Cut to Reimbursement Rates?

[SoulinNeed]

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OK, I know this subject has been discussed repeatedly, but I'm just a bit confused on the matter. I know every few months the SGR rate cuts come up, and Congress just keeps delaying them, but I'm more interested in the Obamacare cuts. In these discussions, people continuously talk about the cuts Obamacare will have on Physician reimbursement rates. From some quick research, this idea seems to come from a MedPAC meeting that recommended that Specialists rates be cut by 16%, and kept at those rates until the end of the decade. Then, it says that Primary Care physicians should see their rates frozen (with no cut or increase) until the end of the decade. Now, these MedPAC recommendations can be overturned by Congress.

Now, I know Obamacare also has certain cuts in the plan when it comes to certain non-Physician care, but I'm asking, because I haven't been able to find it, where are the specific cuts to Physician payments in Obamacare? If it's just a Congress approval cut, wouldn't the thought be that Congress will just continue delaying those cuts like they've been doing with SGR?

BTW, about those SGR medicare rates, I know Congress keeps delaying them, but does that mean medicare payments have been increasing over the past 6 or 7 years, or have they just not increased at all since the cuts were supposed to go into effect. I guess my question on that topic is have doctors been getting paid the same amount for five years by medicare for doing a certain procedure?

I'm sorry for the ignorance, but I'm generally curious on this subject.

 

[link2swim06]

OK, I know this subject has been discussed repeatedly, but I'm just a bit confused on the matter. I know every few months the SGR rate cuts come up, and Congress just keeps delaying them, but I'm more interested in the Obamacare cuts. In these discussions, people continuously talk about the cuts Obamacare will have on Physician reimbursement rates. From some quick research, this idea seems to come from a MedPAC meeting that recommended that Specialists rates be cut by 16%, and kept at those rates until the end of the decade. Then, it says that Primary Care physicians should see their rates frozen (with no cut or increase) until the end of the decade. Now, these MedPAC recommendations can be overturned by Congress.

Now, I know Obamacare also has certain cuts in the plan when it comes to certain non-Physician care, but I'm asking, because I haven't been able to find it, where are the specific cuts to Physician payments in Obamacare? If it's just a Congress approval cut, wouldn't the thought be that Congress will just continue delaying those cuts like they've been doing with SGR?

BTW, about those SGR medicare rates, I know Congress keeps delaying them, but does that mean medicare payments have been increasing over the past 6 or 7 years, or have they just not increased at all since the cuts were supposed to go into effect. I guess my question on that topic is have doctors been getting paid the same amount for five years by medicare for doing a certain procedure?

I'm sorry for the ignorance, but I'm generally curious on this subject.

It all comes down to lobbyists. If you have the more powerful lobbyist group you control congress. Many physician lobbyists are very powerful...regardless to what politicians "say" they arent going to go against the flow of money.

The SGR is insane from a standpoint of fair reimbursement, with the upcoming baby bombers it would tell congress to pay doctors peanuts in 10 years.

When congress changes payment they dont say all procedures are cut by 10%...rather they select certain billing codes for specific procedures which can be adjusted. The trend is old procedures are cut BUT when a new procedure is invented it generally dictates high compensation.

 

[SoulinNeed]

Yeah, it's clear they're not going through with the SGR cuts, but it'll be hard to sell to the nation a $400 Billion bill to save doctors' salaries, so they'll just delay it, instead.

 

[link2swim06]

Yeah, it's clear they're not going through with the SGR cuts, but it'll be hard to sell to the nation a $400 Billion bill to save doctors' salaries, so they'll just delay it, instead.

I wouldn't put it pass our government. We have spent nearly 4 trillion on war in the past decade alone...$400 billion is 10% of that....

Not to mention the people spending the money are in denial about the national debt...i am guessing they will keep on printing money.

 

[SoulinNeed]

Anyone else have any specific physician rate cuts in Obamacare?

 

[Brachyury]

Anyone else have any specific physician rate cuts in Obamacare?

If you want people to take your post seriously, I suggest you don't use the word 'Obamacare.'

 

[SoulinNeed]

If you want people to take your post seriously, I suggest you don't use the word 'Obamacare.'

Sorry. The Patient Protection & Affordable Care Act. Just didn't feel like writing the whole thing out, lol. Didn't mean to offend.

 

[SoulinNeed]

Anyone else?

