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BREAKING: Medicaid Docs refuse to work for peanuts

BREAKING: Medicaid Docs refuse to work for peanuts

No one saw this coming, no one.

http://youtu.be/kDomkBtJC7Q

For months, nay years, I have been predicting that the promise of quality healthcare for the poor via rapidly expanded Medicaid enrollments was a house of cards, a fraud, a three-card monte game, a sham, a man-made disaster, a Gruberesque fake meant to deceive the “stupid” people into believing that the promise of Obamacare was real instead of styrofoam faux-Greek columns basking in the neon light of Hollywood-driven love and media sycophancy.

For many reasons, but mostly because doctors would not work for peanuts, they would revolt like the kulaks and choose not to work rather than see the fruits of their labors handed out for free or close to free:

And now, for “BREAKING” news, As Medicaid Rolls Swell, Cuts in Payments to Doctors Threaten Access to Care (via Instapundit):

Just as millions of people are gaining insurance through Medicaid, the program is poised to make deep cuts in payments to many doctors, prompting some physicians and consumer advocates to warn that the reductions could make it more difficult for Medicaid patients to obtain care.

The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.

The impact will vary by state, but a study by the Urban Institute, a nonpartisan research organization, estimates that doctors who have been receiving the enhanced payments will see their fees for primary care cut by 43 percent, on average.

Stephen Zuckerman, a health economist at the Urban Institute and co-author of the report, said Medicaid payments for primary care services could drop by 50 percent or more in California, Florida, New York and Pennsylvania, among other states.

Here is one physician’s reaction from the same article:

Dr. George J. Petruncio, a family physician in Turnersville, N.J., described the cuts as a “bait and switch” move. “The government attempted to entice physicians into Medicaid with higher rates, then lowers reimbursement once the doctors are involved,” he said.

Hey Dr. George, you and the other physicians f—-d up, you believed the Democrats.

Somewhere, Jonathan Gruber is smiling, nay, laughing his ass off.

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Comments

One suspects students who had thought to go into medicine might now switch to law.

Wouldn’t it be nice if they would actually make something? Do we even do that in the US any more?

    walls in reply to creeper. | December 29, 2014 at 1:47 pm

    Wouldn’t it be nice if they would actually make something? Do we even do that in the US any more?

    Illegals do for pennies on the dollar. It’s the Chamber of Commerce way.

    great unknown in reply to creeper. | December 29, 2014 at 2:37 pm

    Except that law school enrollment is also tanking

    LWGII in reply to creeper. | December 29, 2014 at 5:23 pm

    We have the worlds finest grievance and butt-hurt industry. Other than that, we don’t make a damned thing.

    guyjones in reply to creeper. | December 29, 2014 at 5:37 pm

    As an aviation enthusiast, I find Boeing Corp. to be an inspirational (and, rare) example of American technological and engineering savvy. GE’s aviation division makes jet engines which are similarly amazing with respect to their technical complexity. I suppose the same could be said of Intel and its computer chip design, although its microprocessors are fabricated overseas. The immense resources, R&D and technical know-how that is required to bring a commercial airplane to fruition is staggering. There’s a reason that only four companies worldwide dominate the commercial jetliner market.

    Interestingly, while watching some Boeing promo videos on Youtube, I saw that Obozo had paid a visit to a Boeing factory a few years ago, delivering a speech in which he lavished praise upon the 787 Dreamliner. Notably, though, he refrained from reverting to his embittered community organizer-demagogue alter ego and admonishing the assembled designers, engineers and technicians by telling them, “You didn’t build that.”

      guyjones in reply to guyjones. | December 30, 2014 at 8:27 am

      I should amend my above statement to remove the word “rare.” I think that American ingenuity and creativity in engineering is still formidable, widespread and laudable. I think I meant to say that examples of American manufacturing in advanced technology products are increasingly rare.

Insurance that nobody wanted combined with nobody accepting it would never be the answer to getting more people coverage and accesses. But then, our betters really didn’t care as long as the public bought the lies. In the meantime, the gov got expanded and that was the goal.

One thing i’ve noticed. We hear about how the Drs. will have their fees cut and how the hospitals will have their fees cut but we never get any examples.

