Obama's war on pathology

[Thrombus]

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And we get the next defeat handed to us the day before Thanksgiving!

Before this guy's admin kills us on the 88305. Now he is coming after other profit. He is systematically destroying the profession by edict. Instead of going after those that abuse the system he hurts those of us that practice ethically and with concern for patient cost in mind.

But he will provide free contraception, Medicaid, and viagra for all!

Happy Thanksgiving!

 

[2121115]

Things are about to get Hunger Games, Battle Royale, and Lord of the Flies out here. Would hate to be a new grad looking for a job right now.

 

[scienceguy19]

Man... O-bomb-acare is going to kill pathology.

Now they're trying to Obama-cure the website and insurance fiasco.

I don't think an Obama-cure will help pathology.

 

[yaah]

To suggest this is "Obama's fault" is disingenous and misleading, and does incredible harm to the argument. If you turn everything into a political football, your arguments are less likely to be taken seriously because they will be seen as not based on fact or reality but on political motivations and bias. This is not "obama's fault." This is a trend that has been ongoing for the past 10 years, the ACA is a perpetuation of some bad trends but it is not the cause of them. The ACA includes numerous accounting gimmicks and cost savings which, again, are but a perpetuation of existing laws and trends.

The expansion of medicaid and free birth control and such are part of the ACA and can be directly linked to Obama's policies. Declining reimbursements and disappearance of fee for service would be happening regardless of Obama and the ACA. Repealing the ACA would be highly unlikely to resolve these trends. It might reduce medicaid expansion and reduce some healthcare premiums (while raising others) but would also create a host of other problems for which the ACA's opponents have no real answer other than bluster.

I really really wish the republicans would have been more involved and would continue to be involved in modifying and particularly reducing the government functions involved in healthcare delivery, but unfortunately they continue to deny reality and continue to based their arguments on hyperbole, anecdote, and misleading arguments. And instead of actually helping they would prefer to have things go badly so that they can gain more political points and win future elections, at which point they will do nothing anyway.

So as said we are left with essentially the only ideas getting any traction in healthcare "reform" coming mostly from the left, because the right refuses to participate like children.

 

[LADoc00]

You make some interesting points Yaah. I would go one step further though.

I would argue that Healthcare reform is far less urgent than many suggest. If the Left is imitating Eurocentric models or the Canadian experiment, then I would argue those Socialist initiatives are failing and doomed to fail.

I would theorize there are many MANY aspects of modern life that need "reform" including the spiraling cost of delivering education including our public universities, the general welfare state as well as broken state of rehab and corrections of our massive prison population. Then lets throw what are essentially open national borders with millions of undocumented people strolling about and the continuing out of date principle that the US is somehow the world's Police Force.

If you want to drill down the ACA, then it's now quite apparent it was a shell game. Costs for socially important programs like birth control for all, abortion and maternity care would be shared by everyone, even and perhaps especially if you disagree with those ideologies.

The Obamacare fight has been so bitter BECAUSE it is so ideologically driven not necessarily because it will effect huge changes in the delivery and payment of healthcare.

The actual outcome is less important than the Left's overriding message that "We will make you EAT what you despise."

That is a dangerous game to play.

And The Long Knives are being sharpened.

Chushah l'ezrati

 

[yaah]

Well, the problem with "reform" is that reforms are typically political animals which aim to protect a certain characteristic or garner advantage for a specific group or entity. The healthcare trend for the past 10-15 years has become unsustainable in terms of $$ spent. The only way to really reduce this is to either regulate the hell out of by reducing payments or prohibiting certain services, or to force patients to pay more directly for services. The ACA does very little for the first thing, in fact actually expands coverage for preventive care and such. This CAN be beneficial if it truly results in spending more up front to garner savings down the road, but these perceived future savings are somewhat tenuous.

So, interestingly, the tendency to require more from patients paying for services is also increasing somewhat as a result of Obamacare (but as said, this was an existing trend). This is rather a conservative idea - giving patients more choice in a sense. But given the political environment everything that the ACA does or perpetuates by necessity becomes a "liberal" idea and thus conservatives have to distance themselves from it. So they are left with essentially no response to the ACA except to oppose it. But if the ACA truly was outright repealed, these trends would by no means disappear. Sure, the coverage for preventive care would decline and more people would be dropped from medicare, but private insurances would then likely INCREASE the amount of co-insurance they would require from subscribers. But no one could blame the ACA for it this time.

