Author: cmh

Do Medicare And Medicaid Payment Rates Really Threaten Physicians with Bankruptcy? – Health Affairs Blog

 

Orthopedists. A 2011 survey revealed that orthopedists enjoy a median salary of $514,000.  This is the net physician income after office overhead has been paid.  Overhead costs averaged 46.3 percent for orthopedic surgeons in 2000  and accounted for 45 percent of revenue in 2012.   (This is slightly better than the 50 percent overhead that my practice averages.)  Therefore, the gross practice revenue per orthopedist currently is just over $934,000 with an average overhead cost of $420,000. According to data provided by the American Academy of Orthopaedic Surgeons, orthopedic patients by payer are as follows:  Medicare/Medicaid—31 percent; the uninsured—17 percent; commercial insurance—34 percent; and other sources, such as worker’s compensation—18 percent.  Essentially, half of the average orthopedist’s payment sources are commercial insurance of some type, one third are Medicare or Medicaid, and one sixth is self-pay; this last category—patients paying for their own care—typically contributes only a small amount to practice revenue.

We can test the claim that physicians lose money on their treatment of Medicare patients or make only $8 an hour treating such patients by substituting Medicare reimbursement for the commercial reimbursements to a doctor’s practice.  Would orthopedists truly make $8 an hour or would their practices be bankrupt if all payers used Medicare’s reimbursement schedule?  Remember, this is the articulated position of much of the orthopedic community and a common defense against reimbursement reductions.

According to a comprehensive analysis by the consulting firm, Milliman, in 2008, on average, commercial insurance paid 130 percent of Medicare’s reimbursement, or, seen a different way, Medicare paid 78 cents for every dollar of commercial reimbursement for physicians’ work.   If we reduce the $467,000 in commercial insurance payments to a typical orthopedist’s practice by 22 percent to reflect lower Medicare payments, we obtain $364,000.  Adding this back to the Medicare/Medicaid and self-pay portion of practice incomes yields a new gross revenue figure of $831,000.  This would be the average orthopedist’s practice income if Medicare’s pay scale were universally used.

Taking out $420,000 in overhead, we see that an orthopedist surviving solely on Medicare reimbursements would receive $411,000 in take-home pay, or approximately $100,000 less than we actually enjoy with the current mix of insurance payers.  While I agree that this is a steep reduction, it is abundantly clear that such reimbursement would by no means bankrupt a practice or yield an hourly wage anywhere close to $8 per hour.  Therefore, such statements are gross hyperbole.

Do Medicare And Medicaid Payment Rates Really Threaten Physicians with Bankruptcy? – Health Affairs Blog

How Medicare Fails the Elderly – NYTimes.com

Yet Medicare, which pays for all of the above, does not, except in rare instances, pay for long-term care in a supervised, safe place for frail or demented old people, or for home aides to help with shopping, transportation, bathing and using the toilet.
Nationwide, the median annual cost of a nursing home in 2010 was $75,000; room and board in an assisted living facility, with no additional help, was $37,500; and the most basic category of home health aide, who can perform no medical tasks, like the dispensing of medication, was $19 an hour. These expenses are left to the elderly (and their adult children) to pay for out of pocket until their pockets are all but empty.
Then they are eligible for Medicaid, the state-run safety net for the poor. While Medicare, a federal program, is financed by payroll taxes, and thus is an “earned” benefit, Medicaid is “charity,” in the minds of the formerly middle class who worked their whole lives and never imagined themselves destitute.
In the case of my mother, who died at 88 in 2003, room and board in various assisted living communities, at $2,000 to $3,500 a month for seven years, was not paid for by Medicare. Yet neurosurgery, which I later learned was not expected to be effective in her case, was fully reimbursed, along with two weeks of in-patient care. Her stay of two years at a nursing home, at $14,000 a month (yes, $14,000) was also not paid for by Medicare. Nor were the additional home health aides she needed because of staffing issues. Or the electric wheelchair after strokes had paralyzed all but the finger that operated the joy stick. Or the gizmo with voice commands so she could tell the staff what she needed after her speech was gone.
She paid for the room. My brother and I paid for the private aides and bought her the chair and the “talking board.” What would her life have been like without the skilled care she required and the ability to get around her floor and communicate her needs? I shudder to think. But none of this was Medicare’s responsibility.
Yet Medicare would pay for “heroic” care for a woman who was dying of old age, not a disease that could be treated: Diagnostic tests. All manner of surgery. Expensive medications. Trips to the emergency room or the hospital — had she not refused all of them, in the last year of her life. So, in less than a decade, by my low-ball estimate, my mother spent $500,000 of her own money and uncalculated sums from her two children before winding up what she considered, with shame, “a welfare queen.”
A recent state-by-state study of long-term care, the first of its kind, by a consortium of researchers, has found that this kind of essential help costs anywhere from 166 percent to 393 percent of the average annual income of America’s elderly.

