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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on January 15, 2014, at 18:23:39
Medscape Medical NewsMedicare Will Reveal Individual Doc Pay Starting Mid-March
Robert Lowes
January 14, 2014
In a move that worries organized medicine, the Centers for Medicare & Medicaid Services (CMS) announced today that it will begin to disclose how much Medicare pays individual physicians on a case-by-case basis in response to requests under the Freedom of Information Act.
The agency said it will "weigh the balance between the privacy interest of individual physicians and the public interest in disclosure of such information." In the process, it will guard the privacy of Medicare patients.
The new policy takes effect 60 days after its publication today in the Federal Register.
Opening Medicare's checkbook down to the individual provider level is the latest government effort to make healthcare more transparent to the general public. This fall, CMS will launch a Web site where it will post payments and gifts that physicians receive from drug and device makers. In addition, CMS will expand its Physician Compare Web site this year to include quality-of-care information for clinicians in group practices.
The decision to reveal, in some cases, what Medicare pays individual physicians is the culmination of a decades-old dispute about what the public ought to know. The predecessor of the Department of Health and Human Services proposed a similar plan in the 1970s only to have a federal district judge in Jacksonville, Florida, slap a permanent injunction on it in 1979 because, in his view, it violated a law called the Privacy Act. In May 2013, however, US District Judge Marcia Howard in Jacksonville lifted the injunction, saying that the federal judiciary interprets the Privacy Act differently than it did in 1979. The American Medical Association (AMA) had fought to preserve the injunction.
Payment Data Can Be Misinterpreted, Say Medical Societies
After last May's crucial court decision, CMS invited the public for advice on when and how to reveal what Medicare pays a particular physician. The agency received more than 130 comments, including a good number from the medical profession.
One physician called the idea of disclosing individual reimbursement "punitive."
"My voice is small, but you need to know that a lot of my peers are quitting, and there is no one there to replace them," the physician wrote.
"Releasing physician payment data will do nothing but create an adversarial relationship between patients and their doctors and not lead to greater fraud detection," wrote another clinician. "Many of our local doctors have already dropped Medicare and Medicaid as payers simply out of frustration with attacks on our profession such as this."
A letter signed by the AMA and dozens of other national and state medical societies struck a hopeful note by saying that "if used correctly," Medicare claims data could improve the quality of care. Then the societies ticked off various ways the information could be misused and misunderstood, unless the necessary safeguards were adopted.
For example, patients might misinterpret a physician's Medicare compensation if they are not privy to how much it costs him or her to run a practice. In other words, revenue doesn't equal income. Any release of payment data, therefore, should be accompanied by caveats about its limitations, according to the medical societies.
The AMA and its allies also asked CMS to allow physicians to review Medicare payment data and correct any errors before it enters the public realm lest they suffer harm to their reputations and livelihood.
To illustrate how compensation data can be misleading, Donald Fisher, PhD, the president of the American Medical Group Association, presented CMS with a scenario of a salaried surgeon in a group practice. The surgeon generates a hefty amount of Medicare revenue in part because a physician assistant frees him to spend more time in the operating room. A potential patient could look at this surgeon's reimbursement data and conclude that he earns more than he actually does.
"The emphasis on individual physician-level data is a relic of an outdated care model and a fragmented healthcare delivery system," Fisher wrote CMS. In addition, he warned that releasing a physician's Medicare pay could make him or her the target of "unwanted marketing attempts" or "criminal activity."
While organized medicine has urged CMS to proceed cautiously with its new disclosure policy, others want it to go full speed ahead.
Dow Jones, the publisher of the Wall Street Journal, said during the policy comment period that greater transparency would help journalists and watchdog organizations ferret out fraud, waste, and abuse in Medicare. CMS should release payment data "as broadly and granularly as possible," said the company, which had sued in federal court to lift the injunction against making the information public.
A coalition of groups that included the Society of Professional Journalists, Public Citizen, and the Center for Public Integrity chimed in by saying that medical practices are like any other business that receives federal dollars they're not entitled to privacy. The coalition urged CMS to go a step further and create a publicly accessible database of Medicare reimbursement so anyone could look up what an individual clinician earned.
The new policy announced today by CMS gave no indication, however, that such a database is in the works.
Posted by bleauberry on January 17, 2014, at 6:29:20
In reply to Medicaire to Reveal Individual Doc Pay Mid March, posted by Phillipa on January 15, 2014, at 18:23:39
My primary clinician has opted out of obamacare, or bozocare, for several reasons:
1. Reimbursement is $40 for 15 minutes by obamacare.
2. Any time spent with a patient over 15 minutes is considered overtime and is not reimbursed.
3. Red tape, paperwork, and rules take up more time which cuts significantly into time for patients.
4. Freedom to make prescription decisions is not as flexible as it was.
5. Reimbursement can take months. In the meantime, how does one pay the bills in the office?
6. The cost of running a business under obamacare is on the edge of causing bankruptcy for private practices.
7. This clinician said it very simple....under obamacare, the office would go out of business due to bankruptcy.This clinician insists 15 minutes is not enough time with a patient. The clinician has always done one hour visits and will continue to do that. The diff....cash payment. Thank you obama.
It is sad, but almost hysterically funny, the kind of hysterical laughing that comes with tears of sadness at the same time....
picture yourself as an outside visitor from another planet. You take a quick observation of how these human creatures run their lives. A quick glance at the mechanics of obamacare....you are scratching your head, baffled, totally confused, how could a creature that appears to be quite wise and smart, display such stupidity and un-wisdom? In mass? You get back in your space ship shaking your head and shrugging your shoulders. All you know is, what you saw makes no sense at all, and this place called earth uses some sort of twisted contorted contaminated version of critical thinking. The leaders appear quite unwise in mathematics, economics, and morals. More baffling, the sheep don't seem to care.
