ACA Could Lead Physicians to Drop Coverage of Medicare/Medicaid

[MeBelle]

FWIW-Most everyone here needs to realize the difference between Medicaid and Medicare.

Medicaid NEVER reimburses docs for the actual cost of service, it pays a flat rate, period. In fact, docs end up eating what Medicaid doesn't reimburse.

OTOH Medicare will cover 80% of the actual cost of service. Purchased Supplemental Medicare policies will cover the other 20%. Medicare has thresholds. After the thresholds are met, people get kicked onto Medicaid.

Then what happens?
People cannot find a doc that takes Medicaid.
Then what happens?
The people who can't find a doc end up where?
The most expensive place in town...ER.


*CNAs know squat when it comes to how Medicaid/Medicare work.

 

[Intense]

Here is something from 10/2008, from the AMA on Single Payer....


AMA position on single payer
Posted by Don McCanne MD on Friday, Oct 31, 2008

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Frequently asked questions about the AMA proposal for reform

American Medical Association
October 2008

Q: What are the basic principles of the AMA proposal?

A: The American Medical Association (AMA) proposes that individuals and families receive financial assistance to purchase a health plan of their choice, with more generous assistance to those with lower incomes. The financial assistance could take the form of tax credits or vouchers and must be earmarked for health insurance coverage. Health insurance market regulations should be reformed to establish fair “rules of the game” that protect vulnerable individuals, without unduly driving up premiums for the rest of the population.

Q: How is the AMA proposal different or better than a single-payer system?

A: Both the AMA and the single-payer approaches emphasize the same goal of universal coverage, but they differ on how to implement it. The AMA does not believe that full government control is a workable model for the United States. Single-payer systems are plagued with an undersupply of medical personnel, long waiting periods and a lack of patient choice. Alternatively, the AMA proposal seeks to enhance patient choice and encourage patients to be conscious of health insurance costs, while also maintaining innovation in the private sector.

American Medical Association

 

[Intense]

Here is something from 10/2008, from the AMA on Single Payer....


AMA position on single payer
Posted by Don McCanne MD on Friday, Oct 31, 2008

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Frequently asked questions about the AMA proposal for reform

American Medical Association
October 2008

Q: What are the basic principles of the AMA proposal?

A: The American Medical Association (AMA) proposes that individuals and families receive financial assistance to purchase a health plan of their choice, with more generous assistance to those with lower incomes. The financial assistance could take the form of tax credits or vouchers and must be earmarked for health insurance coverage. Health insurance market regulations should be reformed to establish fair “rules of the game” that protect vulnerable individuals, without unduly driving up premiums for the rest of the population.

Q: How is the AMA proposal different or better than a single-payer system?

A: Both the AMA and the single-payer approaches emphasize the same goal of universal coverage, but they differ on how to implement it. The AMA does not believe that full government control is a workable model for the United States. Single-payer systems are plagued with an undersupply of medical personnel, long waiting periods and a lack of patient choice. Alternatively, the AMA proposal seeks to enhance patient choice and encourage patients to be conscious of health insurance costs, while also maintaining innovation in the private sector.

American Medical Association

Why the Reversal?

 

[auditor0007]

Indeed, I'm quite sure the government hasn't thought of this and won't force physicians who accept ANY insurance to accept ALL insurance. As well they should. Doctors should have to accept ANY insurance, this BS about having to find a doctor "in your network" does nothing to lessen the costs of medical care.

Come to think of it , neither does the ACA, what would help is if doctors were forced to lower their prices.

How is it that a $250 bill can suddenly be reduced to $150 when an insurance company gets involved????

Ype what I would pay $250 cash for the private insurance company pays maybe $150.

And why is that? I mean if you have auto insurance and you total your car, does the insurance company go to the dealership and pay less than what a cash paying customer would for a vehicle? Of course not. So , why is medical insurance different?

Because the whole thing is a scam. Doctors and hospitals don't even know why they charge what they charge for many procedures and tests. Go for lab work, and the lab charges $20 for one test and $300 for another, yet there isn't that much of a greater cost between A and B. The other thing is that if you look and work with them, you can usually get everything discounted if you are paying cash. They won't tell you that up front, but if you talk to them, they usually will give you a big discount so that at most you aren't paying more than they would get from the insurance companies.

