To Lower Costs, Mass. May Restructure Doctor Pay

[MrsSmith]

To Lower Costs, Mass. May Restructure Doctor Pay

August 5, 2009

Massachusetts is proud of its landmark 3-year-old health insurance law. It has brought the state's proportion of uninsured down from around 10 percent in 2005 to only 2.6 percent — the lowest in the nation.

But the achievement is in jeopardy. Massachusetts has the highest health costs in the country.
 
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Massachusetts is going to try to kill off fee-for-service. That's the time-honored system that pays health care providers a separate fee for every service they provide.

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Massachusetts policymakers want to replace fee-for-service with "global payment" — paying groups of health providers a flat yearly fee for each patient they cover.

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But some worry "global payment" sounds suspiciously like the managed care "capitated" HMO plans of the 1990s. Those plans were also based on paying health care providers a fixed amount per patient.

That experiment failed, because it gave doctors and hospitals an incentive to hold back on care.

To avoid a repeat of that experience, advocates of global payment say health providers will have to be watched closely.

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Kane says there are also reliable ways now to protect health plans, so they don't lose their shirts by signing up older or sicker patients.

An incentive to hold back on care...

Protect health plans from older or sicker patients...

Yeah, this health care reform is looking better and better.   

[Chris]

An incentive to hold back on care...

Protect health plans from older or sicker patients...

Yeah, this health care reform is looking better and better.   

I haven't seen any of the legislation that "reforms" our health system.  Does it bother to address the high cost of malpractice insurance, lawsuits, and the resulting over-use of expensive tests?  Not that I would trust Democrats to come up with an equitable solution to that problem... they're all greasy, shyster lawyers anyway.

Have you looked at the Dem side of the Senate?  They're all lawyers, every one of them.

[NHSparky]

What the hell, it only takes two months to get to see a doctor in Massholistan.  Some "care" system Romney foisted on the people, eh?

[thundley4]

What the hell, it only takes two months to get to see a doctor in Massholistan.  Some "care" system Romney foisted on the people, eh?

It's not only the insurance that 0Bama wants to socialize, he'll have to force doctors and hospitals into the system eventually.  With more patients, and less pay, many doctors will want no part of the "public option" patients.  As long as it is legal for the wealthy to pay cash, and doctors want to work that way, 0Bama's plan fails eventually.

[NHSparky]

It's not only the insurance that 0Bama wants to socialize, he'll have to force doctors and hospitals into the system eventually.  With more patients, and less pay, many doctors will want no part of the "public option" patients.  As long as it is legal for the wealthy to pay cash, and doctors want to work that way, 0Bama's plan fails eventually.

We're seeing that already, thundley.  Try being a Medicare/Medicaid patient and switching doctors.  So many of them simply refuse to deal with it any more.  One of the problems I found when I first moved up here is my insurance company doesn't deal with all doctors and there are comparatively few of them, to the point where it took me 2 days just to find one that was approved by my insurance company AND taking new patients.  And I'm not really eager to change doctors even if I wanted to, even though the guy is 35 miles from my house (although only 5 from work) because I'd have to start that search all over again.

[Carl]

Remember a couple of weeks ago Rush played a tape of O saying that he wanted "bundle" patments to doctors...sounds like the same thing.

[GOBUCKS]

Massachusetts is going to try to kill off fee-for-service. That's the time-honored system that pays health care providers a separate fee for every service they provide.

I vaguely recall a discussion among DUmmies a few years ago wherein they tried to decide what would be the highest level of income anyone really needs. The implication was that anything above that amount should be expropriated by a truly compassionate government, and then be given to them. I don't remember details, but it seems to me the consensus was something under $100,000.

That would have to be the next DUmmy concept applied to their health plan.
You could have your chest cracked open by a guy who's making payments on a used Saturn.

[vesta111]

Remember a couple of weeks ago Rush played a tape of O saying that he wanted "bundle" patments to doctors...sounds like the same thing.

So who on earth will want to go into medicine in any form if the governments can place a limit on how much one can charge a patient or be paid by some medical lab.?  

Like Russia, the doctors will have absolutely no reason to investigate their field or spend their own money to gain even more education.  The last to graduate from medical school the Anchor of the class will make just as much money as the top and smartest students  

This is how medical care is coming about,  the Great doctors will go into private pay only, the doctors that had to cheat to get through medical school will be the only option we have unless we make an obscene amount of money.

A very strange friend of mine { and they are all a bit odd } suggests going into the Democrat biogs and mention a rumor that LAWYERS are next to get uniform caps to their fees.  