I also see a lot of strange claims about how the ACA somehow is responsible for the SGR - declining payments are part of the SGR, not the ACA. The ACA builds in SGR persistence as a way to "save money" for the future, but that was existing law. The ACA does not really cut medicare, it just assumes cuts that were already pending will be allowed to persist. Unfortunately because the two parties cannot work together on anything, this bodes poorly for any real reform of the medicare payments system.

But back to the OP, I agree it is just easier to blame Obama instead of actually considering the real issues at play.

 

[LADoc00]

What's coming, in my opinion, is a political Stalingrad that we havent seen in this country in a very long time, if ever.

Whatever Obama does now will be ridiculed and second guessed by the Right and it is a sorry state of his own party's choosing.

My prediction now is pendulum will swing, as it often does, in both the House (even further) and the Senate to the Right. And the resulting payback will be LEGEN.....wait for it..wait for it...DARY.

Obamacare will die in 2016 regardless so Ive stopped putting anymore thought into it. The problem now is the Right has been bled to nothing but the most hardcore street brawlers who will cut Medicare reimbursements to the bone in the coming Nacht der langen Messer.

Clinton once said that indeed Big Government is dead, but it appears his party did not get the message and will pay the ultimate price.

Regardless Yaah, it is now clear that gov. imposed pseudo-market solutions are absolutely impossible in the crazy landscape of modern healthcare. Best to let things settle and let market solutions that work float to the top than practice political hara-kari on this yet again down the road...

If your guiding principle is "Medical care in the US is unsustainable, we have to do SOMETHING!" then we now know that the "something" can always make things worse, much worse.

 

[Silent Cool]

1) Eliminate restrictions/regulations such that interstate health insurance commerce is the norm (in other words, permit people to purchase insurance across state lines). Allow--not 'create'--a true national market place.

2) Eliminate medicare/medicaid. Instead, provide tax-payer-subsidized care for the poor--those who are within a certain percentage of the poverty line.

3) Minimize the government's role in healthcare as much as possible.

4) See Switzerland.

Boom. DONE.

 

[Thrombus]

His edicts come from goon Sebelius' CMS. His aca abomination aside, I fear it's collapse along with the CMS soviet style price fixing is taking down all of us. Along with the rampant exploitation of the profession, this clown in the executive branch who has not so much been the executive of a mcdonalds franchise nor even sat down at the negotiating table with a minimum wage worker, is set to deliver a decisive blow. Med students run from this field!!! We are getting hammered every year (ebenezer Scrooge would be proud the day before thanksgiving!)

 

[Thrombus]

I would add silent in demanding evidence including cost benefit to every regulation the Feds and their ilk (cap, aabb, FDA) try to impose. No evidence of affordable benefit? Rule nullified!

Let's keep the "evidence" in medicine.

 

[scienceguy19]

seriously man. obama's killing pathology.... I can't believe so many doctors voted for him.

we're gonna work like slaves now.... new slaves.

...and no malpractice reform.

 

[yaah]

OK, let's look at what would happen if we just purely eliminate the ACA
1) Preexisting health requirements would return with a vengeance, and resulting premiums would go up.
2) Older young people (college age, 25 years old, whatever the limit is) would now be dumped off their parents insurance, most likely.
3) Increase in uninsured people at the expense of medicaid contraction and the above two conditions.

There would be some benefits no doubt due to reducing adminstrative expense and rules, and maybe ACOs and such wouldn't be as prominent. High-value health care plans (which reimburse well) would continue to exist, at least for awhile longer. Medicaid pays crap but it pays more than nothing.

Things that would also happen if we eliminate the ACA:
A) Reimbursements would continue to decline
B) Increased consolidation would continue
C) Administrative expense would continue to rise
D) healthcare premiums would continue to rise
E) Patients would be increasingly expected to contribute more to their health care (higher deductibles).

