Showing posts with label Medicare perversion. Show all posts
Showing posts with label Medicare perversion. Show all posts

Tuesday, March 8, 2016

Sacrificing Physician Morale To Save Medicare Pennies

Here's another example of why doctors are always getting screwed when lawmakers without any skin in the game make up rules about healthcare. Medicare has decided that in order to save costs from all the expensive drugs that physicians prescribe, they are going to cut the reimbursement for administrating the medications.

Under Medicare Part B, doctors get a fee of 6% of the cost of the drug that they give to a patient in the office or other medical facility. So if a $100 drug is given to a patient, the physician will get a fee of six whole dollars from the government along with the $100 cost of the drug. If the drug costs $1,000, the doctor gets $60 plus the cost of the medication. Sounds pretty skimpy to me already when one considers that the $6 fee has to cover all the risks of administering that $100 drug.

With the new proposal, Medicare wants to increase reimbursements if the doctor prescribes a cheaper drug and cut the fee if a more expensive drug is used. Now the new rules state that doctors will only get 2.5% of the cost of the drug while earning an additional flat rate of $16.80. So now a doctor who administers a $100 drug will receive $19.30 while a $1,000 drug will only net $41.80.

Think about the numbers for a minute. The government saves $18.20 on a $1,000 drug, or 1.7% ((1060-1042)/1060). But for the physician, his reimbursement just got cut by 30% ((60-42)/60). In the meantime, the pharmaceutical company still gets to sell its drug at $1,000. Where is the outrage? Where were our so called advocates in the AMA when these plans were being devised? The drugs companies can continue making billions of dollars and their CEO's raking in hundreds of millions while physician livelihoods are getting chopped by double digits. While government employees are striking over inadequate pay raises, doctors quietly submit to working harder for less pay because we're afraid of tarnishing our image.

I predict that this latest experiment in healthcare authoritarianism will fail miserably. It doesn't make sense when one considers the usual capitalist market forces. If a doctor is getting less money for prescribing an expensive drug, is he likely to switch to a cheaper drug that will reimburse him even fewer dollars? No. A rational person would prescribe even more of the expensive medication to make up for lost income. Using the above as an example, even though the reimbursement for giving the cheaper drug has gone up, it still doesn't make up for the higher fee the doctor gets from giving the expensive drug. So now the doctor has every incentive to give more patients the expensive drug to compensate for lower reimbursements.

The real cost drivers of this scenario, the drug companies and the patients who insist on having expensive drugs so that they feel they are getting their money's worth, get off scot free. But no American lawmaker would dare vote for a British style government rationing system. And they can't resist all the money the pharmaceutical lobbyists throw at them. That leaves doctors out of the loop and holding the bag.

Thursday, November 6, 2014

Your Tax Dollars At Work--Free Anesthesia For Screening Colonoscopies.

The Centers For Medicare & Medicaid Services (CMS) finalized its physician fee schedule for 2015 and there was good news for anybody receiving Medicare. The government has decreed that Medicare recipients will not have to pay a dime for anesthesia services while getting a colonoscopy. No deductibles or copays will be charged. You can walk in with nothing but your Medicare card and receive free anesthesia.

You can thank the ASA for this freebie. Due to their vociferous lobbying, they urged the CMS to classify anesthesia services for colonoscopies as an essential benefit. In their strongly worded letter to the department, "Medicare should pay the anesthesia provider for the service; payment should not be conditioned on the presence or other specified diseases, conditions, or other diseases." Who could turn down a mandate like that?

So thank you, oh great ASA for providing us with more taxpayer money. I am curious though why your letter to the CMS uses the term "anesthesia provider" instead of "physician anesthesiologist" like you use for all your public statements. Don't tell me my membership dues are being used for you to lobby for the CRNA's to get their government handouts too.

Thursday, April 10, 2014

Doctors Should Get Kudos For Accepting Medicare Patients

The government's release yesterday of Medicare payment data has predictably raised an uproar among the public. The conflagration is also being fanned by a media that only sees all the zeroes in the reimbursements but don't care to dig a little deeper into the numbers to understand where all the money is going. Hint: it's not into the doctors' pockets.

While the news concentrates on the witch hunt for doctors who are supposedly raking in millions of dollars from the taxpayers, the CMS database is actually a lot more useful to illustrate how LITTLE doctors make from taking care of our elderly. We should be receiving accolades for how little money we get for treating our nation's grandmothers and grandfathers instead getting smeared with innuendo about our integrity.

If you go to the CMS website, you can download the data that comprise the payment amounts to doctors. The downloads are aggregated by alphabetical order of the physicians' names. Even then each Excel spreadsheet is several megabytes in size. You'll have to be very patient if you have a slow internet connection and an old computer. I loaded just a couple of databases, including the one with my name in it, just to see what kind of information the government is releasing about me to prying eyes. What it tells me is that we are all suckers for accepting such a pittance for Medicare reimbursements.

I only looked at payments related to anesthetic procedures. The horror story is true for all physicians but anesthesiologists already know we receive far less from Medicare as a percentage of private insurance compensation compared to other doctors. This makes the pain of taking Medicare patients particularly acute for anesthesiologists. Since anesthesiologists usually work in a hospital setting, we are all obligated to take these patients whether it makes financial sense or not.