No broad sample and comparison chart. And it would be particularly enlightening to see alongside what is being offered to what it actually costs and from different locations.

I know for a fact that Drs. can be more expensive in certain areas and less in others and not necessarily where you’d think they’d be either.

Let’s see some hard numbers. Using example procedures.

Before, after and how much they cost.

Few other professions manage to hide from comparison with others and the amount of their compensation as well as Drs. and health providers have. (that includes Dentists)

There was/is a lot of fee shifting that goes on in hospitals. I know that. Very difficult to pin them down to a number before an operation. (I understand their are unknown variables caused by the Dr not knowing exactly what they will find during surgery but these days with all the imaging and diagnostic tools, they have a much better idea than they used to.

Let’s see some numbers. And make it a reasonable comparison not oranges and apples.

    JoAnne in reply to jakee308. | December 29, 2014 at 1:24 pm

    If you want to know what a procedure should cost, go to the price list at this hospital. They don’t take insurance – you pay up front. This is what medicine should be like – and was before government interference.

    http://www.surgerycenterok.com/pricing/

      Merlin01 in reply to JoAnne. | December 29, 2014 at 1:49 pm

      Thanks for the link JoAnne. I’m a pretty good example of how insurance adds to the cost of surgery. One of my surgeries in your link is listed at $10,700 while the real cost to me and the insurance company was…wait for it…wait…$175,000! Isn’t this awesome!

      Petrushka in reply to JoAnne. | December 29, 2014 at 2:11 pm

      Those prices are very interesting. They are in line with prices I was quoted for a recurring hernia repair. A bit lower, but in the same ballpark. I had my surgery done at a teaching hospital that took Medicare.

      A one hour procedure turned into a four and one half hour procedure involving two teaching surgeons in addition to the resident. They billed Medicare $55,000 and accepted $5500. My co-pay was $500.

      There are so many imponderables. My first surgery was an emergency, done on Sunday night. Afterwards, it was described as temporary. The second surgeon was not happy with the result and with the difficulties of re-doing it. I wonder what might have happened if the second surgeon was working for himself rather than for a salary. I simply don’t know.

      The rationale for insurance is to share high and unexpected costs. It is not to subsidize payments that are routine and predictable. Somewhere along the way, the concept of insurance got lost.

        Insufficiently Sensitive in reply to Petrushka. | December 30, 2014 at 1:36 pm

        It is not to subsidize payments that are routine and predictable. Somewhere along the way, the concept of insurance got lost.

        That’s another facet to Jonathan Gruber’s approach. It was used during the Obamacare debates by all its protagonists – they talked to the public as if health insurance was healthcare, and implied that once your signed up on the Exchanbe with your subsidy from other suckers, you’d never pay a nickel for anything medical.

        You could think like a European – ‘someone else (one of those ‘others’ who don’t vote right) will pay my medical costs’.

      Karen Sacandy in reply to JoAnne. | December 29, 2014 at 4:26 pm

      And employment-tied insurance, thanks to the government.

    mrtomsr in reply to jakee308. | December 29, 2014 at 2:30 pm

    When I owned my ambulance company, I needed to be vetted and signed with Medicare and Medicaid prior to being able to bill any other insurance. Once you sign, you are attesting to the fact you will adhere to all of the rules. Those rules are not easy to understand, nor are they easy to follow.

    I could be denied for any reason, mostly “not a covered service”. That was a ruling I got from medicaid (mass health) for transporting a heart attack patient to a cardiac cath lab. I appealed, and was denied, no other recourse available.

    At the beginning of 2010, I was forced to take a 9% reduction in reimbursement. This was not what I billed, this was what the government was paying me. Maybe one of the mega ambulance companies was able to negotiate with the feds and the state, but us little guys just did what we were told.

    A quick ballpark of what we were reimbursed in central Mass, for a BLS non emergency transport (A0428) I think was $247 base rate and $7 per mile at the ALS rate non emergent (A0426) was $287 base and the same mileage. Those are from memory and I believe in the ballpark prior to the mandated cut in 2010.

    Chicklet in reply to jakee308. | December 29, 2014 at 2:57 pm

    The temporary ‘Affordable Care’ exemption paid your primary care doctor (and mine) Medicare rates to see Medicaid patients. This has nothing to do with HMO’s or hospital prices.

