While millionaires are being protected ,doctors are being forced to discontinue treating the elderly

[saracat]

While DC argues about protecting the rich, the real agenda of the elite progresses without any protest from those at either the top or the bottom! Sometimes what really matter happens when we are looking the other way! It is mind boggling that this and proposed SS cuts are occuring during a Democratic Admin!

Medicare cuts causing doctors to be unable to treat the elderly!

ghttp://www.washingtonpost.com/wp-dyn/content/article/2010/11/25/AR2010112503638.html


Quote
....Top-ranked primary care doctor Linda Yau is one of three physicians with the District's Foxhall Internists group who recently announced they will no longer be accepting Medicare patients.

"It's not easy. But you realize you either do this or you don't stay in business," she said.

Doctors across the country describe similar decisions, complaining that they've been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress.

And that's not even taking into account a long-postponed rate-setting method that is on track to slash Medicare's payment rates to doctors by 23 percent Dec. 1. Known as the Sustainable Growth Rate and adopted by Congress in 1997, it was intended to keep Medicare spending on doctors in line with the economy's overall growth rate. But after the SGR formula led to a 4.8 percent cut in doctors' pay rates in 2002, Congress has chosen to put off the ever steeper cuts called for by the formula ever since.

This month, the Senate passed its fourth stopgap fix this year - a one-month postponement that expires Jan. 1. The House is likely to follow suit when it reconvenes next week, and physicians have already been running print ads, passing out fliers to patients and flooding Capitol Hill with phone calls to convince Congress to suspend the 25 percent rate cut that the SGR method will require next year....

[LaurenG]

1. and your primary care doctors are being forced into joining big hospital groups

because the insurance companies pay them at 75% of medicare allowable. They can join the corporations or go out of business.

We are all screwed.

[saracat]

3. Another good point!

[patrice]

5. ... big hospital groups who control the patient to direct-care-giver ratios.

Everyone needs to ask him/her-self, "Am I, or a loved one, being admitted to a hospital or a warehouse?"

[w8liftinglady]

12. exactly..and those of us who have been at it a while are pulling our hair out

seeing so many patients with no preventative care,no medication access,no follow-up.They can't.The docs can only give so much charity care (They ALL do here) they have staff to pay,insurance,supplies.Docs ARE NOT the ones getting rich off of health care-try pharmaceuticals and insurance cos.



and as an RN who has taken care of the "Forgotten" ... I am torn by the suffering I see...from the patients,their families...and the staff taking care of them.

[patrice]

33. My last job was 3 years of administrative support in a "low end" long-term care home.

We did really a very good job, for the most part, but I became aware of what goes on in long-term care all of the way across the spectrum. My huge family also has had many experiences with elder care in our "health" "care" systems. There are many horror stories, but I'd bet MOST of them aren't bad people doing bad things:

IT'S THE SYSTEM(S)

So, as hard as some really good people might try, the distributed nature of what's happening makes it no one's responsibility (which makes it really hard to fix), except those controlling the purse strings.

[Recursion]

60. My God... are delivery costs actually being discussed on DU??!!?

This is a red-letter day.

The big hospital groups are a huge problem, and they've been hiding behind insurance companies presenting them as the only bad guys for too long.

[ProudDad]

2. Imagine

if Single-Payer hadn't been "off the table"... :shrug:

[Uncle Joe]

51. That to me coupled with the mandate to purchase insurance from the for profit insurance corporations

has been the greatest sellout against the American People by the Obama Administration to date.

Whether they could ever pass single payer or not isn't the point, not even allowing it to the table for serious debate in public for the American People's consumption was a grave injustice.

It was both politically *stupid and policy wise a disaster all wrapped in one.

*That's my less cynical and more generous interpretation, the other possibility being it was a cold deliberate calculation to allow the Republicans back in to power. What better way to do it than to pass their policies enriching the wealthy and powerful while screwing the people?

[Mimosa]

4. Doctors I know don't want to do it.

But they can't afford to have their practices go bankrupt.


They don't understand the Medicare cuts. They HATE the insurance companies.

[saracat]

6. You are exactly right.

[Ginto]

7. Don't believe the lies. Read the actual article.

These specialists just can't get AS rich through Medicare.

