Congress to consider reforming facility fees

[drusso]

http://medicaleconomics.modernmedic...uring-physicians-talk-costs-patients?page=0,0


This is a very important issue for our specialty. Please write, call, email, your locally-elected Congressional representative and them know that you support a LEVEL playing for Medicare reimbursement for physician work. Hospitals are inflating costs and employing MD's in order to create monopolies in local health care markets. Also, let your health policy representatives on ASIPP, ISIS, AAPMR, ASA, AMA, AOA, etc know that you support reforming facility fees and ask them have their organizations take a stand AGAINST health care inflation.

Why should an ESI cost 3X just because it was done in a HOPD???


"Doug Gerard, MD, a general internist in New Hartford, Connecticut, who submitted written testimony supporting the state law, says that now he avoids referring patients to employed doctors in his local community. At the same time, he sympathizes with those doctors who, he says, pursued employment to avoid the overhead, regulatory and other headaches of independent practice, and find themselves “stuck in this quandary,” as Gerard describes it."

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[jettavr6]

The AHA is such a powerful lobbying force, that they will make sure that a level playing field for medicare never occurs.

 

[drusso]

The AHA would be powerful if the MD/DO's just walked away. I've always wondered why docs who sold-out to hospitals didn't just form MD-governed group practices instead?

 

[jettavr6]

The AHA would be powerful if the MD/DO's just walked away. I've always wondered why docs who sold-out to hospitals didn't just form MD-governed group practices instead?

Yours is the million dollar question -- The wheels of medicine don't turn without the stroke of a physicians pen.

The AHA's power lies in the fact that physicians cannot effectively organize.

 

[lonelobo]

I would post this in office as well.

little off topic
I posted an article in my office about the inflated cost of Hospital employed physicians vs private practice and patients really seem to respond to it.

 

[SSdoc33]

I would post this in office as well.

little off topic
I posted an article in my office about the inflated cost of Hospital employed physicians vs private practice and patients really seem to respond to it.

these wouldnt be the medicaid patients that "respond" would it?

the site of service differential is definitely a big problem. however, it essentially supplements the HOPD practiced who generally take medicaid where most PP does not. if you "even the playing field" for medicare facility fees, are you PP guys gonna see the medicaid patients? i'm guessing no.....

 

[101N]

The AHA would be powerful if the MD/DO's just walked away. I've always wondered why docs who sold-out to hospitals didn't just form MD-governed group practices instead?

Many have.

 

[Ducttape]

i respectfully, again, disagree.

first, MD-governed group practices would be encouraged to do procedures at ASCs, thus encouraging continued differential payments.

second, i concur with SSdoc33. HOPD payment fee schedules are vital for those practices that see a high degree of Medicaid (and, to a lesser extent, Medicare).

as a HOPD, and probably the only practitioner on this board who is an employed physician, i am aware that differential pay is an issue and is highly abused. as i have posted before, much more stringent requirements for billing from HOPD is required. but equalization of the fees across board will almost eliminate services to a significant population, and a segment more at risk.

 

[101N]

i respectfully, again, disagree.

first, MD-governed group practices would be encouraged to do procedures at ASCs, thus encouraging continued differential payments.

second, i concur with SSdoc33. HOPD payment fee schedules are vital for those practices that see a high degree of Medicaid (and, to a lesser extent, Medicare).

as a HOPD, and probably the only practitioner on this board who is an employed physician, i am aware that differential pay is an issue and is highly abused. as i have posted before, much more stringent requirements for billing from HOPD is required. but equalization of the fees across board will almost eliminate services to a significant population, and a segment more at risk.

We are talking about chronic pain treatment here, not HTN, DM, CAD. Your argument falls apart because the services we provide - shots and opioid refills - are elective, costly,
and over utilized. Add to that an unnecessarily costly environment - HOPD/Hospital - and it's clear that this is an area that Medicare/Medicaid should actively drive to the outpatient setting.

 

[hyperalgesia]

It would be cheaper and more direct to just increase ALL reimbursements to treat Medicaid if the problem is lack of doc participation. I think it's reasonable to have higher HOPD fees, but not this much higher. Maybe 30% higher or even 50% higher - for complicated pts who need higher level care. But the existing 300% is ridiculous and is completely distorting the market. Hospitals are buying doctor's offices and saying they're now "on campus" HOPD procedures - it's a joke.

 

[Ducttape]

actually, medicare medicaid actually pay HOPD less for 992xx than office based settings. global fees, no facility fees. pays ASC/HOPD 16-24% less

unless Manchikanti did massive typos on the past 4 fee schedules....

oh and addendum - i definitely agree hyperalgesia. HOPD should be limited to hospital and hospital grounds only. HOPD need to all be JCAHO certified and monitored.

 

[drusso]

actually, medicare medicaid actually pay HOPD less for 992xx than office based settings. global fees, no facility fees. pays ASC/HOPD 16-24% less

unless Manchikanti did massive typos on the past 4 fee schedules....

oh and addendum - i definitely agree hyperalgesia. HOPD should be limited to hospital and hospital grounds only. HOPD need to all be JCAHO certified and monitored.

http://medicaleconomics.modernmedic...es-why-cost-may-give-independent-ph?page=full

JCAHO certification and monitoring is a joke and does nothing to improve patient VALUE in health care. The dirty little secret of health care "reform" and the Obama-Care/ACO movement is that it's more cost effective do to most things in independently owned MD office. Also, practitioner productivity falls off dramatically after independently owned MD's become hospital employed. So, MORE expensive; LESS productive.

That's PROGRESS.

It’s becoming more difficult for independent practices to “perpetuate themselves like they used to” because there are fewer young physicians wanting to purchase practices, Halley says. “Physicians coming out of medical school today are a different breed. They aren’t interested in an 80-hour work week,” Halley adds. “They want a life outside of medicine, and don’t want to work as hard.”

 

[Ducttape]

is it more cost effective? if so, then how does one explain the rise in health care costs on a previously mostly independent practice model?


Halley makes many presumptions that do not encompass the entire picture. most physicians coming out could not afford to purchase a practice because of the increased debt they engender due to the quadrupling cost of medical education. i think it is very presumptuous to assume, as he does, that residents do not want to work as hard as their predecessors - they are spending more years in fellowship training, for example, and more years doing MOCA as opposed to those who were fortunate to grandfather in for eternity to their specialties.


say what you will about JCAHO, but the point about JCAHO was specifically to point out that HOPD should be kept at a much higher standard than private offices, and hopefully JCAHO will improve their monitoring to the point that it will add value to patient care.


fyi the article also points out some salient other reasons for facility fees, and having worked 15 years in ER, i understand the need for hospitals to find some way of recooping some of the costs of ER care, charity care, etc.