Democrats and the Doc Fix
[Guest post by DRJ]
The Instapundit points out an Investors’ Business Daily post entitled “Club Med: Are Dems Using Medicare Payments To Silence Doctors?” The post speculates the Democrats have continued the “doc fix” to delay a 21% cut in doctors’ reimbursement rates and keep the AMA on board until the vote on Obama’s health care reform.
Do most AMA-affiliated doctors know their reimbursement rates are scheduled for cuts? I assume they do, although most of the ones I know work in institutions and spend the bulk of their time on other issues. They have staff to handle reimbursements and billing matters, and sometimes they don’t focus on money until their revenues decline.
These doctors are paid to worry about the problem in front of them, diagnose the likely cause, and prescribe the treatment most likely to solve the problem. In my experience, that means they are less likely to worry about tomorrow’s problems today. If so, the Democrats may be using that to their advantage.
— DRJ
I 100% guarantee you that doctors know exactly how the absence of a Doc Fix will impact their revenue.
And, the first thing that will happen is that doctors will quit taking new Medicare patients. That is going to create an access-to-care problem for seniors that will be trumped-up by Dems just like they are the insurance issues now.
This will lead to greater regulation of doctors’ practices.
shipwreckedcrew (c0d6cd) — 3/11/2010 @ 12:37 am“I 100% guarantee you that doctors know exactly how the absence of a Doc Fix will impact their revenue.”
This came up when Bunning was throwing his tantrum. The AMA was making noise about it.
imdw (3bf1a8) — 3/11/2010 @ 6:23 amBunning’s “tantrum” was about that silly topic of paying for spending. He appears to have been the only one with guts enough to stand up while others knew exactly what it was about. A few more “tantrums” and the country might survive.
The AMA represents the opinions of its board of trustees. They are trying to appear relevant while they have only 18% of doctors as members anymore.
Doctors are steadily dropping Medicare and this will just move that trend along a bit faster.
Mike K (2cf494) — 3/11/2010 @ 7:10 am2, imd-lawbreaker, what is wrong with holding the Democrat majority to the rules of the House and the laws of the US?
Also, who says the Medicare reimbursement fix makes it into the silly putty bill that actually reaches Dumbo and his circus of Liberal freaks?
PCD (1d8b6d) — 3/11/2010 @ 7:11 amThe Obami will simply surround themselves with men and womyn in white coats. Kabuki theater.
GeneralMalaise (d63092) — 3/11/2010 @ 7:44 am“Bunning’s “tantrum” was about that silly topic of paying for spending.”
Sure but it affected payments to doctors, as he was holding up a renewal of the docfix. The AMA was alerting people about this, including doctors.
I say this as evidence that doctors are aware of the docfix issue.
imwd (005125) — 3/11/2010 @ 8:08 amDon’t forget that the made-up numbers on how much money Obamacare is supposedly going to save, all depend on the absence of the “docfix”.
So Bunning’s “tantrum” just emphasized how much brazen lying the Democrats are doing about the finances of this record-breaking boondoggle.
That’s the core principle of Obamacare – lying to the American people.
SPQR (26be8b) — 3/11/2010 @ 8:17 amYep. That’s why people who didn’t vote for Palin voted for McCain. The good-guy voters are catching up with what the rest of us already knew.
Vermont Neighbor (bc137d) — 3/11/2010 @ 8:40 amWe need a modern Diogenes to go looking for an honest Democrat. I sure can’t fine one.
ropelight (83ac46) — 3/11/2010 @ 8:44 amDems are technically honest. If they believed in their nannystate platform, they wouldn’t use so many contortions trying to hide it.
Vermont Neighbor (bc137d) — 3/11/2010 @ 8:48 amRules are what I say they are, at the moment that I speak; nothing more nor nothing less.
Imadimwit (7b127f) — 3/11/2010 @ 9:27 amI am a physician in Southern California. I am a pediatric subspecialist – Medicare is used as a proxy for my contracts but I see only kids so I do not actually take Medicare. All of my colleagues are aware of the 21% drop in reimbursement scheduled about annually. The 21% cut would obviously be a drop in reimbursement. Our costs would remain the same so each physician would see a cut quite a lot bigger than 21%.
Each physician would need to consider whether his or her time is more valuable spending it with family or seeing patients where reimbursement barely pays the bills. For me, with a young family, I would rather spend my time at home. I am a harder worker than most of my colleagues (not that they don’t work hard) but they would certainly make the same choice and presumably stop seeing Medicare. Many of them are gradually decreasing their Medicare load already.
As regards where the rubber hits the road, I am told many of them contacted their medicare patients and instructed them they are rescheduling their visits – essentially canceling them – until the issue was resolved. Fortunately the issue was resolved within a day or two. I suspect they would have decided to transfer the patients to the County hospitals rather than see them if reimbursement fails to pay their overhead.