"But statistics also suggest many doctors have more than made up for the erosion in the value of their Medicare fees by dramatically increasing the volume of services they provide - performing not just a greater number of tests and procedures, but also more complex versions that allow them to charge Medicare more money.

From 2000 to 2008, the volume of services per Medicare patient rose 42 percent. Some of this was because of the increasing availability of sophisticated treatments that undoubtedly save lives. Some was because of doctors practicing "defensive medicine" - ordering every conceivable test to shield themselves from malpractice lawsuits down the line."

"Then you have doctors who order an MRI for an unremarkable headache or at the first sign of back pain," said Robert Berenson, a Commissioner of the Medicare Payment Advisory Commission, an independent congressional agency. "It's pretty well documented that it doesn't help patients to have those scans done in these cases. But if you have the machine in your office ... why not?"

[Mimosa]

8. We're referring to the first line of medical practitioners, Ginto

Family practice and internal medicine practitioners are to whom most patients go for their care.

But specialists are getting squeezed too.

From the article:

Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you're a senior covered by Medicare, the wait is eight weeks.

How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. Still, at least he'll see you. Top-ranked primary care doctor Linda Yau is one of three physicians with the District's Foxhall Internists group who recently announced they will no longer be accepting Medicare patients.

"It's not easy. But you realize you either do this or you don't stay in business," she said.

Doctors across the country describe similar decisions, complaining that they've been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress.

And that's not even taking into account a long-postponed rate-setting method that is on track to slash Medicare's payment rates to doctors by 23 percent Dec. 1. Known as the Sustainable Growth Rate and adopted by Congress in 1997, it was intended to keep Medicare spending on doctors in line with the economy's overall growth rate. But after the SGR formula led to a 4.8 percent cut in doctors' pay rates in 2002, Congress has chosen to put off the ever steeper cuts called for by the formula ever since.

But there aren't any cutbacks in spending for war.

[Ginto]

9. Family practice and specialists are in two different leagues.

I feel for the family practice. The specialists can go pound sand as far as I'm concerned. It's about time that they had to take a haircut. And what kind of dr. orders an MRI with all the included radiation for a non-remarkable headache?

[Mimosa]

15. That isn't even remotely ordinary and you must know it.

Where do you get that kind of propaganda?

Do you really know med professionals and how they practice?

If you did you'd realise specialists make a premium from health insurance company contracts for holding back tests and treatments.

[Ginto]

17. Sorry, I only read and posted right from the article.

Apparently, only pieces of the article are to be believed.

[remember2000forever]

19. Ever Go To A Surgeon's Office?

The game goes like this:

Primary sees elderly patient. Refers elderly patient to specialist. Specialist refers elderly patient to surgeon, or perhaps specialist is a surgeon. Surgeon sees patient and determins: Cut!

Geeze, an orthopedic surgeon insisted my 87 year old mother needed 2 full knee trans-plants. I intervened. I told "Mom" the Dr. didn't need a new yacht this year. I doubt some of these patients even survive the "cure" !

[patrice]

41. "Cut!" Which affects their risk assessment which then affects what the systems will pay for.

[Recursion]

57. This reminds me of my favorite doctor joke

A GP, a psychiatrist, and a surgeon are going duck hunting. They each go to their own stand and wait for the ducks to get flushed. One is, and it flies over them.

The GP looks at it, and thinks, "Well, I think that's a duck, but I'm not sure. We should do some more tests, get a consult with a specialist, read up on anatidaeology..." at which point the duck has flown past him.

The psychiatist looks at it, and thinks, "Well, I know it's a duck, but I don't know if it knows it's a duck. We're going to need some intense cognitive/behavioral sessions to..." at which point the duck has flown past him.

The surgeon looks at it, shoots it, and says, "Somebody go see if that was a duck"

[Hassin Bin Sober]

61. I had dinner with an anesthesia nurse a while back.

She told me of a doctor in her hospital who likes to perform high-risk surgery on elderly patients. If things go sour he keeps them on the ventilator for, IIRC, 30 days so the death isn't counted against him. After he is in the clear he counsels the family to "let it go"

She said she has had to, on more than one occasion, bite her lip when the family questions why the Dr.'s outlook changed overnight after being strung along for a month.

