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Just an Observation
Posted: Jul 16, 2012
I, just on an off chance, was in a position to watch a bit of the Huckabee Show last night. Coincidentally he had four doctors on his show, from various areas of expertise and from various areas across the country. He had them on his show to ask them their ideas and observations concerning Obamacare and how it will affect their practices. All of them were "private practice" physicians, not associated with any large hospitals. All of them said that if Obamacare was passed, that they would all be giving up their private practices. The main two reasons would be:
with the onset of EMR, the billing codes have become much more stringent. One code for one office visit, one disease, one medication, etc is no longer acceptable. Each and every aspect of a patient's office visit needs to be coded seperately and correctly and accurately. with the onset of Obamacare, there will be "auditors" who have the obligation of going through private practice physician's billing records, checking all of the codes that have been used to bill the "government" for their pay, and if any discrepancies are found, a physician can be "fined" up to $11,000 for each code that was incorrect. The physicians do not feel that they can afford that type of potential scrutiny and fines, and therefore rather than being subject to the constant "audits" they would sell off their practices and become employed in another field. They feel the government is way too involved in patient care as it is, but this would be an intrusion (only put in place to gain more money for the government) that could bankrupt a physician in one audit. The physician stated that they would need a huge tremendous staff in order to meet the government requirements for billing codes alone and it would take too much time away from caring for the patient.
the second reason given was that if a physician accepted Medicaide patients, and with the cuts to Medicaide already in place, the payments they would receive from Medicaide for a patient's care would be about 40% of what they are charging. Due to that, the physicians would probably no longer accept Medicaide patients (which is due to increase by 130,000 patients), leaving these people without access to care. If no doctors are going to accept Medicaide patients, how are these people ever supposed to receive treatment??
this was a very interesting program last night. It opened my eyes to the true "value" of this Obamacare thing and its effects on physicians, as well as patients.
;
Result? - Alice
[ In Reply To ..]It sounds like, if this scenario comes to pass, the hospital ERs will be booming with business.
It all would have been more believable if he had - VTMT
[ In Reply To ..]included doctors with the opposite view. There are a lot of them you know. I'll admit the the days are gone where a private/solo practive can be effective and profitable. The only way to go now are group practices where the overhead of office space, personnel and equipment can be shared and no more 24/7 on duty requirements. Also, you spoke about coding, nothing new. MTs know that coding is the direction that many are taking as opportunities for medical transcription decline.
private physicians - anon
[ In Reply To ..]I have mixed feelings on this. I applaud some aspects of Obamacare (eliminating the pre-existing condition clause) but am afraid of too much intrusion and all the bureaucracy that comes with this. I have a different take on the codes though. There has been SO much fraud in the health care field and Medicare that I think they are trying to rein this in, and that will be very necessary in order to control costs. I am studying coding right now, and there ARE differences right now with Medicare rules for coding and private insurance, so the loss of income from Medicare IS a legitimate concern. I don't know what the best answer is.
bureaucracy and intrusion in healthcare = old news - Des
[ In Reply To ..]This is apparently what Americans have been asking for. So many Americans want the gov't to take care of them, provide them with food, shelter, and medical care, but are only now getting peeved because that same gov't is starting to implement restrictions.
WE THE PEOPLE stay strong when we stay independent of our gov't. Our gov't works for us. However, now that we've become fat and lazy and sluggish, we've become easy to manipulate and control, and that's exactly what our gov't is doing.
Why do you think offshoring of jobs has gotten so out of control? WE THE PEOPLE are not getting off our fat butts and doing something about it.
It's so much easier to LET things happen than to MAKE things happen.
I have a different point of view. - Des
[ In Reply To ..]Coding requirements have been that way for decades. A code for the office visit, a code for the chest x-ray, different codes for different labs, and there has to be coordinating diagnoses for each and every one. In other words, you can't use a diagnosis of dysphagia (difficulty swallowing) for an ankle x-ray. This is nothing new.