ACA perpetuates a lot of trends A-E but is not responsible for them. Again, this is not "Obama's" fault. If Obama had not been elected trends A-E would continue to be a problem. Perhaps an alternative version of health care "reform" would have been passed but I very much doubt it.

Why do all of you above think that the current trends would somehow be magically removed if a republican was elected? It might be marginally better, for awhile anyway, but what are the current republican ideas for "fixing" health care? Increasing deductibles and reducing medicare spending. Gee, what does that sound like?

 

[yaah]

We are getting hammered every year (ebenezer Scrooge would be proud the day before thanksgiving!)

Interesting (read: feeble) comparison, since Ebenezer Scrooge was a pure capitalist who exploited the working poor and perpetuated income inequality for his own benefit. I doubt Scrooge would even favor the existence of medicare or even low-deductible health insurance. Good luck getting paid in that environment unless you are truly in the top 1% of pathologists.

I should add that I am no fan of the current administrative policy, the ACA, nor the democratic party's approach to healthcare policy in general. But if you are realistic you have to get out of the fantasy land where everyone's problems are solved if Obama is not in office.

 

[Thrombus]

If the ACA was administered competently, yes it may help....in the short term.

In the long term it helps destroy our sources of leverage at the negotiating table. Our reimbursements are under unprecedented attack under Obamas CMS. That is the main point of the post. Because of our reduced leverage thanks to the ACA and the glut of pathologists, we have limited tools to counter.

 

[Thrombus]

The govt manages almost nothing competently unless it involves imposing regulation$ that benefit the government.

The guy that doesn't pay now will still not pay when he is coerced to buy health insurance. Creating more rules to apply to those who don't follow rules is foolhardy.

Considering Ebenezer Scrooge...it is my experience that he typifies the federal government in the USA to the letter. To find bountiful compassion/charity in this country look to the farmer, the merchant, the entrepreneur, the minister, the janitor, the doctor, the nurse, the laborer, the rough neck, etc etc. (and yes even most in corporate America)

 

[LADoc00]

OK, let's look at what would happen if we just purely eliminate the ACA
1) Preexisting health requirements would return with a vengeance, and resulting premiums would go up.
2) Older young people (college age, 25 years old, whatever the limit is) would now be dumped off their parents insurance, most likely.
3) Increase in uninsured people at the expense of medicaid contraction and the above two conditions.

1.) Why should people with pre-existing conditions SPONGE off the rest of the insured pool? Is that fair? If the government wants to insure pre-existings, then THEY should subsidize them with some high risk pool...OH that ALREADY existed!!
2.) Why is a 25 year old on their parents' insurance to begin with?! Because they are loser and sitting at home with no job? Do we as society now expect grown adults to live as children until they are TWENTY-SIX? WTH kinda of country are we now? I had lived independently from my parents for 7 full years when I was 25. I had served in the military, gone to college. I visited them maybe 3 times a year. I took care of my own insurance. Where is that now?
3.) Medicaid expansion actually helping is a MYTH. most places have nearly no primary care practitioners actually taking new Medicaid enrollees, so expanding the number of potential patients that NO ONE will see in an OP setting is absurd. It does nothing but give emergency departments a way to bill someone...

I can debunk every point one by one, but I think the for the vast majority of Americans, Obamacare is hurting not helping, which is why some 60% of the polled are taking a very dim view of it.

 

[yaah]

Well, I'm not saying these things are necessarily great, but most americans like these things and if they go away they will raise holy hell. Extending insurance to 25 year olds is a little odd, I agree. But people really like this. The pre-existing conditions thing is a huge problem no matter which way you look at it. But the fact remains that for people for whom the reform has relevance, they think it is a lifesaver. For everyone else it is raising their premiums and they may never see the potential consequences. The medicaid expansion is not good for primary care physicians but hospitals sure like it, because these patients are going to come no matter what and they might as well get paid for it instead of writing it off.

Americans have a nonsensical understanding of healthcare and paying for it. Everyone wants to pay for as little as possible, wants everything covered, and wants the best quality and everything done.

