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Jim1969
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Date Joined Jul 2009
Total Posts : 2042
   Posted 12/5/2010 2:53 AM (GMT -6)   
I did not want to hijack another thread on this but Dr Jimmy's post about his doctor being a jerk did bring up an interesting an important issue, which is "Obamacare" or if you prefer the new health care law which is in the process of being phased between now and 2014.

This new law is well over 1000 pages and no one as yet fully understands all parts of it or what the full implications are going to mean to doctors, hospitals, and patients. Because no one understands it all or the full implications some doctors, hospitals, etc are or have gone into full panic mode when, for many of them it really is not needed.

Included in this law are passages that basically say that doctors will have to justify their treatment decisions. The reasoning behind this part of the law is to help eliminate waste in the medical field and was done so because of things like a 95 year old who is bed ridden for a number of reasons getting a hip or knee replacement even though there is little to no chance they will ever be mobile again, or people with terminal cancer (and I am talking about people who have less than a couple of months to live) having to undergo chemo and radiation. Basically we are talking about useless or near useless procedures. This also includes medications as doctor's may have to justify why they have a patient on drug A for extended periods that is only slightly effective or not effective at all, especially when there are other medications out there that could be used or tried.

Then you also have hospitalization issues. I am sure we all know people who should have been admitted and were not, people who should have stayed who were discharged and probably people who didn't need to be in the hospital who were admitted.

Next on the list are tests. Doctors may be asked to explain why the ordered an X-ray when a CT or MRI was really needed, especially when they end up ordering the next level a few hours or days later.

I don't have the exact numbers but several reports indicate that billions of dollars are wasted annually in health care because of fraud or poor decisions being made. Now granted part of this is due to insurance companies betting the cheapest solution will work and basically forcing doctors and patients into less than ideal situations, but there is still a lot of fraud being committed and many doctors who practically order every test imaginable over a sprained ankle because they just want to cover their butts.

I would like to think that the truly good doctors have nothing to worry about and that they already "justify" their decisions, and they probably do and have everything they need in their patient's charts already.

BTW: The entire law is available on line if anyone is interested in reading it. There are also several sites that attempt to summarize it, though most of those only talk about the insurance aspects or the parts that seem or are "questionable" in the way they are written.

Retired Mom
Veteran Member


Date Joined Feb 2010
Total Posts : 1752
   Posted 12/5/2010 4:03 AM (GMT -6)   
I can only say that I have personally had two physicians refere to "Obamacare" by name as serious problems that we will have to face after the first of the year. I honestly don't know enough about the program to personally comment further. It just seems like the Dr's know something and don't like what they know. They don't aways share what they discuss among themselves, but rest assurred, there is much concern in the mdical profession.
Retired Mom

undetermined_dimension
Regular Member


Date Joined Dec 2010
Total Posts : 38
   Posted 12/5/2010 5:17 AM (GMT -6)   
This is a huge issue for me as i don't have health care coverage due to my pre-existing conditions, unable to quit working so i can't file disability yet am barely able to work at all ( i have my bf working with me to keep my house and daycare together, without her i wouldn't be able to have any income coming in), make just a bit to much money to be on state funding but can get into the teaching hospital at 100% coverage (isn't that something) and can't even think how to begin to even afford state pool insurance. I see a lot of good and potentially a lot of bad but as of everything it's how well you know your rights and how willing you are to be your own advocate to get what you need and constantly battle to keep it. I find I get the treatment I need by bartering or volunteering for a naturopath, herbs, and pt but it is getting harder and harder to get into the hospital to get major testing and surgery done as well as keeping up with rx costs. I really hope that this pushes the medical field to look into cheaper, safer, more natural treatments and make them available at an affordable price also standard pricing for the public and not just insurance companies would help people get a fair price for treatment and not face medical bankruptcy (which i am going to have to look into soon if i can't figure out how to make it). But we as patients also have the responsibility to remember you can never have anything from a situation that you don't bring to it. So i wish everyone the knowledge, hope, wisdom, and perseverance to bring in all the good we possibly can and make this the best situation we possibly can. Blessings.
“Maybe if I share the path I walk then a little more of your pain will vanish. I want you to heal, whoever you are. I don't care what pain you've brought the world, I just want yours to subside. No matter what, your path is yours. Dont follow misery or worry. Devote every moment of your life to improving your dreams. Love your world. Cherish the good you do. Let go of hatred. Dream of love.” ~ ?

Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 12/5/2010 7:49 AM (GMT -6)   
It should be mentioned that, beyond the law being over 1000 pages long and very complicated, is that it also calls for the formation of a committee or agency to turn the law into actual regulations and until that committee actually does that and those regulations are formally adopted it really is anyone's guess what many of the provisions in the law will truly mean.