Medicaids (state) actually pay closer to 20% of the original charges. Doctors and hospitals have been wanting to ditch Medicaid patients for a very long time because the reimbursement, which is based on what Medicare (federal) pays, doesn't even cover their overhead. This, too, is nothing new.
I'd like to know why those four physicians aren't "associated" with any "large hospitals." Don't they see their patients when they get admitted, don't they share call with their colleagues? Or were you referring to something else, which would potentially be an ethics violation?
As far as Medicaid patients' ability to get treatment, they'll just do what they and the uninsured have been doing for years: go to the ER.
All of this was happening long, long before Obamacare.
Obamacare requires everybody to have insurance coverage, or face fines. This is a good thing. Under Obamacare, patients who are currently choosing to buy beer and marijuana, get their hair and nails done regularly, go on expensive trips, buy name-brand clothes and food, etc., who are using the ER to get their everyday medical care and then skipping out on the bill, will have to forego these luxuries and buy insurance instead.
Sure, there are always exceptions to the rule, but just ask any ER physician how many patients they have to see for free, patients who don't really need to be there in the first place, patients who are wasting that facility's resources and time, thus decreasing patient care for those who really need to be there.
Hospitals and clinics say they can't afford to treat uninsured patients, and since they don't turn anybody away, they have to "eat" those costs. Thus, in order for the CEOs, CFOs, board members, and owners not to have to take a pay cut themselves, such as having to give up one of their summer homes or go without buying a brand new Escalade SUV that coordinates with the new paint color of their house, they've chosen to outsource and offshore jobs. This puts more people out of work, thus creating more uninsured patients, thus creating a bigger strain on hospitals due to more insured patients coming into the ER for treatment, and so on.
This also creates a massive strain on state's resources for funding programs like Medicaid and welfare. With more people out of jobs, more people will be applying for Medicaid and welfare, though most won't qualify, for various reasons (the readers will have to research this themselves, because I'm not going to get into it here).
Obamacare is a step in the right direction, but it's ONLY GOING TO WORK IF OFFSHORING OF JOBS STOPS! People can't afford insurance if their jobs no longer exist.
Well said. - nm
[ In Reply To ..]
I don't watch his show because even though I like him, his guests aren't usually credible - Remembering why I quit watching him
[ In Reply To ..]He's a pleasant enough guy, but he brings on people who are more titillating than credible.
Actually his guests are more credible than he is - sm
[ In Reply To ..]It's not that I dislike Huckabee, but there is a lot I question about him. However, I have always found his guests to be very credible.
@ I have a different point of view-Des - anon
[ In Reply To ..]Perhaps I chose the wrong word when I said these doctors were not "associated" with any large hospital. What I meant was they were "private practice" physicians and not "employed" by any large hospital as a part of the hospitals system.
as far as being "required" to purchase health insurance, I too, have a difference of opinion. I do not have health insurance. I, at this point, refuse to purchase any because: 1. I cannot afford to put out $350 a month for something I will probably never use until I am maybe on my death bed. That money can be better spent by myself for my own needs, not to what some government tells me I MUST have. The government does not know me personally or know my health needs. Only I know that. If I feel I can live without the "benefit" of expensive insurance that is serving no one other than the insurance companies themselves, that should be my prerogative. 2. I have had many insurance companies give me "estimates" on the cost of health insurance for just me....over 60, good health, self-employed...and to be honest, even the $350 a month policy has huge high annual deductibles of upwards of $3000, which I would never attain anyway, and make having health insurance totally useless to me. What good is having health insurance, if meeting the deductible in order to take advantage of those benefits, is unattainable? Like I told one insurance agent, "why on earth would I want to fork out $350 a month for something I would never use? It's like handing you guys money every month for nothing." His response was "it is pretty much "just in case" something catastrophic happens." "just in case??" what the heck reason is that? Just in case the world ends tomorrow, why would I hand them all my hard earned money? why??? Health insurance is useless, as far as I am concerned. just in case i get sick...I still won't be able to use it because of the high deductibles. makes no sense to me whatsoever. why should I make some insurance company rich, and me stay poor because of it....just in case?? Then on top of that, the insurance compnany who is so all fired eager to take my money in the first place, responds with "dictating" what care I can or cannot have! Why should I give them money when they turn around and tell me....no, you cannot have that surgery, or you cannot have physical therapy, or that injection. NO THANKS!
