State Public Options of WA and NV

[deleted941485]

---

Members don't see this ad.

The public option is now a reality in 3 states

We’re about to learn a lot about how a public health insurance option actually works in the US.

www.vox.com

Any thoughts from people working in these states?

 

[ProRealDoc]

I stopped reading when I came across this line:

"The unifying theme of these three bills is they try to reduce health care costs for consumers by tackling provider prices,”

 

[deleted941485]

I stopped reading when I came across this line:

"The unifying theme of these three bills is they try to reduce health care costs for consumers by tackling provider prices,”

I powered through, ITs a head I win tails you lose situation. If you don't accept the plans then they will tie it to other govt payers and make you accept. Costs aren't below what we wanted...screw you we will reduce reimbursement rates. Small businesses and individuals are gonna flock to these plans and the state will force you to accept them. "providers" are going to have to play hardball at some point. I thought places like CO and WA were good places to practice apparently not anymore.

 

[GassYous]

Right as they fuel massive inflation with trillions thrown around, making our money worth less and less. Thanks for nothing. Maybe get rid of the parasite class that sit around on their computers generating nothing of value?

 

[deleted941485]

Right as they fuel massive inflation with trillions thrown around, making our money worth less and less. Thanks for nothing. Maybe get rid of the parasite class that sit around on their computers generating nothing of value?

well according to CO, NV, and WA, its providers who generate nothing of value and need to be put in the financial equivalent of a dog collar. Seriously they will do everything short of shackling you and escorting you too and from your work.

But in all seriousness, anyone working in these states wanna weigh in? I took a look on gaswork to see what types of jobs are being advertised there its mostly AMCs maybe a few PPs but thats it.

 

[chessknt]

I’m glad it is being beta tested at a state level instead of a national one. I don’t think the public will accept a mass private office closure which is what will happen in response to the cutthroat cost controls behind the bills. Sucks to own a practice in these areas right now for sure

 

[raztes]

Despicable. Everything’s moved so far left these days. Taking more from the hard working and giving it away to the capable, but non working. Better beef up your savings now and hustle to pay off your couple hundred thousand in owed federal government generated student debt. Then cut hours and let the little wool over their eyes premeds take the brunt of the pain.

 

[GassYous]

Despicable. Everything’s moved so far left these days. Taking more from the hard working and giving it away to the capable, but non working. Better beef up your savings now and hustle to pay off your couple hundred thousand in owed federal government generated student debt. Then cut hours and let the little wool over their eyes premeds take the brunt of the pain.

The number of people who are perfectly fine but not working and receiving disability for made up bull**** like fibromyalgia, chronic lyme or long covid is just too damn high

 

[BLADEMDA]

Washington has capped provider payments at 160 percent of Medicare payment rates. Colorado has dictated that provider rates can’t be lower than 155 percent of Medicare; however, if insurers fail to achieve a 15-percent premium reduction, the state insurance commissioner has the authority to mandate lower rates. Nevada has said its public option can’t pay providers less than Medicare, but it otherwise leaves flexibility for the plan to hit its own premium-reduction targets.

One challenge in trying to set lower provider rates is that doctors and hospitals might simply choose not to accept the public option plan. That was Washington’s experience in its first year: Some hospitals refused to contract with the public plan, and since an adequate provider network isn’t possible without a hospital, the plan has only been available in 19 of the state’s 39 counties.

Washington is trying to correct that issue through recently signed legislation that will, among other things, require hospitals in large systems to participate in at least one public option plan. Nevada and Colorado, having seen Washington’s network-adequacy issues, are setting up their own provider participation requirements from the start.

“Nevada and Colorado clearly took a page from Washington’s experience,” Georgetown’s Corlette said.

In Nevada, if a provider accepts the state employee health plan, workers’ compensation, or Medicaid, they must accept the public option. Meanwhile, hospitals in Colorado will be required to accept the public option — with the threat looming that if costs don’t come down quickly enough, the state could step in and mandate lower reimbursement rates.

 

[BLADEMDA]

So, the future of this specialty is quite clear. 160 percent of Medicare. Roughly that equates to $33-$34 per unit. That's about half the commercial rates University's collect today and about 1/4 the top rates SEVO's group collects via NAPA.

So, SEVO should enjoy the remainder of his ride in Reno while it lasts because at $34 per unit he is going to get a BIG paycut. As the nation moves towards a socialist system the reimbursements are being tied to Medicare (as predicted). In 2021 many insurers are going to use the state healthcare plans as a starting point to negotiate the rates.