[w8liftinglady]

20. and remember the specialists go to college for 12-14 years...with HUGE loans

My neurosurgeon didn't go on "His Own" until he was 32...with a wife and 2 kids and almost $1 million in debt.

He has dedicated his life to his work.he works with my neurologist counseling and treating TBI/PTSD kids from OIF/OEF.he has written me multiple times to see how I'm doing,congrat me on my latest editorial or protest.

He drives a Mercedes.
He earned it.

[ProudDad]

52. Blame the AMA

and the for-profit education system in USAmerica...

For the artificial shortage of physicians...

Cuba is exporting medical professionals...

USAmerica is making the few who pander to the rich, rich...

[Recursion]

58. This is a huge problem

The AMA has made a point of keeping the number of doctors in America artificially low.

and the for-profit education system in America

Last I checked, Strayer and U. Phoenix don't have med schools. I've looked and can't find any for-profit medical schools.

[w8liftinglady]

63. The sad thing is..tuition and fees in State Universities rival "for-profit"

My Neurologist trained at UTSW medical school...tuition and fees 25,000/semester...and this DOES NOT COUNT books,supplies,and living.
http://www.matchcollege.com/college/228635/University-of-Texas-Southwestern-Medical-Center-at-Dallas/TX#tuition_and_fees
My Neurosurgeon went to Univerity of South Florida tuition and fees $56,000/semester
http://www.matchcollege.com/college/137351/University-of-South-Florida/FL#tuition_and_fees
Then you look at training beyond a 4 year MD...IM is a 2-year minimum program,cardiology 3-4,surgery 5-6...specialty surgery add a few more years.

[Recursion]

64. While I agree it's sad...

(and I just finished a graduate degree in engineering, and came out with nearly $100K in debts)

...I don't see how it's surprising. Profit itself is not really a big part of the economy.

[ProudDad]

65. The banks that make the student loans for most

middle class and poor student's tuition are the ones making the profits...

[Recursion]

69. Good thing PPACA does away with a lot of that

since they're no longer servicing Federal loans, at least.

[saracat]

10. I posted the actual article and I side with the doctors as opposed to the insurance companies.

And it isn't just "specialists" who were impacted but primary care docs as well. Funny how it isn't an issue if Big Pharma Execs and Insurance Co Bigwigs and lobbyists make a good income but some think docs should take less! Kinda transparent the shifting of the blame to the doctors.

[Ginto]

13. Medicare is an insurance company?

These specialists can make a fine living treating Medicare patients. Family physicians are a different story.

[saracat]

22. Actually a lot of medicare is outsourced to insurance companies but what I meant was

you are supporting the corporate argument. And transferring the blame to doctors. The government cuts to medicare are at the behest of big business and at the expense of the doctors. I ask you to notice that none of the Admins are cutting salaries but they expect the doctors to cut their charges.

[Ginto]

28. Sorry, I don't believe the poor struggling medical specialist meme that is portrayed on TV.

That ranks right up there with the the selfless police officer who's put's it all on the line to clean up the streets. Seen those shows a few times too often. Ever notice how all of TV is Dr's, Lawyers, or Cops year in and year out? Ever notice how it's rarely the working class and when it is we get something like Roseanne?

Meant selfless not selflish. :)

[saracat]

32. You really seem to despise doctors. I have had good ones and bad ones. Bad ones

obviously can harm you but good ones can save your life. Doctors really are not the same as common laborers . They actually hold our lives in their hands and they work many years to be able to be accredited. I have no problem with the dedicated and good being rewarded. I have several friends who were in fact the struggling medical specialists you say do not exist. One is a pediatrician and the other a cardiologist. Both support NHC and both worked their way through school. My own doc is a specialist who makes it possible for me to communicate. He is the top of his field and earns every nickle he gets.
My husbands current doc is arrogant and full of himself. He also saved his life.

[Ginto]

40. Plenty of positions hold our lives in their hands. Cops, firefighters, electricians, home builders.

I just am not an acolyte.

[saracat]

42. Whatever. There is a certain skill set demanded of specialists that

isn't comparable with other professions. Much as I respect the professions you mention, as well as their specific skill sets, they are not comparable to cardiac surgeons or neurologists ,for example. And most do not require the many years of training in order to estanlish themselves.