I had to go without insurance for a couple of years because I moved to a different state and had a pre-existing condition. Now I am insured again through the high risk pool. Before that, they wouldn' touch me. Anyway, I would get my lab work all done by ordering all my tests online, then going to the lab. By prepaying it is cheaper than using insurance. Even now that I am insured, I still do this because I will never hit my yearly deductible and it's half of what the insurance company would make me pay for the same exact tests. The other thing I need is to have an ultrasound done once a year on my liver to check for tumors. I go to a free standing office that mostly does ultrasounds for pregnant women, but they do other ones like mine also. They charge me $200 for an ultrasound that the hospital would charge about $1600.

Here is the thing about doctors saying they will refuse Medicare and Medicaid patients; some may be able to do that, but only if they can get enough patients from private insurance. If they have a lot of fee time that they are not working just because they get paid 30% less does it make sense to not work? If I have a full schedule of clients that are paying me $50 per hour, then I don't need any extra work, but if I only have 25 hours of work per week at $50 per hour and then a client comes along and tells me they will pay me $35 per hour for my remaining 15 hours per week, am I going to turn them down? Not likely, because I'm still making money from them.

 

[Luissa]

Medicare is actually paying what it is worth, not the jacked up price they charge the private insurance company.
It is the same at assisted livings etc. Medicaid pays less for a room, than a private payer would..... Because they can jack up the price for the private payer.

Here is my quote for Mebelle since she couldn't bring herself to directly respond to my post.

 

[MeBelle]

FWIW-Most everyone here needs to realize the difference between Medicaid and Medicare.

Medicaid NEVER reimburses docs for the actual cost of service, it pays a flat rate, period. In fact, docs end up eating what Medicaid doesn't reimburse.

OTOH Medicare will cover 80% of the actual cost of service. Purchased Supplemental Medicare policies will cover the other 20%. Medicare has thresholds. After the thresholds are met, people get kicked onto Medicaid.

Then what happens?
People cannot find a doc that takes Medicaid.
Then what happens?
The people who can't find a doc end up where?
The most expensive place in town...ER.


*CNAs know squat when it comes to how Medicaid/Medicare work.

Is that a dig at me? Maybe you should try quoting my post.
Oh! And PS Medicaid pays for rooms at say an assisted living.Medicare does not, it only covers costs if you are at a skilled nursing facility.
So giving the fact I don't work at a skilled nursing facility, I was correct on Medicaid.
Stop being a passive aggressive bitch.

TMI sweetheart!
I thought you were a nurse, as in RN.

Does Medicaid pay for medications, adult hygiene materials, etc in assisted living?

You may apologize for making assumptions about my post and for cursing at me. We ARE in the clean debate zone...one rule is no personal attacks, correct?

 

[MeBelle]

Medicare is actually paying what it is worth, not the jacked up price they charge the private insurance company.
It is the same at assisted livings etc. Medicaid pays less for a room, than a private payer would..... Because they can jack up the price for the private payer.

Here is my quote for Mebelle since she couldn't bring herself to directly respond to my post.

Not sorry that MeBelle was out for awhile and MeBelle would have most definitely responded to your post, in her time, not yours.

 

[Luissa]

FWIW-Most everyone here needs to realize the difference between Medicaid and Medicare.

Medicaid NEVER reimburses docs for the actual cost of service, it pays a flat rate, period. In fact, docs end up eating what Medicaid doesn't reimburse.

OTOH Medicare will cover 80% of the actual cost of service. Purchased Supplemental Medicare policies will cover the other 20%. Medicare has thresholds. After the thresholds are met, people get kicked onto Medicaid.

Then what happens?
People cannot find a doc that takes Medicaid.
Then what happens?
The people who can't find a doc end up where?
The most expensive place in town...ER.


*CNAs know squat when it comes to how Medicaid/Medicare work.

Is that a dig at me? Maybe you should try quoting my post.
Oh! And PS Medicaid pays for rooms at say an assisted living.Medicare does not, it only covers costs if you are at a skilled nursing facility.
So giving the fact I don't work at a skilled nursing facility, I was correct on Medicaid.
Stop being a passive aggressive bitch.

TMI sweetheart!
I thought you were a nurse, as in RN.

Does Medicaid pay for medications, adult hygiene materials, etc in assisted living?

You may apologize for making assumptions about my post and for cursing at me.

Sure

 

[Luissa]

FWIW-Most everyone here needs to realize the difference between Medicaid and Medicare.

Medicaid NEVER reimburses docs for the actual cost of service, it pays a flat rate, period. In fact, docs end up eating what Medicaid doesn't reimburse.

