Comments on: Obama Calls for Vote on Medicare ‘Doc Fix’

By: The Game Played

The Game Played — Sat, 25 Sep 2010 11:02:54 +0000

Doctors Group Sues AmeriChoice TOM WILEMON | The Daily News
Mid-South Imaging & Therapeutics PA, a hospital-based group of more than 30 radiologists, has filed suit against AmeriChoice, accusing the insurance company of “unfair and deceptive trade practices.” The complaint, filed last week in Shelby County Chancery Court, according to The Daily News online, http://www.memphisdailynews.com, alleges the insurance company made a “phantom offer” to the state in regard to doing business with Mid-South Imaging.
“Because AmeriChoice has not had an opportunity to review Mid-South’s lawsuit and its allegations, we are not in a position to comment at this time,” said Roger Rollman, a spokesman for AmeriChoice. AmeriChoice is one of two companies the state is contracted with to provide TennCare coverage in West Tennessee. The doctors from Mid-South Imaging provide radiology services to patients of Baptist Memorial Health Care Corp.
The lawsuit comes after back-and-forth negotiations between the physicians group, the state and the insurance company, which is a division of United Healthcare of Tennessee. The insurance companies are owned by parent company United Health Group Inc. The complaint alleges that AmeriChoice is paying only 50 percent to 55 percent of the lowest rate paid by any other “equivalent network provider,” which in this case is Medicare. Daniel Van Horn, the lawyer representing Mid-South Imaging (MSIT), wrote about the negotiations in the complaint. “Beginning in January 2009, MSIT complained to the state about AmeriChoice’s failure to make any serious offer,” Van Horn stated. “The state responded to the MSIT complaint by talking with AmeriChoice. AmeriChoice falsely told the state that it had made an offer to MSIT in the range of 78 percent of Medicare – a phantom offer that was significantly higher than the 50 percent to 55 percent offer that it actually made.
“Upon learning of the alleged significantly higher offer as reported to the state by AmeriChoice, MSIT wrote AmeriChoice a letter dated June 11, 2009, offering to enter into a contract with MSIT at the originally offered shockingly low 50 percent to 55 percent reimbursement rate.” The physicians group cannot refuse to take AmeriChoice because it provides radiology services to a hospital, according to the complaint. MSIT is seeking compensatory damages, a declaratory judgment that AmeriChoice’s actions constitute “unfair or deceptive trade practice” and an injunction against the insurance company in relation to its reimbursement rates

By: Medicare Backlash

Medicare Backlash — Wed, 22 Sep 2010 14:02:04 +0000

Limo Divers Protest Medicare Mediciad Reform Cuts, It’s rumored this issue could become part of the Tea Party movement. AmeriChoice Health also rumored to take a position on this issue. Recirculate those tax dollars? Help keep limo drivers working, benefits flowing and overpaid tax dollars remain in abuse.
Medicare.gov as well as other Federal agency’s encourage you to report any fraudulent activities, yet, the same government agency’s were notified the way this company does business yet did nothing. Three years ago they were reported to these Federal agency’s and as of todays date not only were they allowed to continue doing business but were never charged once. Protected vendor status sure, politics sure, limited government budgets sure, Federal and State officals looking the other way sure, and rather then stop these activities a strong desire not to rock the boat previals. Even with the vast changes in the laws, budgets,a hands off policy remains, you tell me what’s wrong with this picture?
The Government created this monster and now they don’t know what to do about it, like shooting yourself in your own foot etc. Tons of money to advance their national growth, it’s market positions, tons of money for political donations, tons of money to send 75 millIon back to its home office from New York state alone, tons of money to suppot National TV shows, tons of money to pay hugh State fines, tons of money to hire the very best law firms, tons of money to pay for bribes and kickbacks, tons of money for hugh salary’s and bonuses, all done on the back of the American tax payor, you see this company receives all it’s money from the Federal government. Should your tax dollars be held to a higher standard? Should our government agency’s responsible for there review and be held to that same standard? Should the IRS audit their corruption? Why has this company not been charged? How long can the buck be passed here in more ways then one?
Hey, it’s your tax dollars don’t complain now.. then don’t complain later on…
ps… I know times are tough for a lot us, but it would be great to have a free limo to go to the Doctors, Pharmacy, Movies, Grocery shopping, and given free tickets for the movies. Offered soda, pop corn and hotdogs, as well as have them receive free coupons for Grocery items…Kind of makes you wish qualified for Medicare and Mediciad right?

By: stormerF2

stormerF2 — Sun, 13 Jun 2010 14:01:49 +0000

The Next 250 Billion,to be added to the Health care total,already. That should put us over the Trillion with some to spare,and the bill has not taken full effect yet…. Talk about being lied to,no increase in the deficit,no increase in Insurance Premiums,Lower health care costs, All Lies and More Lies….. Sheeple wake up.

By: Nephron

Nephron — Sun, 13 Jun 2010 13:57:48 +0000

I would take RAND analyses with a grain of salt.RAND(or BLAND as per Kubrick) is great for Kennedyesque think tank policy projections that have led to horrible consequences.They blew the biggest political developement of the 20th Century, the collapse of Soviet Communism.And yes, most doctors are altruistic and go into the profession to help people.But it is hard to be sympatheic to reimbursement cuts when the doctor comes out of training at age 30 having been paid minimum wages for 4 or 5 years with 2 kids,a wife and a 500,000 dollar debt.Mayo is special-they also have a tremendous endowment with many well-off contributors.They are not as dependent on hospital-generated revenue as most health-care entities. The fact that they are even contemplating leaving Medicare is an ominous sign. Mayo doesn’t change much, but when it does it is like an earthquake-like moving into Arizona and Florida.

