BNET Health Care Industry Talkback

BNET Health Care Industry Talkback http://www.bnet.com/5799-14045-0.html?type=18 Blog Recent Discussion Activity RE: The House Busts The Budget By Passing a http://industry.bnet.com/healthcare/10001416/the-house-busts-the-budget-by-passing-a-doc-fix/#18944_91808 Thank you, Mr. Terry for pointing this out. <img border="0" src="http://www.cnet.com/i/mb/emoticons/happy.gif" alt="happy"> Sat, 21 Nov 2009 00:33:58 GMT http://industry.bnet.com/healthcare/10001416/the-house-busts-the-budget-by-passing-a-doc-fix/#18944_91808 2009-11-21T00:33:58Z RE: Grassley's Attack on Reform Belies Some Earlier Stands http://industry.bnet.com/healthcare/10001411/grassleys-attack-on-reform-belies-some-earlier-stands/#18921_91812 Thank you, MSF, for drawing my attention to the CBO study. It is very interesting that neither the AMA response nor the response from the Medical Group Management Association mentioned how much the House bill would cost.The Senate, however, has already defeated a similar measure. I'll discuss this in a forthcoming post. Fri, 20 Nov 2009 21:41:35 GMT http://industry.bnet.com/healthcare/10001411/grassleys-attack-on-reform-belies-some-earlier-stands/#18921_91812 2009-11-20T21:41:35Z RE: Senate's Unified Reform Bill Owes Much to Finance Committee http://industry.bnet.com/healthcare/10001407/senates-unified-reform-bill-owes-much-to-finance-committee/#18935_91787 vc ... very nice post. Ken... When Senator Reid appeared at the podium to announce the Senate bill was ready Senators Dodd and Shumer added their comments. Durban had to chime in too of course. I'm curious ... You say the final bill closely represented the Finance Committee's product over the HELP bill. Effort to negotiate all the fine points of the product Reid plans to bring to the full Senate this weekend ... that Baucus was too tired to show up with his Senate colleagues. Where was he? To me this does not portend well. Fri, 20 Nov 2009 21:00:43 GMT http://industry.bnet.com/healthcare/10001407/senates-unified-reform-bill-owes-much-to-finance-committee/#18935_91787 2009-11-20T21:00:43Z RE: Senate's Unified Reform Bill Owes Much to Finance Committee http://industry.bnet.com/healthcare/10001407/senates-unified-reform-bill-owes-much-to-finance-committee/#18935_91737 How about we try being a lot more honest about any bills currently being considered. First, the CBO is scoring based on assumptions that clearly cannot be relied upon to be carried out. That would be like cutting Medicare by 400-500 billion which has NEVER been done and will meet stiff headwinds when those on Medicare realize what just happened to them. That cut would be mostly be to the Advantage plan which in the past several years is the choice of many due to what is covered. In the past people automatically took the FFS plan, coupled with supplemental policies called MedGap if they could afford it. Now the government wants to hack out the Advantage plan because it is more costly and also because it is administered by private insurance. That is why AARP endorses Obamacare because they will benefit when they can sell so many more MedGap policies. It is always about who's pocket is being lined. Also when this bill was scored it reflected that fact that the government takes in revenue for the first 4 years without paying out any expenses. This is why they can say that over 10 years this bill will save billions when in fact that is just plain a lie. Looking down the line those expenses will far exceed any funding. The scoring also doesn't reflect that 250 billion payment to doctors that keeps getting set aside as if it doesn't exist. Obama said he does not support taxpayer dollars paying for abortions. He also says that every woman wanting and abortion should get one. Those two comments conflict then which means taxpayers money will indeed pay for abortions if the democrats have their way. I say this because they hold all the cards. The senate can twist the language all they want, but abortions will get funded by taxpayers dollars. Obama will take care of the unions and other than a few will not be made to pay higher taxes on their benefit programs. The language in the house bill is already there. The union position is that they already conceded during the bankruptcy procedures and they do not plan to give any more. That is why the most frequent guest in the WH is the SEIU president. The protection is a guarantee. This reform is all about insurance reform not about holding down costs or reducing health care premiums or improving health care. Recently the president of a company told me their insurance premiums went up 14 percent this year. The reason being is several critical ill employees, and also many that signed up for dental and used up every dollar and then they