The settlement of the Medicare lawsuit is a great thing!

The settlement last week of a significant lawsuit against Medicare now opens the door to increased treatments and therapies being provided to patients in their homes, and paid for by Medicare.

The specific change anticipated by the lawsuit involves a requirement that patients have some possibility of “improvement” in order for services to be approved for reimbursement by Medicare.  In the future, the possibility of improvement will no longer be a consideration.

This is long overdue and will change the lives of millions of patients and their families.

First, receiving necessary treatment will slow the pace of decline even if the possibility of actual improvement does not exist.  For people experiencing physical or cognitive impairment, receiving therapeutic services or treatments is at the very least compassionate.  It is also financially wise, which brings us to the second major benefit:

Paying for several months or years of therapy for a loved one can be financially devastating for all but the most wealthy families.  As a result, families experience the wrenching decision of paying for care for an elderly parent versus preparing the children for an advanced education.

It is also beneficial to society as a whole, because when our loved one declines to a certain point, we bring them to the emergency room where they are frequently admitted to the hospital, at a much higher cost, much of which may have been completely preventable.

Granted, some fear an explosion in fraud as providers of various skill levels rush in to provide, and bill for services.  Fair point.  But I for one am optimistic that as we move further into the world of information exchange and both electronic and personal health records, that services can be effectively monitored and that the impact of fraud will be far, far less than the benefit to patients, their families and society as a whole.

What do you think?

Is it a good thing that Medicare will pay for home based services without the requirement that the patient have a possibility of improvement?

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Maybe Doctors Can Learn From Lawyers

On May 2, an article was published in the New York Times, titled “Top Judge Makes Free Legal Work Mandatory for Joining State Bar”.  The article describes how more and more people need urgent legal services but cannot afford them.  It goes on to describe the pros and cons of requiring lawyers to provide some free services (pro bono) as a condition for joining the New York State Bar.

We have a similar problem in health care- a large number of people who cannot afford health care services.  And I am not talking about insurance.  I am talking about the doctor and hospital visit.

In health care, we have doctors refusing to see patients because Medicare or Medicaid do not pay enough.  And these patients have nowhere else to turn.  The doctors use the threat of refusal as a key part of their strategy when negotiating for higher reimbursement.

How can we allow this?

In a previous post on this blog, I have proposed that doctors be required to accept Medicare as a condition for receiving or renewing their DEA license (federal level- the DEA license is what allows them to prescribe), and to accept Medicaid as a condition for receiving or renewing their Medical license (State level).

We place physicians on a professional and social pedestal, and their incomes are higher than that of any other profession.  In return, we should require something of them- not grant the right to walk away from persons in need.  Doctors, take a lesson from the lawyers, or lose your protected, lucrative turf!

 

A Brief Comment on the Ryan Medicare Plan

Medicare is too expensive and becoming more unsustainable every day.  Congress has also demonstrated that they will bow to special interests before implementing what they have already passed- the so-called “doc fix”, whereby reimbursement cuts to physicians that are already mandated by law are deferred, year after year.

One approach is the Ryan plan, named after Representative Paul Ryan of Wisconsin.  Without delving into the details of the plan, which are debated hotly by very partisan commentators, one great flaw in the plan appears to have escaped comment:

That is, the notion that physicians will compete for patients, thereby reducing costs.

This assumption is deeply flawed for one simple reason- there is a well documented shortage of physicians.  Economics 101, and the basic law of supply and demand, teaches us that if the supply is low, the price is correspondingly high.

Physicians will never have to compete aggressively for patients (the Ryan Plan assumes that they will) as long as there is a shortage of physicians.  Rather, patients will have to chase physicians and endure long wait times to get an appointment.  Physicians will continue to raise fees, not lower them, and they will threaten to stop seeing patients whenever their fees are reduced- hence the “doc fix”, which happens year after year.

If Medicare is changed to a voucher system, as Rep. Ryan proposes, seniors will be at the mercy of physicians, who are in short supply, and who will retain any negotiating leverage as long as there is a shortage of physicians.

Until we are able to address the shortage of physicians (train more and/or allow the greater use of nurse practitioners, midwives, pharmacists and other “physician extenders”), it is wrong to place seniors in this ruinous position.

Fourteen Zeroes!