and I am not one to sit on my lazy butt, smoke marijuana, drink alcohol, and go to the ER everytime I have a sniffle! Don't lump everybody who does not have health insurance into that scenario. Some of us choose not to have it and not to be FORCED to have it, for principals other than not being able to afford it. I just don't like someone telling me what I have to do, and what I can and cannot have. It's my life. I choose to live it the way I choose to live it. I don't believe an "elected" government has the right to tell me that either.
i am done now. flame away.
I think it is time for you to get a DNR bracelet... - sm
[ In Reply To ..]and sign and advanced directive in case you are ever in a serious accident or develop cancer or other life-threatening hugely expensive illness that the rest of the insured population would have to pay for as they do now. At least you only have 5 years before you are eligible for Medicare, which is not "free" either.
that was uncalled for - anon
[ In Reply To ..]you don't pay my doctor bills, because I do not go to the doctor! IF I do go to the doctor, I pay cash. I do not go to the ER for any "free" care that you would have to pay for in any way shape or form. I pay my taxes every year, just like everybody else, so I am paying for YOUR health care, as well. My personal responsibility begins and ends with ME, not you or anybody else. Pay your for your own insurance then and let your insurance company tell you what you can and cannot have in the line of medical care. If you are over 60, they will not pay for anything anyway. they want you to die so they can keep your money and not have to give you anything. this is a "soylent green" society.
Not uncalled for, just the truth. Unexpected medical - sm
[ In Reply To ..]expenses for a catastrophic illness can quickly add up into the hundreds of thousands, if not millions, of dollars. Could you cover that? The people who fail to purchase insurance when affordable insurance is available, as it will be in the case of Obamacare, are the ones who are irresponsible.
I wonder if these people do their own root canals? - nm
[ In Reply To ..]
to I wonder..... - anon
[ In Reply To ..]I have no teeth, except plastic....which I paid for out of my own pocket, no dental insurance either, so do not have to worry about 'DOING MY OWN ROOT CANALS.' what a smart a$$. YOU didnt pay for that either! so what business is it of yours. pggt.
that's just it....it is NOT affordable. - anon
[ In Reply To ..]and yes, I pay for my own health care. I dont need a stinkin insurance company to pay it for me. YOU dont pay it...I do. what part of that do you not understand. I do not seek FREE health care. I pay my own way on everything. always have. always will. I am not asking YOU for anything.
Under Obamacare it WILL be affordable. - That's the point. nm
[ In Reply To ..].
How exactly will it be - affordable?
[ In Reply To ..]It does nothing to lower the cost of any medical procedure and those that can't afford thier own private insurance will be able to get what's basically Medicaid, which is paid for by taxpayers (thus, taxpayers will still be paying for those who can't afford it).
exactly!!!! I think SOMEBODY has drunk the koolaide! - anon
[ In Reply To ..]how can you believe anything that comes out of that man's mouth! He has lied about everything else, and most particularly with Obamacare! Why do you think insurance is going to be any cheaper?? Show me where it says that, and also include what the deductible is going to be on this "cheaper" insurance, and what it will and will not cover??
All I know is it has already benefited my family and I am willing - to give it a chance. nm
[ In Reply To ..].
I'm not against the entire bill... there are parts - that are good.
[ In Reply To ..]And I'm glad that it's helped you. Everything they've rolled out so far has been helpful to some. But next comes paying for it, which is going to hit everyone through higher deductables or premiums on thier private insurance, taxes from those who don't comply, or increased numbers on Medicaid. I just don't see how in the long run this is going to help anyone.
Nothing is perfect at first... - sm
[ In Reply To ..]Certainly Obamacare will need tweeking and better explaining. As in anything, there is always room for improvement. I understand people saying seeing is believing, but what I have seen so far is encouraging.
But again we go back to how will it be - affordable?
[ In Reply To ..]How can it be tweeked to lower the cost of the actual health care so that the eventual price tag won't be so high?
