NYT Article - Following the Money, Doctors Ration Care

[Guest guest]

Interesting article about how the new mandate for everyone to have health insurance may have the unexpected consequence of making it more difficult for Medicaid and Medicare insured patients to get access to care.

Afterall, given the option of taking on a new Medicaid/Medicare patient (and it's reimbursement rates) or a new private insurance patient who just got new mandated insurance (and the private reimbursement rates), many practices will likely take on the private pay and limit Medicaid/Medicare even more.

 

An interesting alternative mentioned in the article that I hadn't heard of before...

" AN entirely different approach is suggested by the system in Singapore, where the government requires savings (say 10 percent to 12 percent of income), patients pay for medical care from those savings, and the government takes care of additional catastrophic expenses. That system has a good record for cost control and access, but would Americans accept so much required saving? "

 

Locke, MD

 

http://www.nytimes.com/2010/12/12/business/12view.html

 

Economic View

Following the Money, Doctors Ration Care

By TYLER COWEN

Published: December 11, 2010

snip/snip

The underlying problem is that doctors are reimbursed at different rates, depending on whether they see a patient with private insurance, Medicare or Medicaid. As demand increases relative to supply, many doctors are likely to turn away patients whose coverage would pay the lower rates.

snip/snip

Depending on the state and on the malady, it is common for Medicaid to reimburse at only 40 percent to 80 percent the rate of Medicare. Private insurance pays more than either.

A result is that physicians often make Medicaid patients wait or refuse to see them altogether. Medicare patients are also beginning to face lines, as doctors increasingly prefer patients with private insurance.

Access to health care will become problematic, and not only because the population is aging and demand is rising. Unfortunately, the new health care legislation is likely to speed this process. Under the new law, tens of millions of additional Americans will receive coverage, through Medicaid or private insurance. The new recipients of private insurance will gain the most, but people previously covered through Medicaid will lose.

Ideally, higher demand for medical care would prompt increases in supply, which in turn would lower prices and expand access. But the health care sector does not always work this way.

snip/snip

We could go further by giving greater scope to nurse practitioners, admitting more immigrant doctors, reforming malpractice law and allowing cheap, retail “Wal-Mart style” medical care, all to increase access and affordability. Yet these changes do not seem to be in the offing, so access is likely to decline.

snip/snip

 

[Guest guest]

Yes, the politicians were very smart about this. They wrote the bill so that

they were not accused of rationing care. The market forces, however, will

drive doctors to ration care. And, there is more and more demonization of

doctors in the media.

Brand

>

> Interesting article about how the new mandate for everyone to have health

> insurance may have the unexpected consequence of making it more difficult

> for Medicaid and Medicare insured patients to get access to care.

> Afterall, given the option of taking on a new Medicaid/Medicare patient (and

> it's reimbursement rates) or a new private insurance patient who just got

> new mandated insurance (and the private reimbursement rates), many practices

> will likely take on the private pay and limit Medicaid/Medicare even more.

>

> An interesting alternative mentioned in the article that I hadn't heard of

> before...

>

> " AN entirely different approach is suggested by the system in Singapore,

> where the government requires savings (say 10 percent to 12 percent of

> income), patients pay for medical care from those savings, and the

> government takes care of additional catastrophic expenses. That system has a

> good record for cost control and access, but would Americans accept so much

> required saving? "

>

> Locke, MD

>

> http://www.nytimes.com/2010/12/12/business/12view.html

>

> Economic View Following the Money, Doctors Ration Care By TYLER COWEN

> Published:

> December 11, 2010

>

> snip/snip

>

> The underlying problem is that doctors are reimbursed at different rates,

> depending on whether they see a patient with private insurance,

>

Medicare<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto\

pics/medicare/index.html?inline=nyt-classifier>or

>

Medicaid<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto\

pics/medicaid/index.html?inline=nyt-classifier>.

