Posts Tagged ‘reimbursements’

Death To America, ObamaCare-Style: ObamaCare Already A Nightmare For Doctors, Soon To Be A Nightmare For Poor, Sick Patients

April 4, 2015

Remember how Barack Hussein Obama said over and over and over again that if you like your doctor, his ObamaCare would allow you to keep your doctor, and if you like your health plan, his ObamaCare would allow you to keep your health plan?

He lied.  And in the minimum of 37 times he lied on that issue alone, Barack Obama became the most documented liar in all of human history as he looked more than 300 million Americans in the eye and lied like the hell that he is again and again and again.  It was “the lie of the year,” and you’ve got to be a world-class demon-possessed liar to emerge out of all the lies that we are told in this country today.

But that was hardly this demon-possessed liar’s only lie about ObamaCare.  Obama promised his ObamaCare would help doctors, that it would help poor, sick patients, that it would bend the cost curve for healthcare down.

All lies.

Here’s an article from Saturday’s USA Today that exposes these lies (it appeared in my print edition under the title, “Maddened by metrics”):

Quality payment incentives: What’s the point?
Jordan Rau, Kaiser Health News 6 a.m. EDT April 4, 2015

Dr. Michael Kitchell initially welcomed the federal government’s new quality incentives for doctors. His medical group in Iowa has always scored better than most in the quality reports that Medicare has provided doctors in recent years, he said.

But when the government launched a new payment system that will soon apply to all physicians who accept Medicare, Kitchell’s McFarland Clinic in Ames didn’t win a bonus. In fact, there are few winners: Out of 1,010 large physician groups that the government evaluated, just 14 are getting payment increases this year, according to Medicare. Losers also are scarce. Only 11 groups will be getting reductions for low quality or high spending.

“We performed well, but not enough for the bonus,” said Kitchell, a neurologist. “My sense of disappointment here is really significant. Why even bother?”

Within three years, the Obama administration wants quality of care to be considered in allocating $9 of every $10 Medicare pays directly to providers to treat the elderly and disabled. One part of that effort is well underway: revising hospital payments based on excess readmissions, patient satisfaction and other quality measures. Expanding this approach to physicians is touchier, as many are suspicious of the government judging them and reluctant to share performance metrics that Medicare requests.

“Without having any indication that this is improving patient care, they just keep piling on additional requirements,” said Mark Donnell, an anesthesiologist in Silver City, N.M. Donnell said he only reports a third of the quality measures he is expected to. “So much of what’s done in medicine is only done to meet the requirements,” he said.

The new financial incentive for doctors, called a physician value-based payment modifier, allows the federal government to boost or lower the amount it reimburses doctors based on how they score on quality measures and how much their patients cost Medicare. How doctors rate this year will determine payments for more than 900,000 physicians by 2017.

Medicare is easing doctors into the program, applying it this year only to medical groups with at least 100 health professionals, including doctors, nurses, speech-language pathologists and occupational therapists. Next year, the program expands Medicare to groups of 10 or more health professionals. In 2017, all remaining doctors who take Medicare — along with about 360,000 other health professionals — will be included. By early in the next decade, 9% of the payments Medicare makes to doctors and other professionals would be at risk under a bill that the House of Representatives passed in March.

The quality metrics used to judge doctors vary by specialty. One test looks at how consistently doctors keep an accurate list of all the drugs patients were taking. Others track the rate of complications after cataract surgery, say, or whether patients received recommended treatments for particular cancers.

There are more than 250 quality measures. Groups and doctors must report a selection — generally nine, which they choose — or else be automatically penalized. This year, 319 large medical groups are having their reimbursements reduced by 1% because they did not meet Medicare’s reporting standards.

Physicians who do report their quality data fear the measures are sometimes misguided, usually a hassle, and may encourage doctors to avoid poorer and sicker patients, who tend to have more trouble controlling asthma or staying on antidepressants, for instance.

