nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Thursday, November 4, 2010

Medicare/Medicaid Announces New Rules, Cutting Physician Payments

It's official.  The government has announced 21% cuts in what it will pay doctors, beginning 1 Dec, with another 4% cut in January.

In my state, the number of doctors who are leaving Medicare has been growing.  This will only accelerate that process.  Several of my own personal physicians have indicated they will no longer be accepting Medicare unless the government fixes the payment system for good.  They're not asking for raises, like the unions do.  It's against the law for doctors to engage in collective activity.  They're just asking that we even out the inequities and move to a different way of paying for health care...rather than just price-cutting.

Most doctors already don't take Medicaid.

The fault lies entirely with Congress and three Administrations, beginning in the late 90's.  At that time, Congress passed legislation that would reduce physician payments by about 2% annually.  Cost savings were expected from a number of practice and disease management efforts, along with payment reform that would reduce overhead.  That didn't no savings accrued.

But Congress just postponed the annual cut every year by kicking the can down the road, as health costs continued to rise.

Organized medicine, in the form of the American Medical Association, supported the President's health care reform with the assurance that payment reform (the "doctor fix") would be a part of it.  When Congress was confronted with an overall extimate of the cost of reform that exceeded $1 trillion dollars, the $250 billion for the "fix" had to be cut in order to make the price tag more palatable.  The AMA felt they were.

So the old law limps along, postponing--and accumlulating--the annual cut, until now.

What this means for patients whose doctor will no longer accept Medicare is paying cash for services and being reimbursed with whatever the government is willing to pay.  Many seniors will be unable to afford that.

But, you can keep your doctor, right?  The President promised.

Under health care reform, Congress also changed the language regarding Medicare fraud, eliminating the word "intent" under the provision that governs how the government will pursue those who file claims for payment inappropriately.  This means if I see a patient, and file a claim for payment--with no intent to defraud--but mistype the code or enter my address wrong, the government can charge me with fraud.  I've heard from several doctors that Medicare is already refusing to pay if an innocent error is made, and there have been cases reported of doctors being charged by the government where there was no intent to defraud.

It's one way to lower health care costs, I guess...just don't pay for it.

Finally, HCR instituted new regulations that require your physician to report more information on your condition that, in my opinion, violates the confidentiality of the patient-physician relationship.

This is an absolute mess that is headed for disaster. 

Health care reform started with such promise.   That promise has evaporated.

Doc D

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