> As demand increases relative to supply, many doctors are likely to turn away

> patients whose coverage would pay the lower rates.

>

> snip/snip

>

> Depending on the state and on the malady, it is common for Medicaid to

> reimburse at only 40 percent to 80 percent the rate of Medicare. Private

> insurance pays more than either.

>

> A result is that physicians often make Medicaid patients wait or refuse to

> see them altogether. Medicare patients are also beginning to face lines, as

> doctors increasingly prefer patients with private insurance.

>

> Access to health care will become problematic, and not only because the

> population is aging and demand is rising. Unfortunately, the new health care

> legislation is likely to speed this process. Under the new law, tens of

> millions of additional Americans will receive coverage, through Medicaid or

> private insurance. The new recipients of private insurance will gain the

> most, but people previously covered through Medicaid will lose.

>

> Ideally, higher demand for medical care would prompt increases in supply,

> which in turn would lower prices and expand access. But the health care

> sector does not always work this way.

>

> snip/snip

>

> We could go further by giving greater scope to nurse

>

practitioners<http://topics.nytimes.com/top/news/health/diseasesconditionsandhea\

lthtopics/nursing_and_nurses/index.html?inline=nyt-classifier>,

> admitting more immigrant doctors, reforming malpractice law and allowing

> cheap, retail

" Wal-Mart<http://topics.nytimes.com/top/news/business/companies/wal_mart_stores_\

inc/index.html?inline=nyt-org>style "

> medical care, all to increase access and affordability. Yet these

> changes do not seem to be in the offing, so access is likely to decline.

>

> snip/snip

>

[Guest guest]

THat is like the prior authorizations for imaging. The insurance company is not

telling you you CAN'T do the test, they just won't pay for it. THerefore, we are

holding the bag on the liability issue of why we did not do that MRI for her

worsening headaches and found the aneurysm before it caused her death.

Re: NYT Article - Following the Money, Doctors

Ration Care

 

Yes, the politicians were very smart about this. They wrote the bill so that

they were not accused of rationing care. The market forces, however, will drive

doctors to ration care. And, there is more and more demonization of doctors in

the media.

Brand

>

> Interesting article about how the new mandate for everyone to have health

> insurance may have the unexpected consequence of making it more difficult

> for Medicaid and Medicare insured patients to get access to care.

> Afterall, given the option of taking on a new Medicaid/Medicare patient (and

> it's reimbursement rates) or a new private insurance patient who just got

> new mandated insurance (and the private reimbursement rates), many practices

> will likely take on the private pay and limit Medicaid/Medicare even more.

>

> An interesting alternative mentioned in the article that I hadn't heard of

> before...

>

> " AN entirely different approach is suggested by the system in Singapore,

> where the government requires savings (say 10 percent to 12 percent of

> income), patients pay for medical care from those savings, and the

> government takes care of additional catastrophic expenses. That system has a

> good record for cost control and access, but would Americans accept so much

> required saving? "

>

> Locke, MD

>

> http://www.nytimes.com/2010/12/12/business/12view.html

>

> Economic View Following the Money, Doctors Ration Care By TYLER COWEN

> Published:

> December 11, 2010

>

> snip/snip

>

> The underlying problem is that doctors are reimbursed at different rates,

> depending on whether they see a patient with private insurance,

> Medicare<

http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medi\

care/index.html?inline=nyt-classifier >or

> Medicaid<

http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medi\

caid/index.html?inline=nyt-classifier >.

> As demand increases relative to supply, many doctors are likely to turn away

> patients whose coverage would pay the lower rates.

>

> snip/snip

>

> Depending on the state and on the malady, it is common for Medicaid to

> reimburse at only 40 percent to 80 percent the rate of Medicare. Private

> insurance pays more than either.

>

> A result is that physicians often make Medicaid patients wait or refuse to

> see them altogether. Medicare patients are also beginning to face lines, as

> doctors increasingly prefer patients with private insurance.