Leanne Chrisman-Khawam, a primary care doctor in Cleveland, said many of her patients have difficulty just getting to follow-up appointments, since they must take two or three buses. She said those battling obesity or diabetes are less likely to reform their diets to emphasize fresh foods, which are expensive and less available in poor neighborhoods. “You’re going to link that physician’s payment to that life?” she asked.

Hamilton Lempert, an emergency room doctor in Cincinnati, criticized one measure that requires him to track how often he follows up with patients with high blood pressure.

“Most everyone’s blood pressure is elevated in the emergency department because they’re anxious,” Lempert said. Another metric encourages testing the heart’s electrical impulses in patients with non-traumatic chest pain, which Lempert said has led emergency rooms to give priority to these cases over more serious ones.

“It’s just very frustrating, the things we have to do to jump through the hoops,” he said.

In the first year doctors are affected by the program, they can choose to forgo bonuses or penalties based on their performances. After that, the program is mandatory. This year, 564 groups opted out, but even if all of them had been included, only 3% would have gotten increases and 38% would have seen lower payments, mostly for not satisfactorily reporting quality measures, Medicare data show.

Smaller groups and solo practitioners are even less likely to report quality to the government. “The participation rates, even though it’s mandated, are just really low,” said Dr. Alyna Chien, an assistant professor at Harvard Medical School. It’s “a level of analytics that just is not typically built into a doctor’s office.”

Dr. Lisa Bielamowicz, chief medical officer of The Advisory Board, a consulting group, predicted more doctors will start reporting their quality scores when the prospect of fines is greater. “They are not going to motivate until it is absolutely necessary,” she said. “If you look at these small practices, a lot of them just run on a shoestring.”

This year’s assessments of big groups were based on patients seen in 2013. A total of $11 million of the $1.2 billion Medicare pays doctors is being given out as bonuses, which translates to a 5% payment increase for those 14 groups getting payment increases this year. That money came from low performers and those that did not report quality measures to Medicare’s satisfaction; they are losing up to 1%.

The exact amount any of these groups lose will depend on the number and nature of the services they provide over the year. This year, 268 medical groups were exempted because at least one of their doctors was participating in one of the government’s experiments in providing care differently.

Officials at the Centers for Medicare & Medicaid Services declined to be interviewed about the program, but said in a prepared statement that they have been providing all doctors with reports showing their quality and costs. “We hope that this information will provide meaningful and actionable information to physicians so that they may improve the coordination and integration of the health care provided to beneficiaries,” the statement said.

Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.

How the hell do you think fining doctors – who are already operating on a shoestring – for not doing something that massively increases their costs because making those reports is very obviously not something they are equipped to do, is going to lower the cost of healthcare?  Are you really that stupid that you believe it will???

Doctors are frustrated and getting more and more frustrated.  We’ve already seen them retiring at the highest rate since Hippocrates was working on his oath millennia ago.  It’s been going on since the damn evil law passed and it’s going to pick up speed.  We’re seeing fewer and fewer doctors left to service larger and larger networks of patients.  Now they are increasingly dropping out of ObamaCare and its reporting requirements as fast as they can.  How in the hell is that supposed to improve patient care?  Are you really that stupid that you believe it will???

You’ve got to love this prophetic title from CBS News that heralds future doom:

Obamacare 2015: Higher costs, higher penalties

With the Affordable Care Act to start enrollment for its second year on Nov. 15, some unpleasant surprises may be in store for some.

That’s because a number of low-priced Obamacare plans will raise their rates in 2015, making those options less affordable. On top of that, penalties for failing to secure a health-insurance plan will rise steeply next year, which could take a big bite out of some families’ pocketbooks.

“The penalty is meant to incentivize people to get coverage,” said senior analyst Laura Adams of InsuranceQuotes.com. “This year, I think a lot of people are going to be in for a shock.”

