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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Phillipa on February 2, 2010, at 21:37:03
Looks like the feared is about to happen. What will come of the baby boomers and those to come? Phillipa
From Medscape Medical News
Senate Sets Stage for SGR Fix to Freeze Medicare Pay for 5 Years, Followed by Massive Cut
Robert Lowes
February 1, 2010 Physicians who were hoping for a permanent solution to the notorious sustainable growth rate (SGR) formula for setting Medicare rates may have to settle for another temporary fix that would freeze their pay for 5 years at 2009 levels and then cut it by 25% to 30% in 2015.This possible scenario emerged from legislation that the Senate passed last week to raise the federal debt ceiling from $12.4 trillion to $14.3 trillion, as well as requiring Congress to make spending and tax cut proposals budget-neutral. The latter provision, called the pay-as-you-go or pay-go rule, would force lawmakers to finance new outlays by cutting the budget elsewhere or raising taxes. Likewise, any move that decreases federal revenue would have to be offset with spending cuts or tax hikes.
The legislation came as organized medicine and lawmakers scrambled to avert a 21.2% reduction in Medicare reimbursement that is scheduled to take effect March 1. Physicians warn that such a draconian decrease, which is triggered by the SGR formula, would force them to stop seeing Medicare patients.
The Senate bill calls for exempting a 5-year Medicare rate freeze which would replace the scheduled rate cut from the pay-go rule, meaning that lawmakers could finance the freeze through deficit spending. The cost of freezing Medicare rates for 5 years instead of cutting them comes to $82 billion, according to the American Medical Association (AMA).
The debt ceiling legislation that the Senate passed last week only makes this SGR fix possible a second bill is needed to actually avert the March pay cut and freeze rates for 5 years. Plus, the House would have to concur, noted Neil Kirschner, PhD, a senior associate in regulatory and insurer affairs for the American College of Physicians. "The House is expected to go along with it."
The Senate plan differs greatly from a bill that the House passed last fall that would scrap the SGR formula entirely and institute a new one with the promise of Medicare pay hikes. That bill would add $210 billion to the deficit, according to the Congressional Budget Office. However, the Senate has already indicated that it is not willing to go into the hole that much. Last fall, a Senate version of the House SGR bill that would have cost $247 billion was defeated in a procedural vote.
"Short-Term Fix Is Not Acceptable"
The move toward a more frugal solution to the SGR crisis, although understandable in the current debate about deficit spending, has alarmed leaders of organized medicine. "Such a short-term fix is not acceptable," William Jessee, MD, president and chief executive officer of the Medical Group Management Association, told Medscape Medical News. "Failure to address this issue at this time will surely lead to far more serious patient access problems."
Lori Heim, MD, president of the American Academy of Family Physicians, said that a 5-year freeze was better than a 21.2% pay cut, but that Congress shouldn't stop there. "I appreciate that we have to control deficit spending, but the Senate bill is short-sighted," Dr. Heim told Medscape Medical News. Failing to permanently fix the SGR problem now, she said, will only make it more expensive to do so in the future.
Created by Congress to control Medicare costs, the SGR formula sets an annual target for expenditures on physician services based on growth of the gross domestic product. If expenditures overshoot the target, Medicare cuts physician pay the following year to recoup the difference. Organized medicine considers the formula flawed because the cost of operating a medical practice typically grows faster than gross domestic product.
The SGR formula has triggered rate decreases going back to 2003, but each time Congress has postponed them with a 1-year "patch." However, the difference between targeted and actual spending on physician services accumulates from year to year, making the next year's pay cut even bigger.
That same math would play out with the proposed 5-year freeze of Medicare rates beginning this year. In 2015, the SGR formula would trigger a rate decrease of roughly 25%, according to Dr. Kirschner. The AMA puts the pay cut at roughly 30%.
By scrapping the SGR formula, Congress would not only avert the deep pay cut but also retire years of SGR "debt." However, the longer Congress waits to do so, the more debt there is to retire. Earlier this month, internist Nancy Nielsen, MD, the AMA's immediate past president, stated that if Congress had eliminated the SGR in 2005, it would have cost only $49 billion, as opposed to more than $200 billion in 2010.
Posted by Sigismund on February 2, 2010, at 22:28:09
In reply to No More Medicaire What Will happen????, posted by Phillipa on February 2, 2010, at 21:37:03
>those to come?
I'm glad I won't be around for it.
Posted by Willful on February 2, 2010, at 23:16:41
In reply to No More Medicaire What Will happen????, posted by Phillipa on February 2, 2010, at 21:37:03
Calm down, Phillipa. There's nothing to be alarmed about. Congress is not about to reduce doctors' pay nor is medicare about to end.
This is about a possible effect of newly passed budget legislation on an accounting system that was set up in order to make sure that doctors pay was not reduced, as otherwise would have been required. Undoubtedly, congress will pass another fix, and any pay cut will be eliminated.
