Doctors retiring

[davesl708]

This is about to become the 'new normal' for US healthcare. The introduction of the 'Accountable Care Organization' model requires huge all-encompassing area coverage by the largest stakeholders in the area, so lots of consolidation is going on. Everyone just loves the big box stores convenience and cheap prices, but finds it difficult to find much expertise about what they're selling, whereas the local guy amassed years of knowledge selling, and could answer your questions about them. New doctors will be indoctrinated into the resource conservation model of the ACO, old doctors will get out, because they already have been dealing with insurers butting heads with them over every decision the past twenty years. Now that the government has formed the ACO, the large organization providing the service will be trying to minimize the expense per patient, and maximize the profitability... Providers will have to justify every decision within and extraneous to their organization, while keeping up the volume. Its a bad time for health care in the US--the end-around Affordable Care Act creating tiers of service for affluent versus poor is a part of it. 100% citizen mandates get handled with taxation, not by creating mega-health conglomerates to monopolize the private business.

Obama Care is not like a big box store. You do not get lots of choices at lower cost. You get fewer choices at higher cost and we still have over 20 million people who will not get health care because they do not make enough money. A big net loss for all.

Your point is well noted about the providers justifying their claims. The problem is compounded by physicians getting claims denied months after the filing.

I have had experience with social health care. Doctors' went on strike for more pay. Leaving patients trying to reschedule months down the road. Was told by a Pharmacist told me to wait till I returned to the USA to get what is over the counter in the US antibiotic because it was prescription only in that county.
She said I would not get in to see a doctor before my three weeks were up.

Since I am retired and under 65 I have to find insurance on my own. I get no gov. subsidy to help with the cost due to low income. Was paying $86 per month for insurance at work. Now it will cost me $1,400 per month. So much for the $2,500 savings we were told we would get.
The worst is yet to come.

 

[WM75Guy]

Would you be able to operate if it took up to 1 1/2 - 2 years to get your paycheck? You have to fight to get your money from any insurer, especially Medicare. The standard is to have your claim denied and then you have to go through the appeal process to fight for your money. To get to the 3rd step, where 70% of denials are reversed, takes an average of 547 days. It's expensive to hire staff just to handle appeals and this is just Medicare. That's why most hospitals settled for 68 cents on the dollar in the latest Medicare settlement offer. But Medicare saved 32 cents on the dollar and they will not hear any new appeals for 2 years which started in 2014. So now it will take longer to get your money. Add in the ICD-10 issue and that's why hospitals are closing and doctors are retiring.

Here is an excerpt from the article about the latest Medicare settlement deal offered to hospitals.

"The settlements offered 68 percent of the net payable sum that most hospitals had appealed or planned to appeal of patient status claim denials by Medicare RACs on the basis that services may have been reasonable and necessary but treatment on an inpatient basis was not. Cases with admissions before Oct. 1, 2013, were eligible for settlement. Hospitals that opted to settle were required to settle all such pending appeals. The initial settlement requests were due by Oct. 31, 2014, although extensions were offered.

The settlement represented an effort to clear a backlog at the third level of the five-level Medicare appeals process. The third-level appeals before administrative law judges fully overturn more than 70 percent of hospital Medicare Part A denials. However, a ballooning number of appeals in recent years led the Office of Medicare Hearings and Appeals, which oversees the administrative law judges, to suspend the assignment of new cases for two years starting in 2014."

Medicare Pays $1.3 Billion to Settle Hospital Claims | HFMA

 

[MikePA]

Obama Care is not like a big box store. You do not get lots of choices at lower cost. You get fewer choices at higher cost and we still have over 20 million people who will not get health care because they do not make enough money.

20 million people WILL get health CARE just like they did before ACA, they will go to emergency rooms, which have been required to provide care to anyone who shows up. They may not have health INSURANCE, but they will receive health CARE.

 

[davesl708]

20 million people WILL get health CARE just like they did before ACA, they will go to emergency rooms, which have been required to provide care to anyone who shows up. They may not have health INSURANCE, but they will receive health CARE.

Bare minimum care from ER. A sign in the hospitals here state if you do not have insurance they will do life saving care only and ship you to a gov. hospital.
Drove a friend to the nearest ER gov hospital for neck pain after an auto accident. She set there six hours before we told them we were going to go to a real hospital. Only then did they put her in an exam room. Another hour before the doctor showed up.

My advice is to take very good care of your health. You are not going to like health care in the future.

 

[MikePA]

The point is they get care. To say they do not is factually incorrect. Not having insurance is not the same as not getting care.

I agree health care will be very different in the future. There are only three levers that can be pulled; Quality, Cost, and Availability.

If Cost is artificially lowered by government edict, then Quality and/or Availability will be impacted. This is not theory, it is what has happened in other countries who have nationalized health insurance.

 

[davesl708]

The point is they get care. To say they do not is factually incorrect.

Not having insurance is not the same as not getting care.

How then is this different than what we had before Obama Care and companies offering (Cadillac plans) to their employees were charge 40% tax on the plans and our deductible and out of pocket expense went way up and are still going up? Where is Obama's big savings?

 

[MikePA]

How then is this different than what we had before Obama Care and companies offering (Cadillac plans) to their employees were charge 40% tax on the plans and our deductible and out of pocket expense went way up and are still going up? Where is Obama's big savings?

Why are you asking me? Ask Obama and the people who voted for the ACA.

 

[davesl708]

Why are you asking me? Ask Obama and the people who voted for the ACA.

Just a question. Yes it is the voters fault. John Robert's said it best when he said it is not the courts job to fix legislation. If we don't like the law we should not have passed it.

 

[Bird]

The point is they get care. To say they do not is factually incorrect. Not having insurance is not the same as not getting care.

That is usually true, but not always. I guess you've heard of Parkland Hospital in Dallas where they took President Kennedy when he was shot. As President, he got the best care possible. And as a police officer, I was taken there one night after my partner wrapped us and the car around a tree, and I couldn't complain about the care I got. But otherwise, I would not have taken a dog to that emergency room. I spent more time there than I wanted to, handling police business when I was a young patrolman.

 

[MikePA]

ERs are not created equal. And I didn't say they'd get good care, just care. Mandatory health care in ERs is also why hospitals close them or provide poor care except for the true emergencies. ERs, as a hospital department lose money.

Sadly, people equate health insurance with health care. They also use the word 'free' when what they really mean is 'someone else pays'.