    In order to entice doctors into accepting patients who had insurance that never paid the cost of their time and effort, Gruber and the gang gave (mostly private practice) primary care docs a 2 year raise.

    Big medical groups and hospitals can ‘cost shift’ by charging fee-for-service and insured patients $200 for a Tylenol, but the average doctor cannot do this. Now that this fee increase is set to expire there are plenty of internists and family practitioners who are thinking- do I want to see Medicaid patients for $37 dollars (or less) per visit (using New York prices)? The network is about to get a lot smaller, just as the Urban Institute is saying.

    snopercod in reply to jakee308. | December 29, 2014 at 3:38 pm

    Let’s see some hard numbers.

    OK, how about Transylvania (NC) Regional Hospital? They lost $1.2 million last year and were on the verge of bankruptcy when they were “saved” by Mission Health Systems in Asheville. Since the takeover, they’ve fired 250 employees (out of roughly 1,000), including all the medical transcriptionists. Their former medical records department is now located in another city. Mission Health has cut their 2015 budget by $1.5 million.

    Mission is in trouble as well. From the Asheville Citizen-Times:

    Mission Health predicts a $500 million decrease in payments over the next decade as more people get medical care outside of hospitals and reimbursements from Medicare and Medicaid decline. Seventy-five percent of Mission’s patients are covered by Medicare and Medicaid.

    Included in that amount is $228 million the company says it will lose under the Affordable Care Act, also know as Obamacare.

    There’s your flipping “hard numbers”.

      jakee308 in reply to snopercod. | December 29, 2014 at 8:00 pm

      You’ve only pointed out that they lost money.

      I want to see the costs of procedures compared with how much they bill to medicare, insurance companies and to individuals.

      That’s all. Why so defensive about asking for how much they are losing to the lower fees being paid?

      I only wish to see by how much they are being underpaid. You wouldn’t accept a bill for services without an itemization would you? Neither would I.

      Since the story is that Doctors and Health providers are being underpaid, the amount should be part of the story. Yet strangely it never is. Why is that? What are some examples? (and there need to be a broad sample. No cherry picking)

      Your comment is an example of the apples and oranges I spoke about. Just because a hospital or health provider goes broke does not determine the reason why. And if it is the lower fees provided then they should be pleased to provide examples of the lower fees.

        snopercod in reply to jakee308. | December 30, 2014 at 6:59 am

        I smell a troll. You ask questions and then when they are answered, you say the answers aren’t good enough for you. You’re just wasting everybody’s time. If you want hard numbers, the annual reports for all hospitals are available online. Do your own research.

        In Israel the doctors are (I was told when I visited years ago) paid less than bus drivers. (Supply and demand?) But hospital and insurance costs there are pretty high. Is the insurance there mandatory? Is health care labor intensive? They do have good care.

If the Urban Institute is saying 43%, you better figure its more like 65%.

Those guys are “non-partisan” like OwlGore is agnostic on the whole Gorebal Climate Thingy.

      platypus in reply to Ragspierre. | December 29, 2014 at 10:37 pm

      Hey Rags, did you notice Jamie Gorelick’s bio just a bit below the opening? They list her “experience” feeding at the trough but one trough they omitted is Fannie Mae. That’s the one where she and a bunch of others conspired to generate subprime loans so they could get a piece of the action off the top upon escrow closing.

      She and Franklin Raines (who I think was Barney Fwank’s butt buddy) pocketed over 800 million taxpayer dollars in bonuses over & above their pension plans and lifetime Caddilac insurance plans.

      “Let them eat used oats.” — Marie Somebody-or-other

        Ragspierre in reply to platypus. | December 30, 2014 at 5:19 am

        I did notice that. And that witch has done more than any single woman in U.S. history to harm this nation than anyone, except Ol’ Walleyes Clinton herself.

        IMNHO.

“One suspects students who had thought to go into medicine might now switch to law.”
****
My great niece and her husband are just finishing medical training and despite going to state college and medical schools, they have a combined student loan debt of >$600,000. That will be difficult to re-pay when the govt forces you to work below cost of doing business.

    platypus in reply to SHV. | December 29, 2014 at 10:41 pm

    I am certain that their training would be welcome in a number of foreign countries at rates that approximate the cost of living. Heck, they could cut a whale of deal to get into Russia on the ground floor.

