ObamaCare: Reports From The Front Lines


A Physician’s New Reality Under ObamaCare: Patients Ask Me to Break the Law...

 “Ironically, but expectedly, the ones who do this now are likely to have supported Obamacare.”

..there is the “annual ” or “preventative” exam, which according to Obamacare is “free” ...

 What they did not tell you, and I am, is that it covers absolutely nothing more than the bare minimum.

I have now posted a notice in my office and each exam room stating exactly what Obamacare will cover for those yearly visits. Remember Obama promised this as a free exam — no co-pay, no deductible, no charge. That’s fine and dandy if you are healthy and have no complaints. However, we are obligated by law to code specifically for the reason of the visit. An annual exam is one specific code; you can not mix this with another code, say, for rectal bleeding. This annual visit covers the exam and “discussion about the status of previously diagnosed stable conditions.” That’s the exact wording under that code — insurance will not cover any new ailment under that code.

If you are here for that annual exam, you will not be covered if you want to discuss any new ailment or unstable condition. I cannot bait and switch to another code — that’s illegal. We, the physicians, are audited all the time and can lose our license for insurance fraud.

You, the patient, will then have to make a decision.

Do you want your “free” yearly exam, or do you want to pay for a visit which is coded for a particular, new problem? You can have my “free” exam if you only discuss what Obamacare wants me to discuss...

Patients can be very tricky. I have had patients make an “annual” exam, only to want to discuss and be treated for another ailment. I can’t do it...

I can hear the complaints from you guys already — I become the bad guy. “Why don’t you just take care of the problem, and not bill out any different code? You’re a rich doctor, and we are entitled to free stuff.”

It doesn’t work that way. First, doctors are not rich and, like most of you, actually work terribly hard for a living. Second, Obamacare is the law — and as I said earlier, we are audited all the time now.
 ...and docs who accept Medicare (the vast majority) are forbidden from selectively providing free care.

Here's a report from the world of cancer care:
I am a Hematologist/Oncologist with 27 years combined training (10 yrs after college) and practice (17 yrs). I am in a large group of oncologists and we do chemotherapy in our offices, have several imaging centers and radiotherapy in two locations. Currently we employ 130 people, and pay 100% of their health care insurance premiums, as well as a matching 401k. Each physician sees approx 15 to 25 patients daily in office and 5-10 hospital patients daily. We are a busy and, at the moment, financially secure business.

Here’s the preliminary numbers when we are paid at Medicaid reimbursement, oops I mean Obamacare rates: Half our offices will close, forcing patients to travel to a restricted number of locations. We will not be able to give chemochemotherapy in our offices, as the drug costs and nursing costs will be higher than what we will get paid, so the patients will have to get their chemo in what hospitals will still be giving chemo in an outpatient suite. In our community, just to cover the number of patients that receive chemo services in our offices, the hospitals will need to set aside 60-80 clinic slots each day. Right now there are approx 15 slots between the 7 hospitals we cover and no plans to add more, so where these patients will receive their cancer treatments, outside of a 2 hr drive to the Texas Medical Center, I don’t know.

Our staff will either be halved or go part time (29.5 hrs). How I will run a medical practice with this kind of staffing, I have no idea.

The physicians will need to see 45 cancer patients daily, yup, 45 patients with a life threatening and devastating disease like cancer, to cover overhead costs, whilst the physicians taking a 50%, likely more, pay cut.

Oh, and then there is the whole caboose of regulations that my practice will have to pay $400/hr lawyers to figure out how to keep us in compliance, since the fines are upwards of $100K per occurrence.

I don’t think the picture is any better for other specialties, but I will tell that for cancer care it is a catastrophe for the patients and the providers. 
As with the "War on Poverty" and public education, we can expect government to waste ungodly amounts of wealth "fixing" the foreseen flaws, strengthening Obamacare's grip on our private lives but making negligible improvements in the quality of health care.