drop it when the work has been done. Nobody is connecting the dots that using the system without proper funding causes rates to keep skyrocketing. The company absorbed most of the increase not wanting to burden the employees. THIS IS IMO A MISTAKE. Until each person with an insurance policy understands his/her impact in the system there will be no prudent policy making by the consumer. The company absorbing that cost just became less competitive in the worldwide market. Chinese companies did not see a 14 percent hike in insurance premiums and thus they can sell below American costs. Yesterday Cypress Semiconductor CEO that has testified many times before congress, said that exports now far exceed their domestic market. 10 years ago that was not the case. I know. I was a stockholder for many years of this company and know their product line well. Chips go in everything, but since the US continues to make fewer products the business is now overseas. We are headed off a cliff and this heath care reform will be the final push. It will be like fuel prices that soared in 2008 that was the final straw for consumers and forced them to choose between gas and their mortgage. How we pay for entitlements should be first on the list, not after the program has been approved. If I plan to remodel my home I do an exhaustive search first detailing all expenses and then try to figure out how I will pay for it, before I call the various contractors to begin the job. There can be no fudging of numbers like the government is doing with this health care reform. Fri, 20 Nov 2009 19:05:38 GMT http://industry.bnet.com/healthcare/10001407/senates-unified-reform-bill-owes-much-to-finance-committee/#18935_91737 2009-11-20T19:05:38Z RE: Grassley's Attack on Reform Belies Some Earlier Stands http://industry.bnet.com/healthcare/10001411/grassleys-attack-on-reform-belies-some-earlier-stands/#18921_91735 Please tell us you are not so naive to think this thing will only cost $849B? For the $200B, it is HR3961 passed yesterday. Though not the $245B which was defeated earlier, CBO scores it at $200B - see link: <a href="http://www.cbo.gov/ftpdocs/107xx/doc10704/hr3961.pdf" target="_blank">http://www.cbo.gov/ftpdocs/107xx/doc10704/hr3961.pdf</a> As for you lack of understanding of the bill itself, maybe you need to read it for yourself - there are some very interesting points to this legislation. The link is: <a href="http://thomas.loc.gov/cgi-bin/bdquery/z?d111:h.r.03962:" target="_blank">http://thomas.loc.gov/cgi-bin/bdquery/z?d111:h.r.03962:</a> For the Chinese, stop thinking like an American and think like the Chinese. Their focus, as with most Asians, is on the long-term - longer than the next quarter or the next election cycle. So what if the US goes bankrupt - they will survive and come out stronger as a result. Fri, 20 Nov 2009 17:16:57 GMT http://industry.bnet.com/healthcare/10001411/grassleys-attack-on-reform-belies-some-earlier-stands/#18921_91735 2009-11-20T17:16:57Z RE: Grassley's Attack on Reform Belies Some Earlier Stands http://industry.bnet.com/healthcare/10001411/grassleys-attack-on-reform-belies-some-earlier-stands/#18921_91706 Our country is already "broke". It would be great if we could blame it on one idiot, like Bush, however, each year since 1969, Congress has spent more money than its income. We owe an estimated $14 Trillion dollars. China is a not a good will ambassador and has us over the proverbial barrel, as do other countries. Obama is tied to strings that others pull. We have sold our nation to foreign interests, based on our enormous debt burden and loss of GNP. Our financial regulators have been hijacked. Welcome to the new third world country. Fri, 20 Nov 2009 14:57:21 GMT http://industry.bnet.com/healthcare/10001411/grassleys-attack-on-reform-belies-some-earlier-stands/#18921_91706 2009-11-20T14:57:21Z RE: Grassley's Attack on Reform Belies Some Earlier Stands http://industry.bnet.com/healthcare/10001411/grassleys-attack-on-reform-belies-some-earlier-stands/#18921_91700 MSF, I suggest you read Ezra Klein's excellent article in the Washington Post about the tradeoffs involved in the Senate bill (I've added the link to the last paragraph of this post). The CBO projects that this bill will actually reduce the deficit in the long run. The Republicans can scoff that there is no way that Congress will actually stick to the revenue reductions and other changes necessary to do that--but it is doable, especially with a Medicare commission making the hard choices. Moreover, it has to be done, or the country will indeed go broke. As for the $200 billion, 10-year "fix" to the physician payment formula, I'm unaware that the House has passed that, although it did repeal the "sustainable growth rate" formula. What will replace that