Oops.  Sorry, poor people.  It sort of looks like Obama and his demonic minions didn’t actually give a DAMN about you, after all.

But the real lie – the lie that makes “Democrat” truly stand for “DEMOn-possessed bureauCRAT” – is the one about helping the poor and the sick get better access to medical care.  Let me replay the lines from the article:

Physicians who do report their quality data fear the measures are sometimes misguided, usually a hassle, and may encourage doctors to avoid poorer and sicker patients, who tend to have more trouble controlling asthma or staying on antidepressants, for instance.

Leanne Chrisman-Khawam, a primary care doctor in Cleveland, said many of her patients have difficulty just getting to follow-up appointments, since they must take two or three buses. She said those battling obesity or diabetes are less likely to reform their diets to emphasize fresh foods, which are expensive and less available in poor neighborhoods. “You’re going to link that physician’s payment to that life?” she asked.

Barack Obama – in his wickedness – has designed a system that pits doctors against the poorest, sickest patients.  The doctor can treat them, sure, but only if he or she is willing to pay severely for it and be punished for it by an evil system that promised to do the very opposite of what it is in fact doing.

Barack Obama looks down on that doctor from his satanic Mt. Olympus and he sees a doctor whose stats aren’t up to muster because that doctor is treating sick patients who will tend to get sicker even with the very best of care.  And Obama decrees, “That doctor must be punished!”  And the fines and the penalties start kicking in.  Better to just leave that poor, sick patient on the side of the road, modern-day Good Samaritan physician.  Because Obama will come after you with all the power of totalitarian government arbitrariness if you try to help that patient.

Here’s another demonic DEMOnic bureauCRAT lie for you: Obama promised fewer people would use emergency rooms; when the very OPPOSITE is happening BECAUSE OF HIS DEMONIC LAW as USA TODAY documents:

More patients flocking to ERs under Obamacare

LOUISVILLE, Ky. — It wasn’t supposed to work this way, but since the Affordable Care Act took effect in January, Norton Hospital has seen its packed emergency room become even more crowded, with about 100 more patients a month.

That 12 percent spike in the number of patients — many of whom aren’t actually facing true emergencies — is spurring the Louisville hospital to convert a waiting room into more exam rooms.

“We’re seeing patients who probably should be seen at our (immediate-care centers),” said Lewis Perkins, the hospital’s vice president of patient care and chief nursing officer. “And we’re seeing this across the system.”

That’s just the opposite of what many people expected under Obamacare, particularly because one of the goals of health reform was to reduce pressure on emergency rooms by expanding Medicaid and giving poor people better access to primary care.

Instead, many hospitals in Kentucky and across the nation are seeing a surge of those newly insured Medicaid patients walking into emergency rooms.

Nationally, nearly half of ER doctors responding to a recent poll by the American College of Emergency Physicians said they’ve seen more visits since Jan. 1, and nearly nine in 10 expect those visits to rise in the next three years. Mike Rust, president of the Kentucky Hospital Association, said members statewide describe the same trend.

Experts cite many reasons: A long-standing shortage of primary-care doctors leaves too few to handle all the newly insured patients. Some doctors won’t accept Medicaid. And poor people often can’t take time from work when most primary care offices are open, while ERs operate round-the-clock and by law must at least stabilize patients. […]

The same “experts” who didn’t see what we conservatives were predicting EVER SINCE THIS DEMONIC LAW THREATENED AMERICA TO BEGIN WITH are refusing the see the REAL cause: the law was based entirely on lies because the Democrats who shoved this evil monstrosity down our collectivist throats are demon-possessed liars.

Not one month ago, I wrote up my own experience with the Veterans Administration as to how this very arbitrary bureaucratic mindset is just taking over the entire system.  Within the span of one week, I suffered that arbitrariness of penalizing decent people because of the behavior of others TWICE.  First, I was contacted and ORDERED to take a urine test.  Why?  I wanted to know; I’d just taken one and that test had nothing to do with my healthcare.  Rather, it had been a drug test because I’m on oxycodone for the pain created by my service-connected medical condition.

