To all residents: the Massachusetts Revolution

[exPCM]

A major revolution has started in Massachusetts which will almost certainly spread to other states and profoundly affect the future of all med students and residents as they enter practice:
Massachusetts is creating an "affordable health care plan" that will be required for all small businesses with less than 50 employees to offer it to their employees. This plan sets physician maximum pay at 110% of prevailing Medicare rates, when the average commercial payor in the market pays a rate of 140%
Here's the kicker...
Doctors will be required to accept this plan as a condition of licensure in the state. This licensure mandate has already been approved by the Senate and is about to be approved by the house.
All doctors must accept payment at the lowest of the statutory reimbursement rate, or the applicable contract rate with the carrier for the carrier's product offering with the lowest level benefit plan available to the general public within the marketplace, whichever is lower, and may not balance bill such person for any amount in excess of the amount paid by the carrier.
Here is the legislation: http://www.mass.gov/legis/bills/house/186/ht04/ht04452.htm
Comments:
This is what we have to look forward to. But, at least those in MA can flee to a neighboring state. Where are we to go when this applies to the entire nation? What do we do when all states, now faced with huge numbers of new unfunded medicaid patients with no doctors to see, start to require participation in medicaid as a condition of licensure?
Slavery forced upon physicians. Oh and I know some will scream that you have a choice but this is not a choice, this is mandated participation and you will be forced to see them, not limit slots available.
This is not why the majority of us spent 12 years or more training, to become puppets of the state. Insane.

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[tkim]

I'm in the ER, so I can't refuse to see anyone anyway.

 

[deleted87716]

Massachusetts is a perfect example of why insurance mandates don't control costs. All they do is increase utilization. Of course, this is totally lost on the Democrats, who can't see beyond their political goal to pass "healthcare reform" at all costs.

"A smart man learns from his mistakes. A wise man learns from the mistakes of others."

 

[Law2Doc]

Actually if I was Vermont or Rhode Island, I would be licking my chops at the prospect of a big improvement to my commercial tax base, and elimination of any healthcare provider shortages in my state when all the doctors relocate all their practices across the border from MA. Don't expect the other states to follow suit. Expect them to capitalize on this misstep.

 

[smq123]

Applicable to all physicians, not just residents. Moving to Topics in Healthcare.

 

[orangele]

I think that it will be a classic teaching moment for politicians that you cannot successfully mandate lower costs in a free society without reducing the supply of whatever goods or services you are attempting to control. Of course most politicians do not appear to learn very easily.

Lets see what happens in a few years. Can you say physician shortage in Massachusetts?

 

[lipomas]

This seems like a peculiar bit of legislation. It would affect hospital income too, correct? It begs the question of what an "Affordable Health Plan" is and how many people are actually covered under this. Is this like the Massachusetts public option or something? I don't see where it says it will apply to all private insurance plans - just the "affordable health plan"/lowest benefit level that they provide. Am I wrong? Before presuming that this is going to cause physician flight from MA, it might be worth trying to figure out just how many people this is going to cover. Because if it is only going to cover people who otherwise wouldn't have ANY insurance, then this will be payment that hospitals and doctors would not have gotten in the first place. And it will be much higher than medicaid levels, which may have been the original intent.

I realize it's more fun and easy to jump to conclusions, but it's more productive and helpful to get all the information before doing so.

What is also extremely odd about this is that the representative listed hails from West Newbury. I lived in Mass at one point. Essex county (and specifically northeastern essex county) is the most conservative part of the state - fiscally conservative. It was the last part of the state to convert to a democratic representative.

 

[medicinesux]

As if dropping hundreds of dollars a year on physician renewal fees and taking BS CME classes weren't painful enough, now they are going to shove this crap down physicians throats to maintain a medical license??? Just when you thought it couldn't possibly get any worse, it always does. Don't think for a second that this proposal only pertains to Massachusetts. This bill forebodes what is coming to the entire nation when Obamacare finally sets in.

 

[MOHS_01]

Oh, it gets better -- this was emailed to me earlier today:

Just heard that there's a "situation" in MA...ins carriers there were told they could not raise premiums, so they stopped selling policies. The Gov decided to sue them to FORCE them to SELL policies...ins carriers refused, so they are headed to court.