    Weather-wise, I’d choose Belize or Costa Rica.

The good thing here is to live in states that didn’t accept the federal money to expand Medicaid, and, thus, lower income people are not forced into the program.

LibraryGryffon | December 29, 2014 at 1:52 pm

My suggestion was that if we felt there were too few doctors, especially in primary care, and that they cost too much, instead of screwing up the insurance side of the equation even further, we should be heavily subsidizing medical education. If doctors don’t start their professional lives with a quarter to a half a million dollars of debt they can charge less.

I suspect even 100% subsidies for all medical students would have cost us less than the current boondoggle and would have had a much better effect in the end.

For months, nay years, I have been predicting that the promise of quality healthcare for the poor via rapidly expanded Medicaid enrollments was a house of cards, a fraud, a three-card monte game, a sham, a man-made disaster, a Gruberesque fake meant to deceive the “stupid” people into believing that the promise of Obamacare was real instead of styrofoam faux-Greek columns basking in the neon light of Hollywood-driven love and media sycophancy.

I nominate this for ” 2014 Blog Sentence of the Year”. 🙂

While money does grow on trees, generally, wealth does not. Neither does medical care. Obamacare is the Fannie and Freddie of the medical industry. Forward with government-oriented financialization.

What I suspect they’ll do – and I admit being very much a layman on this subject – is the same thing they do each time this comes up: They’ll amend the doc’s payments.

I’ve heard tell they do this each time, so they can low-ball medicare & medicaid, and then pay the physicians.

They get to low-guess the budget, then take credit for saving the poor and elderly – and they do so with regularity.

    Daiwa in reply to LSBeene. | December 29, 2014 at 3:04 pm

    You are correct, up to a point. The ‘cut then restore’ dance has been going on with Medicare fees for years, a product of perennial dysfunctional lawmaking which never gets around to addressing the issue on its own – it’s always tacked on to some other megabill. Bad laws are never passed on their own merits, they’re always passed as amendments to totally unrelated legislation. And it’s getting very, very old.

    Medicaid fees have not been subject to the same process. They’ve always been ‘below cost’. The temporary fee increase was a pure political move intended to make the expansion of Medicaid rolls more palatable and to delay the consequences until after the fait was accompli.

So how much does a doctor get now? Let’s consult the Medicaid Fee schedule at emedny.com

An internist seeing you for a routine office visit (CPT code 99213) in New York will get $37.41, if it’s a one hour full-boat consultation (CPT code 99245) he or she receives $137.52. Managed Medicaid plans might pay less, if you can imagine that.

These awfully low fees for your primary care doctor compound the extraordinary waste and inefficiency hidden from the public by the professional politicians and Grubers of the world. When your doc gets such a pittance, he can only afford to see you for 7 minutes only because he has bills to pay. He’ll have a nurse practitioner or PA see you, he’ll have you fill out the history yourself and ‘review’ it. If your issue is a bit more complex, he’ll order some tests and have you come back, to buy some breathing room.

Your doctor, trying to care for 25 people a day at $37 a visit (in New York) may decide to punt and send you to the specialist, who will order some more tests and send you to even more doctors. A consultation and perhaps a CT scan might add some info but in reality this buys time, keeps the malpractice lawyers off the doctors back and makes the patient feel like the wait has some purpose.

In the end a diagnosis will be established and treatment will commence, the only difference is the total cost goes up. Nobody saves any money when primary care doctors resort to breaking up your care into bite-size chunks (37 dollars worth of time, duh). The (usually out-of-network) specialists actually like the idea. Unfortunately these low fees result in a decreased value to the patient and ultimately the taxpayer, all because Gruber and his backers don’t understand that, like everywhere else, the market needs to control the price.

When the “affordable care” incentives expire more doctors will refuse to accept Medicaid, making it significantly worse for the remaining doctors who stay. Expect to see 5 minute visits with the nurse’s assistant at this rate. And don’t complain to elected officials, none of them have this insurance so they won’t know what you are talking about.

    jakee308 in reply to Chicklet. | December 29, 2014 at 8:05 pm

    Thanks for the numbers. Now how much did that visit cost the Doctor or practice? Were there any other fees billed during that visit?