Some things are pretty straight forward like insurance companies no longer being able to deny or limit coverage due to pre-existing conditions. Other things like doctor's and hospitals having to justify medical conditions are about as clear as mud.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

vestabula
Veteran Member


Date Joined Nov 2008
Total Posts : 2784
   Posted 12/5/2010 8:43 AM (GMT -6)   

My gyno and rheumy are both looking for jobs in research thanks to Obamacare as they do not want to be told who they can treat, what line has to be drawn when it comes to treatment and what they can charge.  My dermatologist has a sign in his office that states at the beginning of the year he will be taking cash or credit cards only.  His receptionist told me this is because of all the additional staff they will would have to hire to tackle the reams of paperwork that comes with Obamacare.  My husband teaches Medical Management, has read a great portion of this bill and it is loaded with unrelated pork.

I live very close to the Canadian border.  The hospital and doctor's parking lots are filled with cars from Canada.  If socialized medicine is so wonderful...why do they come here for treatment?

 

Donna


Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 3453
   Posted 12/5/2010 8:59 AM (GMT -6)   
The worst problem has been with us for a few years and has nothing to do with reform. This is probably being mistakenly claimed as due to reform, but it's the RAC audits that are causing more paperwork and driving doctors to drop Medicare (but not insurances). The govt pays private companies by the amount they deny in doctors' claims. These people come into doctors' offices and hospitals and look for any little thing they can find as an excuse to deny claims - stuff like doc didn't ask about bowels when pt came in for a cold. Hospitals are laying off nurses to save millions as "war chest" for defense attorneys to fight these private companys' denials. The nasty part of the audits is not the denials but the penalties. The govt gets back punitive payments of 10 times (I don't know the real number) times the percentage of straight Medicare patients the companies figure are in the practices.

There is some new paperwork, or rather reduction thereof. Medicare claims must be sent electronically, so docs have had to buy computers.

I haven't seen anything different from last year to this because I have a "supplemental" policy instead of straight Medicare. My co-pays are going up, but this is no surprise.
Alcie
 
 

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 11289
   Posted 12/5/2010 5:19 PM (GMT -6)   
Donna made an excellent point about Canada's socialized medicine. its a great if you never have to go the dr. I have a problem with a committee determining what care I need, especially when this committee has no medical training and are not drs. I love it when I am 80 years old and told I don't need any preventive medicine because I am old I will probably get the disease or condition anyway. Yes sir, this is where we are headed.
Moderator Chronic Pain Forum

Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 12/5/2010 7:07 PM (GMT -6)   
 
 
   I thought this might help us to better understand what is going to happen and what has already happened to "American Health Care".
 
 
    ~~~>   "........The Patient Protection and Affordable Care Act (PPACA)is a federal statute that was signed into law in the United States by President Barack Obama on March 23, 2010. Along with the Health Care and Education Reconciliation Act of 2010 (signed into law on March 30, 2010)..."
 
                  "........ The Congressional Budget Office estimated that the new law as amended would reduce the federal deficit by $143 billion over the first decade and in the decade after that by an amount equivalent in a broad range between one quarter percent and one-half percent of GDP...."
 
    A quick look.....
 
                    ".........The law includes numerous health-related provisions to take effect over a four-year period, including prohibiting health insurers from denying coverage or refusing claims based on pre-existing conditions, expanding Medicaid eligibility, subsidizing insurance premiums, providing incentives for businesses to provide health care benefits, establishing health insurance exchanges, and support for medical research. The costs of these provisions are offset by a variety of taxes, such as taxes on indoor tanning and certain medical devices (excluding eyeglasses, contact lenses, hearing aids, and any other medical device which is determined to be of a type generally purchased by the general public at retail for individual use), and offset by cost savings such as improved fairness in the Medicare Advantage program relative to traditional Medicare. There is also a tax penalty....."
 
  To read more in extensive detail go to...
 
     This is very useful information presented in easy to understand format. It explains every aspect of the Patient Protection and Affordable Care Act (PPACA) in both text and video.
 
~~>
 
       *warm huggs*
               dani

TWO roads diverged in a yellow wood
And sorry I could not travel both
And be one traveler, long I stood

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PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/5/2010 7:21 PM (GMT -6)   
Hi, everyone,
I don't participate in the forum as much as I used to, so many of the newer members don't recognize my name, but I stopped by tonight and saw the title of this thread and had to poke my head in.

I guess having been (and still am, until my Medicare kicks in) in a similar boat to Undetermined Dimension, I know what it feels like to have little or no (in some areas) health insurance. I think the issue is a very complicated one, and am not surprised that members of Congress haven't read the bill - that is common. Most of the time it's their staff who do the research and know the details, but by the time most bills are passed they are such a patchwork that they often are confusing and contain things that likely don't belong there, but it's the compromising that gets the needed votes. Messy, yes, but that's how the system works in the U.S. democracy (beats violence, at least in my book!). And it's a normal part of the process to have the regulations drawn up by the Department that has the responsibility to implement the law.

