Interviewing: current state of health care/obamacare?

[OCDOCDOCD]

I don't think you came across terribly, but working in primary care I can assure you they rarely ever have god complexes and already face more paperwork and scrutiny than most other physicians for the least amount of compensation. A patient walks in with complex conditions and they are paid one small sum for all of the management and follow up, including insurance pre-authorization, record requests that happen often, and coordination of care with specialists. The last thing we need in primary care is more regulation and more paperwork, this reduces quality of care because it takes away from patient care and management time. When one only gets paid $45 dollars for an E&M visit that is supposed to include all coordination of care, paperwork, insurance BS, and patient phone calls, and you throw more regulation into the mix-the time has to come from somewhere. Sadly, the time is often taken from time spent with the patient, and this is why over-regulation is a bad thing in Primary Care. I agree the systems need improvement, but you just can't add new regulation on top of defunct systems. Either fix the old system or create a new one, but this Jenga style of healthcare reform is worrisome.

The only other thing I'd point out (again I worked as an health admin in a PCP group) is that the idea that only medicare is effected is a misunderstanding of how insurance works. All private insurance trends after medicare. If medicare gives them an excuse to not reimburse a service or to reduce reimbursement, they will. They won't pay as little, but their precent reduction will trend similarly (e.g. if medicare reduces by 30%, Private insurance will often do the same). They quote medicare guidelines as reasons for not reimbursing all of the time. Also, the idea the most physicians don't accept medicare is wrong as well, especially hospital based physicians. You are thinking of Medicaid. The largest population demographic in america are all on medicare now or arriving shortly.

Hopefully that provides a slightly different perspective.

One misunderstanding in your quote

See, this is what I wanted. Thank you.

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[farnell]

So in other words, as a pompous undergrad interested in MD/PhD programs, who knows absolutely nothing about the real-world practice of medicine, I can't say that you'll do so well at your interviews unless you at least get some shadowing experience first. I'd tone down the rhetoric on what primary care doctors do and don't get upset about until then.

<--- me laughing at you because you think I'll waste my time do an e-debate with you on the "ACA." If you want to debate poly-tics, you can have your go at the people in the "Sociopolitical" forum. My entire involvement in this thread has been about interview advice, so I hope you received mine.

"Aside from attacking "primary care docs", the main thing you are missing is that you just don't know what the hell you're talking about. "

Yeah because that was really good interview advice

 

[plumazul]

Anyone interested in nonpartisan in depth analysis of the PP&ACA(or health issues in general), should check out the Kaiser Family Foundation website.

http://healthreform.kff.org/

 

[DrBarbie08]

I think the issue with the PPACA is not what it does necessarily, because it seems like the ideas behind it are wonderful, but how we're going to pay for it. Since the majority of people who are not insured are in "poverty" (Obama's definition of poverty would technically include me and I can assure you that by making the hard decisions I am perfectly able to afford my own health insurance) they will receive all the benefits at no cost. Also, one of the way they are planning to cut costs is to reduce the amount physicians or hospitals are reimbursed from 60 to 30%. That is what I was told by the surgeons I work with...

If you believe me to be wrong please explain so I can get a better understanding. It is so confusing.

 

[annonymous819]

I think the issue with the PPACA is not what it does necessarily, because it seems like the ideas behind it are wonderful, but how we're going to pay for it. Since the majority of people who are not insured are in "poverty" (Obama's definition of poverty would technically include me and I can assure you that by making the hard decisions I am perfectly able to afford my own health insurance) they will receive all the benefits at no cost. Also, one of the way they are planning to cut costs is to reduce the amount physicians or hospitals are reimbursed from 60 to 30%. That is what I was told by the surgeons I work with...

If you believe me to be wrong please explain so I can get a better understanding. It is so confusing.

PPACA=~2500 pages
Health care reform=~20 pages
Other 2480 pages=???????

 

[Gut Shot]

I think the issue with the PPACA is not what it does necessarily, because it seems like the ideas behind it are wonderful, but how we're going to pay for it. Since the majority of people who are not insured are in "poverty" (Obama's definition of poverty would technically include me and I can assure you that by making the hard decisions I am perfectly able to afford my own health insurance) they will receive all the benefits at no cost.