Well, less than three months after the last test – which proved I was completely clean of anything but what I was supposed to be taking – I was being commanded to take it again.  And apparently under Obama I will have to be treated like a drug criminal at least four times a year from now on.

Why?  Because other veterans somewhere else are abusing their prescription drugs.  So the obvious thing to do – as obvious as it is to treat a 103-year-old Catholic nun in a walker like a young Middle Eastern terrorist male – is to treat EVERYONE like a criminal or an addict.

I have been receiving physical therapy for a major shoulder surgery.  I was given a month-and-a-half worth of appointments and I kept every single one of them.  In fact, I have NEVER missed an appointment with the VA.  But because somebody somewhere had missed appointments, the “system” decided to treat EVERYONE like a no-shower.

So I know firsthand exactly what these doctors are saying: it doesn’t matter if I do right or not; the system will punish me anyway.  And it will do so by protecting the very worst people (who of course vote Democrat, don’t they?) by redistributing the pain for the cost of their godawful behavior onto everyone else.  That’s what the welfare system is based on, baby: “Oh, you don’t have a job because you refuse to get off your fat, pimply ass and look for one and it’s easier to pump out ten kids and collect increased payments for each one?  Don’t worry, dearie, here’s the money somebody else earned by working his butt off.  Please don’t forget to vote for Messiah Obama unless you want mean Republicans to force you to produce something with your life besides flatulence!”

I’ve talked to several veterans who are as livid as I am.  And they are saying they’re just going to start buying the marijuana that the same damn DEMOnic bureauCRATS who are forcing them to take the piss tests for drugs are opening up for everybody else so they can be happier welfare recipients.  And why bother busting your ass to show up for appointments when you’re going to be treated like dirt whether you show up or not???

And so they are producing the very opposite thing to what they are stupidly claiming they are producing.

What Obama is producing is the same thing the ayatollahs Obama is appeasing and negotiating with are calling for: “Death to America!”

The fact of the matter is that ObamaCare was sold and marketed entirely on the basis of lies.  That is just a documented fact.

But the even sadder fact of the matter is that unless the Supreme Court finally steps in and does the right thing and overturns this fascist takeover of the American healthcare system, ObamaCare will destroy America because nothing will be able to prevent it from doing so.  It was crafted as a metastasizing cancer that will keep becoming larger and making the patient America sicker until that patient collapses and dies.

 

Advertisements

Democrats’ Bizarro World: Doctor Reimbursements NOT Part Of Health Care, But Takeover Of Student Loans IS

March 13, 2010

Isn’t it amazing that, as far as Democrats are concerned in their way-too-finite wisdom, doctor’s Medicare reimbursements have absolutely nothing to do with health care, but a government student loan takeover suddenly has everything to do with health care?

The $300 billion “doctor fix” has nothing to do with health care because it would explode the totally bogus myth that the Democrats’ health plan is somehow “deficit neutral.”  But now the Democrats are throwing in their student loan takeover to try to sweeten the pot for hesitant Democrats in the House.

Mitch McConnell put what is going on into proper perspective:

“It’s a very bad idea.  We now have the government running banks, insurance companies, car companies, and now [the Democrats] want to take over the student loan business.  I’m not sure the public thinks the current debate is about that issue, and it would show again the lengths they are willing to go to have the government expand its tentacles into absolutely everything.”

So why don’t we go ahead and rename the Democrats “health care” boondoggle for what it really is: the Government Tentacle Expansion Act.

Bill Kristol had this to say when asked about this latest new wrinkle in ObamaCare:

BRETT BAIER: Bill, now Speaker Pelosi has talked about putting in student loans, a change to the student loan program in the vote for health care reform.