As someone who's also been a health care provider, running a sole proprietorship (up until last year) and being an approved provider by all my area's major insurance companies, decisions were taken, by and large, out of the hands of doctors and other health care providers decades ago with the start first of what were called DRG's (Diagnostic Related Groups), which evolved into HMO's. So all the complaining that the government, or a committee, are going to take decisions out of the hands of our doctors --- well, that's already happened. The ideal is that policies of Medicare (government insurance which most people wouldn't give up, even with its flaws), as well as private insurance companies, are based on what's called the "standard of care" - developed from medical research on what's the best procedure, treatment, etc. for a given diagnosis. Unfortunately, money can and does enter into the equation, sometimes in unscrupulous ways, although some of that has been made illegal. Insurance companies are basically out to make a profit, and that influences the overall policies of the insurance company way more than it should. But that's already happening. Having a government committee making decisions on the standard of care isn't going to be much different than what already happens in Medicare. And those people are doctors, but they are also bureaucrats. The doctors who work for the insurance companies and help make the decisions about care now are compromised, too. My point is it's already happening, and has been for awhile.

I think what's getting confused in the mess of it all is that Congress did not re-authorize reimbursement rates for Medicare earlier this year, and I believe that goes into effect Jan. 1, 2011. That may be mixed into the health care reform package, but it's an authorization that would have needed to happen independent of any health care reform. Unfortunately, it's going to result in a 20% cut in Medicare payments to doctors. That is what is currently upsetting a lot of doctors and hospitals, and, IMHO, rightfully so. Medicare reimbursement rates are not very high to begin with, but a 20% cut is a lot to absorb for any business. Plus with the concerns over our deficit here in the U.S., that cut may become permanent. The answers aren't easy, as health care costs are going up here in the U.S., with or without health care reform. They have to, with the aging population and many of us baby boomers now hitting the Medicare age. So costs are a problem that need to be addressed one way or another. I just hate to see all the problems blamed on health care reform when either way, we're facing problems with health care costs.

Going back to my personal situation, I have to say I was pleasantly surprised to find that one aspect of health care reform was already going to help me. My limited health insurance (which I've paid for with the help of my cousin because I wasn't eligible for Medicaid) had a limit of $1,000 for diagnostic testing. I feared I couldn't get the MRI I needed on my knee. But when I called my insurance they told me one provision of the new health care reform that went into effect lifted the limits on diagnostic tests, so I could get my MRI without worrying I would get a bill for it later. That was HUGE to me, as I need knee surgery and still will not be eligible for Medicare until next July (2 year wait after disability determination). So you see there are some good things in those 1000 pages. I only hope we don't throw the baby out with the bathwater on this. Some of us desperately need it.

BTW, Jim I have a favor to ask. There is a forum rule about not getting political, and I think referring to health care reform as "Obamacare" tends to put it in that direction. Would you mind changing the title of the thread to something more generic, like health care reform? I'm not a moderator, so I'm only asking as a favor. This topic is an important one for all of us, as we will, sadly, need and consume more health care services because we have chronic illness. I think it is very worthy of thoughtful discussion, but I'd hate for it to turn political. I am NOT saying this thread has done that; as a matter of fact I think there are several thoughtful replies, and that's why I posted.

Guess you all got way more than my 2 cents worth! Maybe it's because I've not typed a post in a long time!

Thanks,
PaLady

Post Edited (PAlady) : 12/5/2010 5:27:35 PM (GMT-7)


Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 12/5/2010 9:25 PM (GMT -6)   
 
 
 
For those intrested this is current information on the topic of " Medicare Reimbursement Rates" / ~~>

".....The enabling legislation and regulations, as well as Medicare carrier correspondence and forms, refer to the Medicare physician payment schedule as a “fee schedule.” From the AMA’s perspective, the distinction between a payment schedule and a fee schedule is extremely important: a fee is what physicians establish as the fair price for the services they provide; a payment is what Medicare approves as the reimbursement level for the service. All references to the “full Medicare payment schedule” include the 80 percent that Medicare pays and the 20 percent patient coinsurance. Likewise, transition “approved amounts” also include the patient coinsurance...."

Read more The Omnibus Budget Reconciliation Act of 1989 (OBRA 89) at...

~~~>  http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/the-medicare-physician-payment-schedule.shtml


TWO roads diverged in a yellow wood
And sorry I could not travel both
And be one traveler, long I stood

Chronic Pain Moderator
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Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 8137
   Posted 12/5/2010 10:42 PM (GMT -6)   
There are parts of this healthcare bill that are good, but more area's that need work...
I have a problem with the illegals getting better care than (USA Citizens) me and that'll still happens.
and it's a very hot topic, granted, in a true emergency situation yes anyone should get care, reguardless.
for the time being that's all I want to get into it as it's a hot topic and please this is just my opinion,
don't judge me, just give good arguement, or no point...
Healing Hugz to all
**********************************************
* Asthma, Allergies, Osteoarthritis, Spinal Stenosis, Degenative Disc (Lower Lumbar S1-L3 and Cervical C5,C6, C8 and T1), Fibromyalgia, Gerd,
Enlarged Pituitary Gland, Sjogren's, Ocular Migraines, mild carpel tunnel, ect.... "Would be nice if we could use the edit button in real life"...

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