[Ginto]

45. So pay should be based on amount of training or amount of work?

Or should it just be based on intelligence? How much should a bricklayer make when compared to a cardiac surgeon and why?

[saracat]

48. Skill and value should be rewarded. All professions should be

commensurated fairly but rarity and expertise as well as value have to be considered.

My husband , for instance, put himself through school and got a Masters in Global Management, however he is also mechanically inclined and can fix our A/C if it goes out if he had to, can fix computers, lay brick and repair the roof, and repair our cars and appliances but he could never operate on his own or anyone else's heart. He couldn't operate on a brain or remove a tumor. Few people can do those things. Some skills are in a class by themselves. I believe medical specialties cannot be compared with other professions.

That being said, I would expect to pay a very well established bricklayer, who did specialty brickwork more money than a day laborer who just decided to lay brick for a quick job.

[Ginto]

70. I'm not so sure.

I've seen plenty of manual laborers due work that few people could dream of. They don't get to spend time with their families and then after a short time when their bodies are broken they have nothing left over. Just a lot of bills. I don't see that much with dr's. A recent story, I met up with the BIL of a friend for drinks in New Orleans about 2 weeks ago for my bachelor party. He is a dr. who works in a hospital in Slidell. He's being interviewed for hospital director for a hospital about 2 hours away. I asked him how it was going and he said that he had to lay down the law and tell them that he wouldn't even talk to them if he didn't start at 407K a year and no more than 10 shifts a month. He's at 14 now and considers that unbearable. I really like the guy, but I don't consider that suffering.

[Recursion]

29. Medicare faces the same actuarial realities that insurance companies do

Which is why both Medicare and private insurance companies want to have health care providers get paid less.

[AngryAmish]

11. We must make sure those doctors are able to afford new yachts next year!

[Ginto]

14. If they had to downgrade from a 5 series BMW to a 3 series, it would surely affect

their level of care.

[CountAllVotes]

16. yes and guarantee those fancy vacations abroad

They make me quite sick honestly. When I needed the surgeon that operated on me this past year and my regular doctor, both were in France on vacation (one was gone for a month) while the Euro was low. They really need those likely tens of thousands of dollars yearly vacations so they'll be productive they say.

I could use one too. I haven't been on a "vacation" in years and can't afford another one anytime soon. :argh:

:dem:

[Mimosa]

18. Average family practice graduate may make $60-80K a year, carries $300-400K in debt

An average family practice physician earns $175K to $200K before taxes.

Warring against and demeaning our doctors isn't going to help anything.

[dana_b]

38. thank you

I'm not a doctor but I know a few and have worked with many MDs who were up to their necks in debt with student loans and such. It takes quite a while for them to get out from under it all.

[saracat]

43. This is very true!

[lumpy]

21. Many clinics have been denying Medicare patients for a long

time in this area, Hippocratic oath be damned. Biggest mistake the medical profession has ever made was completely turning over their business to insurance companies. They have managed to burden themselves with reams of red tape and loss of decision making, ultimately lowering the quality of patient care and non-care.

[w8liftinglady]

25. I sincerely believe most ethical physicians would favor NHC

Avoiding the paper shuffle and being able to actually treat their patients...not have to wait and see if insurance will approve a treatment/surgery.

[defendandprotect]

37. Majority of physicians and nurses did favor single payer, government run health care ....

they're no longer in favor of being run around by insurance companies, either!

[defendandprotect]

39. It's right wing politicians who are to be blamed -- if doctors are scamming

patients and overcharging on fees, it is up to our elected officials to deal

with those crimes --

that's not what this is about --

it's about corruption of government and the crimes our elected officials are

permitting to go on and on, without putting a stop to it.

[ProSense]

23. "on track to slash Medicare's payment rates to doctors by 23 percent Dec. 1" The cuts were blocked

Pelosi Statement on Passage of the Physician Payment and Therapy Relief Act

Washington, D.C. – Speaker Nancy Pelosi issued the following statement today after the House passed bipartisan legislation blocking the 23 percent cut in Medicare payments to doctors, scheduled for December 1, for one month, while a longer-term fix is negotiated. The Senate passed the bill on November 18, and it now goes to President Obama for his signature into law:

“Today, the House of Representatives acted to ensure that America’s seniors and military families can continue receiving the care they need and deserve from their doctors. This fully paid-for legislation provides doctors with the stability and support to continue providing vital services to all of their patients in the Medicare and TRICARE systems for the next month, while leaders from both parties work together on a longer-term solution before we adjourn.

