We Must Preserve Access to Quality Health Care (Rep. Tom Price) February 21st, 2008
Dangerous Medicare reimbursement cuts are looming and will threaten access to quality health care. These cuts, scheduled to go into effect July 1, 2008, will discourage physician participation in Medicare, leaving our seniors with fewer options for needed care. Prior to the recess, Rep. David Scott (D-Ga.) and I introduced H.R. 5445, a bill to preserve Medicare reimbursements for 18 months so that Congress can find a long-term solution to this serious problem.
The Sustainable Growth Rate used in the Medicare reimbursement process is fatally flawed. It does not take into account the increased quality of care given to Medicare beneficiaries and rigidly limits payments based on a preset spending target. Physicians are already being reimbursed at a depreciated rate, and these cuts will simply make the situation worse, putting our seniors at greater risk.
Congress must find a sustainable, long-term solution to the Medicare reimbursement problem. The delay Rep. Scott and I propose will provide adequate time for all stakeholders to do this while, at the same time, ensuring the continued availability of quality care to Medicare beneficiaries. We cannot allow our seniors to be put at risk because of unrealistic physician reimbursement levels. Preventing these cuts and finding a viable solution is vitally important to ensuring our nation’s seniors receive the care they need.
I"ll tell you exactly what will fix the problem. Not another delay for 18 months so we have this same problem year after year after year. With a pathetic Congress gridlocked in a perpetual legalized votes for dollars system. Not a Congress full of lawyers and legal aids who are so lacking of understanding as to the root causes of the problem. You want to understand how to fix the problem.
Try asking a physician.
Since you didn't ask me, I'm going to give you my $2s(inflation adjusted) worth of advice anyway.
You want to make access to physicians who accept Medicare close to 100%, and increase competition and quality and service at the same time?
And create a system where physicians and patients are mutually satisfied?
You want to make access to physicians who accept Medicare close to 100%, and increase competition and quality and service at the same time?
And create a system where physicians and patients are mutually satisfied?
A WIN-WIN?
1) Make the patient pay their physician up front for the full value of their service at the rate that has been pre-determined by a mutually agreed upon price between patient and doctor. In other words WIN-WIN. Both parties are mutually satisfied for the rate of payment for services rendered.
Credit cards. Debit cards. Checks. Cash. Gift cards. You name it. Floating loans. You name it. Vouchers. You name it. Doctors take it all.
2) Have the patient submit to Medicare the paper work required to be reimbursed by their insurance, with physician assistance of the process, if necessary. The insurance between a patient and Medicare is a contract between the patient and Medicare. It should be up to the patient to get their money back. The physician provided a service. You pay for that service. The insurance company provides insurance. You get your money back from the insurance company.
Benefits?
1) Patient understands the cost of their care
2) Patient bears the brunt of the responsibility for the reimbursement of their expenses, not the physician. The physician has provided a service for which they should be paid. It is up to the patient to receive reimbursement for a contract they have between themselves and the government.
3) If the patient is unable to pay for the additional cost of unreimbursed service, it is their duty and responsibility as grown adults to seek assistance through government funded assistance plans, their church, their family, societies, or any number of other programs just waiting to give free money to the walking poor, and poor on paper only. And if they cannot find assistance, they need to either find a cheaper doctor, which in a balance billing environment will be flooded with them, or obtain their health care through any number of government funded and subsidized sliding scale clinics and health departments. And it should be up to the government to provide funding of these clinics.
It is not the physicians responsibility to bear the brunt of patients financial inability to pay. It is up to the patient to find assistance, whether that be through government or non government associated aid. And it's up to the government to assist the patient in that process of seeking aid.
The current system has created a system of unpaid and underpaid doctors who are leaving the system in search of alternatives means of economic viability, or turning the physician-patient encounter into a volume mill of LOSE-LOSE interactions, which only increases the cost of care.
The physician is a doctor. The physician is not an economic advisor to the patient . The physician is not a social worker to the patient. The physician is not a bank to the patient. The physician is not a 60-90 day interest free loan to the patient. The physician is not a free service. The physician has a business to run and a service to offer. And as such should be treated and respected as a business in this capitalistic nation of ours.
The current system of getting paid or not paid has created a bloated, over burdened mountain of paperwork and costs that have straddled this countries physicians ability to provide quality care at a reasonable price. Instead your Congress, year after year after year gives the American public burdened care at accelerating government cost, with ever rising rules and regulations that add more cost structure to the bloated bottom line.
Do you know what a physicians office can offer with a secretary, a nurse, and rent? No billing companies. No claims, submissions, denials, stamps, reams of paper, managers and on and on.
A doctor
A nurse
And a couple clerks
When you break it all down, the true cost of delivering affordable care has been stifled by the same government that punishes doctors while claiming innocence from culpability.
The government is the problem.
The idea of balance billing, the only viable solution to the problem sits like the pink elephant on the ballroom dancing floor.
1) Make the patient pay their physician up front for the full value of their service at the rate that has been pre-determined by a mutually agreed upon price between patient and doctor. In other words WIN-WIN. Both parties are mutually satisfied for the rate of payment for services rendered.
Credit cards. Debit cards. Checks. Cash. Gift cards. You name it. Floating loans. You name it. Vouchers. You name it. Doctors take it all.
2) Have the patient submit to Medicare the paper work required to be reimbursed by their insurance, with physician assistance of the process, if necessary. The insurance between a patient and Medicare is a contract between the patient and Medicare. It should be up to the patient to get their money back. The physician provided a service. You pay for that service. The insurance company provides insurance. You get your money back from the insurance company.
