Repealing obamacare bad for hospital employed physicians?

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donnie54

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http://www.investors.com/news/trump...es-into-cardiac-arrest-drug-wholesalers-rise/

I was reading this article and it seems like hospitals are gonna lose a ton of money if people lose their health insurance via ACA. For the first time, uninsured rate dropped under 10% and repealing it seems disastrous for hospitals, which will decrease hospital incomes, reflecting hospital employed physician salaries. Thoughts?

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My hospital isn't in network with the only ACA insurance available in my state so this won't be a problem.
 
Several of the big hospital systems in my area have previously dropped the plans for next year before the election.
 
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im sure there will be some that have problems. from the local level, however, how many hospitals are relying on obamacare funds for the 4% of the US population on the system?

otoh, from that article, insurance companies will revel in the fact that they were able to increase their fees so much during obamacare, and im 99% sure that they wont decrease them when obamacare is gone...
 
i suspect the whole plan by Obama/Clinton to make most physicians employees has been destroyed.
the next generation of liberals (probably Sanders type socialist/populists) will rise up in four years with a new plan.
Trump has a short time to turn things around. If Trump makes conservatives look good, the socialists may never get traction.
 
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depends on your area. this is state-specific. if there are any states that have decently paying ACA exchange plans, then maybe the hospitals suffer. most plans pay like crap, however, and have a ton of restrictions on what they cover.
 
otoh, from that article, insurance companies will revel in the fact that they were able to increase their fees so much during obamacare, and im 99% sure that they wont decrease them when obamacare is gone...
The only way they will is competition. In my area the BCBS carrier is the 800lb gorilla and they have been raising rates in the extreme with zero consequence. I think the federal government can help to make an environment that encourages more companies to participate. What they've been doing is the opposite, trying to punish and force insurance to do xyz. All they succeeded in doing was intimidating potential new players.
 
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Health care policy analyst Bob Laszewski will be speaking at the ASIPP annual meeting in Las Vegas April 20-22nd, 2017. Hope to see everyone there!

http://healthpolicyandmarket.blogsp...log+(Health+Care+Policy+and+Marketplace+Blog)

A few thoughts as all of this sinks in:
  • Some will tell you the Republicans are unprepared for repeal and replace. Wrong. There is a plan. Don't let anyone tell you there is not. The plan was written by Paul Ryan as part of his "Better Way" document released in June of this year. It is not in legislative form, but it is as detailed as the plan Bill Clinton or Barack Obama had the morning after they were elected. I fully expect Speaker Ryan to take the point on putting the legislative details on the table, which will generally follow this outline.
  • As I pointed out in my blog post earlier this morning, Obamacare will effectively be repealed. No ifs, ands, or buts about it. The Trump voters voted for him expecting that he and the Republicans would do it and there is no turning back. This will be the first if not one of the first agenda items. Speaker Ryan, at his press conference this morning, reaffirmed that.
  • The repeal part will be the easiest part––not a literal repeal but a defunding of the money used for the exchange subsidies, the Medicaid expansion, and that run the exchanges.
  • The much harder part will be the replacement. Republicans will say to Democrats, "Help us create the new insurance system or be responsible for the consequences." Some are saying the Democrats won't cooperate. Here is why they will. In 2018, there are 23 Democratic and two Independent Senators (who caucus with the Dems) that will be up for reelection––a great many in states that Donald Trump won last night! There is a clear mandate here to replace Obamacare. If these Democrats fight it and that arguably results in millions of people thrown off their coverage they will do so at their peril.
  • The best news here is that defunding and then replacement of Obamacare could ironically set the table for the first real bipartisan legislative effort in a very long time. The one we should have had in the first place.
  • As challenging as creating a replacement will be the transition period before the new plan can be operative. It is not possible to instantly replace the Obamacare policies and the exchanges overnight. There will need to be a transition period between the old and the new that will be at least a year, if not two, for the new market to be prepared and implemented.
  • I have to believe that the ongoing 2017 open enrollment will be a real problem for the insurers that are already losing lots of money in Obamacare. Healthy consumers, promised a new and cheaper plan by the Republicans, will likely hold back rather than pay the big prices and suffer with the big deductibles. That means fewer healthy people in the pool while the sick people stay with Obamacare during 2017.
  • Insurers will be asking a very important question this morning: Why should we stay with Obamacare during the transition and lose even more money while the program deteriorates at an accelerating rate? Beyond 2017, why should an insurer withstand more losses during what will likely be the transition year of 2018? I expect that Republicans will find themselves in the uncomfortable, but necessary, position of having to subsidize these losses in the transition or have no insurers for people. Don't forget the point I have been beating the drum on for the last three years––half of those with Obamacare compliant individual health policies do not get a subsidy. I expect the vast majority of these people, hit with the big premiums and deductibles, voted for Trump and the Republicans. If for no other reason, Republicans have to worry about supporting these people in the transition.
  • Obamacare may be dead law walking but it will be the only individual health insurance marketplace––and the place millions of people get their Medicaid coverage––for at least 2017, and very likely, 2018. Republicans will have to support it in the transition or face their own "If you like your health insurance you can keep it," debacle.
  • Can I coin a new term here? Trumpcare.
  • Will Republicans do a better job of paying attention to how the market works than Democrats did? I don't presume anything here. The Obamacare repeal and replace effort has left the station. No turning back. But, health care is hard. It is easier to screw it up than get it right. Democrats just learned that lesson. Republicans would do well to see what happened to the Democrats as sobering example of what not to do. A fully ideological Republican plan that doesn't pay attention to how this market really works could put the Republicans right back where the Democrats are today.
  • As Barack Obama said eight years ago, "Elections have consequences."
 