OTOH Medicare will cover 80% of the actual cost of service. Purchased Supplemental Medicare policies will cover the other 20%. Medicare has thresholds. After the thresholds are met, people get kicked onto Medicaid.

Then what happens?
People cannot find a doc that takes Medicaid.
Then what happens?
The people who can't find a doc end up where?
The most expensive place in town...ER.


*CNAs know squat when it comes to how Medicaid/Medicare work.

Is that a dig at me? Maybe you should try quoting my post.
Oh! And PS Medicaid pays for rooms at say an assisted living.Medicare does not, it only covers costs if you are at a skilled nursing facility.
So giving the fact I don't work at a skilled nursing facility, I was correct on Medicaid.
Stop being a passive aggressive bitch.

TMI sweetheart!
I thought you were a nurse, as in RN.

Does Medicaid pay for medications, adult hygiene materials, etc in assisted living?

You may apologize for making assumptions about my post and for cursing at me. We ARE in the clean debate zone...one rule is no personal attacks, correct?

Depending on resident Medicare pays for medication. Medicaid pays for hygiene etc.

 

[MeBelle]

So if a resident is only Medicaid qualified, who pays for the meds in an assisted living?
Good to know hygiene materials (didn't want to call them what they really are) is covered by Medicaid.

 

[Luissa]

So if a resident is only Medicaid qualified, who pays for the meds in an assisted living?
Good to know hygiene materials (didn't want to call them what they really are) is covered by Medicaid.

Medicare to begin with, it depends on their plan. If they qualify for Medicaid they play for everything else. Shampoo, deodorant etc., and we call them briefs.

 

[Luissa]

But Medicare will only cover meds, pt, or medical equipment in an assisted living.
If a resident needs a lot of pt or more care other than if they are hospice patient or on the memory care side, they are moved to a skilled nursing facility.
A resident can also go to a skilled nursing facility for PT and keep their room.

 

[MeBelle]

So if a resident is only Medicaid qualified, who pays for the meds in an assisted living?
Good to know hygiene materials (didn't want to call them what they really are) is covered by Medicaid.

Medicare to begin with, it depends on their plan. If they qualify for Medicaid they play for everything else. Shampoo, deodorant etc., and we call them briefs.

Adult diapies (not a typo).

I leave with this last post, cause I must get going, but I will check back!

Assisted Living residents generally come from hospitals where a large portion of their Medicare days have been eaten, leaving very few Medicare days left.
In your state, is there a waiver/voucher program that helps Medicaid patients bridge costs?

And...

Are you seeing cuts to Medicaid services?

 

[jillian]

The value of a product is the price people are willing to pay.

What is the product here?

People.

no... the SERVICE people provide.

 

[MeBelle]

But Medicare will only cover meds, pt, or medical equipment in an assisted living.
If a resident needs a lot of pt or more care other than if they are hospice patient or on the memory care side, they are moved to a skilled nursing facility.
A resident can also go to a skilled nursing facility for PT and keep their room.

Yes, but my original post was about the horrors of Medicaid, not Medicare.

 

[MeBelle]

What is the product here?

People.

no... the SERVICE people provide.

No... People are viewed as the product... IE whatever the EVUL corps can make money on.
People are disregarded when they are called census for the sole purpose of making money.

 

[jillian]

People.

no... the SERVICE people provide.

and...?

and what? the question asked was what is the product being sold. your answer was "people". i clarified since those aren't the same thing. Cheers.

 

[Luissa]

But Medicare will only cover meds, pt, or medical equipment in an assisted living.
If a resident needs a lot of pt or more care other than if they are hospice patient or on the memory care side, they are moved to a skilled nursing facility.
A resident can also go to a skilled nursing facility for PT and keep their room.

Yes, but my original post was about the horrors of Medicaid, not Medicare.

The horror is Medicaid in the case of assisted livings is paying the price the room and board is actually worth.
I don't think I can go into more, but Medicaid in the case of paying just the room and board fees is paying what it is worth. Private payers are paying a bloated price in some cases.

 

[MeBelle]

no... the SERVICE people provide.

and...?

and what? the question asked was what is the product being sold. your answer was "people". i clarified since those aren't the same thing. Cheers.

and...
I clarified it myself when I edited my post.
Thank you.

 

[Luissa]

People.

no... the SERVICE people provide.

No... People are viewed as the product... IE whatever the EVUL corps can make money on.
People are disregarded when they are called census for the sole purpose of making money.

Welcome to the medical field.