Thursday, March 6, 2014
Patient Choices of Outside Networks
Despite the fact that so many Americans are already in selective networks, they are nervous that the Affordable Care Act, which I helped design as an adviser to the Obama administration, will further restrict their choice of doctors or make them pay higher out-of-network charges. But selective networks themselves are not a problem. The problem is that not all networks are of consistently high quality.
Ekekiel Emanuel, MD, “In Health Care, Choice Is Overrated,” New York Times, March 6, 2014
Patients shouldn’t worry about lack of choice,
Saith Ekekiel, ObamaCare’s most vocal voice,
Instead, they should worry about networks’
access to outside second opinions as perks,
To networks’ of adequacy and transparency,
Above all else, to government endorsed quality.
Tweet: Ekekiel Emanuel. MD, ObamaCare architect, says health plans should include choices of networks wotj adequacy, transparency, quality, and 2nd opinions outside their current networks.
ObamaCare: When Is Enough Enough?
You never know what is enough unless you know what is more than enough.
William Blake (1757—1827), Proverbs of Hell
Now this is not the end. It is not even the beginning of the end. But it is perhaps, the end of the beginning.
Winston Churchill (1874-1955), Speech at the Lord Mayor’s Day Luncheon, November 10, 1942
From the beginning, March 23, 2010, the strategy was clear.
Addict the people with sweeteners, for example, covering all with pre-existing conditions and promises they could keep their doctors and health plans at lower costs, then at the end, hit them with realities – the launch with its conditions for enrollment, the mandates and fines, increased premiums and deductibles, and the loss of health plans and doctors.
What was not clear was that the people, in increasing numbers, would resist the plan, and what would happen when the promises could not be kept and costs.
What was not incorporated in the strategy were that most of these realities would take hold just before the midterms elections of 2014 and that President Obama’s approval ratings would be as low as 38%.
What was also not clear was that many Democrats would abandon the ObamaCare ship. These Democrats, particularly 15 vulnerable ones running for the Senate, would begin to wonder if the law was worth all the trouble, as they saw the death of the their political lives flash before their eyes.
Was the health law worth saving?
Was it really worth losing the Senate over?
Those Many Maybes
Maybe the health law wasn’t worth all the political pain.
Maybe a two year delay of those 6 million health plan cancellations would help.
Maybe those techno-wizards in Washington would step in, fix healthcare.gov, and save the day.
Maybe enough of those signing up for ObamaCare subsidized plans would rejoice and let the world know of their joy.
Maybe those losing their plans and their doctors would not complain too much and would not release their stories to the media.
Maybe the young and the non-subsidized middle class would be mum about unaffordable premiums and ridiculously high deductibles.
Maybe the 31 million left uninsured would be silent.
Maybe the unworkable would work out.
Maybe, just maybe, “maybe” has become the biggest word in the political language for ObamaCare.
Twitter: There is increasing evidence that ObamaCare’s troubled implementation may be not worth the political pain for Democrats.
Wednesday, March 5, 2014
President Obama – Concierge Medicine Salesman
"ObamaCare helps the concierge medicine movement. President Obama is the direct care salesman of the year. ObamaCare will drive people right to our door. "
Josh Umbehr, MD, Concierge Medicine Practitioner, in Medinnovation and Health Reform blog interview
Recently I interviewed Dr. Josh Umbehr, a concierge physician in Wichita, Kansas, He is one of three physicians in a thriving direct pay practice. The practice is based on the premise that patients will willingly pay monthly fees for an insurance-free practice for convenient personal 24/7 cell phone access to physicians who offer unlimited time for a one-on-one relationship with a physicians, same day appointments, free procedures, biopsies, lesion removals, lab, and other tests, wholesale prices for generic drugs, and reductions of premiums from health insurers with an overall savings in their health care expenses.
As part of that interview, Umbehr made the statement that President Obama is concierge medicine’s salesman of the year. Umbehr’s statement rested on his belief that ObamaCare was driving up costs of premiums and deductibles, causing millions of patients to lose their health plans, and creating uncertainty, anxiety, and confusion among patients about present and futre access to doctors.
Umbehr expressed great satisfaction over the fact that he had not had to code during his 3 ½ years in practice. This and other factors allowed him and his two partners to have a staff of two registered nurses, one half-time, while similar traditional practices may require a staff of 20 or so members.
Coding for 3rd party payers, either private insurers or government programs. like Medicare or Medicaid, drives up costs. Doctors have to hire staff to properly code to be paid. Their staffs may grow to 5 or 6 just to enter the data for the codes, to select the right code, to document the code, and to hassle with the payer about the validity of the code.
As ICD-9 coding now stands, doctors have to pick and choose among 1700 codes to find the right one. This will change in October 2014 when new ICD-10 codes, which will number 150,000, will be introduced. This can be a logistical nightmare among physicians, causing them to hire new staff, and resulting in decreased productivity with lower reimbursement revenues because of the lower payment rates.
According to a 2008 study, the total cost of the ICD-10 implementation would be $83,290 for a small practice (3 physicians and 2 administrative staffers), $285,195 for a medium practice (10 providers, 1 professional coder, and 6 administrative staffers), and $2.7 million for a large practice (100 providers, 10 full-time coding staffers, and 54 medical records staffers). Code costs will be higher in 2014, may require an electronic health record system to cope with, and will lead inexorably to higher costs.
The new coding system , which President Obama and CMS endorses, is yet another example why Obama is a salesperson in disguise for direct concierge care and for physicians fleeing from government sponsored health plans.
Tweet: ObamaCare, besides creating higher premiums and deductible, is backing an complicated new ICD-10 coding system, in the process, driving doctors into concierge direct pay practices.
1. Grace-Marie Turner, “New Rule Creates Avalanche of Time Wasting Paperwork for Doctors : Is There a Code for That?“ Investors Business Daily, March 4, 2014.
2. Stephen Hayes, “Coding Chaos: another Nightmare for Doctors, Courtesy of the Federal Government, The Weekly Standard, March 10, 2014.
Health Insurer Losses
“Insurer Losses To Reach $5.5 billion in 2015”
Bloomberg News, March 5, 2014
Health plans to lose billions from ObamaCare?
Don’t fret, a billion here, a billion there.
That’s nothing in a $4 trillion budget.
Insurer bailouts are a money midget.
So declares President Obama,
The Democrats' main source of drama.
So declares President Obama,
The Democrats' main source of drama.
Tweet: Government may have to pay $5.5 billion to bailout insurers from ObamaCare losses.