Amen! - Personal responsibility...
[ In Reply To ..]there's not enough of it these days.
to OP "anon" - Des
[ In Reply To ..]No doctors are employed by hospitals. All doctors are independent contractors who simply practice AT the hospital. Being "associated" with a hospital could imply that the doctor has a financial interest in that hospital, which does happen, but is unethical.
As for your right not to have to buy insurance... if you do get sick -- and you will -- who's going to pay for that? Hmm? Well, right now MTs, medical billers, payroll clerks, housekeeping, and other hospital employees who are now former employees because their jobs were outsourced have paid dearly for it.
You say the gov't doesn't have the right to force you to buy insurance, while at the same time you're saying that same gov't has every right to force ME to pay for your medical expenses with either the loss of my job or my tax dollars.
You buy car insurance, don't you? How many car accidents have you been in? You buy homeowner's or renter's insurance, right? How many times have you had to use those?
You're just peeved because you're not getting what YOU want at the expense of others.
TOUGH!
That's fine if you don't have health insurance - except that I then SM
[ In Reply To ..]will have to pay for you if you find yourself in the hospital because of illness and/or accident. I will pay by having my premiums increased to pay for you. I also am over 60, have my own insurance, basically just catastrophic because the deductible is so high. It does not cost $350 either. It is CareFirst and costs $121 a month. The ACA is meant to prevent me from having to pay for people just like you.
I will pay for my own illnesses, thank you! - anon
[ In Reply To ..]I just don't understand why YOU ALL think you will have to pay for my illnesses! I pay for everything by CASH. How can my not wanting to be FORCED to buy insurance FORCE you to pay for ME?? explain that please, because obviously I "just don't get it." I don't go to ERs. I am not on "public assistance" so how can my going to a doctor affect YOU??? If you are paying higher premiums, it is not because of me! I have not been to a doctor, hospital, or other health program in over 15 years, and I am not about to start now. so you are NOT paying for me! get off of it. If that is the only thing you can "spout" about having to buy insurance, then you have your heads in the sand. Go to Canada and live off of their "FREE" health benefits. and yes, it does cost #350 a month, because I have talked to MANY insurance co's and CareFirst was one of them. the premiums go by state, location, and age. and yes, the deductible is too high. $3000 per OCCURRENCE, not annually. Why should I give anyone that kind of money for something that I cannot even use? If I have to pay the first $3000 deductible before I can even use any "benefits", then I may as well pay the whole thing myself. Then I, ME, can determine the kind of care I get....not some money grubbing insurance company, pharmaceutical, or PRESIDENT, if he can even be called that! and besides that, car insurance and homeowners insurance cost a WHOLE LOT LESS per month than health insurance, and the deductibles are well within reach. and they do not DICTATE how I can drive my car, where, when or what time of day, or what color my house has to be in order to be able to use it. comprende???
$3000 is peanuts when it comes to hospital bills today. - sm
[ In Reply To ..]What if your bill was $30,000 or $300,000? If you have cancer or a heart attack are you going to refuse treatment?
I would still attempt to pay it on my own... - anon
[ In Reply To ..]If I had cancer, would I refuse treatment?? You betcha! More people die from the "treatment" than they do from the disease. I have seen that first hand. If I get cancer, so be it. Heart attack? probably would not even get as far as "treatment." It would probably end my life right then and there. No bills to pay. Besides that, at least there would be no insurance company telling me what "treatments" I was "allowed" to have or not have. It would be my choice and my choice alone...not the government, not the insurance company. If it is my time to die, it is my time. Besides, anyone over 60 and the insurance companies will refuse proper "treatment" anyway. They do not consider the elderly as worth "saving" and a waste of THEIR (which comes from us) money.
Make sure you don't sign up for Medicare then. - nm
[ In Reply To ..].
Oh, anon, you couldn't be more wrong. - Des
[ In Reply To ..]If you have a sudden pain in your chest that's radiating down your left arm, and just as suddenly, you've lost use of that arm, the first thing you're going to do is dial 9-1-1, not say "If it is my time to die, it is my time."
