Medicare Update – If You Like Your Doctor . . .

Remember "if you like your health insurance plan you can keep it"? The same carny pitch guy who delivered that line should now be saying "if you like your doctor you can keep him (or her)".

Well, not really . . .

Just like keeping your existing health insurance plan was a lie, so is the idea of keeping your doctor if you are covered by Medicare. One of the provisions of Obamacare is the establishment of ACO's (Accountable Care Organizations). The purpose of the ACO is to "bend the cost curve" (another over-zealous pitch line) on health care making health insurance, and in this case, Medicare, more affordable.

How will this ACO work?

According to the N. Y. Post, you may be in for some surprises.

Under ObamaCare, an ACO is supposed to take "accountability" for local Medicare patients, who in turn get most care from providers working inside the ACO's network. To encourage efficiency and cost-cutting, an ACO can share in the savings it achieves from more closely managing its assigned pool of patients.

Sounds OK on the surface, but let's dig a bit deeper.

Notice the words "accountability", "Medicare patients" and "get most of their care inside the ACO network.".

Doesn't sound like you can keep your doctor, does it?

And there is this tidbit.

the ACO concept builds on the 1990s approach to "capitation," in which health-maintenance organizations gave doctors a lump sum to care for a group of patients. This arrangement put a financial onus on doctors to cut costs. The concept lowered spending but was unpopular with patients, leading to a backlash against managed care.

This approach to funding health care is also known as a per diem reimbursement where providers are paid a flat fee for certain routine services. One common use of per diem's is in the case of pre-natal care and delivery. Most health insurance companies have negotiated flat rates for OB's and hospitals to cover the cost of a routine pregnancy and vaginal birth without complications.

How does this translate into other areas of health care delivery?

Some trades are paid on a flat rate. For example, auto mechanics are typically paid a "shop" rate for services regardless of whether it takes them 15 minutes to complete the work or an hour. So what can happen if the shop rate is for 30 minutes of expected labor but something goes awry and it is taking the mechanic longer to complete the work. Don't you think it might be possible they would cut corners to get you in and out the door?

What if the same thing were to happen in the doctors office.

"I probably should run some more tests but it seems like you have the same thing everyone else has, so let's try this. Let me know if it doesn't work."

Yeah, that's real comforting.

But what if your doc is not part of an ACO?

Even if the Obama team dresses up the same concepts in a new acronym, their regulatory impulse to tightly manage how these organizations operate tilts the ACOs into the hands of hospitals. It forces doctors to sell their medical practices to these networks if the physicians want to maintain what they're paid by Medicare.

If your doc wants to continue seeing Medicare patients they must either sell their practice to a hospital and become a salaried employee of the ACO or stop seeing Medicare patients.

That's a real bummer.

Obamacrap is wrong on so many levels, but as Princess Pelosi told us, "they had to pass the bill so we would know what was in it".

Just another stupid government trick.

Affordable Medicare Supplement Plans in Georgia

For now at least, those who are on Medicare or will be going on Medicare need to know there is a place where they can find the most affordable Medicare supplement plans in Georgia. We have rates from all the major Medigap carriers including AARP, Blue Cross of Georgia and others. Ask for a competitive Medigap quote.

Speak Your Mind