Posted by baseball55 on January 17, 2014, at 19:27:47
In reply to Re: Medicaire to Reveal Individual Doc Pay Mid March, posted by bleauberry on January 17, 2014, at 6:29:20
This is nonsense. Obamacare has no such rules. The rules and reimbursement rates are determined by the insurance companies that issue the policies, as they always have been.
Posted by Phillipa on January 17, 2014, at 19:58:36
In reply to Re: Medicaire to Reveal Individual Doc Pay Mid March » bleauberry, posted by baseball55 on January 17, 2014, at 19:27:47
Yes that is correct. Some doctors are now only taking pay only patients with no insurances. So they go through no paperwork and all the money is theirs. For the wealthy. Phillipa
Posted by bleauberry on January 19, 2014, at 14:26:08
In reply to Re: Medicaire to Reveal Individual Doc Pay Mid March » bleauberry, posted by baseball55 on January 17, 2014, at 19:27:47
My source of information was the doc's office.
I wish it was nonsense.
The rules and reimbursement rates have changed quite a bit in case anyone missed that part.
> This is nonsense. Obamacare has no such rules. The rules and reimbursement rates are determined by the insurance companies that issue the policies, as they always have been.
Posted by Phillipa on January 19, 2014, at 21:01:38
In reply to Re: Medicaire to Reveal Individual Doc Pay Mid March, posted by bleauberry on January 19, 2014, at 14:26:08
Since on straight medicaire for retirees still can pick my docs of choice. And with a secondary plan my rates have actually gone down not up. I still get the same amount. Just a $20 deductible for a docs visit even specialists. And MRI's just used less. Phillipa
Posted by bleauberry on January 20, 2014, at 14:54:10
In reply to Re: Medicaire to Reveal Individual Doc Pay Mid March » bleauberry, posted by Phillipa on January 19, 2014, at 21:01:38
That's great Phillipa!
> Since on straight medicaire for retirees still can pick my docs of choice. And with a secondary plan my rates have actually gone down not up. I still get the same amount. Just a $20 deductible for a docs visit even specialists. And MRI's just used less. Phillipa
Posted by europerep on January 20, 2014, at 15:57:54
In reply to Re: Medicaire to Reveal Individual Doc Pay Mid March, posted by bleauberry on January 17, 2014, at 6:29:20
> All you know is, what you saw makes no sense at all, and this place called earth uses some sort of twisted contorted contaminated version of critical thinking.
America. Not Earth.
A lot of countries have gotten their act together, healthcare-wise, decades ago, and many of them are even quite significantly less wealthy than the USA.
Posted by bleauberry on January 21, 2014, at 13:12:10
In reply to Re: Medicaire to Reveal Individual Doc Pay Mid March » bleauberry, posted by europerep on January 20, 2014, at 15:57:54
A family member lives in Austria. I know from discussions that they have a decent system. But, it is a tiny country, much easier for that type of plan to be appropriate and to be managed. And, they pay very high taxes for it all.
Sad, but we pay about the same amount of tax, but we get nothing! For their high taxes, they get guaranteed paid vacations and a lot more than we get, easy access healthcare, and lots of other stuff. We pay the same, and get nothing but firetrucks and police cars and a fairly worthless school system.
I meant Earth, not America. We all for the most part got it all wrong. Expected. Humans. Flesh and bone. Mistakes common. Ego common. Exaggerated sense of wisdom common. Born flawed.
Some do better than others, but it is merely a relative comparison. Sad...the USA used to be the best in the world. I heard something recently that put us at about #7.
The entire insurance thing is one massive scam imo, and it falls under the category of "generally accepted", so it is not questioned or opposed. The medical system itself is what might be called a polygonomy....a monopoly involving an entire industry....one player raises price, they all raise price....no one lowers price because there is no competition....a whole lot of sheep willing to pay the trusted shephard whatever he asks, no questions asked.
Quick calculations showed that if I had paid my insurance premiums of 2013 into a piggy bank, I would have paid all my expenses in cash and had about $300 left over.
"Coverage" is a fairly empty useless word unless it means "you get good care when you need it and in an affordable manner." I was covered in all of 2013. Practically every bill I got from a doctor visit or lab test I had to pay most or all in cash. Insurance, even though it was the best I could get, was not helpful enough to justify its cost.
Catastrophic insurance makes sense I think. But even then, if something catastrophic happens without insurance, the hospital is going to take you, and to avoid malpractice risks, give you good care too. The bill afterwards can be paid with monthly payments as low as $10 a month (for the rest of your life :-))
I am one of the ones that Obama kicked out. I had decent insurance. Except for the high deductible. Anyway, that was taken from me without any asking or warning or anything. The Obama insurance that would replace it, happens to cost TWICE what my other insurance did....enough to make TWO car payments per month....and the deductible is so high the insurance will never be of any help in real life.
Coverage does not equal health care. The best health care, in my opinion, comes from free societies with growth economies. We haven't seen that since Reagan and then Clinton. Prior to that, Coolidge and Kennedy. Growth. That's where all other good things happen. The current administration practices most of the no-growth or slow-growth strategies known, and none of the pro-growth strategies.
> > All you know is, what you saw makes no sense at all, and this place called earth uses some sort of twisted contorted contaminated version of critical thinking.
>
> America. Not Earth.
>
> A lot of countries have gotten their act together, healthcare-wise, decades ago, and many of them are even quite significantly less wealthy than the USA.
>
This is the end of the thread.
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