Affordable Care Act

[flowho]

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so some coffee talk.

The affordable Care act... is neither Affordable nor provides for better care... discuss.

 

[WEBB PINKERTON]

The status quo isn't either. It's a trainwreck either way.

 

[Thrombus]

There are too many people with their hands in the cookie jar who don't do anything productive.

Big Insurance, Big Hospital (all these suits running around), Big Regulators (including CAP), and Big Government.

All this does is give patient's less for more.👎thumbdown👎

 

[WEBB PINKERTON]

The biggest insurance company in my state is going to omit some large hospitals and physician practices for patients buying from the exchange. Looks like patients have a choice between only two companies, Anthem and MDWise.

http://www.ibj.com/anthem-to-omit-some-big-hospitals-from-exchange-network/PARAMS/article/43499

 

[yaah]

It's a perfect political storm. It is so big that anyone can find things that they hate about it to get angry about (or conversely find something they love and highlight that). A lot of the trends in healthcare have zero to do with the ACA but people are either giving the ACA credit for it (like bending the cost curve even though it hasn't even started yet) or blaming it for it (like reimbursement rates and such). IMHO, it was an incredible waste of a political opportunity to do something better. And now it has become so politicized as a result of how it was passed and how easy it is to criticize that it is basically impossible to alter. Both sides are being completely dishonest and using more to score political points than anything else. Kind of pathetic.

The best example of the disconnect between reality and truth in the political realm regarding healthcare is to look at those polls about medicare and where the money goes. Most people think that most of the problem in medicare spending is due to waste, fraud, extraneous programs, etc. In actuality it is due to aging population and more and more expensive tests and therapies (which people who are polled rank LAST as the major contributor to increasing costs). Politicians are only too happy to perpetuate these misconceptions and then throw red meat or candy at their supporters.

If you were to describe the actual medicare plan to people today only call it something else and say it is a new proposal for healthcare, I would wager that 80% of people would say that they hate the idea and it would be terrible.

 

[2121115]

Here is a practical question about the ACA -

Will the insurance plans offered through the exchanges via private insurance companies pay at the rates already contracted for that company, or will they pay medicare rates, or will new rates need to be negotiated?

 

[WEBB PINKERTON]

Here is a practical question about the ACA -

Will the insurance plans offered through the exchanges via private insurance companies pay at the rates already contracted for that company, or will they pay medicare rates, or will new rates need to be negotiated?

Has to be negotiated is my understanding. Sounds like everyone needs to get prepared to be paid somewhere in between, IF you can get in network.

 

[WEBB PINKERTON]

Cleveland clinic just announced they need to cut 330 million from next year's budget.

http://www.cleveland.com/healthfit/index.ssf/2013/09/cleveland_clinic_to_cut_330_mi.html


Two largest hospital chains in my state have recently laid off hundreds of employees as well.


Just the beginning I'm afraid.

 

[LADoc00]

I want to say our Government should almost never be trusted. I say this as a former and current government employee as well as a private practice owner.

Government since the Industrial Revolution has grown to be too big and disconnected for almost all of the large population nations and will continue to fail its people until their eventual collapse.

There are literally 2 solutions (aside from the obvious central Benevolent Omnipotent Dictator/SkyNet running everything) 1.) cut nations down to the pop size of Finland and/or 2.) relinquish central control for local autonomy (a favorite tenet of Reagan to make America "work" again).

ACA plows more force into an already known failed socio-economic paradigm (centralized control of a HUGE diverse human pop into the hands of totally inept and disconnected gov. employees).

 

[MOHS_01]

Here is a practical question about the ACA -

Will the insurance plans offered through the exchanges via private insurance companies pay at the rates already contracted for that company, or will they pay medicare rates, or will new rates need to be negotiated?

Negotiated and closed network.

 

[WEBB PINKERTON]

If I get bored farming, I think I may study to become an actuary. I sure am seeing that job title alot reading all these article about the health insurance exchanges.

 

[MOHS_01]

Has to be negotiated is my understanding. Sounds like everyone needs to get prepared to be paid somewhere in between, IF you can get in network.

From the rumblings underground, it will not be between MC and private; it will be more in line with Medicaid. Many larger provider organizations (big enough to have a seat at the table during discussions) have come away with notion that they are better off taking their chances with private pay than being a participating provider. It seems that there will not be out of network benefits... and it is just suicidal to contractually obligate oneself to a payment that is less than the cost of providing the service.

 

[MOHS_01]

If I get bored farming, I think I may study to become an actuary. I sure am seeing that job title alot reading all these article about the health insurance exchanges.