What about that? This is the student loan legislation that would end private lender’s involvement in the original student loans and the Department of Education would essentially take over?

BILL KRISTOL: Yes, the government would be the direct loaner to the students. Well that passed the House by a larger margin last year. So they are adding something that they think is more attractive to try to bring home few extra members to the bill.

It shows how unpopular this bill is. It is jaw dropping to step back from the day-to-day thing. A year into president’s top agenda health care is the Democrats favorite issue. They have had 30 point margins on it in polls over the Republicans for the last 15 years basically.

And as this debate has gone along this bill has become so unpopular and toxic that they now can’t pass it through a normal conference committee. They can’t have a normal situation where each house passes its own bill and get together and have a compromise. They have to pass the Senate bill or nothing because they’re terrified to go to conference.

They are now terrified to let the members go home for Easter recess before a vote, so they are going to — the president is delaying his trip so they can jam the vote in at the end of next week, they hope by one or two vote margin. It’s really stunning.

Bottom line: the people – who are now opposed to ObamaCare by a 3-1 margin – don’t want the government to take over our health care system.  And the Democrat leadership is literally afraid to let the Congress go home for Easter recess and hear what their constituents have to say before a vote, lest they respect the will of the people and vote against this monstrosity.  And so, as Obama postpones his foreign trip, the leadership is trying to overcome opposition to ObamaCare by offering as an inducement yet ANOTHER Democrat big government takeover, this time of the student loan system.

President Obama’s approval has sank to an all time low of 46% in the Gallup poll as he has determined to impose his health care boondoggle on the American people who do not want itThe Hill points out that this “demonstrates that the healthcare debate has taken a toll on Obama’s approval numbers.”

A new poll released by the Associated Press finds that the American people overwhelmingly want the Republicans involved with any health care overhaul, rather than having an ideological Democrat boondoggle rammed down their throats:

More than four in five Americans say it’s important that any health care plan have support from both parties. And 68 percent say the president and congressional Democrats should keep trying to cut a deal with Republicans rather than pass a bill with no GOP support.

And only 27 percent of voters want to see ObamaCare rammed down the nation’s collective throat.

And as for what the Democrats are trying to impose:

Fifty-seven percent (57%) of voters say the health care reform plan now working its way through Congress will hurt the U.S. economy.

A new Rasmussen Reports national telephone survey finds that just 25% think the plan will help the economy. But only seven percent (7%) say it will have no impact. Twelve percent (12%) aren’t sure.

Two-out-of-three voters (66%) also believe the health care plan proposed by President Obama and congressional Democrats is likely to increase the federal deficit. That’s up six points from late November and comparable to findings just after the contentious August congressional recess. Ten percent (10%) say the plan is more likely to reduce the deficit and 14% say it will have no impact on the deficit.

Underlying this concern is a lack of trust in the government numbers. Eighty-one percent (81%) believe it is at least somewhat likely that the health care reform plan will cost more than official estimates. That number includes 66% who say it is very likely that the official projections understate the true cost of the plan.

Just 10% have confidence in the official estimates and say the actual costs are unlikely to be higher.

Seventy-eight percent (78%) also believe it is at least somewhat likely that taxes will have to be raised on the middle class to cover the cost of health care reform. This includes 65% who say middle-class tax hikes are very likely, a six-point increase from late November.

And yes, ObamaCare will raise taxes.  In fact, for every one family who gets a subsidy to pay for the Democrats’ health care plan – which will cost $2.5 trillion – three middle class families will be taxed more to provide that subsidy.

Meanwhile, Barry Hussein has just broken his own record for the worst deficit in human history.

