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Peter1469
12-27-2014, 01:57 PM
Access to health care in peril in medicaid system (http://www.nytimes.com/2014/12/28/us/obamacare-medicaid-fee-increases-expiring.html?_r=0)

The government wants to cut medicaid payments, so doctors are starting to refuse medicaid patients.


Just as millions of people are gaining insurance through Medicaid (http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicaid/index.html?inline=nyt-classifier), the program is poised to make deep cuts in payments to many doctors, prompting some physicians and consumer advocates to warn that the reductions could make it more difficult for Medicaid patients to obtain care.

The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.

Matty
12-27-2014, 02:06 PM
They were warned.

ace's n 8's
12-27-2014, 02:12 PM
Access to health care in peril in medicaid system (http://www.nytimes.com/2014/12/28/us/obamacare-medicaid-fee-increases-expiring.html?_r=0)

The government wants to cut medicaid payments, so doctors are starting to refuse medicaid patients.Why are they surprised, take$700 billion out to fund another disaster and something negative is going to happen, typically bad.

Common
12-27-2014, 02:27 PM
They took 700 billion out of Medicare not Medicaid, this is about medicaid.

ace's n 8's
12-27-2014, 03:02 PM
They took 700 billion out of Medicare not Medicaid, this is about medicaid.That's right, I was wrong,,it didn't even hurt that bad either.

This should pretty much sum up ALL the issues that the States will have with ACA and Medicaid.

http://www.naco.org/newsroom/countynews/Current%20Issue/12-17-12/Pages/Affordable-Care-Act-implementation-moves-to-states.aspx

Bottom line here; Obama did this, AND how much will your taxes need to be raised to cover this Obamacare bullshit?

Newpublius
12-27-2014, 03:20 PM
Well, this is how single payer systems save money (fact medicaid isn't single payer doesn't undermine the premise). The government uses its monopsony power to compel the suppliers to accept lower rates. Voila, free lunch! Wrong.

Price controls have consequences and those consequences are really quite predictable.

Peter1469
12-27-2014, 03:20 PM
That's right, I was wrong,,it didn't even hurt that bad either.

This should pretty much sum up ALL the issues that the States will have with ACA and Medicaid.

http://www.naco.org/newsroom/countynews/Current Issue/12-17-12/Pages/Affordable-Care-Act-implementation-moves-to-states.aspx

Bottom line here; Obama did this, AND how much will your taxes need to be raised to cover this Obamacare bullshit?

They are not going to raise the money. Most states have balanced budget amendments and people are taxed too much already.

ace's n 8's
12-27-2014, 03:31 PM
They are not going to raise the money. Most states have balanced budget amendments and people are taxed too much already.
With that assumption of yours, seems there will be a coming pickle in the brew.

All States have Balanced Budget Amendments, as I recall.

Peter1469
12-27-2014, 03:38 PM
With that assumption of yours, seems there will be a coming pickle in the brew.

All States have Balanced Budget Amendments, as I recall.

That is why many states didn't start the exchanges. The feds only promised to help pay for them up front. Very few if any of the states are going to be able to afford them over time.

Shadow
12-27-2014, 03:41 PM
Access to health care in peril in medicaid system (http://www.nytimes.com/2014/12/28/us/obamacare-medicaid-fee-increases-expiring.html?_r=0)

The government wants to cut medicaid payments, so doctors are starting to refuse medicaid patients.
Yep. They had a big write up about this in a monthly news letter that went out at my place of employment before Christmas( I work for a hospital). Doctors who do deal with Medicaid currently are not taking any new patients. And others are refusing Medicaid patents all together. Not cost effective and they lose money so....Not good.

Adelaide
12-27-2014, 03:46 PM
Well, this is how single payer systems save money (fact medicaid isn't single payer doesn't undermine the premise). The government uses its monopsony power to compel the suppliers to accept lower rates. Voila, free lunch! Wrong.

Price controls have consequences and those consequences are really quite predictable.

The way it works up here, contracts are awarded based on a competitive bidding process where the contracts go to those who offer the best options for both quality of care and affordability. This doesn't apply to doctors. We have the highest paid ophthalmologists and cardiologists in North America, to use an example where my province is looking at the salary's of physicians and questioning whether they should intervene. On the flipside, general physicians educated in Canada who move to the US for better salaries is causing the government in my province to evaluate how to retain those doctors.

