Wednesday, July 9, 2008



Well, I hope that opening got your attention. The deadline is today!! TODAY!! Congress is supposed to vote to repeal a bill already passed for a proposed 10.6% decrease in medicare allowable payments to doctors for treatments rendered to patients. This was enstated as of July 1, 2008 with a stipulation for reconsideration which has a deadline today. What are the ramifications as a result of this order?

The CRISIS is a crisis to doctors because their practices have to factor in a net loss of 10% immediately. The loss of 10% now must be made up in patient volume equal in the new allowable fees. Plain english: 10% loss cannot be made up in 10% increase in patients. It will take at least 11% increase in patient load and the overhead costs of operating to make it up. The time alone means more time spent in the office doing the additional paperwork, increased liability, and treating time. In addition, the insurance companies paid by medicare like HMO, PPO, HSA, PFFS, etc (anyone over 65 and insured) will also be reimbursed 10% less. The insurance companies are like a middle man and pay doctors a discounted fee schedule after they take their share out. Now the discounted fee schedule the middle man uses is additionally discounted 10%.

The average patient is under the misconception that "all doctors are rich." Therefore the cry for help from doctors is falling on deaf ears. The view the patients have is of a time pre-HMO and pre-third party administred health care which has been around for over 20 years. The percentage of overall patients on these plans over the last 20 years has exploded into a majority stake. Personally, I have been cashing checks from companies that pay less THAN 10 CENTS a patient after a co-pay of $10 or less. That is $10.10 per patient!! Patients see a busy office and assume the doctor is still being paid the fees they were 20 plus years ago per patient which calculates into a typical $40 or more. Now at $10 on the average, the doctor has taken a loss equivalent to a 50 year pay cut.

What would the average auto worker do if he or she took a 50 year paycut? How could anyone contend with further cuts as being implemented this month?! And another bill is in the works for another 5.4% CUT in Jan 2009!! And another in 2010 of another 5%!! And another 5% in 2012!!!

Doctors in my state average age is approx 55 years old themselves. They have been toying with the possibility of retiring before anything gets much worse. The aggravation of running an office is creating a feeling of anger making practicing impossible. Add lawyers, problem patients, increased energy costs, insurance woes, and more!! No other profession provides such a vital service yet has to contend with such red tape.

Doctors locally are now starting to take action by taking out ads encouraging people to write their congressman. Since the average attitude is "Doctors are all rich", I feel any threat about denying access to patients to one's private practice is futile. All plans have a contract that takes a minimum of 60 days to opt out. Threatening not to take Medicare patients will only encourage patients to leave Medicare and go on a private insurance which pays less anyway. Thereby, losing one's best patients.. Or they could go to another doctor!

At this juncture, patients do not feel the pressure because access to a provider hasnt been a problem. When will they get involved? John Q Public feels they are entitled to health care and it should be free or low cost. The public has been toying with the idea for years. Private insurance plans with tremendous discounts have brainwashed the average patient into paying only low co pays and anything higher is robbery. Socialized medicine is so ingrained into the fabric of public thought, both Republicans and Democrats believe a socialized system is the only way forward. Getting everyone on a discount plan is believed to contain costs for the government. Further wrongly believed, the financial distress to the average medical provider will magically work its way out eventually.Meaning the doctor can absorb the lost revenue after adjustments are made to his/her practice. I forsee a mass retirement and closing of all private practices across the country. With the overhead to practice today, doctors can no longer maintain a viable practice. With the aging baby boomers flooding the sytem, the decrease in admissions to medical schools, and the problems listed here to new practitioners when graduating, the CRISIS is coming fast.....

If you live in Palm Beach County, check out Sunday's paper for an article addressing this matter and who you should contact in the state of Florida. The New York Times on July 7 2008 has an article "Doctors press Senate to undo Medicare Cuts."
Further, CQ Politics has an article entitled "Medicare Pressure On Republicans" by Drew Armstrong. And while not complete, if you desire a better understanding about how private insurers are involved see the article "Two Insurers Increase Bet on Medicare" in the New York Times Dec 5 2007.
Government link which provides information on the voting!! Here!!

More info links Please read!
Medicare pay cuts

Doctors lobby cuts link
Adminstration delay payments/cuts link

Pharmacists weigh in link

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