As Medicaid Rolls Swell, Cuts in Payments to Doctors Threaten Access to Care

Medicaid has been on life support, lacking adequate professionals, for decades. ACA will put it into a coma, from which it may never come out of. Nothing is ever free.

 

What claims are you referring to? If it's federal financing of direct medical education, see the post above yours.

I'm not offering a proposal. I'm just pointing out that the nation's medical workforce exists because Medicare and Medicaid pay for the education and training of our doctors. Not in a roundabout way, they literally give hospitals the money needed to support residencies for physicians.

It seems to me like incredibly bad form to accept a half a million dollars from the public payers and then refuse to apply to their patients the skills they paid for you to acquire.

 

You forgot to respond to this...............

Now if you wish to tie this program into compelling doctors to accept Medicare/Medicaid patients you tell them upfront and you tell them what they will be reimbursed. Then they can either opt in or opt out of this program. And you tell them what they will be reimbursed and that the costs will never change. Sound fair?

 

You are neglecting the costs of a 4 year undergraduate degree along with the costs of a 4 year medical degree. Even your link references this. Docs also need to get a decent score on the MCAT to gain acceptance to medical school. At this point, most Docs have taken in excess of $100k in student loans. The training they receive in residency is funded in part by Medicaid. The money goes to directly to the hospital.

PCP makes less than Docs who specialize. Your link references this.

We are facing a shortage of PCP in this country. Why do you think that is?

 

And it's certainly fortunate for them they don't need to then take out another $500,000 in loans to get through the next few years of residency.

I'm all for putting more money into primary care and less in specialty care.

 

Succes, could you give me the current total cost of this succes? How much?

 

Okay. So you agree that Docs here in the US pay for the majority of their training. You agree that the money for the Medicare training goes to the Hospital.

Do you think some hospitals are more efficient with that money than others?

I want my PCP to be qualified and trained. I do not want my PCP shuffling patients in like cattle because the insurance premium is due by the end of the week and oops, they accepted too many Medicare patients into their practice and they are now operating this week and that week at a loss.

You are seeing more PCP doctors either closing up shop or moving into hospitals to set up shop.

Why do you think that is?

 

Like most students, they take out federal loans to pay for their schooling. Their actual training in a clinical environment, however, is more expensive than their time in school. And it's paid for by the public insurers some of you seem to believe they should shun.

Sure.

What you're describing is an artifact of having a volume-based reimbursement system. Which is why we're seeing emphasis on moving away from paying for volume toward paying for value.

 

Where did I say "shun"? How do you expect a PCP to continue to serve Medicare patients when they are losing money? At some point, the practice goes out of business.

Paying for value does not exist under ACA. In order for a PCP to stay afloat, year to year, as the ACA unfolds, they need to maximize the number of patients they service in relation to the Medicare patients they service.

So, in essence, I am subsidizing a second time when I visit my PCP.

 

We're seeing big movement toward the sort of per member month infrastructure payments that give primary care providers a revenue stream independent of the sort of 15-minute increment / face-to-face revolving door of patient visits you're talking about.

Movement like Medicare participation in state-based primary care transformation strategies under the MAPCP demo, or CPCi. And movement like payment for health homes in Medicaid, Medicare transition care management codes that allow PCPs to provide non-face-to-face post-acute services, and the big enchilada, the new chronic care management payment under Medicare:

The system is evolving fairly quickly at this point. And in large part it's because the public and private payers are collaborating and aligning their efforts to transform primary care.

 

http://en.wikipedia.org/wiki/Declaration_of_Geneva

Its not binding but it seems to me refusing to care for the poor especially when the government offers payment for their care violates several parts of this noble declaration as agreed upon by ,I would assume, a suitably representative body of physicians.

I would say refusing to take some Medicaid patients when asked would be unethical to their main duty to society as physicians.

 

I'm just not a fan of my Doctors getting paid in full this year, then next year they get paid half, or something.

I was lucky to get in as it is. There is plenty of patient demand in my area. My doctors aren't going to miss me if they have to start paying out of pocket for some of my medical care because my insurance doesn't cover it.