The cutting of costs usually applies to other areas of health care where costs can be cut safely without jeopardizing quality of care. Fiddling around with the pay for physicians and nurses isn't so much an issue. Nurses make about $80,000/year up here if they're an RN working in the hospital on a shift schedule - through collective bargaining over the years. I know of nurses who can make up to $120,000 if they work in the right area of health care and are willing to do a lot more (including additional education so they can perform more advanced nursing). They're generally paid what their worth plus a bit extra so they won't strike. It's a bit of a hostage situation, though.

But, with the province in the red it is health care and education being viewed as a quick way to cut costs. Teachers making $100,000+ for example, shouldn't be getting paid that much. Physicians making hundreds of thousands more than they should be is being looked into. Retaining our own talent by raising the salaries for family physicians helps save money and reduce wait times for hospitals and higher paid professionals since people will go to their doctor instead of the hospital.

But no one can refuse any patients. There are limited situations in the community where nurses can refuse to do things due to occupational health and ability to refuse unsafe working conditions. I can think of no other exception. Obviously GPs/family physicians only have to take as many patients as they are able to have.

ace's n 8's
12-27-2014, 03:50 PM
That is why many states didn't start the exchanges. The feds only promised to help pay for them up front. Very few if any of the states are going to be able to afford them over time.100% agreed, something that I knew prior.

It's in the link I provided earlier.

With this 'NEW' kindleing issue that is bearing it's ugly head, I suspect Congress will come to the aid os the States in some manner.

Newpublius
12-27-2014, 03:51 PM
In the US, the result will be a doctor who answers the phone and says he or she doesn't take Medicaid, in Canada, the result will be a queue, in the link below, the wait times being reported by the provincial government in Ontario. The issue is complex in implementation of course, but the bottom line is that the broad impact of price controls are still easily predicted.
http://www.health.gov.on.ca/en/public/programs/waittimes/

Howey
12-27-2014, 06:36 PM
Access to health care in peril in medicaid system (http://www.nytimes.com/2014/12/28/us/obamacare-medicaid-fee-increases-expiring.html?_r=0)

The government wants to cut medicaid payments, so doctors are starting to refuse medicaid patients.

Just like the so-called medical device "tax", this is technically a return to the previous payment schedule, which has been historically low for Medicaid.

Peter1469
12-27-2014, 06:44 PM
Just like the so-called medical device "tax", this is technically a return to the previous payment schedule, which has been historically low for Medicaid.

Getting lower. So docs are saying no.

Newpublius
12-27-2014, 06:45 PM
Getting lower. So docs are saying no.

Exactly, but "supply side" economics doesn't work!

Peter1469
12-27-2014, 06:47 PM
Exactly, but "supply side" economics doesn't work!

Some people learn the hard way. :smiley:

Howey
12-27-2014, 07:33 PM
Getting lower. So docs are saying no.

They've been turning away Medicaid patients for over 20 years. It's got nothing to do with Obamacare, it's got to do with the greed of the 1%.

Bob
12-27-2014, 07:44 PM
I should show you guys the shafting doctors and hospitals in America already get.

Maybe if it is nice out tomorrow when it is light enough, I will find some actual invoices and show you photographs. Doctors and hospitals get crapped all over. Doctors who supported Obama feel better than those that did not.

(In-Depth Video: The Exorbitant Prices of Health Care)
Dozens of midpriced items were embedded with similarly aggressive
markups, like $283.00 for a “CHEST, PA AND LAT 71020.” That’s a
simple chest X-ray, for which MD Anderson is routinely paid $20.44
when it treats a patient on Medicare, the government health care
program for the elderly.
Every time a nurse drew blood, a “ROUTINE VENIPUNCTURE”
charge of $36.00 appeared, accompanied by charges of $23 to $78 for
each of a dozen or more lab analyses performed on the blood sample.
In all, the charges for blood and other lab tests done on Recchi
amounted to more than $15,000. Had Recchi been old enough for
Medicare, MD Anderson would have been paid a few hundred dollars
for all those tests. By law, Medicare’s payments approximate a
hospital’s cost of providing a service, including overhead, equipment

http://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDemandAndGreed.pdf

Bob
12-27-2014, 08:08 PM
They've been turning away Medicaid patients for over 20 years. It's got nothing to do with Obamacare, it's got to do with the greed of the 1%.

ACA pays for zero health care.

If you like it, at least learn who it pays. And the insurance companies are getting a lot more wealth.

Mac-7
12-27-2014, 08:13 PM
What would the original hitler do?

Maybe Der fuhrer can sign an executive order that forces doctors to take Medicare patients.

Peter1469
12-27-2014, 08:14 PM
They've been turning away Medicaid patients for over 20 years. It's got nothing to do with Obamacare, it's got to do with the greed of the 1%.