If you're sitting at home, or maybe outside washing your car, or maybe out working in your garden, when you get this sharp, stabbing, severe pain in your lower belly, again you're going to call 9-1-1, because this pain is not something you've ever had before, and with all that adrenalin flowing, all you'll be able to think is "SOMEBODY HELP ME!"
Now, that pain in your belly is probably just gas, but could be an obstruction, an abscess, or cancer. Once you're in the ER and a diagnosis of cancer is made and they tell you all you'll need is to have that section of bowel removed and six months of chemo and your chances of beating the disease are 90%, there's no way in Hades you're going to say no.
You're in your house making dinner, which consists of, say, boiling some eggs for a salad. The water's boiling, you're multitasking by getting other ingredients out of the fridge, you turn around and the sleeve of your shirt catches the pan handle, jerking the pan off the stone and onto your arm and foot and leg. You rush to get some ice, but the damage has been done. What do you do? You call 9-1-1, because your skin's bubbling up and your adrenalin is flowing and all you can think is "HELP ME!"
THIS is why you need insurance.
As far as the elderly, I've worked in 3 different hospitals and I've personally witnessed the kindness and extensive efforts taken to save the lives of the elderly. Just FYI, AGE 60 IS NOT ELDERLY.
Furthermore, far more "elderly" patients have medical insurance coverage, even if it's just Medicare, than the youth. Elderly patients are the reason hospitals can continue to keep their doors open, and continue to treat people like you at the hospital's expense. However, the elderly are growing older and older and beginning to die, and with them goes the hospital’s reimbursement dollars.
If the doors of the hospitals are going to stay open, they have to get paid, and if those wanting or needing treatment won’t pay voluntarily or buy insurance to at least partially cover those costs, then the gov’t has no choice but to step in.
You think you won't want medical treatment when the times comes, but you will.
you have no idea! - anon
[ In Reply To ..]I wish you all would just stop judging me for the reasons why I do not want to be FORCED to buy insurance. My reasons are my reasons, and if you think what you have to say is going to change my mind, you are dead wrong. I watched my father die of cancer, and all the "treatment" in the world was not going to save him. the treatment prolonged his suffering. Most of these "treatments" are research only and the poor patient is the guniea pig. If he survives...hooray...it worked, but nobody knows exactly what the "treatments" will cause the patient in the future. Most of it is chemical and chemicals kill more than just the cancer. If the patient dies...oh well, back to the drawing board. This is not what doctors and treatments should be...just a crap shoot on a person's life. but however the bills are paid should be up to me and not the government. This is no different than trying to tell a person they HAVE to have cable TV! whether a person can afford it or not, and whether they want it or not. I do not want the government telling me I have to have something that is only going to line their pockets and not do a damn thing for me. the current government sucks, has no concern whatsoever for the people of this beloved nation and is only concerned about the almighty dollar. and that can carry over to doctors, hospitals, nurses, pharmaceuticals, insurance companies, anything that involves huge sums of money. Every one of them is corrupt and only concerned for themselves.
as for the elderly, I heard a radio station interview from a higher up in the writing of the Obamacare fiasco, and it was definitely mentioned that people over the age of 60, which yes, they do consider "elderly", would only be granted and given "minimal care" because they were too close to the age of retiring from the earth permanently and were of no use in the medical field. they were and are looked at as a "drain" on the finances of the medical society, meaning doctors, hospitals, and insurance companies. They apparently do not want to waste their time and money on someone who is going to die sooner than later. Unfortunately I do not remember the radio station that aired this interview, which was a telephone call from an anonymous person while driving and trying to explain this part of the "bill" included in Obamacare. I will do some research on this and get back to you with the content and where to find it, although I am sure it has been "buried" along with the rest of us who are over 60.
