork.

Headlines I Wish I Hadn’t Seen

risingObamaCare is driving up Medicaid costs — even in states that rejected Medicaid expansion.

Buyer’s remorse: ObamaCare patients learn their doctors are not in network — even though insurers told them they were.

ObamaCare contractors paid to do nothing: “Their goals are set to process two applications per month and some people are not even able to do that.”

Study: Being ignored on Facebook leads to low self-esteem.

Goldman Sachs: ObamaCare is good for economy.

Provider Networks Shrinking in All Markets

No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want. These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans.

doctor-mom-and-sonSmaller networks are also becoming more common in health care coverage offered by employers and in private Medicare Advantage plans. Insurers, ranging from national behemoths like WellPoint, UnitedHealth and Aetna to much smaller local carriers, are fully embracing the idea, saying narrower networks are essential to controlling costs and managing care. Major players contend they can avoid the uproar that crippled a similar push in the 1990s.

“We have to break people away from the choice habit that everyone has,” said Marcus Merz, the chief executive of PreferredOne, an insurer in Golden Valley, Minn., that is owned by two health systems and a physician group. “We’re all trying to break away from this fixation on open access and broad networks.”

(Reed Abelson, New York Times)

Headlines I Wish I Hadn’t Seen

Almost halfway through the year, only four hospitals and 50 physicians have achieved federal goals for electronic health records for 2014.

ObamaCare’s individual mandate penalty also delayed for policies bought off-exchange.

Second U.S. MERS case reported.

Are Doctors Really Better Than Nurses?

Confident DoctorsSimply put: the preponderance of empirical evidence indicates that, compared to physicians, NPs provide as good — if not better — quality of care. As I’ve written previously, patients are often more satisfied with NP care — and sometimes even prefer it.

The Institute of Medicine is unambiguously clear about this:

No studies suggest that APRNs [Advanced Practice Registered Nurse] are less able than physicians to deliver care that is safe, effective, and efficient or that care is better in states with more restrictive scope of practice regulations for APRNs.

More.

Headlines I Wish I Hadn’t Seen

iStock_000008945197XSmallSome hospices decline to treat the dying.

Paper: 90,000 Nevada residents could lose health insurance due to ObamaCare

Polio is spreading again.

72 percent of physicians say their peers order at least one unnecessary test per week.

U.S. is one of only eight countries where maternal deaths in childbirth rose, 2003-2013.

Massachusetts is ditching its ObamaCare exchange, replacement to cost $100 million.

The Medicare “Doc Fix” Might Not Be Such a Bad Solution After All

This is Austin Frakt:

yuHowever, from another point of view, the formula — as flawed as it is — has helped keep Medicare spending lower than it might otherwise have been. Instead of cutting physician payments by the large amount the S.G.R. demands, Congress has increased payment rates, but typically by only tiny amounts — at an annual rate of just 0.7 percent.

But, although fees have only increased 8 percent since 2000, Medicare’s spending on physicians has increased 69 percent per patient. This is because the number and intensity of treatments has increased significantly. Could doctors have responded to lower real fees by cranking up volume?

Should Doctors Decide if Your Health Care is “Worth It”?

StethoscopeThis is Aaron Carroll:

I’m truly conflicted here. Like any good “economist”, I’m worried about future health care spending. I know that fee-for-service just sucks, and that the financial incentives for practice are totally misaligned. But I remain totally skeptical about pay for performance (see this, this, this, this, this, this, and this). I don’t see much evidence that programs like that work, and I don’t believe that the things we can measure are necessarily the same as how we’d ideally define quality.

I’m also concerned with making doctors the ones responsible for deciding what’s “worth it.”