That is a silly unsupportable statement. For one it has gotten worse. For another, most docs, particularly the general practitioners are not in the one percent.

Bob
12-27-2014, 08:47 PM
I am like most Americans in that the ACA was so terribly long and complex it takes a super-human to decipher it. While it pays insurance companies, I know of no doctor or hospital it pays. Medicare pays both. Paying an insurance company does not mean you will get the outcome you hope for.

Howey
12-27-2014, 08:50 PM
That is a silly unsupportable statement. For one it has gotten worse. For another, most docs, particularly the general practitioners are not in the one percent.

20 years ago I was billing Medicare and Medicaid. I know what I'm talking about.

Peter1469
12-27-2014, 08:52 PM
20 years ago I was billing Medicare and Medicaid. I know what I'm talking about.

I also understand your agenda.

Howey
12-27-2014, 09:27 PM
I also understand your agenda.

Which is?

zelmo1234
12-27-2014, 11:15 PM
Just like the so-called medical device "tax", this is technically a return to the previous payment schedule, which has been historically low for Medicaid.

You are correct the legislators in the past called it the Medicare/Medicaid fix.

Now to keep the cost of the ACA low, they have stopped fixing the payment schedule, fewer and fewer Doctors are accepting it as a form of payment.

Imagine that, even doctors are not willing to go broke for the sake of politicians

zelmo1234
12-27-2014, 11:19 PM
They've been turning away Medicaid patients for over 20 years. It's got nothing to do with Obamacare, it's got to do with the greed of the 1%.

Of the fact that they have bills to pay and a business to run, that can't run at a loss.

It would be nice if could all print money to cover the bills, but that is not how it works.

What you are failing to acknowledge is that fact that fewer and fewer Doctors and Hospitals are accepting Medicare, just as the baby boomers are getting to the age that they qualify for it

Waiting times are increasing for treatment and that is going to be unpopular with the older folks that already don't like the ACA

zelmo1234
12-27-2014, 11:21 PM
20 years ago I was billing Medicare and Medicaid. I know what I'm talking about.

So tell us how do you think that the government will solve the problem of fewer and fewer doctors accepting it as a form of payment?

zelmo1234
12-27-2014, 11:22 PM
Which is?


socialism

Redrose
12-28-2014, 12:53 AM
Access to health care in peril in medicaid system (http://www.nytimes.com/2014/12/28/us/obamacare-medicaid-fee-increases-expiring.html?_r=0)

The government wants to cut medicaid payments, so doctors are starting to refuse medicaid patients.


We tried to tell them. Many doctors are not taking on new Medicare patients too. Before long, all Medicare patients will be refused care. Only people with private policies will be able to see a doctor. Affordable Care Act. Created by snake oil salesmen.

ace's n 8's
12-28-2014, 01:06 AM
We tried to tell them. Many doctors are not taking on new Medicare patients too. Before long, all Medicare patients will be refused care. Only people with private policies will be able to see a doctor. Affordable Care Act. Created by snake oil salesmen.http://www.usatoday.com/story/news/politics/2014/12/15/tennessee-medicaid-expansion/20435105/

http://www.tennessean.com/story/news/politics/2014/12/15/haslam-expanding-medicaid-in-tennessee/20428655/ (http://www.usatoday.com/story/news/politics/2014/12/15/tennessee-medicaid-expansion/20435105/)

Mac-7
12-28-2014, 10:58 AM
20 years ago I was billing Medicare and Medicaid. I know what I'm talking about.

Doctors are greedy because they expect to be paid for the work they do?

Howey
12-28-2014, 01:02 PM
Doctors are greedy because they expect to be paid for the work they do?

Doctors (some) are greedy because they overcharge for the work they do.

Peter1469
12-28-2014, 01:21 PM
Doctors (some) are greedy because they overcharge for the work they do.

I don't know that they do. They don't set the prices when insurance is involved. And they still have to make a profit unless you want them to go out of business.

Now with hospitals you see some over charging to help make up the difference for uninsured. But that is a different issue.

Bob
12-28-2014, 01:29 PM
Doctors (some) are greedy because they overcharge for the work they do.

I believe doctors have to pay for too much overhead. They have staff that but for both insurance and the Feds and states, they would not need to have on staff.

Doctors are crapped on by the insurance industry and of course by Medicare.

While hospitals appear to have high bills, it would seem if it was really that lucrative, a lot of new hospitals would be under construction yet we see hospitals closing their doors.

Something smells.

ace's n 8's
12-28-2014, 01:31 PM
Doctors (some) are greedy because they overcharge for the work they do.