I'm SHOCKED, I tell you, just SHOCKED...

http://www.boston.com/business/heal...ass_health_insurers_halt_new_coverage_offers/

http://www.boston.com/business/heal...rers_plead_rate_case_judge_to_rule_by_monday/

 

[Bobblehead]

I had to root around for this on the MMS website and couldn't find anything there on a quick search. However Google turns this up and the Mass Medical Society has already taken up a position on the subject.

http://www.heartland.org/healthpoli..._Doctor_Payments_Could_Lead_to_Shortages.html

Mario E. Motta, M.D., president of the Massachusetts Medical Society (MMS), strongly opposes the proposal.

"It will pass over our dead body," Dr. Motta said.

 

[badasshairday]

hahaha. Let it pass. Then watch physicians jump ship. Stupid politicians. I'm a student, definitely will not be applying to any residency programs or jobs in the future in Massachusetts.

 

[dAnthony1918]

This is an outrage.. Massachusetts' physicians should post what the state is forcing them to do on every single one of their offices and have all of their patients read it. Now that the state regulates their pay they are technically employees of the state and should form a union. Every physician should refuse licensure from the state at the same time for a month and the state will bend immediately. They don't understand that medicine unlike almost every government social program is an essential service that means we have the leverage. Doctors need to realize enough is enough and tell their patients that the state forced them to do this. As much as we care for our patients, the state is taking advantage of our kindness and that is wrong. Now with the federal government following in Mass failed footsteps, in time we will all wonder where is Dr. John Galt when we need him.

 

[Slack3r]

It's funny how everyone supporting Obamacare said this kind of stuff wouldn't happen. It already has, who wants to start a pool as to when this goes nationwide?

 

[JaggerPlate]

WOW. Unreal.

 

[bronx43]

It's funny how everyone supporting Obamacare said this kind of stuff wouldn't happen. It already has, who wants to start a pool as to when this goes nationwide?

I don't know anyone supporting Obamacare, who doesn't secretly want this to happen.

 

[Themistocles]

Until recently, about 3/21 to be exact, I was 95% certain I wanted to pursue a surgical specialty. Not so sure anymore, and reading something like this only dissuades me further. I felt prepared to handle all the sacrifice such a path entails when the end result would be the ability to practice my trade with autonomy and on my own terms; but do I really want to sacrifice so much of my life so that I can finish a fellowship at the age of 36 with 300k in debt, and find that I've earned a spiffy new dog collar making me some slimy politician's b*tch?

I guess I knew that some changes were a comin' when I signed up for this, but it seems those changes are coming awful hard and awful fast. Currently interested in ways to earn as comfortable a living as possible with as little commitment as possible.

 

[MOHS_01]

Until recently, about 3/21 to be exact, I was 95% certain I wanted to pursue a surgical specialty. Not so sure anymore, and reading something like this only dissuades me further. I felt prepared to handle all the sacrifice such a path entails when the end result would be the ability to practice my trade with autonomy and on my own terms; but do I really want to sacrifice so much of my life so that I can finish a fellowship at the age of 36 with 300k in debt, and find that I've earned a spiffy new dog collar making me some slimy politician's b*tch?

I guess I knew that some changes were a comin' when I signed up for this, but it seems those changes are coming awful hard and awful fast. Currently interested in ways to earn as comfortable a living as possible with as little commitment as possible.

I feel your pain. Our best hope is to educate the profession as well as the people, and help them understand the implications of the bill along with its inevitable ramifications down the road.

 

[bronx43]

Until recently, about 3/21 to be exact, I was 95% certain I wanted to pursue a surgical specialty. Not so sure anymore, and reading something like this only dissuades me further. I felt prepared to handle all the sacrifice such a path entails when the end result would be the ability to practice my trade with autonomy and on my own terms; but do I really want to sacrifice so much of my life so that I can finish a fellowship at the age of 36 with 300k in debt, and find that I've earned a spiffy new dog collar making me some slimy politician's b*tch?

I guess I knew that some changes were a comin' when I signed up for this, but it seems those changes are coming awful hard and awful fast. Currently interested in ways to earn as comfortable a living as possible with as little commitment as possible.

Autonomy? You mean money? Nothing in this bill says you can't practice with medical autonomy. It simply low-balls you financially.

 

[Sneezing]

Money is heavily tied into autonomy. The person who pays makes the rules.

 

[dAnthony1918]

the only true independence.. is financial independence

 

[bronx43]

Money is heavily tied into autonomy. The person who pays makes the rules.

This makes no sense in relation to what he's saying. There is no autonomy in this day and age in medicine.

 

[dilated]

Autonomy? You mean money? Nothing in this bill says you can't practice with medical autonomy. It simply low-balls you financially.