10 comments:

  1. .

    "... there is the “annual ” or “preventative” exam, which according to Obamacare is “free” ...


    What they did not tell you, and I am, is that it covers absolutely nothing more than the bare minimum."

    "This annual visit covers the exam and “discussion about the status of previously diagnosed stable conditions.”"

    Then this is great. _Bare minimum_ can cover quite a large amount of preventative medicine initial investigative medical questions, exams, and tests. Any medicine man/woman worth his/her salt would know this.

    The accounting issues you and your "physicians" bring up are with US now and have been since modern medicine began.

    "Oh, and then there is the whole caboose of regulations that my practice will have to pay $400/hr lawyers to figure out how to keep us in compliance, since the fines are upwards of $100K per occurrence."

    The $400/hr lawyers, which doctors already have in place, are needed today to meet the whole caboose of regulations to figure out how to keep us in compliance with the current 'for profit insurance companies'. Keeping in mind how doctors have been behaving this will not change.

    As with the "War on Poverty" and public education, two programs that have successfully helped millions of people in USA over the years, we can expect our governments (federal/state/local) to make improvements in the quality of health care.

    Ema Nymton
    ~@:o?
    .

    ReplyDelete
    Replies
    1. "As with the "War on Poverty" and public education ..."

      Why, then, do official gub'ment measures classify *more* people as impoverished and why does US educational standing consistently decline in comparison to other countries?

      Been so lonely, Ema, when you comin' back?

      Delete
  2. So good to know we have Ema the expert in the room. Just think how great it will be went the government is wiping our noses for us as well.

    ReplyDelete
    Replies
    1. Stupidity isn't covered under Obamacare. So don't feed the trolls. Let them die of their affliction so there will be fewer of them crowding the waiting rooms in the few remaining Dr's offices.

      Delete
    2. .

      "So don't feed the trolls."

      Is it wise for you to refer to Ration Nation USA as a troll? He is after all, one of the few posters who support your nonsense ideas without questioning. (Though one guesses it must be difficult for you when one considers RN has trouble staying focused on the subject of your posts.)

      Ema Nymton
      ~@:o?
      .

      Delete
    3. Chuckling quite hard mow Ema. Quite hard! Thanks for the laugh. Oh, and you obviously do not know what I support. Ever hear of the Swiss Plan Ema? Just wondering. You can take it from there...

      Delete
  3. .

    "Just think how great it will be went the government is wiping our noses for us as well."

    Just think how great it will be when we have NO government. Now, can we get back to the subject at hand?

    Please tell US, how having a safety net under a high flying trapeze artists prevents a high flying trapeze from being as good as he/she can be? How does USA having quality health care for all, prevent people from being as good as he/she can be?

    When answering, avoid the 'USA cannot afford it' argument. When USA corporations can afford paying CEO's million dollar tax free salaries/income, then surely USA ain't broke! And it is not going broke.

    Ema Nymton
    ~@:o?
    .

    ReplyDelete
    Replies
    1. " When USA corporations can afford paying CEO's million dollar tax free salaries/income, then surely USA ain't broke! And it is not going broke."

      Well Ema, it is just great that you have it all figured out. Good for you.

      Given the idiocy of your above quoted statement I can see why the USA is going broke. Apparently too many think like you. And please Ema don't ask me to explain why I said what I just did. If you don't understand it w/o being spoon fed you never will understand it.

      See ya when the going bet tough Ema. I promise not to tell ya I told ya so.

      Delete
  4. "Bare minimum_ can cover quite a large amount of preventative medicine initial investigative medical questions, exams, and tests."

    Incorrect. Read the article.

    "annual visit covers the exam and 'discussion about the status of previously diagnosed stable conditions."

    ReplyDelete
    Replies
    1. Here are the details on the light services that come with the annual wellness visit:

      http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7079.pdf

      This isn't going to provide a substantial benefit for most people.

      Delete

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