    Before we can assume how much Doctors are being underpaid, we have to determine how much the difference between fee and cost is.

    It’s a simple equation.

      Chicklet in reply to jakee308. | December 29, 2014 at 10:33 pm

      Costs vary, the answer is ‘it depends’. If my office is in Manhattan, if I have a nurse and a receptionist, if I have cable TV in the reception area, costs will be higher, but the Medicaid reimbursement never changes.

      For the same amount of time and space a doctor is better off with fee-for-service or HMO patients, even Medicare pays more. Plus, you’ve got compliance costs, a fancy electronic medical record the government made you buy and the cost of countless medical record requests, chart audits and other intrusions the single-payer Medicaid folks make you endure.

      In the end, the amount is different for every doctor, and they adjust accordingly- leave practice, reduce staff,sell the practice or see more people per day to maintain revenue. Your doctor is getting a pay cut, up to 40% per visit, how can this not hurt?

      Actually a calculation of the gross profit on an office visit has nothing to do with how much the doctor is being underpaid. The correct calculation is the difference between what the fair market going price for an office visit is to the medicare price paid. Indicators of that fair market going price would be the price private insurance pays for an office visit and the price charged by that doctor for a cash pay no insurance office visit adjusted upward to account for the added cost of complying with government rules paperwork and billing requirements plus time value of m9ney costs in delayed receipt of payment.

        snopercod in reply to Gary Britt. | December 30, 2014 at 7:17 am

        Here are some numbers for a recent “established outpatient office visit, typically 10 minutes” with an orthopedic surgeon:

        Amount provider charged: $72
        Medicare approved amount: $41.54

          platypus in reply to snopercod. | December 30, 2014 at 3:19 pm

          And the Medicare approved amount is NOT what Medicare actually pays.

          The hits just keep on coming on Solid Gold Oldies Weekend Blowout.

      9thDistrictNeighbor in reply to jakee308. | December 30, 2014 at 12:02 am

      Okay, jakee, we get the point…you have a problem with doctors.

For peanuts, you get monkeys. Take a look at the slaughterhouses called hospitals by the National Health Service in England, or the waiting lines for even life-saving procedures. Meanwhile the administrators are by far among the highest paid government employees.

“refuse to work for peanuts”

Standard progressive tactics will be to demonize these doctors as “wreckers”.

The Feds can get this to work in the same way the government in Ontario did years ago. Threaten the doctors with significant jail time unless they get with the program.

    Forcing a person to do a job they don’t want to do is called slavery. What if I thought computer programmers should be forced to work for 10 per hour and somebody else thought that office clerks should work for 10 dollars per hour and another thinks the same for plumbers and electricians and college professors. Put them in jail if they say no. Same exact thing as what you advocated for doctors. Let’s just take it to its logical conclusion we can all everyone work for the government for the wages and benefits the government decides doing work chosen for us by the government and anyone who doesn’t like it will be put in jail. Then we can all be slaves together.

    I understand I have described the ultimate liberal progressive paradise above but to me it stinks of the inhumanity of slavery.

How long before Congress passes a bill forcing doctors to accept Medicaid? The NJ Legislature tried that in 1962 when a group of NJ doctors refused to accept Medicare patients.

On May 5, 1962, the New York Times reported that 200 New Jersey doctors had signed a resolution stating that they would “refuse to participate in the care of patients under the provision of the King-Anderson bill [precursor to Medicare] or similar legislation,” but they would “continue to care for the medically indigent, young and old, as we have in the past.” Subsequently, similar resolutions were signed by small groups of doctors in several sections of the country. In July, the King-Anderson bill was defeated in the Senate.

Source: http://www.aapsonline.org/brochures/persuasi.htm

    Your question is easy to answer. 1. With any luck the law would be held unconstitutional under the federal and state constitutions. As it should be viewed as violating due process, equal protection, and the 13th amendment outlawing slavery. 2. if not held unconstitutional a huge number of doctors would move to one of the remaining states where citizens remained free. 3. those that don’t move would follow the soviet union workers solution. “if they are going to just pretend to pay us we will just pretend to give quality health care to patients”.