Incorrect. While this bill doesn't do it in particular (it's kind of hard to destroy EVERYTHING in a one page bill), MA and the national health care reform both push a move towards requiring all physician payment to be in the form of Accountable Care Organizations instead of fee for service. In this scheme, instead of doctors receiving payment from the patient's payor, all payment goes to the hospital organization which then doles it out among physicians as it sees fit.

And per this bill you will then be required to participate in this system as a condition of having a medical license. If you don't see how that represents the complete end of medical autonomy, then I can't help you.

 

[MOHS_01]

Incorrect. While this bill doesn't do it in particular (it's kind of hard to destroy EVERYTHING in a one page bill), MA and the national health care reform both push a move towards requiring all physician payment to be in the form of Accountable Care Organizations instead of fee for service. In this scheme, instead of doctors receiving payment from the patient's payor, all payment goes to the hospital organization which then doles it out among physicians as it sees fit.

And per this bill you will then be required to participate in this system as a condition of having a medical license. If you don't see how that represents the complete end of medical autonomy, then I can't help you.

What he (she?) said.

The direction of these bills (both MA and ObamaCare) will expedite the "corporatization" of medicine; they politicize payment to an undue level and will transform the industry into one of rent seekers. It is by design; it is easier to control and direct the few vs the many.

 

[badasshairday]

What if you are not a hospital based physician?

 

[MOHS_01]

What if you are not a hospital based physician?

My gut feeling is that there will be the incentive to exclude you. ACOs is simply capitation by another name; as such, dollars referred out of the collaborative agreement may be viewed as losses. No one likes losses.

 

[JaggerPlate]

Just a fat government push into big, HMO style managed care.


huge shocker ...

 

[JaggerPlate]

So I have a question here ...

hypothetical - this piece of **** goes through. Say I'm a derm in MA who only does cosmetic stuff. Fillers, lasers, etc ... I haven't done med derm in years. I go to renew my license ... do I have to now offer botox and laser peels for some sort of reimbursement through this health care thingey or not get my license renewed?????

 

[dilated]

What if you are not a hospital based physician?

Because the goal of this is to make providers financially responsible for things like needing to be admitted for a CHF exacerbation, there's no question that chronic diseases are going to be lumped in. Non-hospital based physicians will need to be forced into a larger organization so they can be held financially responsible for outcomes. The govt will pay a certain amount per CHF patient per year which will have to cover any hospitalizations, thus theoretically "incentivising" doctors to decrease the rate of CHF hospitalizations.

It has been explicitly stated that shifting the burden of risk for outcomes onto providers is a good thing. Obviously, only large organizations will be able to tolerate the actuarial risks involved. Which is another benefit from the government perspective, just look at the "models" Obama, Orszag and crew have cited which are all huge self-contained provider systems like Kaiser and Geisinger.

Say I'm a derm in MA who only does cosmetic stuff.

If you don't accept ANY commercial insurance you're probably under the radar for now. It's such a small percentage of doctors that it's not worth their trouble. If that balloons into a large enough percentage to piss off politicians, though, it's just a stroke of the pen to draft you in too. If you liked mandatory CME, you'll love not being allowed to renew your license unless you've seen enough insurance patients.

 

[JaggerPlate]

If you don't accept ANY commercial insurance you're probably under the radar for now. It's such a small percentage of doctors that it's not worth their trouble. If that balloons into a large enough percentage to piss off politicians, though, it's just a stroke of the pen to draft you in too. If you liked mandatory CME, you'll love not being allowed to renew your license unless you've seen enough insurance patients.

If it ever came to this point where docs were mandated to take x amount of patients by the government, would they then be able to unionize and strike??? Fight bullsh*t fire with bullsh*t fire, if you will??

Even for them, this is still shocking to me. Would any other profession that didn't START as a government profession take this??? Would plumbers forcefully accept seeing x% welfare patients per month for pennies because the government said so???

 

[Themistocles]

I feel your pain. Our best hope is to educate the profession as well as the people, and help them understand the implications of the bill along with its inevitable ramifications down the road.

In the past I've optimistically, probably foolishly, held out hope that physicians can organize themselves into some cohesive and effective lobbying group before it's too late. It is my understanding that the AMA was once a powerful force that looked out for physician's interests; clearly today it has little power and even less interest in advocating for physicians. It's a shame there is no organized force to represent to both politicians and the public at large the great majority of physicians (at least in private practice, and in my experience) who are disgusted with many of the changes afoot. There needs to be either a coup within the AMA or the founding of a rival group which would do what the AMA should be doing. Although I don't really see either happening anytime soon.