I am glad I am not a hospital CEO today. Monday, the job would have been nearly impossible with new regulations rolling out all the time and unclear impacts. Now it is literally impossible to predict the business environment in healthcare 60 days from now. It's like driving on a mountain pass during a whiteout, no visibility and maybe no margin of safety. Nobody should be getting bitter or dancing in the endzone right now IMO.
 
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Where this will go is a big unknown. For patients, allowing consumers to join buying consortiums would be the answer. Imagine if your state had 3 consumer/business groups that you could join and then this consortium with millions of covered lives would negotiate rates. The power would be reversed. This would be a huge win for patients.

How physicians would fare under this plan would be anyones guess, either much better or much worse than today.
 
Hospitals are inefficient and costly and bailed out by tax payers. they need to be drained just like the rest of the swamp...

Hospitals should be forced to operate based on the same CMS payment schedule that pp and concierge hospitals and ACSs. Hospitals have become local governments...
 
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Hospitals are inefficient and costly and bailed out by tax payers. they need to be drained just like the rest of the swamp...

Hospitals should be forced to operate based on the same CMS payment schedule that pp and concierge hospitals and ACSs. Hospitals have become local governments...
I agree but would rather argue that our schedule is too low. The hospital schedule is where all should be.
 
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Putting hospitals on the same schedule, stim, is entirely unrealistic, unless hospitals are allowed to deny care to the 50% of the population that cannot pay for their healthcare.

In addition, impatient care will suffer tremendously, because admin will hold on to their positions as long as possible. Who will get cut first as the chafe? Techs, aides, nurses, lab techs, and, of course, doctors.
Imagine 20 patients per nurse, no hospitalists and PP docs will once again have to come in on their own time and dime to round on inpatients...

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Putting hospitals on the same schedule, stim, is entirely unrealistic, unless hospitals are allowed to deny care to the 50% of the population that cannot pay for their healthcare.

In addition, impatient care will suffer tremendously, because admin will hold on to their positions as long as possible. Who will get cut first as the chafe? Techs, aides, nurses, lab techs, and, of course, doctors.
Imagine 20 patients per nurse, no hospitalists and PP docs will once again have to come in on their own time and dime to round on inpatients...

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Drain the hospital swamp period... youre a biased hospital employee . Your reponse is obvious.
 
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Putting hospitals on the same schedule, stim, is entirely unrealistic, unless hospitals are allowed to deny care to the 50% of the population that cannot pay for their healthcare.

In addition, impatient care will suffer tremendously, because admin will hold on to their positions as long as possible. Who will get cut first as the chafe? Techs, aides, nurses, lab techs, and, of course, doctors.
Imagine 20 patients per nurse, no hospitalists and PP docs will once again have to come in on their own time and dime to round on inpatients...

If a hospital is in a Medicaid expansion state, why the need for the same inflated fee schedule?