    After healthcare in the state is destroyed regular citizens will start moving to states that still respect personal individual freedom which will be the states where they could still get quality medical care.

    Yes a dream solution absolutely. Say it with me slavery for doctors is a great way to save on medical costs and expenses.

      snopercod in reply to Gary Britt. | December 30, 2014 at 7:31 am

      With any luck the law would be held unconstitutional under the federal and state constitutions.

      Oh, like Obamacare was? Each state determines the qualifications to practice medicine within its borders – they can pretty add whatever requirements they want. Lawyers are required to do pro-bono work, so why not doctors? As far as the feds go, they already require hospitals and doctors to treat the indigent at ERs at no cost. It’s later than you think, my friend.

    9thDistrictNeighbor in reply to snopercod. | December 29, 2014 at 11:58 pm

    My first job was working in a surgeon’s office. The answer to the question “Do you accept Medicaid?” was No. This was in the mid ’70s in Ohio. Medicare was bad enough; payment was nowhere close to what it should be and it arrived six months after service was rendered. The doctor for whom I worked charged $25 for an office visit, made house calls, and didn’t charge priests and nuns at all. Patients paid cash for their doctor visits, some in bills that had been saved in a box somewhere since the 1930’s. When someone once suggested to him that doctors should be capped at an $8000/year income, his response was “That’s fine, but what am I supposed to do after February?”

One article, two nays. I like it. 😉

As a Home Health nurse, I’ve been seeing this go on for years. The number of doctors who will accept Medicaid and Medicare patients has been decreasing steadily, with those having Medicaid being the hardest to find an accepting provider. These days Medicare isn’t far behind as far as a fewer doctors are accepting Medicare patients too. Obamacare simply will accelerate the process.

BTW, having “insurance” is one thing, finding someone who will accepts it is another. Hospitals, which have bought up huge number of physician practices, are also part of the dumping of government insurance patients. You have Medicaid, Medicare and now Obamacare, they’re going to make sure you don’t get admitted (note there are as long as 3 day ‘observation’ periods being allowed in the EDs)or you’ll be discharged too soon, only to have more complications. Rude awakening awaiting those who thought that the government was going to take care of them.

Also, let’s note, that the quality of care offered these patients is not going to be the best. Period.

Where was this said? Which case, which brief?

“[J]ust weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.”

You can join the American Association of Physicians and Surgeons for free if you aren’t in the medical profession.

Here is the link.

http://www.aapsonline.org/index.php/join

They are always in the front, bringing lawsuit after lawsuit on these anti-American laws. I am a member. We marched together against Hillary and Hillarycare in ’94.

The low fees generating excess visits is a problem I’m very aware of. My doctors hold my prescriptions hostage to unnecessary visits (and then have the gall to show up an hour late to the appointment) in order to generate more fees.

Everyone wants something for nothing, and not just ‘any’ something – but a high quality lushly extravagant ‘something’. Thankfully, I can testify that this is possible – just as long as the ‘consumer’ is willing to accept the application of all the services available at the doctors offices. Manditory electroshock liberally applied with a cattle prod to the different openings of the body, these little ‘bell ringers’ will cause a person to sit up and take notice! Let’s say 20 seconds of stimulation applied to each opening: Anus, vagina, ears, mouth, nostrals, mouth – the application of this type of massage will keep the patient load down, with only the truly ill showing up for treatment.

The patient numbers would fall drastically, while the cost of patient care could increase without a worry of overspending. Only the truly sick would show up for ‘sick call’, while all the ‘gold bricks’ would find something else better to do with their time. Those cattle prods really sting a person, especially one jammed up your bumm!

To be fair, its not as if Leftists from Obama on down failed to anticipate a “revolt of the Kulaks”.

That’s why guys like Bill Ayers have published their predictions that some 25 million Americans would have to be “re-educated” in order for the progressives to complete their transformation of America. That’s on top of all those “conservative terrorists” they’ll “have” to kill first.

But, its not all doom and gloom. After decades of liberal dominance of our educational system, Ayers currently believes that enough Americans have been “pre-educated” to accept Marxist ideology that ‘only’ 5-10 million would have to be forcibly re-educated.

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