By: progressive mama

progressive mama — Sun, 13 Jun 2010 06:38:03 +0000

the health policy blog at Mayo Clinic (prior to WSJ’s article, but worth mentioning…)
“Some recent media reports have inaccurately stated that Mayo Clinic in Arizona is no longer seeing any Medicare patients. This is not true.
Rather, a five-physician Mayo Clinic Arizona family practice clinic in Glendale, Ariz., has opted out of Medicare as part of a Mayo Clinic time-limited trial that will be reviewed at its conclusion…. Current Medicare patients may continue receiving primary care at the Glendale clinic but will be required to pay out-of-pocket for office visits….
…In many ways, Medicare patients are Mayo Clinic’s ideal patients – they match the strengths of Mayo’s practice. Medicare patients are typically dealing with multiple complex health problems, which many people face as they age.
Nevertheless, decades of underfunding and paying for volume rather than value in Medicare have led us to this decision. Providers who do fewer unnecessary tests and services are paid the least, and they are the doctors and hospitals which will go out of business first if we don’t change the payment system.
That is why Mayo Clinic strongly supports health insurance reform and health care delivery reform. Health care delivery reform in the patients’ best interests means changing the payment system to reward value — defined as better outcomes, better safety, better service and lower cost. Better value results in fewer tests and decreased overall costs.”
In regards to the last paragraph, ARRA delivered health insurance reform, and trial programs to work toward health delivery reform. I mentioned a RAND analysis and June’s issue of health affairs journal in a prior post. In Health Affairs, there is an article about how unsavy we are, in general, in regards to evidence-based medicine (see the right wing freak out over the release of information pertaining to breast cancer and mammograms) and we’ve all seen how unwilling any politicians are to touch Medicare.
Sacrifices will have to be made. The status quo is unsustainable and ARRA is only a first meager step toward what needs to be done. And Republicans didn’t even want to take that step.

By: Mary

Mary — Sun, 13 Jun 2010 06:11:39 +0000

“Mayo Clinic pays medical doctors a fixed salary. From what I hear, they’re quality of care is excellent, and they tend to attract good doctors. Indeed, they are consistently ranked as one of Fortune’s 100 Best Companies to Work For.”
From the WSJ (January 8, 2010):
“Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors.
Mayo says it lost $840 million last year treating Medicare patients, the result of the program’s low reimbursement rates. Its hospital and four clinics in Arizona—including the Glendale facility—lost $120 million. Providers like Mayo swallow some of these Medicare losses, while also shifting the cost by charging more to private patients and insurers.
Of course, only governments can lose that much money and pretend they don’t have to change. “Mayo Clinic loses a substantial amount of money every year due to the reimbursement schedule under Medicare,” the institution said. “Decades of underfunding and paying for volume rather than value in Medicare have led us to this decision.”
Mayo is probably a leading indicator of where other hospitals and doctors are headed. Physicians on average earn 20% to 30% less from Medicare than they do from private patients, and many are dropping out of the program. While about 92% of family physicians participate in Medicare, only about 73% of those are now accepting new patients. In some specialties—neurology, oncology, gynecology—in places like Manhattan and Washington, patients can struggle to find any doctor who’ll accept Medicare.

By: progressive mama

progressive mama — Sun, 13 Jun 2010 06:02:18 +0000

“I don’t know, I guess I was under the misunderstanding that many people become doctors because they like helping people.”
—
Amen to that, too.
Mayo Clinic pays medical doctors a fixed salary. From what I hear, they’re quality of care is excellent, and they tend to attract good doctors. Indeed, they are consistently ranked as one of Fortune’s 100 Best Companies to Work For.
And it seems to me that there are always plenty of folks trying to work for the government, vying for seats in the House and Senate, hoping to be chosen for cabinet positions, on waiting lists to be a cop or fire fighter. Go figure.

By: Mary

Mary — Sun, 13 Jun 2010 05:55:48 +0000

“Doctors might have to lower their standard of living just like the rest of us because as a society we consume more than we produce…”
They might. Or they might not enter the field because it’s not worth the expense and effort. This is happening in other fields already. Because of the outsourcing of IT labor the past few years, we’ve experienced a huge drop in Computer Science graduates because many fear being outsourced. So what happened to them? They simply went into other fields that provided what they felt was more security and compensation. The unexpected drop in new graduates is causing a shortage in the low-end of that labor market. Ironically, companies who want U.S. talent and can’t find it are being forced to go outside the U.S. That could happen with doctors as well.
“Which kind of doctor would you rather have?”
The most qualified I could afford, particularly if it were a cancer specialist trying to keep me alive.

By: progressive mama

progressive mama — Sun, 13 Jun 2010 05:47:53 +0000

so while conservatives apparently cry about the debt all the time they show absolutely no sign of really wanting to actually do anything about it.
Posted by: Skip | Jun 13, 2010 1:40:54 AM
———–
Amen to that.

By: Skip

Skip — Sun, 13 Jun 2010 05:40:54 +0000

“There’s no way to get out of this mess without huge tax increases and/or severe cuts in federal spending”
Amen to that.
-But the only places you’re going to be able to get severe cuts in federal spending are the military and the entitlements–Republicans will never cut those and they’ll demonize the Democrats if they try–and huge tax increases–Republicans will never enact those and they’ll demonize the Democrats if they try to—-so while conservatives apparently cry about the debt all the time they show absolutely no sign of really wanting to actually do anything about it.