You've heard about the idea of block grants to states for Medicaid. How about block grants to hospitals to cover the uninsured?

No skimming off the top.
 
If a hospital is in a Medicaid expansion state, why the need for the same inflated fee schedule?

You've heard about the idea of block grants to states for Medicaid. How about block grants to hospitals to cover the uninsured?

No skimming off the top.
Or let the hospital charge more for inpatient services to cover the uninsured, since the hospital isn't giving away non-emergent services. Why does that elective gallbladder need to pay 4X compared to non-hospital facility?
 
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Or let the hospital charge more for inpatient services to cover the uninsured, since the hospital isn't giving away non-emergent services. Why does that elective gallbladder need to pay 4X compared to non-hospital facility?

Dont get it all to be honest.

Sounds like a bunch of nonsense.
 
20150429_growthinadministratorsopt.jpg
 
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Thats the game plan.

Cut procedures, physician fees, etc. Add in NP/PAs to replace PCPs/Anesthesiologists/other non surgical fields due to cost "effectiveness"

Increase administrators and "consultants" numbers and fees so they make huge dollars.

Overall cost of healthcare continues to increase but the money moves to the administrators and "consultants", big pharma, device companies, etc.

Winning!
 
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Heh, my favorite scam in economic statistics is to publish them in nominal dollars, rather than inflation-corrected real dollars.
I wonder if that was done in this case, there has been a lot of inflation between 1970 and 2009.
 
Heh, my favorite scam in economic statistics is to publish them in nominal dollars, rather than inflation-corrected real dollars.
I wonder if that was done in this case, there has been a lot of inflation between 1970 and 2009.

No scam here:

A Harvard Business Review analysis shows the healthcare workforce has grown by 75 percent since 1990, but 95 percent of new hires aren’t doctors.

A blogger for the Harvard Business Review recently crunched the numbers on healthcare employment and found something startling. From 1990 to 2012, the U.S. healthcare workforce grew by 75 percent. At a time when millions of Americans will soon enter the system under the Affordable Care Act (ACA), this seems like a welcome trend.

But there’s a catch. All but five percent of that job growth was in administrative staff, not doctors.

The ratio of doctors to other healthcare workers is now 1:16, up from 1:14 two decades ago. Of those 16 workers for every doctor, only six are involved in caring for patients—nurses and home health aids, for example. The other 10 are in purely administrative roles.

rest of article: http://www.healthline.com/health-news/policy-ten-administrators-for-every-one-us-doctor-092813#1
 
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http://www.nejm.org/doi/full/10.1056/NEJMp1614438?query=TOC

"Health policy debates could ignite beyond the ACA. Speaker Ryan supports major changes to Medicare and Medicaid. The new Congress and the Trump administration could enact large-scale tax cuts that reduce federal revenues and increase the budget deficit, creating pressures to constrain spending on government insurance programs. The 2015 House GOP plan called for transforming Medicare into a modified voucher system, raising Medicare’s age of eligibility, and converting federal Medicaid payments to states into block grants or per capita allotments. Pursuing those controversial policies, which would shift more costs onto older and lower-income Americans, could trigger a backlash. However, Trump may not support Ryan’s Medicare reform plans (though he has voiced support for block granting Medicaid). The expiration of funding for the Children’s Health Insurance Program also looms in 2017."
 


Good job not mentioning any of the negative consequences of the ACA.

See 5:48. Since when are ACOs/bundled payments "patient-centered"?


His white-house colleague has changed his tune:

http://www.wsj.com/articles/i-was-wrong-about-obamacare-1469997311

Concierge/Direct Primary Care is "patient-centered". ACOs/Bundling incentivizes that the bare-minimum be done, justified using EBM.


Interesting write-up from the conservative think-tank. Differs slightly from the Paul Ryan plan and disagrees with the notion that you can't provide increased insurance coverage without a mandate.

https://psmag.com/heres-what-a-reas...ent-to-obamacare-would-look-like-57561147cffa

https://freopp.org/transcending-oba...-a-new-approach-to-health-reform-5517bd69e0d8


If both sides agree on increasing coverage for the uninsured, the difference between the progressive and conservative mind-set (taxation/regulation/public health vs. personal responsibility)
 
Good job not mentioning any of the negative consequences of the ACA.