How Medicare Fails the Elderly – NYTimes.com

Moving beyond Parity — Mental Health and Addiction Care under the ACA — NEJM

Moving beyond Parity — Mental Health and Addiction Care under the ACA — NEJM

Enactment of the Mental Health Parity and Addiction Equity Act in 2008 was the culmination of a decades-long effort to improve insurance coverage for mental health and addiction treatment. The law’s passage constituted a critical first step toward bringing care for people with mental health and addiction disorders — including depression, anxiety, psychoses, and substance abuse and dependence — into the mainstream of the U.S. medical care system by requiring parity in coverage (benefits for mental health and substance abuse, often referred to collectively as “behavioral health,” that are equivalent to all other medical and surgical benefits). Now, the passage of the Affordable Care Act (ACA) has the potential to affect the financing and delivery of mental health and addiction care even more profoundly.

NHS reforms: Moving care to the community | Healthcare Professionals Network | Guardian Professional

NHS reforms: Moving care to the community | Healthcare Professionals Network | Guardian Professional:

Expanding community services does not simply mean moving care out of hospital – it means developing a whole new way of caring.

“This is not a like-for-like shift,” says Nick Goodwin, senior research fellow at the King’s Fund. “We’re not taking current activities in hospital and placing them into the community. We’re creating a capability in the community [to remove some of the demand for] a range of different activities in hospital.”

Goodwin predicts that groups of general practices will increasingly work in federations or networks. He sees a “fairly limited” role for the private sector but a significant increase in not-for-profit partnerships with the public sector. Goodwin believes telehealth, whereby health-related services are delivered over the internet, will be “as common as internet banking and hole in the wall cash machines”.

Numerous examples exist of diagnostic tests and procedures being moved to the community. NHS Suffolk has transferred echocardiography (which uses ultrasound to investigate the heart), while Cambridgeshire has moved sexual health, musculoskeletal services and minor oral surgery out of hospital.

Bill Moyers: Foul Play in the Senate

Bill Moyers: Foul Play in the Senate

The Times story described how Amgen got a huge hidden gift from unnamed members of Congress and their staffers. They slipped an eleventh hour loophole into the New Year’s Eve deal that kept the government from going over the fiscal cliff. When the sun rose in the morning, there it was, a richly embroidered loophole for Amgen that will cost taxpayers a cool half a billion dollars.

Amgen is the world’s largest biotechnology firm, a drug maker that sells a variety of medications. The little clause secretly sneaked into the fiscal cliff bill gives the company two more years of relief from Medicare cost controls for certain drugs used by patients who are on kidney dialysis, including a pill called Sensipar, manufactured by Amgen.

The provision didn’t mention Amgen by name, but according to reporters Lipton and Sack, the news that it had been tucked into the fiscal cliff deal “was so welcome, that the company’s chief executive quickly relayed it to investment analysts.” Tipping them off, it would seem, to a jackpot in the making.

Amgen has 74 lobbyists on its team in Washington and lobbied hard for that loophole, currying favor with friends at the White House and on Capitol Hill. The Times reporters traced its “deep financial and political ties” to Baucus, McConnell and Hatch, “who hold heavy sway over Medicare payment policy.”

All three have received hefty campaign donations from the company whose bottom line mysteriously just got padded at taxpayer expense. Since 2007, Amgen employees and its political action committee have contributed nearly $68,000 to Senator Baucus, $73,000 to Senator McConnell’s campaigns, and $59,000 to Senator Hatch.

And lo and behold, among those 74 Amgen lobbyists are the former chief of staff to Senator Baucus and the former chief of staff to Senator McConnell. You get the picture: Two guys nurtured at public expense, paid as public servants, disappear through the gold-plated revolving door of Congress and presto, return as money changers in the temple of crony capitalism.

Hurray for Health Reform – NYTimes.com

Hurray for Health Reform – NYTimes.com: It’s said that you can judge a man by the quality of his enemies. If the same principle applies to legislation, the Affordable Care Act — which was signed into law two years ago, but for the most part has yet to take effect — sits in a place of high honor.

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Elder Law: Kin may be held liable for care – Pittsburgh Post-Gazette

Elder Law: Kin may be held liable for care – Pittsburgh Post-Gazette: In July 2005, the Pennsylvania General Assembly passed the “Filial Support Law,” commonly known as Act 43. As we approach the seven-year anniversary of the re-codification of this law (it previously existed in the Welfare Code from the 1930s and was re-codified in the Domestic Relations Code for modern usage), there have been increasing instances of facilities pursuing family members to pay for care, usually for parents’ care in a long-term care facility.

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Gov. Bobby Jindal’s administration reverses planned elimination of Medicaid hospice program – The Washington Post

Gov. Bobby Jindal’s administration reverses planned elimination of Medicaid hospice program – The Washington Post

BATON ROUGE, La. — Louisiana Gov. Bobby Jindal’s administration scrapped plans Wednesday to shutter the state’s Medicaid hospice program in February, meaning the state will continue to provide end-of-life care to people on their death beds who can’t afford private insurance.

Jindal’s health secretary Bruce Greenstein made the announcement as hospice program supporters were gathering for a candlelight vigil on the state capitol steps to protest the cut. Greenstein said his department will use grant funding to cover the hospice costs this year.

The stupidity, economically speaking, and the heartlessness, you know, human being-wise, of some of these self described “Christians” (ChristoRepublicanus Americanus?) is astounding.