 

[deleted87716]

An interesting article: http://www.aynrand.org/site/News2?id=13873

 

[docB]

If it ever came to this point where docs were mandated to take x amount of patients by the government, would they then be able to unionize and strike???

I would think not. Though there are govt. employee unions the ones deemed "essential" like the air traffic controllers and undoubtedly doctors are prohibited from striking.

 

[JaggerPlate]

I would think not. Though there are govt. employee unions the ones deemed "essential" like the air traffic controllers and undoubtedly doctors are prohibited from striking.

I love these words ... government, forced, prohibited

Land of the freeeeee.

 

[DoctwoB]

Because the goal of this is to make providers financially responsible for things like needing to be admitted for a CHF exacerbation, there's no question that chronic diseases are going to be lumped in. Non-hospital based physicians will need to be forced into a larger organization so they can be held financially responsible for outcomes. The govt will pay a certain amount per CHF patient per year which will have to cover any hospitalizations, thus theoretically "incentivising" doctors to decrease the rate of CHF hospitalizations.

It has been explicitly stated that shifting the burden of risk for outcomes onto providers is a good thing. Obviously, only large organizations will be able to tolerate the actuarial risks involved. Which is another benefit from the government perspective, just look at the "models" Obama, Orszag and crew have cited which are all huge self-contained provider systems like Kaiser and Geisinger.



If you don't accept ANY commercial insurance you're probably under the radar for now. It's such a small percentage of doctors that it's not worth their trouble. If that balloons into a large enough percentage to piss off politicians, though, it's just a stroke of the pen to draft you in too. If you liked mandatory CME, you'll love not being allowed to renew your license unless you've seen enough insurance patients.

I personally feel that ACO's aren't a bad idea. While physicians often say that defensive medicine is the reason there are so many unnecessary tests/procedures (and it may be a big factor), the main reason is that there is a financial incentive to order those test (especially for private physicians who own their own equipment and need to pay off the capital costs). I don't blame the doctors for this, I think that its unreasonable to expect anyone to go against financial incentives, and most of the extraneous treatment likely comes on borderline cases. That being said, as a future physician, I don't want to have to choose between courses of action best for the patient vs. best for my wallet. In an ideal system, those actions would be one and the same.

You are correct, however, in pointing out that there is a natural risk in pay-per-outcome type systems, as even with perfect care there can be adverse outcomes, which creates a large need to aggregate that risk.

 

[tkim]

While physicians often say that defensive medicine is the reason there are so many unnecessary tests/procedures (and it may be a big factor), the main reason is that there is a financial incentive to order those test (especially for private physicians who own their own equipment and need to pay off the capital costs).

I'd be curious to hear what's the source of this claim. Few office-based practices own their own lab equipment, much less X-ray equipment, and simply send their patients to Quest for lab work or a radiology office for films.

So, let's hear it.

 

[MOHS_01]

I personally feel that ACO's aren't a bad idea. While physicians often say that defensive medicine is the reason there are so many unnecessary tests/procedures (and it may be a big factor), the main reason is that there is a financial incentive to order those test (especially for private physicians who own their own equipment and need to pay off the capital costs). I don't blame the doctors for this, I think that its unreasonable to expect anyone to go against financial incentives, and most of the extraneous treatment likely comes on borderline cases. That being said, as a future physician, I don't want to have to choose between courses of action best for the patient vs. best for my wallet. In an ideal system, those actions would be one and the same.

You are correct, however, in pointing out that there is a natural risk in pay-per-outcome type systems, as even with perfect care there can be adverse outcomes, which creates a large need to aggregate that risk.

Perhaps you do not fully appreciate the predictable responses and changes that will likely result from the incentive structure that is created with ACOs. Consolidation is not always a bad thing -- depending upon the reason for doing so and the result of the consolidation -- but it generally is of detriment to the public when the impetus for the consolidation is regulation. If you are not familiar with the concepts of economic rents and rent seeking behaviors, I would recommend becoming so as this is the incentive structure that ACOs and centralization employs.

 

[DoctwoB]

Perhaps you do not fully appreciate the predictable responses and changes that will likely result from the incentive structure that is created with ACOs. Consolidation is not always a bad thing -- depending upon the reason for doing so and the result of the consolidation -- but it generally is of detriment to the public when the impetus for the consolidation is regulation. If you are not familiar with the concepts of economic rents and rent seeking behaviors, I would recommend becoming so as this is the incentive structure that ACOs and centralization employs.