Just one thought from one physician…
SoCal Doc (5018dd) — 3/11/2010 @ 12:51 pmI’m not sure I would characterize Sen Bunnings refusal for unanimity as a tantrum Could you please expand on your choice of the term/ And,at a dinner last night,a lot of us (docs0 were talking about what if the Blues,Aetna,etc also cut 20 %. it’s scary. But, I have the option of taking cash only patients.Ans, I’m good enough to have a full schedule in a month or two.The 20 % cut will insure the less competent docs will be seeing Medicare.
corwin (03e7fd) — 3/11/2010 @ 3:13 pmDoc,
I have been told that many insurance companies base their reimbursement schedules on Medicare schedules. Is this true? If so, what will be the likely impact of such a huge drop in Medicare reimbursement for patients with private insurance?
iconoclast (ac26cc) — 3/11/2010 @ 3:55 pmSoCal Doc,
I understand that doctors like you — and presumably others who oppose ObamaCare — have already faced these changes and decided to wean themselves from Medicare when possible. But I still believe many AMA doctors aren’t accepting the reality of what they will be paid under government health care or they think the doc fix will somehow magically continue.
I’m also interested in what you think about iconoclast’s question.
DRJ (daa62a) — 3/11/2010 @ 8:52 pmI know this much – after BarckyCare passes, or if it does, I am certain that our family’s health insurance will be waaaaaaaaaaaaay more expensive, and the speed and quality of care that my daughter has received the last few weeks will be greatly diminished.
JD (cc3aa7) — 3/11/2010 @ 8:56 pmhi. sorry 4 the late response. I’m on palm pilot so pls forgive typos…yes many (most?) contracts r based off medicare but indirectly. that is to say – docs who see medicare pts will see immediate decr in revenue 21 pct. expenses r fixed tho n so the practice profits – ie ability to hire staff, purchase equipment n our own salaries – would drop immediately much more than 21 pct. for the insurance contracts, eventually the changes will trickle down through the ppo contracts bc many r based on medicare n that may take a few months or a year. not all contracts r built that way.
I kno colleagues who canceled all medicare pts until it was clear what reimbursement would b bc with the cuts it did not make sense to see those pts. the overhead costs just as much but the time spent with patients barely would pay the overhead.
my bet is if we get nationalized healthcare, all or most physicians at or older than 60 or 65 would have their homes paid off n enuf savings to call it quits. I’m only 41 n my practice gives me a lot of stress figuring out how hard I must work just to pay the bills. if my house were paid off I’d just call it a day – the stress – not only of taking care of kids but also of paying bills wouldn’t b worth it.
Socal Doc (af7fe0) — 3/12/2010 @ 12:46 pm(part 2) I am acutely aware that I am the only one responsible for my bills – prob between 100 and 120K per month – that if nationalized healthcare did go through and reimbursement decreased I would prob have to close the practice n hopefully get a job at a public hosp. I take care of a lot of poor kids too n could consider dropping bad insurance n only seeing good insurance. some colleagues r switching to a cash-only practice n expect full payment in cash for each visit. all possible alternatives but I suspect not only me but a lot of colleagues would find quite a lot less satisfaction and would look 2c how early to retirement. I’m lucky that there aren’t many people in my subspecialty so I may have more options. but I think increasing the number of people consuming healthcare regularly (how that decreases costs I hv no idea) and at the same time anticipating a large wave of early retirement n decreasing the number of physicians cannot lead to better or even equal healthcare. I don’t c any way we don’t end up with medi-cal or medic-aid for all of us. it seems to me instead of making healthcare better, everyone will get treatment as good as the county hospital.
Socal Doc (af7fe0) — 3/12/2010 @ 12:55 pmThanks, Socal Doc. Now I’m curious what percentage of physicians are in private practice vs work for institutions. It seems to me the former would feel the immediate impact of government health care more than the latter, although ultimately I think they all would.
DRJ (daa62a) — 3/12/2010 @ 12:58 pmAn interesting interview over at PJTV
AD - RtR/OS! (597a8f) — 3/12/2010 @ 1:29 pmhttp://www.pjtv.com/v/3227;jsessionid=abcdeEsMwM1wHgccFruDs
of an Obama cousin, who is a Doc, and a critic of ObomaCare.
Boy, I don’t think he’ll be asked to the WH Christmas Dinner.
Hi again. I suspect the vast majority of physicians are in private practice in contrast to employees of universities or healthcare systems (eg Kaiser Permanente). There are just scores more community hospitals than academic facilities. Here in Los Angeles we have UCLA, USC, the county systems, Children’s Hospital, and Orthopedic Hospital. Add a Shriner’s Hospital here and a couple of VA institutions to boot. I would have to look it up but there are probably a dozen Kaiser Permanente hospitals. I may be missing a few. But there are probably at least hundreds of hospitals that are staffed by independent, private practice physicians.
The private physicians would feel the impact most immediately and change their practices to respond – either retire, close their practices and take jobs with a university or HMO like Kaiser, or see more patients with less time each and try to make up quality with volume. I suspect most physicians 60 years old and older would choose to retire. Their homes are paid off and they (or at least I do) stress about meeting payroll, rent, and other expenses every few weeks.
The large institutions have foundations that can help. Soon though as reimbursements decrease that would no longer be sufficient and they would soon find themselves in the company of the private physicians. I volunteer at one of those hospitals above to care for the indigent and they are cutting back hours and staff already because of poor reimbursement and because their endowment or foundation is insufficient for them to keep their doors open as many hours as they would like.
While there are problems in the system, I don’t see any way Obamacare or Nancycare doesn’t destroy the system.
SoCal Doc (5018dd) — 3/12/2010 @ 2:12 pm