In brief, it's about an old formula for limiting doctors' pay increases each year, which limitation has also been deferred every year-- and which will no doubt be deferred again-- The issue again is too complicated to explain-- although it's in this short article if you read it--
I'd explain more, but I think it would just confuse you.
Just trust me that what's going on here will be resolved in a way that satisfies doctors (even if it doesn't meet all their hopes and wishes).
Just take my word for it. I read about this the last time you posted on the issue-- and it has nothing even remotely to do with ending Medicare.
Willful
Posted by Phillipa on February 3, 2010, at 14:07:09
In reply to Re: No More Medicaire What Will happen????, posted by Willful on February 2, 2010, at 23:16:41
Willful JaneJane said to read your reply. That you knew your stuff. It seems that when my docs see I have Disability they then change how they were going to treat me. One internist actually said hasimotos isn't autoimmune and we only treat symtoms. I asked the endo he said definitely autoimmune so yes I get terrified as I don't want to die from using the hormones and other things. I'm as you see panic and Gad and wear myself out worrying. See you get to age going to be 64 and feel worse daily and it's really scarey especially when real medical problems start occurring. Phillipa write me I'd like that
Posted by bleauberry on February 3, 2010, at 16:00:17
In reply to No More Medicaire What Will happen????, posted by Phillipa on February 2, 2010, at 21:37:03
Medicare never lived up to its promise. Government entitlements hardly ever do. And as is customary, it ended up costing multitudes more than anyone ever admitted.
Few doctors accept Medicare patients anymore. Those that do are swamped and unable to give the proper care and attention. They wait months for their payments from Medicare and it is not unusual that they receive 10% of what was billed or nothing at all...after waiting months through piles of paperwork.
And these people (government) are the same ones that want to take over medicine for the entire country. Oh boy. No doubt we need improvements and overhauls, but government takeover never has had and never will have a rewarding outcome.
So on one hand, if Medicare were to die away, it wouldn't bother me...except for the thousands of dollars I've had taken out of my paychecks for it. That's not cool.
I understand that at this point in time, Medicare is the only "perceived" option that many people, such as Phillipa, have. It isn't, but it is thought to be. Another problem with programs like this is that they are not only poorly managed, deliver poor performance, and have costs far in excess of what the quality would justify, they get people dependent on them. That's not cool.
I'm not sure what to say. On one hand I feel aweful for everyone who might get even less from Medicare than they do now. On the other hand, I say kill the beast and learn lessons from the whole fiasco.
Free markets always win. Example. A hospital in Pennsylvania was started by a rich widow, and is today maintained by charity donations only. Anyone can go there regardless of ability to pay. They have the best doctors in the country who are paid set salaries instead of per-service-fees. It is a nationally acclaimed hospital and is still growing in leaps and bounds. All started by some widow. The standards, care, and technology of this hospital are well above the average hospital.
So let Medicare fade away, and let free people make better things happen.
But don't forget to give me all my money back! Geez I can't believe what huge chunks they take out of my paycheck, and I will likely never see any benefit from it. Geez.
Posted by Phillipa on February 3, 2010, at 19:51:55
In reply to Re: No More Medicaire What Will happen????, posted by bleauberry on February 3, 2010, at 16:00:17
I get medicaire statements monthly and they get paid and an aweful lot as they overcharge for their services which then are paid for by those who are working now. I've paid my dues too working as an Rn, secretary a few times. So what are your plans when you retire? As the entire system will disappear. No monthly benefits from all that money you contributed and are contributing now. Do you have lots and lots of money in the bank as you will need it to live. At least we own our home mortgage free. Phillipa ps example $275.00 billed for his office visit and medicaire paid $87.00. And I was billed 17.55. Another office visit $170.00 billed paid $88.00 My portion $17.00. Short visits also. So if people are paying co-pays of $25.00 for a visit what's the insurance company paying? And for those with no insurance at all they pay nothing we pay all.
Posted by bulldog2 on February 4, 2010, at 12:28:14
In reply to No More Medicaire What Will happen????, posted by Phillipa on February 2, 2010, at 21:37:03
Do you think they even care?
Posted by Phillipa on February 4, 2010, at 19:49:03
In reply to Re: No More Medicaire What Will happen???? » Phillipa, posted by bulldog2 on February 4, 2010, at 12:28:14
If you mean the government no they are wealthy. Phillipa so what do you plan on doing about this? Phillipa
Posted by bulldog2 on February 5, 2010, at 17:14:49
In reply to Re: No More Medicaire What Will happen???? » bulldog2, posted by Phillipa on February 4, 2010, at 19:49:03
> If you mean the government no they are wealthy. Phillipa so what do you plan on doing about this? Phillipa
Nothing. Their to powerful to fight.
Posted by Phillipa on February 5, 2010, at 21:09:40
In reply to Re: No More Medicaire What Will happen????, posted by bulldog2 on February 5, 2010, at 17:14:49
I don't feel that's true at all. Phillipa
This is the end of the thread.
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