“In taking this vote, Members of Congress have taken a clear stand on the side of seniors, service members, and the physicians and medical professionals who treat them.”

[Mimosa]

27. Thanks, ProSense. We'll miss Nancy as Speaker. :( n/t

[saracat]

34. We will indeed miss Nancy , Mimosa. And forget about Obama the work to restore the

majority should be what begins now!

[patrice]

46. +1~ We NEED to build something that survives no matter who is President. nt

[saracat]

30. Good for Nancy but it is only a temporary stopgap.

And docs are, as is clear from the article, reacting to cuts in place.

[RKP5637]

24. This country has been so out of control for so long it's a wonder

the lights even come on each day.

[Recursion]

26. And this is the program we want to make universal?

Yes, I'm being snarky. But still.

[ProudDad]

53. Check it out...

If Medicare were improved and enhanced and made Universal...

The USAmerican government would save at least $400 BILLION of current health care costs...

If we had the French system, Health Care costs in USAmerica would be cut in half -- and our health care outcomes would improve substantially...

[Recursion]

56. If everything in the USA were like France, yes

We disagree on cause and effect: health care can be universal in Europe because they have much lower delivery costs. If we had lower delivery costs, we would have universal health care already.

[ProudDad]

66. Health Care is less costly in Europe

and much of the Orient (Taiwan, Japan, Korea, etc.)

and Australia...

and the rest of North America...

BECAUSE PROFIT has been legislated out of Health Care and most have single-payer type systems...!

You have the cart before the horse -- they are less costly and more effective (healthier populations) BECAUSE they are universal and essentially single-payer...

USAmerica has the 37th ranked and most expensive health care BECAUSE they pander to the profit makers...

[mmonk]

31. Well our party created it and if it is going to be dismanteled

because our party has changed its politics, it will be our party that helps get rid of it.

[defendandprotect]

35. How does Obama sleep at night .... ???

[Recursion]

59. By reminding himself HCR extended Medicare's solvency by 12 years

As a guess.

[defendandprotect]

36. Most of all, the aim is to destroy any confidence in MEDICARE ...!!

On the part of patients -- or doctors --

many of them had their payments delayed -- not paid by government for 6 months and

more under W--!!

[Desertrose]

44. Makes it easier to eliminate then, doesn't it?

These bastids think of everything, don't they?

[defendandprotect]

50. Technique .....

that has been in place a long time -- "starve the system" --

:evilgrin:

[Mimosa]

55. Did the "starve the system" phrase originate with Gingrich or earlier? n/t

[defendandprotect]

62. Oh, earlier ... at least Nixon ... and then Thatcher, of course ... !!

Probably right wing has been using it since Garden of Eden!!

:evilgrin:

[patrice]

47. Medicare can do just fine in Long Term Care, if the care ratios are good enough to allow

acquisition of the VERY specific kinds of information about the person being cared for - AND - if those providing & supervising the care understand CMS data collection well enough to translate what's effective in patient care into the kinds of data the CMS pays for, which, then, implements the care plans - all of that is complicated and IS hard to do, requires longitudinal focus in staffing environments in which there are chronic shortages and lots of churn, but it DOES work, if everyone is focusing on picking up VALID info about those in their care, then translating that effectively, without any attrition, into what CMS pays, and then following-up.

[Jeffersons Ghost]

49. K&R

I'm glad that I have the VA

[EFerrari]

54. Like many American workers, my mother has no pension.

She has her social security and she had a little real estate that she worked very hard for. Well, that equity is gone and she's struggling to hang onto what little is left. Really struggling, rationing her medications and food struggling.

My mother worked seven days a week for most of her adult life. She was a good person who gave at every level whenever she could. She doesn't deserve this shit.

[akbacchus_BC]

67. Please correct me if am wrong! Are you saying that doctors are refusing

to treat patients under the new HCR that was recently passed?

[Recursion]

68. You are wrong. This has nothing to do with PPACA

This rate cut was passed in 1997 and has been put off over and over again since then.