Part 1- the problem.

If you look at our present level of health care spending ($2.6 Trillion), and project it forward, growing at 6% annually for the next 20 years, the total exceeds $100 Trillion.

That’s 14 Zeroes:

  • Just for health care
  • Just in America
  • Just for the next 20 years (if we look at 30 years, the number is over $200 Trillion).

That number is incomprehensible.  Not only is it not sustainable, it is not even possible to finance this number.  Yet, that is the path that we are on.

The present discussion aims to “bend the cost curve” and to somehow shift the burden:

  • Blame the insurers
  • Blame the pharmaceutical companies
  • Reduce provider reimbursement
  • Limit what Medicare pays on behalf of seniors.

Whomever we choose to blame, we are clearly headed for a scenario where we all  work our entire lives just to pay for health care, and when we get old, all of our assets, if there are any left, get paid over to our huge, for-profit health system.

We must fundamentally restructure our health care system, and our expectations of living and of dying, or life will become one long health-care payment treadmill.

Part 2- the discussion.  Please answer the following questions. One answer per question:

What is the responsibility of consumers (the system calls us "patients")?

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What is the responsibility of insurers?

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What is the responsibility of the government?

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What is the responsibility of providers (doctors and hospitals)?

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What is the responsibility of suppliers (pharmaceutical companies and device manufacturers)?

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Now, please consider all of the answers you provided.

What do your answers, taken together, mean for the 14 zeroes in our future?  Something to think about…

Should physicians have the right to refuse Medicare and Medicaid patients because they are not paid as much as they feel they should be? What options does society have?

This is a tough one…

On the one hand, physicians have to run their practices, which costs money.  They want to live well, as we all do, and that costs money.

On the other hand, they provide a vital service which not just anyone is allowed to provide- so in a way, they are on “protected turf”- protected through licensing and long years of training.

But when physicians refuse to see Medicare or Medicaid patients, those patients have nowhere else to turn.  In fact, the threat of physicians refusing Medicare is often used as a reason not to cut Medicare rates.

This sets up a sort of “health care hostage situation”, where we, as a society, can no longer afford the costs of care, but seem to be powerless to do much about it.

So here is the question.  Actually 2 this time.  What do you think?

In return for the right to practice medicine, should physicians be required to accept at least some Medicare and Medicaid patients?

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As a society, what should we do when physicians refuse to see Medicare and Medicaid patients because the pay isn't high enough, and we have nowhere else to turn? Select up to 3 answers.

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It’s Time to Really Look at Costs

As we all know, the federal government and nearly every state is facing huge budget gaps.  Health care is a large part of every crisis:

  • Medicare is a large part of the federal budget crisis
  • Medicaid is a large part of every state budget crisis

Health insurers are not to blame this time:

  • The Medicare discussion is about Medicare, not Blue Cross, Aetna, Cigna, United or Humana.
  • The Medicaid discussion is about Medicaid, not Blue Cross, Aetna, etc.

The health care reform bill that we recently passed was really health insurance reform- yes, we needed to reform the insurance system.

Since Medicare and Medicaid are not traditional insurers, but still seem to be drowning in costs, the question is, “Where should we focus our reform efforts going forward?”  What do you think?

Since the Medicare and Medicaid discussion is not about the insurers, where should we focus our reform efforts going forward? Select all that apply.

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Introduction

We are headed for difficult times in this country.

Over the past 50-60 years, the economic pie has been growing. This has made possible a number of positive social changes, such as Medicare, Social Security, Civil Rights and Women’s Rights.  When our situation is getting better, it is easy to share a little with those who have less.

We are now entering a period where the economic pie is shrinking, or at least perceived to be shrinking. What we now see is an unwillingness to share- in fact, many want to reduce or eliminate some of the social programs that have been introduced over the past half century.

I am not arguing that this is either good or bad. I am asking “how do we get there?” How do we reduce the costs of health care in a way that is fair? Who pays? Who sacrifices?

This is what this blog is about.

Further, it is not just about what I think. Over time, this blog will make available a discussion forum and brief surveys (polls) so the readers, you, can make your opinions known, hopefully with a minimum of partisan politics.

I hope you will participate, and that you find this blog and related forums and polls to be useful, timely and engaging.

Steven Yergan, CEO, Health Tactics