I's been framed!!!
Last week, many House republicans broke party ranks and voted for a flawed medicare bill that would provide physicians with a reprieve of an anticipated 10.6% cut in reimbursement for services. Senate republicans stood firm with the President and voted against this bill. In the final analysis, physicians now have to deal with a major cut in reimbursement at precisely the time that many costs are skyrocketing, including fuel, labor, and insurance. Furthermore, new regulations require more and better documentation that require physician investment in electronic health records and other costly office upgrades.
The average cost of operating a medical practice is between $100-200/hour (all costs, not including physician income, divided by 40 hours/week, 52 weeks/yr). Prior to July 1, Medicare paid on average $130/hour for evaluation and management services. With reimbursement now down to $116, and, after Jan 1, 2009, down to $110, few practices will be able to cover costs while seeing Medicare patients. In markets where other insurers index their coverage to Medicare (some might call this price-fixing), the physician will not be able to offset the loss with income from other patients.
Some physicians will retire. Others will restrict medicare patient visits. Others will create medicare mills, where patients with mild problems are processed rapidly through an impersonal system and complicated cases are referred out or dismissed from the practice. Others will use the visits as loss leaders to fuel diagnostic and therapeutic procedures that will pay well enough to keep the practice profitable. Others will limp on, trying to be healers at work and dealing with poverty at home.
The democrats have positioned themselves as the saviors of physicians, military families and the elderly while republicans have been manipulated into being the party that would rather support an insurance company than physicians and patients. If there ever was a recipe for electorial failure, this is it! The elderly, the military and physicians are generally more conservative than liberal. These groups see themselves has having been dissed by the republicans in the Senate and the White House. The only hope for the Republicans for this fall is to find a way to prevent this cut from going into effect.
Gas prices are beyond any party to control, and the argument will be spun. The war is less of an issue each day. Health care will be handed to the democrats on a silver platter. Swing states with many old people and health care workers (think Florida and Ohio) will go democrat in a big way. Senators such as Arlen Specter and John Cornyn will likely lose their seats. And not because republicans don't care. But because they were outfoxed. Stupid is as stupid does. You can't allow yourself to be framed as uncaring about the elderly and military dependents. The republicans will have to be in a position of defending their position. Nixon said that he was NOT a crook and look where it got him!
If the cuts go into effect, then the republicans will be through for this year, and perhaps for a very long time.
The average cost of operating a medical practice is between $100-200/hour (all costs, not including physician income, divided by 40 hours/week, 52 weeks/yr). Prior to July 1, Medicare paid on average $130/hour for evaluation and management services. With reimbursement now down to $116, and, after Jan 1, 2009, down to $110, few practices will be able to cover costs while seeing Medicare patients. In markets where other insurers index their coverage to Medicare (some might call this price-fixing), the physician will not be able to offset the loss with income from other patients.
Some physicians will retire. Others will restrict medicare patient visits. Others will create medicare mills, where patients with mild problems are processed rapidly through an impersonal system and complicated cases are referred out or dismissed from the practice. Others will use the visits as loss leaders to fuel diagnostic and therapeutic procedures that will pay well enough to keep the practice profitable. Others will limp on, trying to be healers at work and dealing with poverty at home.
The democrats have positioned themselves as the saviors of physicians, military families and the elderly while republicans have been manipulated into being the party that would rather support an insurance company than physicians and patients. If there ever was a recipe for electorial failure, this is it! The elderly, the military and physicians are generally more conservative than liberal. These groups see themselves has having been dissed by the republicans in the Senate and the White House. The only hope for the Republicans for this fall is to find a way to prevent this cut from going into effect.
Gas prices are beyond any party to control, and the argument will be spun. The war is less of an issue each day. Health care will be handed to the democrats on a silver platter. Swing states with many old people and health care workers (think Florida and Ohio) will go democrat in a big way. Senators such as Arlen Specter and John Cornyn will likely lose their seats. And not because republicans don't care. But because they were outfoxed. Stupid is as stupid does. You can't allow yourself to be framed as uncaring about the elderly and military dependents. The republicans will have to be in a position of defending their position. Nixon said that he was NOT a crook and look where it got him!
If the cuts go into effect, then the republicans will be through for this year, and perhaps for a very long time.
posted by DocBrain at
8:29 PM
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