60% of those polled take a dim view of obamacare because they associate whatever they dislike about healthcare or whatever is changing with it. I would wager that those 60% who dislike obamacare (and most of the 40% who like it) don't understand it very well. A lot of people think it's just a website that sucks or it's a tax increase or death panels or whatever.

 

[LADoc00]

Yaah-

Per J. Myles at CAP, Obamacare has DIRECTLY led to the destruction of pathology in 2 ways I wasnt clear on prior to the webinar.

1.) Obamacare has given the CMS a greenlight to (illegally) ignore the RUC panel recommendations and establish their own coding system that is no longer in parallel to the CPT coding sent to private payors, the institution of the dreaded G-code system through the Correct Coding Initiative.

2.) Obamacare has also directly led to the ongoing and soon to be full bundling of Pathology services INCLUDING, yes INCLUDING anatomic path codes.

Once this over, all private pathology groups will dissolve, likely with less than a 3-4 week notice prior to the 2014, 2015 or 2016 bomb being dropped.

I think the very nervous tenor of the CAP speakers hinted at their clear realization that bundling is the goal of the Obamacare Coding Initiative.

Now pathology could have collapsed under its own power or not, who knows but this is sure hastening the demise!

 

[emd123]

If it makes you all feel any better Pain took a bullet on 2014 CMS cuts, much worse than reported. We took an across the board 4% cut, which does not include a bundling, and effective 90% evisceration of our most reimbursed procedure, in office spinal cord stimulator trials.

90% !

It's an L code that doesn't factor into their "numbers." For Pain MDs that do this work in office, it amounts to an effective 15-20% overall slashing of collections. For someone trying to start up a practice ethically, practicing Pain the right way, it's devastating.

:bloodbath:

 

[yaah]

Yaah-

Per J. Myles at CAP, Obamacare has DIRECTLY led to the destruction of pathology in 2 ways I wasnt clear on prior to the webinar.

1.) Obamacare has given the CMS a greenlight to (illegally) ignore the RUC panel recommendations and establish their own coding system that is no longer in parallel to the CPT coding sent to private payors, the institution of the dreaded G-code system through the Correct Coding Initiative.

2.) Obamacare has also directly led to the ongoing and soon to be full bundling of Pathology services INCLUDING, yes INCLUDING anatomic path codes.

Once this over, all private pathology groups will dissolve, likely with less than a 3-4 week notice prior to the 2014, 2015 or 2016 bomb being dropped.

I think the very nervous tenor of the CAP speakers hinted at their clear realization that bundling is the goal of the Obamacare Coding Initiative.

Now pathology could have collapsed under its own power or not, who knows but this is sure hastening the demise!

Point 2 you are right on (I think) although i would say that this type of change was essentially inevitable whether obamacare passed or not. Everything in the health policy media and dialogue over the past 5 years has suggested this. But I would agree that bundling is a big problem and has to be handled correctly. Everyone hates it except health policy people because it "saves money" (read: Cuts payments). When health policy people talk about saving money they almost always refer to cutting reimbursement in some way or another.

My reason for saying this is to bring up the fact that complaining about Obamacare isn't really going to help a lot. If Obamacare is totally repealed (unlikely) these initiatives are still going to happen. The momentum is here. They are going to happen until they are proven to be a problem for whatever reason. And blaming Obama is not the solution. Unfortunately politicians have decided that they are either for it or against it, and they seemingly refuse to work to make the system better for everyone. This stinks.

As for point 1, G codes existed prior to the ACA, didn't they? First I heard of G codes for saturation prostate biopsies was prior to 2010 I thought. Maybe it's just increased utilization of these codes?

 

[LADoc00]

I maybe be wrong but I had NEVER EVER heard of a G code for Pathology until after the ACA was passed and these committees were birthed in the Beltway.

2010-2011 is when I first became aware of them.

 

[yaah]

Well I was still in training when I heard of new codes (G codes) applying to saturation biopsies, and I finished in 2009. Maybe they weren't called G codes then, who knows.

Regardless, I think this was inevitable.

We see many many prostate biopsies every year and I would wager less than 5% have more than 10 specimen containers.