If they can lump in Lawyers with Doctors on this bill bundle both professions together, then,  this will be one of the few things Bill Clinton cannot get involved in----He did loose his license as a lawyer didn't he. and he never had a license to practice medicine ---wasn't that how he got into trouble, giving PAP Tests to the internee's.?

[NHSparky]

OMFG--it's starting to sink in, isn't it Vesta?

Go into the light, Vesta--GO INTO THE LIGHT!!!!

[Carl]

So who on earth will want to go into medicine in any form if the governments can place a limit on how much one can charge a patient or be paid by some medical lab.?  

Like Russia, the doctors will have absolutely no reason to investigate their field or spend their own money to gain even more education.  The last to graduate from medical school the Anchor of the class will make just as much money as the top and smartest students  

This is how medical care is coming about,  the Great doctors will go into private pay only, the doctors that had to cheat to get through medical school will be the only option we have unless we make an obscene amount of money.

A very strange friend of mine { and they are all a bit odd } suggests going into the Democrat biogs and mention a rumor that LAWYERS are next to get uniform caps to their fees.  

If they can lump in Lawyers with Doctors on this bill bundle both professions together, then,  this will be one of the few things Bill Clinton cannot get involved in----He did loose his license as a lawyer didn't he. and he never had a license to practice medicine ---wasn't that how he got into trouble, giving PAP Tests to the internee's.?

It is the law of unintended consequences that make that statement true and also the reason that there is a still somewhat vague monstrosity of a bill being put forward.
To "work" such a thing as you suggest cannot be allowed so somewhere in the bill the grafters will address that issue making it either illegal or inflict punitive tax measures to discourage it.

Why does anyone think it takes hundreds to over a thousand pages?
To kill any and all free market alternatives so as to enslave the population to a government program and a ruling class.

[AllosaursRus]

It's not only the insurance that 0Bama wants to socialize, he'll have to force doctors and hospitals into the system eventually.  With more patients, and less pay, many doctors will want no part of the "public option" patients.  As long as it is legal for the wealthy to pay cash, and doctors want to work that way, 0Bama's plan fails eventually.

What's the name of that new series on the USA channel where the guy only works for the rich?

[thundley4]

What's the name of that new series on the USA channel where the guy only works for the rich?

Royal Pains, it's not bad.

[rich_t]

Royal Pains, it's not bad.

And he doesn't only work for just the rich.

[thundley4]

And he doesn't only work for just the rich.

No, he does treat the indigent.

[Gratiot]

This is how medical care is coming about,  the Great doctors will go into private pay only, the doctors that had to cheat to get through medical school will be the only option we have unless we make an obscene amount of money.

Is that too far from the way it is now?

[MrsSmith]

Is that too far from the way it is now?

There are some doctors that take ONLY Medicare/Medicaid patients, so it is possible now.  After healthcare is reformed, it will be the norm to have doctors that don't care.  Why should they care?  They make the same money regardless of how well you're treated, how healthy you stay.  Today, many doctors work 14 hour days...they do hospital visits in the morning, see patients all day in their office, and often do rounds again in the evening.  You know that will be history when their paycheck reflects an 8 hour day regardless.

[RobJohnson]

In Las Vegas they continue to shut down back door clinics. Most of these are in the back room of Hispanic grocery stores. They have Rx drugs with Mexican labels & butcher tables in the back room used for outpatient surgery. One lady was found walking down the street with blood running down her leg. The police office asked her what happened and she explained she just had surgery, when they asked her what hospital, she pointed to a "mexican mart"...they had done a vaginal procedure and cut an artery. They found her in time, she lived.

A dentist from Mexico was busted for treating patients in a Motel 6 room once a month...he drove up for the extra money.

[formerlurker]

What the hell, it only takes two months to get to see a doctor in Massholistan.  Some "care" system Romney foisted on the people, eh?

Whatcha talking about Willis?  

Also note that the plan Romney passed is long gone.   Deval Patrick saw to that, hence the reason it is marching toward socialized medicine here.

[NHSparky]

I'm talking about how under the state-run health program, if you're on their program, you're looking at (on average) a 51-day wait--your stats, not mine.  If you have your own family doctor on your own insurance, I'm sure it's much less.

[formerlurker]

I'm talking about how under the state-run health program, if you're on their program, you're looking at (on average) a 51-day wait--your stats, not mine.  If you have your own family doctor on your own insurance, I'm sure it's much less.

Same day for primary care if I am sick (or for pediatrician when children are sick), and urgent appt for a specialist is within a week.  Not urgent and yeah you are looking at 3,6 months to a year, but that is standard everywhere for the good specialists (MA has some of the best hospitals and specialists in the world).