The collapse of reimbursement for this specialty will take time so don't jump out any windows just yet. If I had to guess I would say another 5-6 years before 160-180% of Medicare becomes the norm for Anesthesiology. Other specialties will be left relatively intact in terms of reimbursement at 130-140% of Medicare.

 

[Wolverines83]

Well, America, it’s been fun. Might be time to move on.

 

[chessknt]

So, the future of this specialty is quite clear. 160 percent of Medicare. Roughly that equates to $33-$34 per unit. That's about half the commercial rates University's collect today and about 1/4 the top rates SEVO's group collects via NAPA.

So, SEVO should enjoy the remainder of his ride in Reno while it lasts because at $34 per unit he is going to get a BIG paycut. As the nation moves towards a socialist system the reimbursements are being tied to Medicare (as predicted). In 2021 many insurers are going to use the state healthcare plans as a starting point to negotiate the rates.

The collapse of reimbursement for this specialty will take time so don't jump out any windows just yet. If I had to guess I would say another 5-6 years before 160-180% of Medicare becomes the norm for Anesthesiology. Other specialties will be left relatively intact in terms of reimbursement at 130-140% of Medicare.

Does anesthesia behave differently than other specialties? Cms pays based on Rvu and a conversion factor that, to my knowledge, is applied universally which is currently about $32 before gcpi. 30-40 units per day for an office based specialty is reasonable without an insane schedule—I assume that anesthesia gets multiples of that.

 

[aafisahar]

Despicable. Everything’s moved so far left these days. Taking more from the hard working and giving it away to the capable, but non working. Better beef up your savings now and hustle to pay off your couple hundred thousand in owed federal government generated student debt. Then cut hours and let the little wool over their eyes premeds take the brunt of the pain.

If America didn't have nukes, it'd have more in common with Eastern Europe than the developed world. The US is the most right wing country in the West.

 

[<(^_^)>]

So, the future of this specialty is quite clear. 160 percent of Medicare. Roughly that equates to $33-$34 per unit. That's about half the commercial rates University's collect today and about 1/4 the top rates SEVO's group collects via NAPA.

So, SEVO should enjoy the remainder of his ride in Reno while it lasts because at $34 per unit he is going to get a BIG paycut. As the nation moves towards a socialist system the reimbursements are being tied to Medicare (as predicted). In 2021 many insurers are going to use the state healthcare plans as a starting point to negotiate the rates.

The collapse of reimbursement for this specialty will take time so don't jump out any windows just yet. If I had to guess I would say another 5-6 years before 160-180% of Medicare becomes the norm for Anesthesiology. Other specialties will be left relatively intact in terms of reimbursement at 130-140% of Medicare.

Correct me if I’m wrong but it looks like the % Medicare cap is only for Washington. Nevada and Colorado actually mandate a lower bound, but have no upper limit technically. So really only Washington is potentially screwed.

 

[nimbus]

Despicable. Everything’s moved so far left these days. Taking more from the hard working and giving it away to the capable, but non working. Better beef up your savings now and hustle to pay off your couple hundred thousand in owed federal government generated student debt. Then cut hours and let the little wool over their eyes premeds take the brunt of the pain.

How is anybody’s student debt generated by the federal government?

 

[raztes]

How is anybody’s student debt generated by the federal government?

They sold us students the debt at a terrible interest rate to pay for school. You must be one of the lucky ones that had someone pay your way.

 

[nimbus]

They sold us students the debt at a terrible interest rate to pay for school. You must be one of the lucky ones that had someone pay your way.

??

I took out loans for medical school. It was my debt. Not the government’s. No one is forced to go to medical school or to take a government loan. You’re free to find the best rates from the government or private lenders so I don’t know why you are complaining. Are you saying you want affordable medical education like those socialist countries?

 

[GassYous]

??

I took out loans for medical school. It was my debt. Not the government’s. No one is forced to go to medical school or to take a government loan. You’re free to find the best rates from the government or private lenders so I don’t know why you are complaining. Are you saying you want socialist support for your medical education?

Hell yea i do

 

[chessknt]

??

I took out loans for medical school. It was my debt. Not the government’s. No one is forced to go to medical school or to take a government loan. You’re free to find the best rates from the government or private lenders so I don’t know why you are complaining. Are you saying you want socialist support for your medical education?

Arguably the unlimited educational lending from the government has enabled astronomical increases in educational costs so to some degree I could see the 'government-generated' angle of debt but I do agree that in the end you agree to take the debt on yourself.