 

[ppfizenm]

OK, I know this subject has been discussed repeatedly, but I'm just a bit confused on the matter. I know every few months the SGR rate cuts come up, and Congress just keeps delaying them, but I'm more interested in the Obamacare cuts. In these discussions, people continuously talk about the cuts Obamacare will have on Physician reimbursement rates. From some quick research, this idea seems to come from a MedPAC meeting that recommended that Specialists rates be cut by 16%, and kept at those rates until the end of the decade. Then, it says that Primary Care physicians should see their rates frozen (with no cut or increase) until the end of the decade. Now, these MedPAC recommendations can be overturned by Congress.

Now, I know Obamacare also has certain cuts in the plan when it comes to certain non-Physician care, but I'm asking, because I haven't been able to find it, where are the specific cuts to Physician payments in Obamacare? If it's just a Congress approval cut, wouldn't the thought be that Congress will just continue delaying those cuts like they've been doing with SGR?

BTW, about those SGR medicare rates, I know Congress keeps delaying them, but does that mean medicare payments have been increasing over the past 6 or 7 years, or have they just not increased at all since the cuts were supposed to go into effect. I guess my question on that topic is have doctors been getting paid the same amount for five years by medicare for doing a certain procedure?

I'm sorry for the ignorance, but I'm generally curious on this subject.

The PPACA moves from the fee-for-service to a bundled payment system. Right now you get paid for everything you do. The PPACA wants to change that to getting paid for expected care meaning that for a specific condition you will be expected to do A B and C and you will only be getting reimbursed for that. Additional procedures D and E will not be reimbursed. It is supposed to reduce frivolous testing and encourage coordinated care.

The only thing these debates in congress are currently doing is preventing new medicare patients from finding physicians because so many do not want to take on new medicare patients with a reimbursement cut hanging over there heads.

 

[SoulinNeed]

The PPACA moves from the fee-for-service to a bundled payment system. Right now you get paid for everything you do. The PPACA wants to change that to getting paid for expected care meaning that for a specific condition you will be expected to do A B and C and you will only be getting reimbursed for that. Additional procedures D and E will not be reimbursed. It is supposed to reduce frivolous testing and encourage coordinated care.

The only thing these debates in congress are currently doing is preventing new medicare patients from finding physicians because so many do not want to take on new medicare patients with a reimbursement cut hanging over there heads.

That's pretty interesting. Considering the amount of new patients that will be coming in, I don't know if this is a bad thing. I'm not to sure if it will actually cut income, either.

 

[ppfizenm]

That's pretty interesting. Considering the amount of new patients that will be coming in, I don't know if this is a bad thing. I'm not to sure if it will actually cut income, either.

unfortunately like any solution it has it's downsides as well. For example it promotes the treatment of conditions as if people all experience them in the same way. For some diseases this is very true. For others there is a lot of variation in the way people are treated. Also, there is the testing leading up to a diagnosis. How will that be covered? I have not read the exact specifics so I don't know if there is a system in place to deal with such concerns as well as others, but in theory this is supposed to work (which doesn't give me too much faith in it).

 

[bassvp]

Sorry. The Patient Protection & Affordable Care Act. Just didn't feel like writing the whole thing out, lol. Didn't mean to offend.

You are not at fault for others who are overly sensitive.

 

[SoulinNeed]

unfortunately like any solution it has it's downsides as well. For example it promotes the treatment of conditions as if people all experience them in the same way. For some diseases this is very true. For others there is a lot of variation in the way people are treated. Also, there is the testing leading up to a diagnosis. How will that be covered? I have not read the exact specifics so I don't know if there is a system in place to deal with such concerns as well as others, but in theory this is supposed to work (which doesn't give me too much faith in it).

I don't know if it will be that detrimental, though. I read in an AMA newsletter that there is going to be a 2% cut to pay in the first year, but that this may be delayed like the SGR cuts.

 

[FrkyBgStok]

You are not at fault for others who are overly sensitive.

it is not that people are overly sensitive. when someone asks questions about "obamacare" that start off sounding legit, 99% of the time is a republican setup to cause a heated debate. not saying the OP did this, but it is what happens. OP you could simply say "health care reform."

As for me, I am for some kind of universal health care, but I do not think that Obama's health care reform is perfect. First off, I don't think the "fee for healthy outcomes" plan is in the best interest of the patient. This will essentially bring a flow chart for disease that the physician will not want to stray from because of reimbursement. not for all, but for many. but i also think we need to figure out a way to cut down stupid stuff. and regulating malpractice would help.