formula is still unknown, but I think that some combination of short-term payment increases and long-term methodological changes to reward quality and cost-efficiency would be the right way to go. As for the Chinese, they're not about to slit their throats by yanking the rug out from under us. And let us not forget that the Bush Administration roughly doubled the size of the national debt that had accrued in the entire history of our country--and that didn't count the bailout that the Republican Administration's myopia and favoritism to Wall Street made inevitable. The Obama people are now starting the long process of digging out of the very deep hole that Bush put us in. Fri, 20 Nov 2009 13:52:05 GMT http://industry.bnet.com/healthcare/10001411/grassleys-attack-on-reform-belies-some-earlier-stands/#18921_91700 2009-11-20T13:52:05Z RE: Grassley's Attack on Reform Belies Some Earlier Stands http://industry.bnet.com/healthcare/10001411/grassleys-attack-on-reform-belies-some-earlier-stands/#18921_91674 Mr. Terry: Once again you disappoint. To be quite honest with all of us - are you in favor of socialism or do you just have this infatuation with the Democratic Party and all things liberal? If you let us know at least this one tidbit of information, it will let us know if we need to determine how much credence to put with what you "write". For your criticism of Senator Grassley, maybe you need to do more research. His concerns about Medicaid are completely valid. The tactic used by Senator Reid to push more of the costs to Medicaid has the benefit of lowering what CAN be scored by the CBO. What Senator Grassley is referencing with the $2T cost refers to the TOTAL package - what is in this piece of trash, err, legislation (sorry, Freudian slip) and the ultimate costs that will be pushed off to the states in the form of Medicaid. Once again to return to the larger picture, the much larger picture - how is this going to be paid for? ALL of it, not just the portion in this one bill. Just this week, Congress passed an additional $200B appropriations bill for the doctors in Medicare (remember that one from the House version where cost adjustments were not included in the bill?) which is obviously not included in either calculation of the House or Senate bills. On yet a much larger scale is who is going to continue to finance our country? Liberals, like you, have these grand ideas of all these things you want to do. The problem is you really don't know how to pay for them. China now holds a majority of our debt. Just this week, the Chinese government expressed misgivings over the amount of debt we are running up. Such comments sound more like a bank than a "trading partner" as they are so often referred. If you check out the White House's own budget projections through 2019 <a href="http://www.whitehouse.gov/omb/assets/fy2010_msr/10msr.pdf" target="_blank">http://www.whitehouse.gov/omb/assets/fy2010_msr/10msr.pdf</a> on page 60 you will see that by the year 2019, the federal TOTAL budget deficit will be over $24T, yes TRILLION, dollars. Currently, it is just under $10T. Now, let's be completely honest with everyone reading this - are you comfortable with the Chinese owning such a large chunk of our debt? Are you comfortable with any debt? Do you have any idea what will happen if the Chinese decided to simply dump a percentage of the debt they own? And we will be expecting others to shell out another $15T over the next 10 years? When are you, and all of the liberals and some Republicans going to figure out you cannot continue to do this? And this is where it starts - with budget projections that are naive at best, at worst they are completely deceptive. Senator Grassley is trying to explain to you and to us there are costs that the legislators on the Hill know full well will come to pass making this project much more expensive than the pie in the sky number the CBO scored and you are simply not listening. Mr. Terry, let's call it what it is - THE KING HAS NO CLOTHES! Fri, 20 Nov 2009 12:54:46 GMT http://industry.bnet.com/healthcare/10001411/grassleys-attack-on-reform-belies-some-earlier-stands/#18921_91674 2009-11-20T12:54:46Z RE: White House Puts Focus On Medicare and Medicaid Fraud http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91530 I recently went through an OIG (office of inspector general ) audit where 4 auditors (who we were training) wanted to make sure we returned money to medicare when paid by someone else..they spent months where the cost was greater then their return..I work for a large academic medical center where aditors think they smell blood..These resources would be better spent on those companies whose business is to cheat the government..why should we expect efficient and effective management from