My cousin is one -- pays better per hour for consulting work than I would earn as a salaried dermatologist in a larger healthcare organization. It's a lot of assumptions and projections... tea leave mumbo jumbo.

 

[rollwithit]

I want to say our Government should almost never be trusted. I say this as a former and current government employee as well as a private practice owner.

Government since the Industrial Revolution has grown to be too big and disconnected for almost all of the large population nations and will continue to fail its people until their eventual collapse.

There are literally 2 solutions (aside from the obvious central Benevolent Omnipotent Dictator/SkyNet running everything) 1.) cut nations down to the pop size of Finland and/or 2.) relinquish central control for local autonomy (a favorite tenet of Reagan to make America "work" again).

ACA plows more force into an already known failed socio-economic paradigm (centralized control of a HUGE diverse human pop into the hands of totally inept and disconnected gov. employees).

This is why I've never understood using a country like Finland as an example of support for a strong central government. Finland has a small population that is not diverse. It's much easier to have a strong centralized force because you can get the masses to pull the same direction. Plus, the land area is small so logistically it's much easier to make infrastructure related decisions.

That doesn't work in the United States. We have a large population that is extremely diverse and spread across thousands of miles. You can't govern Ohio the same way you govern New Mexico or Washington or New York. That's why we have a State system in the first place. Government closer to the people is far more effective than government that's disconnected and attempts to treat everyone the same. Set some guiding American principles at a federal level and take care of things like defense and the highway system, but let smaller groups of people learn to govern themselves the way they want to be governed.

 

[2121115]

From the rumblings underground, it will not be between MC and private; it will be more in line with Medicaid. Many larger provider organizations (big enough to have a seat at the table during discussions) have come away with notion that they are better off taking their chances with private pay than being a participating provider. It seems that there will not be out of network benefits... and it is just suicidal to contractually obligate oneself to a payment that is less than the cost of providing the service.

*** drop cup ***

 

[LADoc00]

FYI...in many states Medicaid funding is actually quite juicy for Pathologists. So bending the curve that way may have some unintended yumminess for us...that is until those the forces of darkness realize this and hack off our collective boy parts...

 

[WEBB PINKERTON]

I wonder how many insurance companies are going to take part in these exchanges. There was an article in a local business journal a few days ago that said only 2 would be participating in my part of state. I live in one of the most unhealthy areas in America according to surveys. Seeing a 30 year old with small cell lung cancer is not that uncommon, many are obese and meth labs outnumber pathology labs 1000-1 easily. I guess they are worried the patients in the exchanges won't be very healthy. Maybe in future years some more will jump in but right now there doesn't appear to be much competition.

One of the insurance companies in the exchange is actually co-owned by two large hospital networks. Hospitals have their thumbs in every pie. I guess they have their eyes on taking over health insurance next.

 

[MOHS_01]

Two in my state as well - and I believe this will likely be the cast in most states given the functional monopolies that is the health insurance market in most states.

 

[WEBB PINKERTON]

FYI...in many states Medicaid funding is actually quite juicy for Pathologists. So bending the curve that way may have some unintended yumminess for us...that is until those the forces of darkness realize this and hack off our collective boy parts...

Hell, medicaid pays a LOT more than good ole "client pricing". Sad but true. 🙁

 

[yaah]

Don't forget that lots of these new plans are going to have high deductibles. So it's almost like they are private pay except maybe for catastrophic events. You will hear a lot about "Cost savings".

There are also opportunities in the ACA for collaboration and such, but uncertain how significant these are.

But as our hospital CEO told us, remember that ACA is not really defining things as much as it is a response to the underlying trends. The underlying trends which have been happening for several years and predated the ACA. If the ACA didn't exist there would still be a coming proliferation of high-deductible plans, companies shifting health insurance costs to other entities, reimbursement cuts, increasing "collaboration" etc.

 

[MOHS_01]

Yeah, things were trending badly to begin with... but there would not have been the expansion of Medicaid, the accelerated shift from private plans to Medicaid, the de facto managed Medicaid that is the exchange, etc. There would not have been the wholly arbitrary price fixing entity known as IPAB... nor would there have been the rate increases for the healthy and young that is the result of a back door community rating system.

No matter how one rationalizes, justifies, or seeks to create a pretext for it, it remains a colossal assraping event for many physicians (even if said assraping was going to occur sooner or later anyway).

I'm just angry about the whole thing, really. There had to be a better solution that throwing accelerant on a burning fire.