I am familiar with the issues of economic rents, but I'm curious about what you feel the negatives of ACOs are in theory (assuming that they are well run with incentives that reward good care/punish poor care, a large assumption I know)

What I can think of is:

-Reduced physician autonomy from operating in an ACO and the "death" of the traditional single-physician practice

The reduced levels of autonomy is indeed disturbing, but if an ACO is well set up then the pressure to help the groups bottom line will also be pressure to provide good care

-Decreased competition between physicians consolidation into larger groups potentially leading to worse care at higher prices

Possible, but given that prices are set by third parties anyway, I'm not sure if it truly applies

On the benefit side there is:

-ACOs can operate efficiently under large group practices because risk is sufficiently spread across enough physicians

-Reduced overhead per physician from practice consolidation, as well as the normal benefits of consolidation (better call schedule, vacation time, etc.)

-potential to provide better care at lower cost

 

[Dr Oops]

I am familiar with the issues of economic rents, but I'm curious about what you feel the negatives of ACOs are in theory (assuming that they are well run with incentives that reward good care/punish poor care, a large assumption I know)

What I can think of is:

-Reduced physician autonomy from operating in an ACO and the "death" of the traditional single-physician practice

The reduced levels of autonomy is indeed disturbing, but if an ACO is well set up then the pressure to help the groups bottom line will also be pressure to provide good care

-Decreased competition between physicians consolidation into larger groups potentially leading to worse care at higher prices

Possible, but given that prices are set by third parties anyway, I'm not sure if it truly applies

On the benefit side there is:

-ACOs can operate efficiently under large group practices because risk is sufficiently spread across enough physicians

-Reduced overhead per physician from practice consolidation, as well as the normal benefits of consolidation (better call schedule, vacation time, etc.)

-potential to provide better care at lower cost

The biggest problem I see is who defines what good care is? How do you factor in patient non compliance? It is too easy to screw the physician even when its not their fault.

 

[cpants]

This is an outrage.. Massachusetts' physicians should post what the state is forcing them to do on every single one of their offices and have all of their patients read it. Now that the state regulates their pay they are technically employees of the state and should form a union. Every physician should refuse licensure from the state at the same time for a month and the state will bend immediately. They don't understand that medicine unlike almost every government social program is an essential service that means we have the leverage. Doctors need to realize enough is enough and tell their patients that the state forced them to do this. As much as we care for our patients, the state is taking advantage of our kindness and that is wrong. Now with the federal government following in Mass failed footsteps, in time we will all wonder where is Dr. John Galt when we need him.

This is the first thing I thought of when reading this thread too. Forcing doctors and insurance companies to operate at losses for "the good of the people". It's right out of Atlas Shrugged.

 

[deleted87716]

This is the first thing I thought of when reading this thread too. Forcing doctors and insurance companies to operate at losses for "the good of the people". It's right out of Atlas Shrugged.

"I quit when medicine was placed under State control, some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything – except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only 'to serve.' That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards – never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind – yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of a man who resents it – and still less safe, if he is the sort who doesn't."

 

[MOHS_01]

This is the first thing I thought of when reading this thread too. Forcing doctors and insurance companies to operate at losses for "the good of the people". It's right out of Atlas Shrugged.

Whenever we (local MDs) need to recruit someone MA is always the first place we start looking. We have been remarkably successful with this tactic... and seek to empower the Galt that lives in us all.

 

[jp104]

dfgfdnbbnfggh

 

[Slack3r]

Guess I can strike Mass. off the list of states to set up shop.

You're naive if you think this won't happen in other states as well. I'd bet both testicles at least Cali and NY will follow suit.

 

[jp104]

You're naive if you think this won't happen in other states as well. I'd bet both testicles at least Cali and NY will follow suit.

dfgfgb

 

[JaggerPlate]

What do you guys think is more fun ... the new DNP derm residency issue or the issues in MA???