I also don't like the idea of medicare using its "bargaining power" to "negotiate" affordable healthcare. Maybe if medicare did this in the past it would be fine, but they don't. They demand. They say, "this is how it is, take it or leave it."

So to stay on topic and not get into a healthcare debate, I do think physician pay will drop in order to provide healthcare for all. The question is how much? I definitely don't think a government run system will be good as it will cause the most cuts to pay. care, quality, etc. However, if I were a family physician, the average in America is about $170,000. The average in Germany's system is about $110,000 (these are rough estimates). American physicians pay say $1200/week on malpractice while German physicians pay about $1200/year. So as a family physician, I wouldn't care if I made $110,000/year here in America as long as the malpractice was at a rate similar to Germany or Japan.

 

[MT Headed]

And if the tuition was the same as Germany or Japan...

 

[FrkyBgStok]

And if the tuition was the same as Germany or Japan...

+1. Yeah that too.

 

[Gut Shot]

OK, I know this subject has been discussed repeatedly, but I'm just a bit confused on the matter. I know every few months the SGR rate cuts come up, and Congress just keeps delaying them, but I'm more interested in the Obamacare cuts. In these discussions, people continuously talk about the cuts Obamacare will have on Physician reimbursement rates. From some quick research, this idea seems to come from a MedPAC meeting that recommended that Specialists rates be cut by 16%, and kept at those rates until the end of the decade. Then, it says that Primary Care physicians should see their rates frozen (with no cut or increase) until the end of the decade. Now, these MedPAC recommendations can be overturned by Congress.

Now, I know Obamacare also has certain cuts in the plan when it comes to certain non-Physician care, but I'm asking, because I haven't been able to find it, where are the specific cuts to Physician payments in Obamacare? If it's just a Congress approval cut, wouldn't the thought be that Congress will just continue delaying those cuts like they've been doing with SGR?

BTW, about those SGR medicare rates, I know Congress keeps delaying them, but does that mean medicare payments have been increasing over the past 6 or 7 years, or have they just not increased at all since the cuts were supposed to go into effect. I guess my question on that topic is have doctors been getting paid the same amount for five years by medicare for doing a certain procedure?

I'm sorry for the ignorance, but I'm generally curious on this subject.

MedPAC is advisory, it's recommendations have no teeth. Congress has routinely ignored its suggestions for the past 15 years.

To my knowledge, the only specific cuts the PPACA lays out involve imaging. Most of the provisions actually entail increases in reimbursement. For a nice breakdown, try the ABA's current issue of The Health Lawyer (February 2012), linked on this site: http://www.americanbar.org/publications/health_lawyer_home.html

Specifically see pages 6-7 of the lead article. You should probably read the entire thing. It's a nice piece, intended to be comprehensive yet digestible by non-experts in health policy. The bundled payment systems mentioned above are part of an ongoing pilot program, which presumably will not be spread system-wide if they don't work.

I actually don't object to bundled payment systems in principle. They could be a fine way to get paid the same for doing less. Here is an example of one (Prometheus): http://www.hci3.org/node/4/ , which has also been published in the NEJM and elsewhere.

One big area of uncertainty for everyone is the establishment of accountable care organizations, which are supposed to enhance coordination of care and create incentives to share cost savings. I imagine these will work in some places and not others, depending upon the idiosyncrasies of how each one is implemented and run.

Oh, and then there is the Independent Payment Advisory Board, or IPAB. That's the new MedPAC, and this time they are giving it regulatory authority. Nobody knows what it is going to do, but it should be fun to watch.

 

[Gut Shot]

One more thing, if the individual mandate holds up to legal scrutiny (which I pray it does), any cuts in reimbursement will be at least partially offset by increases in collection rates, as the number of uninsured and/or non-paying patients will be significantly decreased.

For the sake of clarity, please allow me to illustrate:

Current system:
- I make 10 cupcakes
- 7 people pay 10 cents apiece for a cupcake
- 3 people steal the remainder
- Total revenue = 70 cents

Reformed system:
- I make 10 cupcakes
- All 10 customers pay 8 cents apiece
- Total revenue = 80 cents

Hence, cutting individual reimbursement does not necessarily hurt my bottom line.