Wasn't that something we were trying to avoid with the ACA?

At least I know WHY the ACA was going to save money on medical care. I just hope I still have it after this. I need a lot of care.

 

I think it's already been happening. A friend of mine now needs to travel about 200 miles to get to a GI specialist that will accept Medicaid. I went with her once to help her, so I know she's not lying.

 

Total cost per taxpayer?
I think those numbers can be extrapolated.
However, are you willing to also look at a 2 year rate window and the increase?
Because we didn't bear the same cost in taxes just two years ago.
We paid for it in inflated rates for health services to make up for all of the shortfall from the folks who didn't pay --- and in taxes.

However, since there are 68 million people that We the People pay insurance for, this savings is also realized directly by the taxpayer on the form of lower annual deficit.

Health Insurance is REALLY expensive.
An argument can be made that we just shouldn't do it for those who can't afford it.?
I respect that argument.

An argument can not be made that the ACA makes providing health care, to those who cannot otherwise afford it, more expensive.
It doesn't. According to CBO.

max

 

Long winded and a not so pretty dance.....just empty words You cant quantify it can you? So, this success story you so proudly hold as a trophy comes at a price tag of what? What is the burden and liability to the citizen?

What has this ACA done with big pharma? Who wrote ACA? Can I buy a plan out of state? Did HSA increase dollar amount per individual? Will all the illegal aliens eventually be accepted into the roles with State's fast and loose regulations circumventing Federal exchange?

Again, please quantify this wonderful cost for me.....

 

Someday in the near future, private practices will no longer be an option. It will be large hospital networks taking care of their population. Lowering payments to private care providers is the method being used so they will lose their practice and have to work for the hospitals. This is being done intentionally by our government and the reason why is because large hospital networks will contribute to political funding whereas private practices have no incentive to provide that funding.

 

Okay, it seems the worst has happened the Medicaid extension failed in Congress and now it looks like doctors are going to get over 50% cut in payments.

Medicaid doctors to see 52.4 percent reimbursement cut

 

what we really need is state run hospitals and state run quick care facilities around the states, when medical students graduate, if they work at one for 10 years, their debt is repaid in full by the gov for their service

we also need to remove the caps for the rich on the SS\Medicare tax, the elderly should not have to buy secondary insurance for hundreds of dollars a month to cover what Medicare doesn't and also include coverage for (eyes, dental and vision need to also be covered)

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Rationing of Medicare was already happening prior to ACA...ask your Red State legislators and governers why they have not expanded Medicare in their Red States?

 

thanks Congress....

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as long as republicans have a say in it, death panels will exist, look at republicans in Arizona and Bush in Texas for examples

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the only way we get a great public option is if all government employees and congress themselves get the same public option

 

We are swollen with medical students enrolling in college to get in the game when they graduate. It will work itself out, or some of these older doctors will just be replaced with new ones.

 

Republicans? I am no fan boy but progressives own this lock, stock and barrel. Who would pass such a (*)(*)(*)(*) bill....tax, knowing government is never a constant? Freshair seems stale when the people in the middle are left holding the burden.

What did you think would happen?

 

Amen....

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Obama wanted a public option, the conservative individual mandate was an attempt to get some conservative votes, it was a mistake, I do not support the individual mandate

at some point if repubs and\or dems ever create a bill with a public option to replace the ACA, I will support it

and I agree, those that have the most should pay the most taxes in this country, there should be no caps after you make over a certain amount, and labored income should not be taxed more then unlabored income

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And POTUS is constant? Can you see past your nose?

 

no one has said the ACA is perfect, it needs much tweaking, just Congress is not up for the task right now

http://www.cnn.com/2009/POLITICS/09/02/health.care.compromise/

"The compromise plan would lack a government-run public health insurance option favored by Obama, but would leave the door open to adding that provision down the road under an idea proposed by Snowe, the sources said."

if congress wants to replace the ACA, give us something BETTER, republicans are in control the next two years, show dems how it's done..... otherwise repubs have no room to talk

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