 

[Sushirolls]

The only reason WA didn't set the rate to medicaid or Medicare equivalent was their pre-surveys showed no one would take it.

One article I read recently in the past few months shows only like 2000 people signed up for it patient wise.

I'm glad to see that hospitals and doctors were wise to not jump on signing up for it despite their rates better than medicare. It's nothing more than a 'first taste is free' tactic. I don't forsee people flocking to these when they utilize the state based exchange and start looking at all their options. Brand noteriety of 'blue cross blue shield' and the others carry weight. Some will sign up because the don't know what they are doing, but overall I think it will only be a minor component to the insurance industry, and without more aggressive legislation to force it on more people, it won't really go anywhere.

 

[BLADEMDA]

The only reason WA didn't set the rate to medicaid or Medicare equivalent was their pre-surveys showed no one would take it.

One article I read recently in the past few months shows only like 2000 people signed up for it patient wise.

I'm glad to see that hospitals and doctors were wise to not jump on signing up for it despite their rates better than medicare. It's nothing more than a 'first taste is free' tactic. I don't forsee people flocking to these when they utilize the state based exchange and start looking at all their options. Brand noteriety of 'blue cross blue shield' and the others carry weight. Some will sign up because the don't know what they are doing, but overall I think it will only be a minor component to the insurance industry, and without more aggressive legislation to force it on more people, it won't really go anywhere.

I disagree with your post. These State or federal plans should easily beat the cost of private plans as well as have very low or Zero deductibles. I foresee a future where about 1/2 the eligible workforce is enrolled in such a plan. This would bring the total number of CMS based plans to 2/3 of the overall market. But, these new plans will reimburse 160% of Medicare which only leaves out ONE specialty for decent reimbursement. I expect that specialty to become a casualty of the system (unlike others who think that specialty will be granted 300% of Medicare).

The country is definitely moving left and those who fail to see it do so at their own peril. This means more social programs, more holidays, more government run healthcare in terms of fixed reimbursement and higher taxes.

By gradually moving the country left on healthcare there will be more support among the public for these state/federal healthcare options. It's only a matter of time before employers see the opportunity to purchase these government plans for their employees. Right now the ACA is reserved for people who can't get employer sponsored healthcare or CMS.

 

[raztes]

Find a good job (above average pay and without midlevels), work hard and get out as soon as you possibly can.

 

[aneftp]

Problem with anesthesia compared to other specialities is the huge discrepancy in private vs Medicare rates. Makes zero sense an anesthesiologist for 4-5 unit colonoscopy 15-20 min procedure gets reimbursed $$600-800 for private and $90 for Medicare patient

vs GI docs get $600 for the actual physicians fee for private. And $200 for Medicare colonscopy. And whatever facility fee

So anesthesia Medicare billing is roughly 15 cents on the dollar compared to private.

 

[deleted941485]

Problem with anesthesia compared to other specialities is the huge discrepancy in private vs Medicare rates. Makes zero sense an anesthesiologist for 4-5 unit colonoscopy 15-20 min procedure gets reimbursed $$600-800 for private and $90 for Medicare patient

vs GI docs get $600 for the actual physicians fee for private. And $200 for Medicare colonscopy. And whatever facility fee

So anesthesia Medicare billing is roughly 15 cents on the dollar compared to private.

Medicare rates are abysmal in anesthesia and pretty low for many other specialties but then the a**hole bean counters point to Medicare or if they are feeling really randy that morning Medicaid rates and say LOOK John Q Public you're being robbed blind!! Medicare for all.

 

[BLADEMDA]

Medicare rates are abysmal in anesthesia and pretty low for many other specialties but then the a**hole bean counters point to Medicare or if they are feeling really randy that morning Medicaid rates and say LOOK John Q Public you're being robbed blind!! Medicare for all.

Medicare will become the benchmark. The Federal Option will pay 160%, maybe even 180% of Medicare. The goal will be to shift healthcare into a Federally FUNDED system. This means CMS + the public option will be 2/3 of all citizens in the USA. Once the left gets to the 2/3 mark it should be fairly easy to use taxes, incentives, fees, etc to "encourage" the remaining 1/3 to abandon private insurers. But, What I do see is a robust secondary insurance market for the vast majority of people to offer better coverage in terms of access to first class facilities. The poor and lower middle class will get the public plan while the upper middle class gets the secondary insurance plus the public plan.

 

[narcotics999]

So, the future of this specialty is quite clear. 160 percent of Medicare. Roughly that equates to $33-$34 per unit. That's about half the commercial rates University's collect today and about 1/4 the top rates SEVO's group collects via NAPA.

