Posted by DrJohn on 30 November, 2012 at 6:00 am. 24 comments already!

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Each year, Congress holds a sword of Damocles over the heads of the medical profession. The “doc fix” is a budget adjustment to bring Medicare fees into the world of reality. democrats love to omit it for the sake of appearances.

Obamacare cuts $716 billion from Medicare. Obama calls it “waste.” Physicians call it reimbursement. What that will do is make finding Medicare providers far more difficult.

The AMA supported Obamacare, on the promise that the law would include a permanent “doc fix.” But Democrats reneged on that promise, owing to the cost of a permanent SGR adjustment: something on the order of $200 billion over ten years, depending on the prescribed growth rate of the fees.

Instead, the Affordable Care Act further reduced fees to health care providers, by $415 billion over the 2013-2022 time frame. As these reductions go into effect, more and more physicians are certain to stop taking new Medicare patients. We already see this problem with the Medicaid program for low-income Americans, where doctors don’t accept Medicaid patients, leading to poor health outcomes.

The Obama campaign offers several lame defenses of these cuts. “The President’s plan doesn’t cut [benefits] by one dime,” insists deputy campaign manager Stephanie Cutter. “He ends taxpayer subsidies to insurance companies, and weeds out waste, fraud, and abuse, which saves the Medicare system $716 billion.”

But Cutter’s assertion the law doesn’t cut benefits only makes sense if you don’t count getting a doctor’s appointment as a “benefit.” And her argument that the provider cuts merely amount to eliminating “waste, fraud and abuse” displays a callous disregard for how the law’s blunt, across-the-board payment reductions affect doctors like Joseph Shanahan, and seniors like Beverly Frake.

About that “free” exam Obama promised you:

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.

This happened to me personally, as a patient, when I went for my physical. It is the law. If you are complaining of a new problem, then you have to reschedule, since Obamacare is very clear as to what is covered and what is not. Obamacare — intentionally — makes it as difficult to be seen and taken care of as possible.

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.

Also — I don’t ask for free gas when I go to the gas station, or ask for free food from the supermarket. Additionally, Obamacare has a 23% cut in Medicare reimbursement to doctors and hospitals.

These lower payments won’t cover the cost of staying in practice to take care of the patient.

Sound goofy? You ain’t heard nuthin’ yet:

On top of all of that, doctors will be obligated — that’s right, obligated — to talk to you about things you may have no interest or need to talk about.

You may just want to have a pap smear or check your cholesterol. However, I am now mandated by the government to talk to you about your weight, exercise, family life, smoking, sexual abuse(!), and even to ask if you wear seat belts. And I am mandated to record your answers.

I am a physician. But I need to tell you to wear a seat belt and then record your answer.

And yes, Virginia, there are death panels:

“It was my plan to admit this woman to the hospital. I found out a little later that this same woman had been a patient here just slightly more than 2 weeks ago with a DIFFERENT DIAGNOSIS. I was told that if this woman was admitted, the hospital would not be paid.

The new Medicare rule now is that if the same Medicare patient is re-admitted to the hospital within 30 days, the hospital will not be paid. When they first started this nonsense they said this only applied to patients with the same diagnosis. Now they have “expanded” the rule to include re-admissions for any reason. So if you’re in the hospital for pneumonia, and 3 weeks later, you break your leg…….too bad. Medicare will not pay the hospital to fix your leg.

A little later a man was brought in by ambulance, very sick, in pain, and near death. I did my usual evaluation and treatment, doing my best to ease pain and stabilize this man’s illness. He needed to be admitted. To my chagrin I found out that he had been treated for the SAME problem at a DIFFERENT HOSPITAL about 10 days prior. If I admitted this man, our hospital would be paid nothing. I admitted the man.

My friends I am caught in a terrible position. I could have given treatment to both of these people and sent them out. There is no doubt that both of them would have died. Oh, I could also be sued for malpractice, but nobody cares about that.

I am sure that when Mom or Dad die because they could not be readmitted for an illness you will find comfort knowing that Obama is not subject to the same rules.

Now a failure to steer away from the fiscal cliff would mean even more pain for physicians:

As the nation hurtles toward the fiscal cliff, doctors are staring down a much more daunting abyss, a panel of experts said Thursday at POLITICO Pro’s health care breakfast briefing.

Not only do doctors face a 2 percent cut in Medicare reimbursements because of the failure — thus far — to avoid sequestration, but they’re also looking at a 27 percent reduction in pay in the absence of a deal to fix the Medicare payment formula.

The medical profession is under duress:

Gail Wilensky, who led Medicare and Medicaid for President George H.W. Bush, warned that “having this looming out year after year … must really wear on physicians who are actively involved in Medicare wondering what they’re doing being involved in, for them, such an unstable program.”

“All that’s being publicly discussed is reducing payments under the same dysfunctional payment system,” she added.

And keep in mind that Obamacare provides absolutely no relief from malpractice liability. So doctors have the same exposure for less money.

Obamacare will indeed mean that the elderly will have an increasingly difficult time finding a participating provider which in turn means the waiting periods to see a participating provider will be lengthy. Delay in examination means delay in treatment and that will certainly mean many elderly will expire while waiting. It’s one way to cut costs.

Grandma may as well get run over by a reindeer.

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