A few quotations from Ronald Reagan are in order here:

  • “Government is not a solution to our problem, government is the problem.”
  • “The federal government has taken too much tax money from the people, too much authority from the states, and too much liberty with the Constitution.”
  • “Nations crumble from within when the citizenry asks of government those things which the citizenry might better provide for itself.”
  • “As government expands, liberty contracts.”
  • “Government is like a baby. An alimentary canal with a big appetite at one end and no sense of responsibility at the other.”
  • “No government ever voluntarily reduces itself in size.”
  • “Are you entitled to the fruits of your labor or does government have some presumptive right to spend and spend and spend?”
  • “Government’s view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it.”

The American people have overwhelmingly shouted – and there have been three big statewide elections in states that voted big for Obama to prove that the polls are correct – that they don’t want a government takeover.  And how do Democrats respond?  By offering another government takeover (of the student loan system) as an inducement for Democrats to vote for the government takeover of health care.

Mayo Clinic Realizes ObamaCare A Total Disaster, Stops Accepting Medicare

January 1, 2010

What we have here is a very cute and clever title for a very disastrous development.

Mayo Says: Hold The Medicare
By Ed Carson
Thu., Dec. 31, ’09

The Mayo Clinic will stop accepting Medicare patients at one of its primary care clinics in Arizona. Why? The government doesn’t pay enough:

More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won’t affect other Mayo facilities in Arizona, Florida and Minnesota.

Obama in June cited the nonprofit Rochester, Minnesota-based Mayo Clinic and the Cleveland Clinic in Ohio for offering “the highest quality care at costs well below the national norm.” Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians.

This is nothing compared to what might happen under Democratic health overhaul plans, which would slash Medicare spending by nearly $500 billion over 10 years. As Medicare actuaries recently pointed out in understated fashion, such cuts “may be unrealistic.” But, if Congress actually carried them out, about one in five hospitals, nursing homes and home care agencies could lose money, they warned in their report.

As a result, such providers could drop Medicare, leaving seniors with less access.

This is now only going on at one Mayo clinic – but it is going to spread.

Don’t think for a second that this isn’t directly related to the disaster known as ObamaCare.  Democrats are gutting Medicare reimbursements and blocking the essential “doctor fix” from their bill to create the contrived and bogus illusion that their boondoggle will provide “deficit neutrality.”  They are playing all kinds of games and gimmicks, such as taxing for ten years and only providing benefits for five, to support that illusion.

It will fail, and a lot of people will die.

Alan B. Miller, an expert in the field of health care, wrote:

Medicare reimbursements to hospitals fail to cover the actual cost of providing services. The Medicare Payment Advisory Commission (MedPAC), an independent congressional advisory agency, says hospitals received only 94.1 cents for every dollar they spent treating Medicare patients in 2007. MedPAC projects that number to decline to 93.1 cents per dollar spent in 2009, for an operating shortfall of 7%. Medicare works because hospitals subsidize the care they provide with revenue received from patients who have commercial insurance. Without that revenue, hospitals could not afford to care for those covered by Medicare. In effect, everyone with insurance is subsidizing the Medicare shortfall, which is growing larger every year.

As much as Obama and the Democrats have demonized private insurance (before co-opting them in the current version of ObamaCare – what is it, ObamaCare version 6.0 by now?), the higher prices paid by private insurance have been all that has allowed doctors and hospitals to continue to accept Medicare and Medicaid at a loss.

And so, what do you think will happen when Democrats cut the reimbursement rates?  People who have commons sense know: hospitals and doctors will begin to see fewer and fewer Medicare patients, as a matter of simple economic necessity.

That isn’t a “reform,” but a disaster.

And this stuff is why the dean of the Harvard Medical School gave ObamaCare a failing grade.  It’s why the California Medical Association recently came out strongly against the bill.  It’s why more and more state governors – Democrats as well as Republicans – are beginning to scream that ObamaCare merely turns Medicaid into a giant deficit-creating unfunded mandate on the states (again, to create the illusion of being “deficit neutral”).

Enough with illusions.  This bill is absolutely terrible.  It’s more than 2,000 pages long, nobody understands it, and it has changed again and again, yet actually seems to be getting worse and worse.