See 5:48. Since when are ACOs/bundled payments "patient-centered"?


His white-house colleague has changed his tune:

http://www.wsj.com/articles/i-was-wrong-about-obamacare-1469997311

Concierge/Direct Primary Care is "patient-centered". ACOs/Bundling incentivizes that the bare-minimum be done, justified using EBM.


Interesting write-up from the conservative think-tank. Differs slightly from the Paul Ryan plan and disagrees with the notion that you can't provide increased insurance coverage without a mandate.

https://psmag.com/heres-what-a-reas...ent-to-obamacare-would-look-like-57561147cffa

https://freopp.org/transcending-oba...-a-new-approach-to-health-reform-5517bd69e0d8


If both sides agree on increasing coverage for the uninsured, the difference between the progressive and conservative mind-set (taxation/regulation/public health vs. personal responsibility)
These guys are never gonna get it and Kocher's commentary saying he was wrong is not sufficient. He's only saying he was wrong about forcing hundreds of small practices all across the country to merge with hospitals or shut down. He still believes that there need not be any compromises with population-based healthcare. He's saying if the government incentives are just on a 3 year basis, that's gonna fix it??

These academics should go to a rural area and set up a medical clinic, where they can actually provide medical care like they were trained.
 
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its not "Medicaid" he is talking about. he is talking about an insurance company that offers a specific ACA exchange/insurance product, for patients who may not qualify for pure Medicaid.
 
Gruber was lying on tv the other day stating only the AcA plan premiums have risen and that commercial plan-premiums have not... total bs.
My small business plans have sky rocketed. Plus Gruber always avoids discussing deductibles and the ******* interviews never bring it up...
 
Hence the entire rust belt voting to anhilate the ACA.
 
But health care costs were rising significantly before the ACA...

Nothing is going to lower costs unless somehow insurance companies and big pharma are controlled. And that won't happen.


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Or accept that all costs rise to a certain extent and a better economy and more money in your pocket with additional tax credits and free interstate commerce (open markets) will stabilize healthcare... let's see, right?
 
But health care costs were rising significantly before the ACA...

Nothing is going to lower costs unless somehow insurance companies and big pharma are controlled. And that won't happen.

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Exactly. Instead of going after insurance companies/big pharma, they went after doctors and put the burden on the middle class. Why would you expect anyone in either of these groups to support the ACA?
 
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But health care costs were rising significantly before the ACA...

Nothing is going to lower costs unless somehow insurance companies and big pharma are controlled. And that won't happen.
Either full govt control or full patient control will lower costs. I'd rather it be the patient.
 
Exactly. Instead of going after insurance companies/big pharma, they went after doctors and put the burden on the middle class. Why would you expect anyone in either of these groups to support the ACA?
I wouldn't. but I do support attempts to improve the lot of those who are lower middle class, who were most harmed by medical bankruptcies

dont forget that attempst were made to target insurance companies and big pharma, and those were shot down - in no small part due to lobbying on Congress.
 
Attemp
I wouldn't. but I do support attempts to improve the lot of those who are lower middle class, who were most harmed by medical bankruptcies

dont forget that attempst were made to target insurance companies and big pharma, and those were shot down - in no small part due to lobbying on Congress.

Attempts... yeah right. That's why we need an unshackled leader that can attack big pharma and device companies and hospitals...
 
Attemp


Attempts... yeah right. That's why we need an unshackled leader that can attack big pharma and device companies and hospitals...

if trump can do that. if he can reign in big pharma and the insurance industry. i could even.... gulp.... consider voting for him in a second term. this is just not gonna happen.
 
if trump can do that. if he can reign in big pharma and the insurance industry. i could even.... gulp.... consider voting for him in a second term. this is just not gonna happen.
Bernie said he'd stand behind him if he goes after Wall Street, which trump has said he would do by raise their 15-20% bull**** tax rates .
 
Bernie said he'd stand behind him if he goes after Wall Street, which trump has said he would do by raise their 15-20% bull**** tax rates .

for hedge funds only. a very small step in the right direction
 
Trump has promised a lot of Sh't like all presidential contenders.."Drain the swamp", repeal obamacare, build a wall, etc
So far he has backtracked some on Obamacare, The wall will NOT be built, and his Cabinet selections so far are career politicians
Time will tell
 
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