On Thu, May 20, 2010 at 6:15 PM, Jerry Barnes <[email protected]> wrote: > > "Those are all legitimate concerns and ones that were problems before health > insurance reform passed." > > No doubt. Unfortunately, at least to me, it doesn't seem like a lot of > these issues were addressed. Medicare will still not be an attractive > option for doctors. Some Illegals are still getting health care at > tax-payer expense. Finally, there is still a looming shortage of general > care physcians.
Medicare is a weird beast that is obviously a result of political infighting. Part B (which is what we are talking about with normal doctor visits) has had its formula changed a number of times. Medicare assigns RVUs (relative value units) to various procedures and items and those are used as the basis for billing. This was combined with a geographic adjustment factor and then converted to dollars. But then doctors started to put in a whole bunch of extraneous billing items (the whole fee for service thing) so Medicare responded by putting in a volume component that started decreasing the rate as line item billing by a physician increased. That whole model changed, however, when Republicans passed the 97 budget that made substantial changes in Medicare. Instead of just paying out on RVUs, Medicare was given an annual payout budget and if physician billing was outstripping the planned rate part way through they year, Medicare would have to change the RVU values part way through the year so that they would come under budget. They set up what they said was a "sustainable growth rate". Suffice to say, the established sustainable growth rate has never been anywhere close to what changes in medical costs actually have been. This means that every year, by law, Medicare has to tell physicians that they are going to cut reimbursement rates to be in line with the SGR. Some years, Congress overrides this and sets the rates to be roughly what they were the previous year. The SGR from 1997 still says they should be dropping because of the increase in the number of Medicare patients. so regardless of what Congress ends up doing, Medicare has to go out every year and say "we're cutting our rates" and then just wait and see what Congress does. Suffice to say, Republicans in 1997 fucked over Medicare and doctors. Which isn't to say that Medicare doesn't have problems of course. Medicare could be dealt with in the short term by applying the FICA tax rate to all income and indexing reimbursement rates to cost increases/inflation. That would amount to a slight increase on the highest earners but would ensure the financial stability of the program and the reimbursement changes would help maintain provider interest in the program. Longer term, we definitely need the changes we discussed earlier like malpractice insurance/tort reform, changing the fee for service model, encouraging patient-directed care, etc. And we really really need to work on training more physicians in this country. I have a friend who worked her ass off to try and get in medical school. She's worked in the health care field for years, volunteers in community clinics, went back to school and got good grades in Biochem, A&P, etc and got a solid 30 on her MCAT. But getting into Med school is a suckers game and it totally drained her. She'd be a great doctor. But then on a whim, she applied at the last minute for a Masters of Public Health program and got in on the first try. She's excited now and will do great things I'm sure. But she isn't going to be an MD because the med school system is too full and broken. J ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| Order the Adobe Coldfusion Anthology now! http://www.amazon.com/Adobe-Coldfusion-Anthology-Michael-Dinowitz/dp/1430272155/?tag=houseoffusion Archive: http://www.houseoffusion.com/groups/cf-community/message.cfm/messageid:319259 Subscription: http://www.houseoffusion.com/groups/cf-community/subscribe.cfm Unsubscribe: http://www.houseoffusion.com/groups/cf-community/unsubscribe.cfm