the government?. Thu, 19 Nov 2009 19:11:59 GMT http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91530 2009-11-19T19:11:59Z RE: White House Puts Focus On Medicare and Medicaid Fraud http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91515 Absolutely right Pam74leo - most of what goes on in facilities that delivers improper payments is completely accidental. To be Fraud it needs to be deliberate or irresponsible disregard and NOT confusion based. We spend hours of training time and education to try to keep up and understand the regulations. Thu, 19 Nov 2009 18:05:34 GMT http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91515 2009-11-19T18:05:34Z RE: White House Puts Focus On Medicare and Medicaid Fraud http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91502 I'd like to point something out here..."improper payment" does NOT equal "fraud". I'm really tired of the "F" word being thrown around without regard to fact (another "F" word that the media has issues with). Medicare creates unclear rules and regulations which they then allow their non-governmental contractors (also known as Fiscal Intermediaries and Medicare Administrative Contractors) to interpret those vague and sometimes contradictory rules however they choose. As a result, providers are really lost on exactly what is expected of them. In the meantime, we're just trying to provide for patients and keep our heads above water. If you want to talk about organized crime, start talking about what a crime it is that Congress allows CMS programs to be run in such a haphazard manner and then points the finger at the people who are trying to just make patients better and save lives and yells FRAUD! Spend a day or two at your local hospital and just see how criminal we really are! I can guarentee that Congresses new public option "wonder program" will be just as fraught with issues as MCR and MCD. Thu, 19 Nov 2009 17:39:23 GMT http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91502 2009-11-19T17:39:23Z RE: Doctor Shortage Is Worsening, Say Hospital CEOs http://industry.bnet.com/healthcare/10001396/doctor-shortage-is-worsening-say-hospital-ceos/#18782_91482 vc... here's a quick info source (Medscape Today by WebMD) on nurse practitioner reimbursement by Medicare as an example. QUOTE: Medicare pays NPs 85% of physician rate. Medicare pays 80% of the patient's bill for physician services and the patient pays 20%. Medicare reimburses NPs at a rate of 85% of the physician fee, as stated in Medicare's Physicians Fee Schedule.? So, Medicare pays NPs 80% of the 85% of the Physicians Fee Schedule rate for a procedure. For example, assume the Physicians Fee Schedule rate for a particular service is $100. If a physician performs the service, Medicare pays the physician $80; the patient pays the physician $20. If an NP performs the service, Medicare pays the NP $68; the patient pays the NP $17. UNQUOTE Source: <a href="http://www.medscape.com/viewarticle/422935_3" target="_blank">http://www.medscape.com/viewarticle/422935_3</a> The lower reimbursement for services provided back to the practice results in a disinsentive for practices to add physician extenders to their practice. This results in fewer patients being able to access health care services. Physician lobby groups at state level also lobby for laws restricting scope of practice... what procedures can be performed by other licensed medical professionals. These other professionals perform under the supervision of a physician and there have been cases where lobbying has been to require the supervising physician to be in the room when the treatment is provided. If the physician has to be in the room then there is no reason to higher an extender to expand the ability of a service to meet a community need. These defensive efforts are usually taken by physician groups who do not support the efforts of other physicians to meet the needs of more people. Physicians may press for these limitations and then simultaneously petition for greater reimbursement for physician provided services in more remote disadvantaged areas where nurse practitioner services may be more effective making services readily available to the population. Following is a link to a MEDPAC paper provided to Congress on 2002 on the subject: <a href="http://www.medpac.gov/publications/congressional_reports/jun02_NonPhysPay.pdf" target="_blank">http://www.medpac.gov/publications/congressional_reports/jun02_NonPhysPay.pdf</a> Thu, 19 Nov 2009 16:06:12 GMT http://industry.bnet.com/healthcare/10001396/doctor-shortage-is-worsening-say-hospital-ceos/#18782_91482 2009-11-19T16:06:12Z RE: White House Puts Focus On Medicare and Medicaid Fraud http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91462 The above posters have pretty much