Topic: Medicare now pays Drs. $42. mo.- chronic cases
Keebler
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posted
- Another case of "well, hey, paying a doctor to manage patients with chronic / multiple diagnoses . . . that sure sounds good." Until the details come to light.
What an insult all the way around. Medicare, touting this as wonderful, will now cover payment of a whooping $42. a month for doctors to manage care for patients with chronic / multiple diagnoses.
And those doctors, or their staff, must be available to the patient 24/7. Every minute, every day of the week - and weekend.
$42. a month per patient, not per action of help or interception, or planning - or counting contacts with other specialists, coordinating (although I'm sure office visits are billed separately but this management business is very complicated and time consuming).
Were I to be a doctor, I'd never want a patient with any chronic condition. Seriously, how can they think this is fair compensation that will result in a proper result?
Bad for patients, bad for doctors. And it also will put further stigma on those needed such help as being too much work for the return.
Reimbursement fees are already just mortifying (for the patient) & unreasonable for the doctor who has to pay their bills / staff) for most medicare office visits as it is.
Medicare to Start Paying Doctors Who Coordinate Needs of Chronically Ill Patients
By Robert Pear - The New York Times - Aug. 16. 2014 -
Posts: 48021 | From Tree House | Registered: Jul 2007
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randibear
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my drs fee is 85 just for routine office. new post in his office "no medicare patients".
duh....
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
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Keebler
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- That's not nearly what their typical reimbursement is. And, while it may seem like a lot for a typical visit - it's not when overhead is considered.
With office and practice operation costs so sky high (another matter entirely that I would sure try to fix) . . . . Some manage okay but it depends upon the ration of medicare patients to those with better insurance (yet all insurances are trying to cut the doctor out).
The cost of medical college (college loan repayment) is a huge factor, equipment, malpractice, staff, etc.
I think this latest move will force doctors to just stop taking any medicare patient. No doctor can be compensated just $42. blanket monthly fee to cover medicare patients they have with "every minute, every day" on call service.
They couldn't even hire a college student to cover this for them. Every minute, every day the patient must be able to communicate with them. No way. That's not going to work out very well for anyone.
key stipulation: "on a doctor’s staff" - that is not the free standing urgent care in town, not the ER, but the doctor's own staff. Seems this also treats the patient as too stupid to figure out on their own how to access urgent care independent of their doctor.
excerpt: "Under federal rules, these patients will have access to doctors or other health care providers on a doctor’s staff 24 hours a day and seven days a week to deal with “urgent chronic care needs.”
Medicare patients' needs usually involve more urgent care than those covered by other insurances (due to the enrollment demographics). -
Posts: 48021 | From Tree House | Registered: Jul 2007
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poppy
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This is what is paid between office visits. But it is still nuts. $42 to coordinate difficult conditions 24 hours a day 7 days a week? Someone was drinking spiked cool aide when they dreamed this one up.
Posts: 2888 | From USA | Registered: Mar 2004
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posted
Absolutely. Doctors have been phasing out of Medicare for several years now. The latest governmental changes have put the nail in the coffin.
Being reimbursed $17 a patient for office visits is not enough for doctors to continue taking Medicare patients. They can't possibly pay their staff and bills that way.
Isn't the $42 on top of whatever they get per office visit for the same patients? (still not enough)
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96223 | From Texas | Registered: Feb 2001
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Keebler
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- Yes, that $42. is in addition to an office visit. But that is for a full month - to be on call for every single minute - to set up & to coordinate care on a variety of matters, not just urgent care.
It's to be the patient's "case manager" actually. Very time consuming. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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Keebler
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- I used to especially enjoy reading the Sunday news. I'd always find all kinds of interesting stories from around the world. These days, though, certain issues seem to pop up and make that less enjoyable.
Along the lines of imbalance, it's wide reaching, beyond Medicare:
. . . With open enrollment for 2015 three months away . . . .
. . . More than 300 patient advocacy groups recently . . . complain about some insurer tactics that "are highly discriminatory against patients with chronic health conditions and may violate the (law's) nondiscrimination provisions." . . .
. . . Kansas' commissioner, Sandy Praeger, a Republican, said the jury is out on whether some insurers are back to shunning the sick. . . .
. . . Much of the concern is about coverage for prescription drugs.
Also worrisome are the narrow networks of hospitals and doctors that insurers are using to keep premiums down. . . .
- [full article at link above. Some of the patient advocacy groups are listed. Enlightening.] -
Posts: 48021 | From Tree House | Registered: Jul 2007
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poppy
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Personally, I think having insurance involvement in medical care delivery is at the heart of the problem. Until that changes, and doctors go on salary instead, there will continue to be endless problems.