How much more Redtape has been added to the medical field due to the Federal/State Government getting involved, rather than providing some common sense solutions to lowering medical care costs, insurance premiums, malpractice suits and also healthcare availability?

I suspect the doctors staff has grown exponentially, those folks need a paycheck too, ya know.

Bob
12-28-2014, 01:34 PM
Rural hospitals forced to close.

http://www.usatoday.com/story/news/nation/2014/11/12/rural-hospital-closings-federal-reimbursement-medicaid-aca/18532471/

RICHLAND, Ga. — Stewart-Webster Hospital had only 25 beds when it still treated patients. The rural hospital served this small town of 1,400 residents and those in the surrounding farms and crossroads for more than six decades.
But since the hospital closed in the spring of last year, many of those in need have to travel up to 40 miles to other hospitals. That's roughly the same distance it takes to get from Times Square to Greenwich, Conn., or from the White House to Baltimore, or from downtown San Francisco to San Jose.
Those trips would be unthinkable for city residents, but it's becoming a common way of life for many rural residents in this state, and across the nation.
Since the beginning of 2010, 43 rural hospitals — with a total of more than 1,500 beds — have closed, according to data from the North Carolina Rural Health Research Program. The pace of closures has quickened: from 3 in 2010 to 13 in 2013, and 12 already this year. Georgia alone has lost five rural hospitals since 2012, and at least six more are teetering on the brink of collapse. Each of the state's closed hospitals served about 10,000 people — a lot for remaining area hospitals to absorb.
The Affordable Care Act was designed to improve access to health care for all Americans and will give them another chance at getting health insurance during open enrollment starting this Saturday. But critics say the ACA is also accelerating the demise of rural outposts that cater to many of society's most vulnerable. These hospitals treat some of the sickest and poorest patients — those least aware of how to stay healthy. Hospital officials contend that the law's penalties for having to re-admit patients soon after they're released are impossible to avoid and create a crushing burden.

Bob
12-28-2014, 01:37 PM
http://www.reuters.com/article/2014/09/03/us-healthcare-rural-insight-idUSKBN0GY14620140903
Small, rural hospitals like Linden have always struggled to remain viable, but things are getting worse, fast. Rural communities are shrinking at a time when healthcare providers are being pressured to cut costs and release patients sooner.
Twenty-four rural hospitals have closed across the country since the start of 2013, double the pace of the previous 20 months, according to the North Carolina Rural Health Research Program. For graphic see: reut.rs/1lGqpBb. (http://reut.rs/1lGqpBb.)
“Even with community support, investment in quality personnel and equipment, patient activity was not at a sustainable level,” Steve Altmiller, president and chief executive of Linden hospital's owner, Good Shepherd Health System, said in a statement announcing the closure. “The decision to close the Linden facility, while difficult, is one that is occurring across the country."
Now the Affordable Care Act, better known as Obamacare, is bringing additional pressure. Obamacare is designed to fold the poor and uninsured into the healthcare system, but changes in how the federal government pays for the disadvantaged are already pressuring the hospitals that cater to them, such as rural ones.

Bob
12-28-2014, 01:39 PM
http://www.bloomberg.com/news/2013-11-25/obamacare-cutbacks-shut-hospitals-where-medicaid-went-unexpanded.html

Pam Renshaw had just crashed her four-wheeler into a bonfire in rural Folkston, Georgia, and her skin was getting seared in the flames. Her boyfriend, Billy Chavis, pulled her away and struggled to dial 911 before driving her to the nearest place he could think of for medical attention: an ambulance station more than 20 miles away.
The local public hospital, 9 miles from the crash, had closed six weeks earlier because of budget shortfalls resulting from Obamacare and Georgia (http://www.bloomberg.com/quote/BEESGA:IND)’s decision not to expand Medicaid (http://www.bloomberg.com/quote/NHEXHPMC:IND). The ambulances Chavis sought were taking other patients to the next closest hospital. It took two hours before Renshaw, in pain from second- and third-degree burns on almost half her body, was flown to a hospital in Florida.
At least five public hospitals closed this year and many more are scaling back services, mostly in states where Medicaid wasn’t expanded. Patients in areas with shuttered hospitals must travel as far as 40 miles (64 kilometers) to get care, causing delays that can result in lethal consequences, said Bruce Siegel, chief executive officer of America’s Essential Hospitals, a Washington-based advocacy group for facilities that treat large numbers of uninsured or low-income patients.
“Everyone in a community will be affected

Mac-7
12-28-2014, 02:13 PM
Doctors (some) are greedy because they overcharge for the work they do.

"Some" applies to any profession.