summed it up. M.s.f. your views are shared NOW by MILLIONS that have come out of their lifelong stupor, because economic conditions have forced them to see the mess years of bureaucrats have made of our country. What this administration says for public consumption and what they actually are capable of doing are two very different things. While I applaud efforts to improve systems, this administration is intent on reinventing the wheel and bashing all previous administrations for dereliction of duty. The private business sector has figured out his motivation and now they are paralyzed. This is what happens when so many systems are changed at the same time, giving no time for any system to even get on board correctly. I know this administration believes they can do more than one thing at a time, but can they do it without turning all systems upside down. I believe in the past that congress tried in vain to cut 10-20 billion of waste out of medicare, but of course hit a cement wall on that well intentioned action. We have to assume that if they can put a number to this waste, then they know where it is. If they know where it is why did they wait an entire year to stop it? It is because politically it doesn't make sense to touch entitlement programs because then the party that does loses the next election. When you keep adding layers to government, the task of being a policemen and ferreting out fraud becomes nearly impossible. It requires manpower and leadership that can only come from those with private business experience that knows the system and the loopholes that make fraud so easy. So maybe reel in the criminals and get them to cough up their criminal prowess. Many of us have worked for private business and have seen heads roll and new management come in. There is usually a quiet period before the changes begin. It doesn't take 10 minutes for employees to figure out if the top brass has sound ideas or is just "experimenting". The ones that succeed are the ones that bring everybody, including the janitor, into the conversation, vs the ones that do all this magnificent planning behind closed doors with other top managers that all live in the same bubble. Thu, 19 Nov 2009 15:12:53 GMT http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91462 2009-11-19T15:12:53Z RE: White House Puts Focus On Medicare and Medicaid Fraud http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91421 Macdaddy6 - that will all change when PBO signs an executive order. Ha! If you believe that, I've got a bridge to sell you! Thu, 19 Nov 2009 04:00:08 GMT http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91421 2009-11-19T04:00:08Z RE: White House Puts Focus On Medicare and Medicaid Fraud http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91408 That's funny because just two weeks ago I called Medicare to turn in a person committing fraud but the lady on the phone didn't care. She said that wasn't her department and Medicare wasn't concerned. My question now is - if the employees of Medicare don't give a hoot, what makes them think the others will? Thu, 19 Nov 2009 03:44:10 GMT http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91408 2009-11-19T03:44:10Z RE: White House Puts Focus On Medicare and Medicaid Fraud http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91401 Mr. Terry: Once again you are accepting mediocrity. Why can we NOT have a system that prevents fraud? Why accept any fraud? Yes, I know, I'm a naive perfectionist. Call it time in the military where we were taught there is always something else to be done, especially when preparing for a combat operation. Or just call me responsible. I know, I'm just a crazy kid... It is time to stop thinking like a DC insider (not sure if you are or not - you sure sound like one) or some government bureaucrat completely reliant on the government handouts and start thinking like a business person who actually has to make a profit. There may come a day in the not-so-distant future when all of us will be surviving by the sweat of our brow and real creativity. Again, you have highlighted what is completely and totally wrong with the US government - basically no one there has ever ran a business or made anything, tangible. They are a bunch of lawyers, for the most part, who have only created mountains of paperwork (I know, I was recently involved in a lawsuit) as their life's work. My hope is 2010 will result in a bunch of unemployed former legislators and their staffs who, as a result of years of not creating anything, only have as a marketable skill something in the fast food industry or ambulance chasing. Thu, 19 Nov 2009 00:30:58 GMT http://industry.bnet.com/healthcare/10001403/white-house-puts-focus-on-medicare-and-medicaid-fraud/#18866_91401 2009-11-19T00:30:58Z