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posted
I can't see ANY doctors being on 24/7 call for anyone. Never happens at my doctor's office.
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96223 | From Texas | Registered: Feb 2001
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kam
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When I first came down too sick to work, I had Blue Cross/Blue Shield.
I learned docs sign a contract to only spend so much each quarter.
They would get a bonus at the end of th quarter if they stayed within the contract.
One doc showed me the headlines in the morning paper....where Blue Cross or Blue Shield had billion dollar profit that year.
Docs also get paid for a 10 min visit. Although they could do a back to back making it 20 min.
Our health care system has been broke for a long time.
It is upside down. Profits come before patient's health.
I watched a documentary back then that showed how all the different countries handle health care.
I think we need to take what will work for our country by learning what works in other countries.
CEO's of insurance companies have million dollar salaries.
Posts: 15927 | From Became too sick to work or do household chores in 2001. | Registered: Dec 2002
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kam
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I think my question as to what a doc gets paid was ansswered hree. If I understood correctly, the doctor gets $42 a month whether they see me or not.
When I saw my doctor last time which I think was a year ago??
The bill was almost $500. It was my first visit with medicare.
My part of the bill was close to $200. The office visit was the same tool box that doctor's have been using since I came down sick in 2001.
SAme testing was suggested as was done back in 2001 to 2003 also.
Posts: 15927 | From Became too sick to work or do household chores in 2001. | Registered: Dec 2002
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Keebler
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- Not sure about how that would work. The "manager" fee may not be automatic, unless they log in some kind of action. Still, considering how little they are compensated for typical appointments, $42. a month won't even bring them up to par.
You would first have to sign up for it. It's not an automatic "case manager" assignment just because someone has Medicare as their insurance - it's an extra form to sign.
But, it can't be assumed they would get $42. for a month where they may not see you - but there may still be some case management on their part even if you don't come into the office.
Still, I have a feeling for every patient they don't see in a month, there are so many more who require a high number of interactions to coordinate between all the health care they receive or need to have arranged.
There could be a time where you, too, would require complicated arrangements for diagnosis, treatments. They would be required to be there for you in this regard.
I know, that is a farce with Medicare, of course, thinking it might ever actually provide the medical care required for someone with a tick borne diagnosis & complications that arise from such.
But, I posted this more out of concern for the whole - a social commentary - than regarding those with lyme who have usually never been covered by any insurance in the first place.
Still, IMO, this new "feature" will force many doctors to reject signing on to treat any patient with Medicare as their insurance provider - for any diagnosis, at all.
Maybe it's a ploy to get people to jump ship when they can't find a doctor. No effort was given to talking with doctors as to how this might work for them, practically. The doctors' opinions were ignored about the 24/7 requirement.
The answer was, "well, it's basically all on computer, anyway" (implied to mean it won't be much extra work to coordinate a patient's care, anyway - little thought would be required - my interpretation here). -
[ 08-18-2014, 03:18 PM: Message edited by: Keebler ]
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poppy
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Yes, you would have to wonder if the real intention is to get more doctors to drop out of medicare. That will certainly be the result. Got some real imbeciles planning this program.
Another possible outcome will be more doctors requiring patients to come to the office instead saying it can't be handled on the phone. What they need to do instead is allow phone appointments at the same pay rate as office appointments. That would help the doctor and the patient.
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Keebler
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- Not just doctors dropping out of Medicare but patients just not going to any doctor anymore. That really seems the goal here. Too many obstacles for those with Medicare (non)coverage.
They say they are making it more effective but that's not what's happening. -
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posted
I worked for the largest hospital/health delivery system in my city. We were told point blank that the goal of the ACA was to transition into a single payer system.
Lyme patients will get screwed on this.
Single payor = government = CDC = your 21 days of treatment was more than enough...next patient please.
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MADDOG
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No they want you to not get treatment each month. Then they can say oh you are not sick anymore you don't need your SS dissability.
MADDOG
Posts: 4001 | From Ohio | Registered: Oct 2000
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Absolutely true, koo. No one would listen to me. Been saying that for about 4 years now.
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96223 | From Texas | Registered: Feb 2001
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Ann-OH
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The doctors and patients sign on for this. The $42 is not to cover all the Medicare patient visits and care.
I am sure the doctor and patient can work out everything about contacting the doctor during off hours and on weekends and who will be keeping account of the patient's needs.