Benefits?
1) Patient understands the cost of their care
2) Patient bears the brunt of the responsibility for the reimbursement of their expenses, not the physician. The physician has provided a service for which they should be paid. It is up to the patient to receive reimbursement for a contract they have between themselves and the government.
3) If the patient is unable to pay for the additional cost of unreimbursed service, it is their duty and responsibility as grown adults to seek assistance through government funded assistance plans, their church, their family, societies, or any number of other programs just waiting to give free money to the walking poor, and poor on paper only. And if they cannot find assistance, they need to either find a cheaper doctor, which in a balance billing environment will be flooded with them, or obtain their health care through any number of government funded and subsidized sliding scale clinics and health departments. And it should be up to the government to provide funding of these clinics.
It is not the physicians responsibility to bear the brunt of patients financial inability to pay. It is up to the patient to find assistance, whether that be through government or non government associated aid. And it's up to the government to assist the patient in that process of seeking aid.
The current system has created a system of unpaid and underpaid doctors who are leaving the system in search of alternatives means of economic viability, or turning the physician-patient encounter into a volume mill of LOSE-LOSE interactions, which only increases the cost of care.
The physician is a doctor. The physician is not an economic advisor to the patient . The physician is not a social worker to the patient. The physician is not a bank to the patient. The physician is not a 60-90 day interest free loan to the patient. The physician is not a free service. The physician has a business to run and a service to offer. And as such should be treated and respected as a business in this capitalistic nation of ours.
The current system of getting paid or not paid has created a bloated, over burdened mountain of paperwork and costs that have straddled this countries physicians ability to provide quality care at a reasonable price. Instead your Congress, year after year after year gives the American public burdened care at accelerating government cost, with ever rising rules and regulations that add more cost structure to the bloated bottom line.
Do you know what a physicians office can offer with a secretary, a nurse, and rent? No billing companies. No claims, submissions, denials, stamps, reams of paper, managers and on and on.
A doctor
A nurse
And a couple clerks
When you break it all down, the true cost of delivering affordable care has been stifled by the same government that punishes doctors while claiming innocence from culpability.
The government is the problem.
The idea of balance billing, the only viable solution to the problem sits like the pink elephant on the ballroom dancing floor.
Everyone sees it and recognizes it as a pink elephant.
But nobody is willing to step up to the plate and proceed with the only fixable alternative to concierge medicine. The problem, so obvious, is that acknowledgeing this as the fix is political suicide, even though it is the only llong term viable solution.it is a viable solution.
Making old people pay for their care is about as palatable to a Congressman as making a Congressman survive on Medicare for a year.
Why this only viable solution is never entertained is a testament to the powerful lobbying capabilities of the old people societies. The only problem is that while they claim such policies will create hardship for the elderly, the current policies are bankrupting the very programs from their viable existence for future generations.
If you want to turn FREE=MORE into MORE=LESS, you must give people a financial stake in their decisions.
Even just doing this for "E&M" services only would go a long way toward solving the crisis. Medicare could try to control costs for expensive procedures, but it has to get its nose out of the doctor's office. I could offer my services at a very reasonable fee if all of the paperwork and billing overhead would go away.
ReplyDelete* loud applause *
ReplyDelete...but you forgot one equation:
AARP = insurance industry
Great idea. This is what I have to do with my catastrophic insurance--pay up front and get reimbursed if I've met my deductible.
ReplyDeleteGreat blog. I'll have to add you to my blogroll--but you're not an ER doc...hmm...
I completely agree! Some obstetricians do this for pregnancy services (and most insurances will reimburse this way, also). For an uncomplicated pregnancy prenatal care and delivery, you get $x. (I think it's like $2500, which is pretty reasonable, imnsho)
ReplyDeleteExcellent post, as always. But I think I may have created a monster: I don't have any problem with perpetual emphasis on the word PAYMENT (and derivations thereof) but always italicizing reimbursement; I never meant for that to happen. (Though I have to admit that it works.)
ReplyDeletePsychiatry already does this.
ReplyDeleteMost good psychiatrists operate out of network with insurance companies and Medicare. And offer reduced fees to many of their patients. Office staff? Often none. Just the doc and the patient, the old fashioned way.
Why? Because insurance reimbursement is so minimal for mental health care, that this is the only way to make any money and have time to talk to your patients.
what do the psychiatrists do for after hours calls and weekend calls and vacations?
ReplyDeletethanks
This WIN-WIN reimbursement model you speak of already exists. It’s called stop playing the game. Nothing will change until the provider severs the umbilical cord from the commercial carriers and the government.
ReplyDeleteYou want patients to pay providers up front? Then don’t participate in any plans, don’t sign those ridiculous contracts, tell the Medicare patients you don’t participate and here’s an ABN form to fill out. Then give the patient a price list for services, payment is expected up front and for a fee we can provide a coded claim for them (the patient) to submit to either their carrier or Medicare for reimbursement.
Done.
btw, love the blog.
Anonymous,
ReplyDeletePsychiatrist differ on how they cover after hours, but most check their voicemail religiously (obsessively?), have an answering service that can page them, give their pager or cell numbers to patients, or have the patients call a local psych crisis service who has their pager and cell numbers.
I also make lots of contingency plans with my patients. So if they have an active issue, I will ask them to call in the next morning with an update and we will manage sub acute problems with brief phone calls. This often prevents subacute problems from becoming acute.