 

[pathstudent]

I did 2 bone marrows on two different patients in the same say. One was an uninsured 23 year-old man that was just diagnosed with Burkitt lymphoma of the testicle. The other was a 89 year old significantly demented woman who lived with her caretaker son who had a bone marrow ordered on her for mild pancytopenia. . These two patients demonstrated everything that is wrong with us healthcare. One was young and had a likely curable but certainly and rapidly fatal disease without treatment whose entire family will bebankrupted for years for pursuing treatment. The other has an open checkbook for all of healthcare and really had no business accessing it. Unless the 89 year old is your Nana, who cares if she has mds or even aml, she needs to die of something. Her son doesn't have the sense or knowledge to tell the doctors to leave his mother alone. I told him he should defer the bone marrow and just take the best care of his mother that he could but his primary care referred hi to heme onc so heme onc sends them to me.

Hopefully Aca will get people like the young man insured! Although, he likely got Medicaid after a few weeks, but it would be nicer To get him a plan that reimburses Medicare rates as a lot of Medicaid don't cover costs. It would also be nice if their was a panel that would say demented nannies with platelet counts don't get bone marrow biopsies for platelet counts of 75 and white counts of 2,4 and we certainly aren't going to treat it if you have mds.

So I would support a healthcare reform that expanded Medicare to uninsured but also showed some sense in rationing rather than promising everyone everything and ratcheting back physician reimbursement.

 

[longlakeboy]

The best example of the disconnect between reality and truth in the political realm regarding healthcare is to look at those polls about medicare and where the money goes. Most people think that most of the problem in medicare spending is due to waste, fraud, extraneous programs, etc. In actuality it is due to aging population and more and more expensive tests and therapies (which people who are polled rank LAST as the major contributor to increasing costs). Politicians are only too happy to perpetuate these misconceptions and then throw red meat or candy at their supporters.

Therein lies the major problem. Most people thinks more testing, more intervention, more anything = better medicine. And to suggest otherwise means you're pro-health care "rationing." Which makes any discussion of the real problem a political non-starter.

 

[yaah]

Therein lies the major problem. Most people thinks more testing, more intervention, more anything = better medicine. And to suggest otherwise means you're pro-health care "rationing." Which makes any discussion of the real problem a political non-starter.

Right. No one wants to pay for anything, unless it's for them or their family. In that case they want everything done. No one wants to be the rationed one. It's obviously understandable, but doesn't solve any problems.

 

[WEBB PINKERTON]

Sounds like labs are going to be getting LESS specimens. Remember that propaganda about all the newly insured people and how it was going be so great for those of us in health care? That talk has stopped.

http://www.forbes.com/sites/investor/2013/12/18/buying-opportunity-among-lab-stocks/

 

[Pathwrath]

Sounds like labs are going to be getting LESS specimens. Remember that propaganda about all the newly insured people and how it was going be so great for those of us in health care? That talk has stopped.

http://www.forbes.com/sites/investor/2013/12/18/buying-opportunity-among-lab-stocks/

I know. This is why we just let a whole bunch of (CP) lab techs go, because of the ACA.

 

[yaah]

Sounds like labs are going to be getting LESS specimens. Remember that propaganda about all the newly insured people and how it was going be so great for those of us in health care? That talk has stopped.

http://www.forbes.com/sites/investor/2013/12/18/buying-opportunity-among-lab-stocks/

Yeah I never undertstood that argument - part of the point of newer CMS regulations and insurance reimbursement practices (not just the ACA) revolves around efficiency and reducing testing. The other factor is that the gravy train of "produce more specimens and get paid more" has been declining in importance, so clinicians have been having less incentive to order more tests (again, not just because of the ACA).

Common sense would suggest that higher deductibles would lead to decreased utilization of lab tests, particularly expensive ones. But sometimes common sense is not intuitive to some people, especially analysts who look at past numbers, future numbers, and trends, and assume everything else stays constant.

 

[Johnny Sunshine]

When a patient goes to a doctor, the vast majority just do whatever the doctor suggests. I've even seen many patients desire the expensive lab tests more, as they view "hitting their deductible" and thereafter having sweet insurance coverage as some sort of prize.

Although clinicians may have less incentive to order tests for profit purposes, I don't know if that will reduce the number of lab tests ordered all that much. I suspect that the practice style of "shotgun medicine" and/or litigation concerns will continue to keep the number of ordered tests up.

 

[yaah]

I think a lot of doctors are going to have to develop a standard, boilerplate kind of legal document that says, "These are the tests that are recommended for you, we will not be held liable if you fail to get them and they would have revealed something treatable..."