So, SEVO should enjoy the remainder of his ride in Reno while it lasts because at $34 per unit he is going to get a BIG paycut. As the nation moves towards a socialist system the reimbursements are being tied to Medicare (as predicted). In 2021 many insurers are going to use the state healthcare plans as a starting point to negotiate the rates.

The collapse of reimbursement for this specialty will take time so don't jump out any windows just yet. If I had to guess I would say another 5-6 years before 160-180% of Medicare becomes the norm for Anesthesiology. Other specialties will be left relatively intact in terms of reimbursement at 130-140% of Medicare.

Sevo's group is collecting 120$/unit but paying less than 40/units to the MDs?

Why the CMS rates for our specialty are so low? I once asked an orthpod; he said that he would do ok with CMS rates. In addition, much less paper work and other administrative headache for him.

 

[chessknt]

Again what are people referencing for specialty based cms rates? Is there a document somewhere? Medicare uses a universal conversion factor and specialty pay difference exists because of rvus not the conversion rate.

 

[BLADEMDA]

Sevo's group is collecting 120$/unit but paying less than 40/units to the MDs?

Why the CMS rates for our specialty are so low? I once asked an orthpod; he said that he would do ok with CMS rates. In addition, much less paper work and other administrative headache for him.

NAPA has many different Payers/Insurance companies. Medicare pays $22 per unit while one private insurer like UHC may pay $120 per unit. BC/BS may pay $90 per unit. The blended unit rate is the average rate across all payers and that is around $50 per unit. In Sevo's group NAPA takes a 20% cut leaving the MDs $40 per unit.

For many groups the blended unit is $40 per unit before the AMC takes its cut.

 

[kmurp]

Medicare will become the benchmark. The Federal Option will pay 160%, maybe even 180% of Medicare. The goal will be to shift healthcare into a Federally FUNDED system. This means CMS + the public option will be 2/3 of all citizens in the USA. Once the left gets to the 2/3 mark it should be fairly easy to use taxes, incentives, fees, etc to "encourage" the remaining 1/3 to abandon private insurers. But, What I do see is a robust secondary insurance market for the vast majority of people to offer better coverage in terms of access to first class facilities. The poor and lower middle class will get the public plan while the upper middle class gets the secondary insurance plus the public plan.

I think that’s how it works in Australia.

 

[BLADEMDA]

From the ASA:

The ASA Executive Committee recently discussed health care priorities, including Medicare for All, with key committees and House and Senate leadership staff. Specifically, they met with the House Congressional Progressive Caucus to share concerns regarding the potential impact of the new legislation on anesthesiologists and anesthesia services.
Also in March 2021, Senators Tim Kaine (D-VA) and Michael Bennet (D-CO) re-introduced their “Medicare X” legislation (S. 386), which would provide a public option plan based on Medicare rates (up to 150% at the discretion of the secretary) in jurisdictions with only one (or no) insurers on the federal or state exchange.
ASA is also closely monitoring budget reconciliation negotiations, which may include provisions to expand coverage. One such provision has been dubbed “Medicare for More,” which would lower the age for Medicare eligibility to those aged 55 or 60 years and expand the benefit to include dental, vision, and hearing care. The eligibility change could add as many as 18 million new Medicare beneficiaries to the system.
Budget reconciliation is an intricate legislative mechanism that revises previously adopted federal budget and spending measures under fast-tracked consideration and requires a simple majority vote (only 51 votes needed) in the Senate for adoption.

 

[Sushirolls]

Medicare will become the benchmark. The Federal Option will pay 160%, maybe even 180% of Medicare. The goal will be to shift healthcare into a Federally FUNDED system. This means CMS + the public option will be 2/3 of all citizens in the USA. Once the left gets to the 2/3 mark it should be fairly easy to use taxes, incentives, fees, etc to "encourage" the remaining 1/3 to abandon private insurers. But, What I do see is a robust secondary insurance market for the vast majority of people to offer better coverage in terms of access to first class facilities. The poor and lower middle class will get the public plan while the upper middle class gets the secondary insurance plus the public plan.

This could only work in states that don't have certificate of need. CON states typically hitch the opening of a new Psych hospital or any hospital to accepting medicare/medicaid as part of the state Department of Health licensing it. So in summary only a handful of states might not be bogged down by such limiting bureaucracy to truly create such a two tiered system.

I do believe it possible the Indian reservations might be able to step up to create their own separate tourist like medical hospitals and operate outside of the usual state/federal based jurisdiction.