Thursday, February 26, 2009

Obama strategies - Obama Health Care Budget

Well, details of the Obama “down payment on health care reform are filtering out.

They include.

• $634 billion to help pay for health care reform over the next ten years.

• $318 billion of that—about half—will come from tax increases that include reducing the mortgage and charity deduction for high income Americans.

• Charging wealthier seniors more for the Medicare Part D drug benefit—as is done for Medicare Part B now.

• Cutting Medicare HMO payments by $175 billion over ten years.

• Reducing Medicare hospital payments by $17 billion over ten years by bundling inpatient and outpatient reimbursement to include the 30-days after discharge.

• Cutting Medicare hospital payments by $8.4 billion over ten years for re-admissions resulting from substandard care.

• Requiring drug makers to increase the rebates on drugs sold to Medicare patients from 15% to 21% saving $19.5 billion over ten years.

What does this mean for doctors? I do not know. Some of it, of course, will come form higher taxes on doctors making over $250,000. Some may come from forcing doctors to “bundle bills” with hospitals. Some may come from only paying those doctors who use EMRs. Some of it may be indirect, as HMOs tighten financial screws on doctors to compensate for Medicare HMO losses. Little mention yet of how much is to be saved from prevention, EMR use, and lower Medicare fees for high ticket items that “don’t work” according to comparative effectiveness. Curiously, no mention of single-payers or universal coverage which will impractical unless costs are lowered.

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