 

[medsurg2010]

A major revolution has started in Massachusetts which will almost certainly spread to other states and profoundly affect the future of all med students and residents as they enter practice:
Massachusetts is creating an "affordable health care plan" that will be required for all small businesses with less than 50 employees to offer it to their employees. This plan sets physician maximum pay at 110% of prevailing Medicare rates, when the average commercial payor in the market pays a rate of 140%
Here's the kicker...
Doctors will be required to accept this plan as a condition of licensure in the state. This licensure mandate has already been approved by the Senate and is about to be approved by the house.
All doctors must accept payment at the lowest of the statutory reimbursement rate, or the applicable contract rate with the carrier for the carrier's product offering with the lowest level benefit plan available to the general public within the marketplace, whichever is lower, and may not balance bill such person for any amount in excess of the amount paid by the carrier.
Here is the legislation: http://www.mass.gov/legis/bills/house/186/ht04/ht04452.htm
Comments:
This is what we have to look forward to. But, at least those in MA can flee to a neighboring state. Where are we to go when this applies to the entire nation? What do we do when all states, now faced with huge numbers of new unfunded medicaid patients with no doctors to see, start to require participation in medicaid as a condition of licensure?
Slavery forced upon physicians. Oh and I know some will scream that you have a choice but this is not a choice, this is mandated participation and you will be forced to see them, not limit slots available.
This is not why the majority of us spent 12 years or more training, to become puppets of the state. Insane.

Ex-PCM,

Where is the licensure mandate in the link to the bill you posted? Maybe I missed it in the text (and I'm not a lawyer), so could you please explain where it says we have to take the plans with 110% to have a license?

This is what I see: "Every health care provider licensed in the commonwealth which provides covered services to a person covered under "Affordable Health Plans" must provide such service to any such person, as a condition of their licensure, and must accept payment at the lowest of the statutory reimbursement rate, an amount equal to the actuarial equivalent of the statutory reimbursement rate, or the applicable contract rate with the ca rrier for the carrier’s product offering with the lowest level benefit plan available to the general public within the connector, other than the young adult plan, and may not balance bill such person for any amount in excess of the amount paid by the carri er pursuant to this section, other than applicable co-payments, co-insurance and deductibles. "

Which I take to mean that if you decide to take patients covered under "affordable health plans" then you take the 110% reimbursement rate. I am not seeing where it says any provider MUST take patients with "affordable health plans." Unless everyone has affordable health plans?

I'd like to have concrete evidence this is what is happening before I believe it (denial is my coping mechanism).

Thanks

 

[Slack3r]

How many of these patients would you technically have to see? Lots of doctors don't see new patients, couldn't you see like 2 Commonwealth patients and still be in compliance with the law? How does that work?

 

[Dr Oops]

How many of these patients would you technically have to see? Lots of doctors don't see new patients, couldn't you see like 2 Commonwealth patients and still be in compliance with the law? How does that work?

Doesnt matter.

Right now it could be one patient. But more doctors move you of mass and then they have to make it 2 etc.

 

[exPCM]

Ex-PCM,

Where is the licensure mandate in the link to the bill you posted? Maybe I missed it in the text (and I'm not a lawyer), so could you please explain where it says we have to take the plans with 110% to have a license?

This is what I see: "Every health care provider licensed in the commonwealth which provides covered services to a person covered under "Affordable Health Plans" must provide such service to any such person, as a condition of their licensure, and must accept payment at the lowest of the statutory reimbursement rate, an amount equal to the actuarial equivalent of the statutory reimbursement rate, or the applicable contract rate with the ca rrier for the carrier’s product offering with the lowest level benefit plan available to the general public within the connector, other than the young adult plan, and may not balance bill such person for any amount in excess of the amount paid by the carri er pursuant to this section, other than applicable co-payments, co-insurance and deductibles. "

Which I take to mean that if you decide to take patients covered under "affordable health plans" then you take the 110% reimbursement rate. I am not seeing where it says any provider MUST take patients with "affordable health plans." Unless everyone has affordable health plans?

I'd like to have concrete evidence this is what is happening before I believe it (denial is my coping mechanism).

Thanks

Read the bill again. Docs are really angry about this on Sermo.
Look at: "A provider that participates in a carrier’s network or any health benefit plan shall not refuse to participate in the carrier’s network with respect to the “Affordable Health Plan”.
So if you take part in any health plan you are under the mandate. The only docs who are not would be docs who are 100% cash only and don't participate in any plan.

 

[medsurg2010]

Thanks Ex-PCM. I see now.

Since you're plugged into this, here is what concerns me-- I can see a day that the federal government makes it mandatory for states to have this exact licensure mandate in order to accept federal medicaid money.

So, the feds say "you can't have medicaid money unless a requirement for a physician license in your state is to accept x% of medicaid in your practice"... I am especially concerned that this will happen with the upcoming huge expansion of medicaid.

Are you aware of any talk of this?