The PPACA expands coverage in two major ways (and a number of minor ones, but that's for another time).

1. For the poorest citizens it expands Medicaid by raising the income limit 133% of the federal poverty level (FPL). To entice primary care providers into accepting these patients the reimbursement schedule is increased to match Medicare rates.

2. For those with incomes in the range of 133%-400% of the FPL who don't otherwise have coverage, the purchase of private insurance is subsidized on a sliding scale. Each state is supposed to establish an exchange where individuals can shop for policies. This process ostensibly allows individuals to form pools, and thereby lower their aggregate premiums.

Also, one of the way they are planning to cut costs is to reduce the amount physicians or hospitals are reimbursed from 60 to 30%. That is what I was told by the surgeons I work with...

They may be referring to the SGR formula, which is the infamous annual fix that Congress pushes through, and is a separate issue.

Most of the defined Medicare "cuts" are actually just limits in spending growth over a 10 year window, and the biggest target is Medicare Advantage. If you are unaware, Medicare Advantage was an experiment where public dollars were given to private insurers who were supposed to do a better job of managing Medicare patients. The program's main accomplishment was higher per capita spending without better outcomes.

 

[Bacchus]

The PPACA expands coverage in two major ways (and a number of minor ones, but that's for another time).

1. For the poorest citizens it expands Medicaid by raising the income limit 133% of the federal poverty level (FPL). To entice primary care providers into accepting these patients the reimbursement schedule is increased to match Medicare rates.

2. For those with incomes in the range of 133%-400% of the FPL who don't otherwise have coverage, the purchase of private insurance is subsidized on a sliding scale. Each state is supposed to establish an exchange where individuals can shop for policies. This process ostensibly allows individuals to form pools, and thereby lower their aggregate premiums.



They may be referring to the SGR formula, which is the infamous annual fix that Congress pushes through, and is a separate issue.

Most of the defined Medicare "cuts" are actually just limits in spending growth over a 10 year window, and the biggest target is Medicare Advantage. If you are unaware, Medicare Advantage was an experiment where public dollars were given to private insurers who were supposed to do a better job of managing Medicare patients. The program's main accomplishment was higher per capita spending without better outcomes.

You could probably make a better salary going around and explaining this for President Obama.

 

[DrBarbie08]

The PPACA expands coverage in two major ways (and a number of minor ones, but that's for another time).

1. For the poorest citizens it expands Medicaid by raising the income limit 133% of the federal poverty level (FPL). To entice primary care providers into accepting these patients the reimbursement schedule is increased to match Medicare rates.

2. For those with incomes in the range of 133%-400% of the FPL who don't otherwise have coverage, the purchase of private insurance is subsidized on a sliding scale. Each state is supposed to establish an exchange where individuals can shop for policies. This process ostensibly allows individuals to form pools, and thereby lower their aggregate premiums.



They may be referring to the SGR formula, which is the infamous annual fix that Congress pushes through, and is a separate issue.

Most of the defined Medicare "cuts" are actually just limits in spending growth over a 10 year window, and the biggest target is Medicare Advantage. If you are unaware, Medicare Advantage was an experiment where public dollars were given to private insurers who were supposed to do a better job of managing Medicare patients. The program's main accomplishment was higher per capita spending without better outcomes.

Thank you, this is helpful. So my remaining question is do we have enough primary care docs to support these people, even with the incentive?

 

[goodkarma]

I also found this article to be very helpful. Some of you may recognize the author, he wrote Complications, Better, and The Checklist Manifesto.

 

[Gut Shot]

Thank you, this is helpful. So my remaining question is do we have enough primary care docs to support these people, even with the incentive?

We don't really have enough primary care docs now, but nobody really knows how much the expanded coverage will strain the system. The uninsured as a group are not huge consumers of health care, but the already utilize some, albeit on an out-of-pocket basis. Some theorize that emergency room visits will decrease, although this didn't happen in Massachusetts following the implementation of Romneycare.

 

[Palam]

I know very little to nothing about obamacare, but I'm told from a reasonable rationale group of people that obamacare means greater efficiency which means insurance companies will make less. And much like every other s***** industry, they'll do what needs to be done to make up the difference. That could mean less reimbursements and therefore less money to doctors.