The following is a list of procedures performed and billed by anesthesiologists that I randomly pulled from the spreadsheets to illustrate how little money they made from the program. The first column is the average amount they charged for the procedure while the second column is the average they received from Medicare.

As you can see, anesthesiologists barely make back ten cents on the dollar for interventions that have life and death consequences. Only $99 for an emergency intubation? That is somebody's life on the line. If we failed and the patient dies, or worse suffers anoxic brain injury, that $99 wouldn't even cover the lawyer's lunch bill. A brachial plexus block for only $48? It take at least twelve years of education after high school and thousands of hours of training to be able to confidently and successfully place a block. For all that hard work we don't get paid enough to take a family out to see a movie? If there is nerve injury or a catastrophic complication, that $48 suddenly doesn't seem worth the risks.

The worse news for anesthesiologists though, if it could possibly get worse, is that our reimbursements from Medicare aren't all that different from CRNA's who bill for the same procedures. Again here is just a quick random sampling of the spreadsheet. The amounts that are reimbursed are determined by complicated formulas that is beyond my scope to explain here. This tiny sample does not imply an overall trend, which will require analysis of thousands of numbers for which I'm not getting paid enough to do, as in zero.

Notice how CRNA's make nearly as much money as anesthesiologists, give or take a few dollars? Data like this along with the government's lovefest with nurse anesthetists could make medical students start having second thoughts about going into anesthesiology.

If you think these number look bad, wait until millions of patients start arriving at the hospital doorsteps with their new Obamacare insurance plans. Those reimburse at Medicaid rates, which is even lower than Medicare if that is even possible. Doctors need to show their patients and the media these numbers, not hide from them as if we have something to be ashamed of. If the amount of money we get paid for performing life saving procedures isn't enough to even get a plumber to come to your house to look at your stopped toilet, there is something wrong with the system. And Congress's and the AMA's only solution is to prolong the pain.

Wednesday, December 30, 2009

Medicare Sleight of Hand

The New York Times has a nice article about the fraud in Medicare savings the new health care bills in Congress are perpetrating. Medicare will cut reimbursements to doctors, hospitals, and nursing homes by $500 billion over the next ten years. In addition, they plan on raising taxes on the wealthy and medical device makers, taxing expensive health care plans, or raising Medicare withholdings from your paycheck.

Together this is supposed to "save" Medicare by delaying its date with bankruptcy court by all of nine years. But wait. Since this is the federal government, they can't have all this extra money sitting around waiting to be handed out in the future. So using the same savings they are trumpeting, they are going to use it to subsidize health insurance for 30 million people.

So this is the conundrum Medicare and Congress are dealing with. You can't use the money to save Medicare in the future if the money is being spent today to pay for health insurance for the uninsured. Try explaining that to the voters back home. Of course by the time Medicare is truly in trouble, most of the current members of Congress who voted for these "reforms" will have passed on or retired (synonymous with Congressmen).

Medicare=Bernie Madoff

How is Medicare equivalent to Bernie Madoff, the perpetrator of the biggest Ponzi scheme to date?

1. Early participants made off with the most benefits.

2. People are promised fantastic, virtually unlimited, returns for their investment, no matter how little money they actually put into the program. (Free single payer health care for everyone!)

3. An ever greater number of people have to be recruited to pay into the program to keep it running.

4. Money paid into the program is supposedly kept in a "trust fund" for future benefits but in reality has already been paid out to current users.

How is Medicare different from Bernie Madoff's Ponzi scheme?

1. Madoff's scheme was bought by investors voluntarily. Medicare is forced onto every working American.

2. There is no clawback of money and benefits from early users of Medicare

3. No prosecutor is going to come in and arrest the federal government for running the world's largest Ponzi scheme.

Sunday, September 13, 2009

Medicare perversion

The NY Times details the struggles of a young kidney transplant patient. Apparently Medicare is all too willing to pay for a kidney transplant at a cost of over $100,000 but is only willing to pay for antirejection medications for 36 months if you're not over 65 years old or disabled. This poor patient thus lost her first kidney when she became unemployed and couldn't afford her drugs. Now she has a second Medicare paid kidney transplant but the clock is ticking on her eligibility for government paid medications. The cost of antirejection drugs is $1000-$3000 per month but the government would rather pay the much higher cost of a transplant than the lower cost of medications. This system points to one of the reasons Medicare is going broke. Arguments have been made in a previous editorial that in a rational world, we would pay more to keep younger patients healthy instead spending unlimited sums to maintain old age. But that is the power of older voters and the AARP.

Though I sympathize with the article's subject, I couldn't help but think something else is going on that isn't reported. The article said her "downward spiral" began when her dog chewed up her hearing aid, leading to the loss of her job then the loss of her transplanted kidney. But I thought she took her job precisely because it offered health benefits. Didn't her insurance cover hearing aids? Doesn't Medicare disability cover hearing aids? And even if they didn't couldn't she just go down to Walmart to get one and put it on her credit card? Couldn't her grandmother help her out with getting new hearing aids before catastrophe happened? What's her job worth to her? Does she just expect everybody to do everything for her instead taking the initiative to get her own hearing aid? Curious.