Including government workers or lazy bums on Medicaid.

But government is underpaying most of the doctors and they are voting on Obamacare with their feet.

Bob
12-28-2014, 02:18 PM
"Some" applies to any profession.

Including government workers or lazy bums on Medicaid.

But government is underpaying most of the doctors and they are voting on Obamacare with their feet.

My personal doctor gave me the impression he has more new patients. But in my area, that is no surprise. HE feels the ACA was introduced with enormous blunders.

Doctors bills get steeply discounted by the Government. Often a procedure they do is refused payment by the Feds.

ace's n 8's
12-28-2014, 02:22 PM
My personal doctor gave me the impression he has more new patients. But in my area, that is no surprise. HE feels the ACA was introduced with enormous blunders.

Doctors bills get steeply discounted by the Government. Often a procedure they do is refused payment by the Feds.Some of that 'redistribution of wealth' at it's finest.

Mac-7
12-28-2014, 02:47 PM
Doctors bills get steeply discounted by the Government. Often a procedure they do is refused payment by the Feds.

My doctors have a promise to pay sheet where I agree to pay what my insurance does not cover.

But I'm not on Medicaid.

doctors know that Medicaid patients cannot and will not pay.

lynn
12-28-2014, 02:52 PM
That is why many states didn't start the exchanges. The feds only promised to help pay for them up front. Very few if any of the states are going to be able to afford them over time.

How expensive is it to maintain a already establish websites such as the exchanges?

lynn
12-28-2014, 02:59 PM
Most if not all states are contracted with private health insurance to take care of their Medicaid population. Each state pays on average 3,000 per individual per year to private insurance companies. The health insurance contracts with doctors in a capitation arrangement contract. Each capitated physician is assigned a list of Medicaid patients where they are paid a agreed amount per patient each month.

They cannot refuse these patients so where are they getting this information from that they are denying new patients?

Peter1469
12-28-2014, 04:31 PM
Lots of doctors are refusing new Medicaid patients. (https://startpage.com/do/metasearch.pl)

My brother was refused treatment at many hospitals and he is basically paralyzed and has to be taught to use his muscles again. Two places took him for a couple of weeks each, then a third took him but they don't do anything since they are not getting paid.

Another problem is with the doctor pool in general for the plans. Many people don't have doctors near them in their plans.


Most if not all states are contracted with private health insurance to take care of their Medicaid population. Each state pays on average 3,000 per individual per year to private insurance companies. The health insurance contracts with doctors in a capitation arrangement contract. Each capitated physician is assigned a list of Medicaid patients where they are paid a agreed amount per patient each month.

They cannot refuse these patients so where are they getting this information from that they are denying new patients?

webrockk
12-28-2014, 06:52 PM
Gruber's stupids lined up to vote for this law...let Gruber's stupids line up for health care.

or, per the left's mocking taunt; "elections have consequences"

Captain Obvious
12-28-2014, 10:02 PM
Peter1469 - Medicaid pays shit, always has but it's better than no coverage.

Independent docs and for-profit systems often refuse to participate in Medicaid plans and refuse non-emergent patients. NFP providers really can't, it goes against their "charitable" mission.

Medicaid cuts don't concern me, there's more stuff behind the scenes like DSH payments and underserved area add-on's with Medicaid that make it worthwhile for me as a provider CFO to continue with it, what concerns me more is Medicare cuts, which are regular. This is the first year I've seen an actual reduction in inpatient reimbursement. 1.4% redux for me this year, base coverage. Add the sequestration and RAC audit take-backs and I'm losing money on my Medicare business - which is probably my biggest chunk of volume. Outpatient Medicare reimbursement rose something like .8% and ~ 80% of my volume is outpatient and that gives me some relief, but the future of Medicare is what's more concerning to me.

The concept of single payer terrifies me.

donttread
12-29-2014, 07:00 AM
Access to health care in peril in medicaid system (http://www.nytimes.com/2014/12/28/us/obamacare-medicaid-fee-increases-expiring.html?_r=0)

The government wants to cut medicaid payments, so doctors are starting to refuse medicaid patients.

I can remember as little as 10or 12 years ago Medicaid paying less than ten bucks a visit and few practices were accepting new Medicaid. But dental care and eye glasses Medicaid providers were nearly impossible to find.

lynn
12-29-2014, 09:07 AM
Eventually all private practices will merge with hospital networks because of lower reimbursement. This is what the government wants to happen and so do the hospitals. This provides greater control over healthcare and at the same time allows hospitals more funds to buy politicians with elections.

This happened with small businesses being put out of business by larger corporations for the same reason mentioned above.