Don't forget to wear your DNR bracelet so you are not inadvertently - treated against your will. nm
[ In Reply To ..].
here is that radio station conversation... - anon
[ In Reply To ..]the telephone conversation to a radio station from a physician describing a part of the O-Care bill that describes elderly patients as "units" and that they will be denied care, simply due to their age.
http://www.youtube.com/watch?v=mKRsBSTgprU
Fortunately, according to the American Association of Neurological Surgeons.... - sm
[ In Reply To ..]it is all completely false. This has also be debunked by Politifact, FactCheck and Snopes.
snopes is not a reliable source. I do not know about the others. - anon
[ In Reply To ..]show me where they say it is completely false, and not snopes either.
I think the AANS is a reliable source. - nm
[ In Reply To ..].
Right, because everything on youtube is "fact." - Des
[ In Reply To ..](sigh)
I did not originally hear this on YouTube.... - anon
[ In Reply To ..]I heard it when it very first aired on the radio show back in 2011. I said that I would locate the dialog to the post I posted above and that is where I found it. It has since been swept under the rug, debunked as you put it, and represented as being "fake" simply because the GOVT. does not want the general public to know this or anything like this. They are counting on you people to keep believing everything they say as fact and trusting them to "take care of you." ha! The only thing they want to take care of is you working only for the govt. taking all of your earnings, and providing you with "free services". I believe they call this "socialism." and you are eating it up hand over fist. Not me! I am not as blind as you are. but yet you attack me for having a differing opinion than you. In the end, you will see who was right and who was wrong. keep believing everything the O and his govt WANT you to believe.
Just be careful you don't believe everything you hear - on talk radio. nm
[ In Reply To ..].
and don't believe everything you hear out of a politician either. - anone
[ In Reply To ..]I can believe anything I want to believe, just as much as you can, but I don't have to take what you want to spew out both sides of your mouth as gospel either! and you don't have the right to FORCE me to either.
Equating cable TV to healthcare.... seriously? - Des
[ In Reply To ..]nm
and you know everything about everything. - anon
[ In Reply To ..]let's put it this way...if YOU didn't want insurance FORCED on you, it would be a totally different story, wouldn't it? I don't want it forced on me and you are not paying for me, because I do not frequent doctors, hospitals, urgent care clinics, emergency rooms, or anything of the like. You, however, expect your insurance company to pay YOUR bills. I take care of my own, and my taxes are higher because I have to compensate for the pay that YOU do not provide to the healthcare industry and your "insurance" won't. pppffftt.
To be reasonable... - Dickens
[ In Reply To ..]If you were to have a heart attack or get cancer or get in a car accident or have a stroke or WHATEVER happens to millions of otherwise perfectly healthy people, you would certainly end up in the hospital, being treated. Even if you opted out of treatment for cancer, guess what--you would still end up in the hospital for various issues, and it is all very expensive.
I personally don't give a fig if you have insurance or not, and on top of that, I actually don't mind paying for people who don't have insurance because I'm a caring human being and I think taking care of people is important. But at some point, there is a very large possibility that someone will end up paying your medical bills. To say otherwise is, in my opinion, total denial. You could set up a payment plan, sure. And in 14 lifetimes, you just might pay off that bill.
and that concerns you how??>>>> - anon
[ In Reply To ..]you say you dont give a fig if I have health insurance or not, but then why are you so vehemently trying to make it seem that you are right and I am wrong? I only object to the fact that it is being FORCED and nothing else. and unless you are God, you have no idea whether i will ever end up in a hospital or not. I am betting, much like the insurance companies, that I will not. and just because you say otherwise does not make it a "reality." there are plenty of people who go through life never needing a doctor or a hospital. I bet that I am one of them. so what do you care anyway? you aren't paying my bills....and unless you start doing so, who makes you the person to tell me what I have to buy and what I don't? you are not my mother. thank god!
Cheaters never prosper - Does anyone think?
[ In Reply To ..]I have never had a medical bill sent to insurance that has not been gone over with a fine tooth comb looking for ways to deny coverage. I don't know if there are cases of insurance companies sueing physicians for fraud, but these docs who are worried, probably have cause to worry if they are not doing things properly. Let them quit. They can get in the unemployment line just like many of their patients who are unable to pay for their care. There are a million other people wanting to go to medical school and will learn to be in a medical business,
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