>

> Access to health care will become problematic, and not only because the

> population is aging and demand is rising. Unfortunately, the new health care

> legislation is likely to speed this process. Under the new law, tens of

> millions of additional Americans will receive coverage, through Medicaid or

> private insurance. The new recipients of private insurance will gain the

> most, but people previously covered through Medicaid will lose.

>

> Ideally, higher demand for medical care would prompt increases in supply,

> which in turn would lower prices and expand access. But the health care

> sector does not always work this way.

>

> snip/snip

>

> We could go further by giving greater scope to nurse

> practitioners<

http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/nurs\

ing_and_nurses/index.html?inline=nyt-classifier >,

> admitting more immigrant doctors, reforming malpractice law and allowing

> cheap, retail " Wal-Mart<

http://topics.nytimes.com/top/news/business/companies/wal_mart_stores_inc/index.\

html?inline=nyt-org >style "

> medical care, all to increase access and affordability. Yet these

> changes do not seem to be in the offing, so access is likely to decline.

>

> snip/snip

>

[Guest guest]

I like the frame " Doctors Ration Care "

 

Interesting article about how the new mandate for everyone to have health insurance may have the unexpected consequence of making it more difficult for Medicaid and Medicare insured patients to get access to care.

Afterall, given the option of taking on a new Medicaid/Medicare patient (and it's reimbursement rates) or a new private insurance patient who just got new mandated insurance (and the private reimbursement rates), many practices will likely take on the private pay and limit Medicaid/Medicare even more.

 

An interesting alternative mentioned in the article that I hadn't heard of before...

" AN entirely different approach is suggested by the system in Singapore, where the government requires savings (say 10 percent to 12 percent of income), patients pay for medical care from those savings, and the government takes care of additional catastrophic expenses. That system has a good record for cost control and access, but would Americans accept so much required saving? "

 

Locke, MD

 

http://www.nytimes.com/2010/12/12/business/12view.html

 

Economic View

Following the Money, Doctors Ration Care

By TYLER COWEN

Published: December 11, 2010

snip/snip

The underlying problem is that doctors are reimbursed at different rates, depending on whether they see a patient with private insurance, Medicare or Medicaid. As demand increases relative to supply, many doctors are likely to turn away patients whose coverage would pay the lower rates.

snip/snip

Depending on the state and on the malady, it is common for Medicaid to reimburse at only 40 percent to 80 percent the rate of Medicare. Private insurance pays more than either.

A result is that physicians often make Medicaid patients wait or refuse to see them altogether. Medicare patients are also beginning to face lines, as doctors increasingly prefer patients with private insurance.

Access to health care will become problematic, and not only because the population is aging and demand is rising. Unfortunately, the new health care legislation is likely to speed this process. Under the new law, tens of millions of additional Americans will receive coverage, through Medicaid or private insurance. The new recipients of private insurance will gain the most, but people previously covered through Medicaid will lose.

Ideally, higher demand for medical care would prompt increases in supply, which in turn would lower prices and expand access. But the health care sector does not always work this way.

snip/snip

We could go further by giving greater scope to nurse practitioners, admitting more immigrant doctors, reforming malpractice law and allowing cheap, retail “Wal-Mart style” medical care, all to increase access and affordability. Yet these changes do not seem to be in the offing, so access is likely to decline.

snip/snip

 

-- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com

[Guest guest]

So why do we take the blame if the rules are stacked against us and the

patients?

Order whatever test or prescription you feel the patient needs. If the insurer

denies the test, advocate for the patient to get the test anyway. Ask the

patient who they prefer to take advice from, their doctor or bureaucrat? If they

still choose not to have the test, document, document, document.

All it takes is a little explaining to the patient that you are on their side,

but the government has set up the rules to save itself money over their health!

Horvitz, D.O.

stown, NJ

Www.drhorvitz.com

Sent from my iPad