As I understand it, it can be other professionals in the doctor's office. It is good that the patient can contact the doctors' offices rather than go to the emergency room, if they have issues during off hours.
The $42 is not the entire amount that Medicare will pay that doctor. She/he will get the usual payments for everything else in caring for the patient.
I think everyone should have decent health care, and Medicare and Medicaid have been an amazing step forward.
kam
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I wonder how much a doctor gets paid on Blue Cross or Blue Shield.
I noticed doctor's would extend my appt time to 3 months after I actually signed up with them until the first visit back in 2001 to 2003.
It became a pattern. Then I learned about the quarterly bonus and assumed it had to do with money.
Our health care system changed with the 80's government to what it is today.
I can't see the insurance companies letting go of their billion dollar profits and million dollar CEO fees.
It seemed I did read that part of the Affordable Care Act was that insurance companies will make less profits and need to put some of the profits back into finding better health solutions..but that was a one liner and I haven't heard anything more about that.
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Pocono Lyme
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Government Healthcare Killing the Family Practice?
FARMVILLE, Va. -- The small town of Farmville, Virginia, only has two private practitioners, or what we used to know as family doctors.
One of them, Dr. Lawrence Varner, is considering closing his doors after more than 20 years of service.
"If anyone finished medical school now and had the least thoughts of opening a solo practice, they would be absolutely insane, there's just no way," Varner said in a recent interview with CBN News.
Buried in Paper Work
Thanks to increased pressure from the government, Medicare, and insurance companies, Varner said he no longer recognizes the practice of medicine.
"I started when things were good, when physicians were physicians and they could do what they thought was best for the patient and not having to crawl and beg to insurance companies to get certain tests approved, certain medicines approved," he explained.
Government intervention into the healthcare system was supposed to improve patient care. Instead, many doctors say they feel more like clerks, stuck behind their computers instead of taking care of patients.
One example of that government intervention is Electronic Medical Records, or EMR. As part of the 2009 Economic Stimulus Package, physicians received incentives to convince them to buy into EMR.
The system promised to make their lives easier. But according to Varner's wife, Linda, it's done the exact opposite.
"Overhead is through the roof now because it requires more people to do it -- and the more requirements they have," she said. "And they said it would be paperless and we're buying more paper then ever and it's just backfired."
"And we're never done, whereas before we were at least done, it was late but we were done. With EMR we're never done," she explained.
Less than Minimum Wage
Time put in at the office seems endless, as do the sacrifices to keep the practice running.
"Family -- our youngest, he's 19 but he's still home a lot -- and he's like, 'I'm home but I'm not really home because ya'll physically are there but we're still working,'" Linda said.
An increasing number of doctors are closing their doors on private practice. Others are being acquired by hospitals in an effort to combat their loss of revenue.
Four years ago, Dr. Varner tried the route of becoming an employed physician. He laid out two conditions: First, that he continue working in the building he owns and second, that his daughter continue on as one of his nurses.
"At the end of two years they decided they wanted to move me," Varner said. "They would not honor the commitment to the office building. Then a month after they told me that, they came and said my daughter could no longer work here."
After the three-year contract was up, Varner went back into private practice where things had only gotten worse during his years working for the hospital.
"I'm making the equivalent of $12 an hour and my wife is making $2.90 since January 1," he said.
For the Love of the Job
So why not just close the doors? Varner said it's a mix of refusing to be pushed around and a love for his patients, patients who love him back.
Ray Fawcett is one of those patients. He's been a patient of Dr. Varner's for 25 years and he can't imagine finding another doctor now.
"The major strain is that Dr. Varner knows our minds and our bodies so well that it takes years for another doctor to build that rapport with us," he said. "I'm not nearly so concerned over the driving distance as I am the time required to build that rapport."
Regardless of the intentions of the administration, the results in the medical world are disturbing. Dr. Varner's message to the government: Stop being the problem.
"I've got the computer system, I've got the EMR, let me use it in a way that suits my practice and my patients," he said. "And not because of some rules and regulations that someone that doesn't have a clue regarding patient care has decided that we need to meet. That would be a big huge step."
-------------------- 2 Corinthians 12:9-11
9 But he said to me, �My grace is sufficient for you, for my power is made perfect in weakness.� Therefore I will boast all the more gladly about my weaknesses, so that Christ�s power may rest on me. Posts: 1445 | From Poconos, PA | Registered: Jul 2004
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steve1906
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Pocono, Thanks for the current news (today 08-20-14)on Government Healthcare!
Steve
-------------------- Everything I say is just my opinion! Posts: 3529 | From Massachusetts Boston Area | Registered: Jul 2008
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