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Severe Paperwork Burden Tempts Physicians To Quit Medicine

For physicians, and especially those in primary care, it seems like there is a form for every purpose imaginable—often for purposes that are hard to imagine.

An ACP member in Rhode Island recently gave this example:

“I was just asked by my Medicare Advantage plan to sign a form for [a well-known pharmacy benefit manager]. This form is to be faxed to them in order for them to send me a prior authorization form for a med. So in other words, I had to complete a form in order to get another form. This is nuts!”

Or how about this, from another ACP member in a private internal medicine practice:

“The documentation that is getting to me, is that documentation that the ‘durable medical equipment people want including repetitive- recurrent documentation, whenever we see a patient to document “continued need”. The list of things we have to document, sign, approve or prior authorize, I believe is what makes most physicians think they chose the wrong field. A PBM letter to me about my prescribing practices today nearly did me in! Luckily I just shredded it. If I am kicked out of this business, I am so close to retirement it would be a blessing!”

Or this: Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

More Employers Are Dropping Healthcare Insurance Coverage

McKinsey Quarterly has reported its survey concluding there will be a radical restructuring of employer-sponsored health benefits (ESI) as a result of President Obama’s following the 2010 passage of the Affordable Care Act.

Healthcare insurance rates have already skyrocketed as a result of anticipating the conditions of Obama care. President Obama has been powerless to do anything about the increases.

Thirty percent (30%) of companies providing ESI to their employees will drop healthcare insurance coverage once Obama care takes effect in 2014.

The survey included 1300 employers providing ESI across industries, geographies, and employer sizes. Other surveys have found that as we get closer to 2014, President Obama’s Healthcare Reform Act will provoke a much greater number of employers to drop employer sponsored healthcare insurance.

The penalty for not providing healthcare insurance coverage is much cheaper than providing healthcare coverage.

McKinsey’s survey suggests that when more employers become aware of the new economic and social incentives embedded in Obamacare the percentage of employers dropping ESI will Read more »

*This blog post was originally published at Repairing the Healthcare System*

How Much Taxpayer Money Is Spent On Unnecessary Procedures?

“Doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it.”

So argues Dr. Rita Redberg, a cardiologist and professor of medicine at the University of California, in a provocative op-ed published in the New York Times. She writes that Medicare “spends a fortune each year on procedures that have no proven benefit and should not be covered” and offers the following examples:

“Medicare pays for routine screening colonoscopies in patients over 75 even though the United States Preventive Services Task Force, an independent panel of experts financed by the Department of Health and Human Services, advises against them (and against any colonoscopies for patients over 85), because it takes at least eight years to realize any benefits from the procedure.”

“The task force recommends against screening for prostate cancer in men 75 and older, and screening for cervical cancer in women 65 and older who have had a previous normal Pap smear, but Medicare spent more than Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Supporting Primary Care Has Become A Partisan Issue

You’d think that ensuring that there will be enough primary care doctors would not become a partisan issue. If you are a Republican congressman from Texas, or a Democratic Senator from California, you’d want your constituents to have access to a primary care doctor, right?

Apparently not: in the hyper-polarized and ideological world in which we now live, even modest steps to support primary care have been caught up in the worst kind of partisanship. The Washington Post reported recently that funding for a new expert commission authorized by the Affordable Care Act (ACA), which was to examine barriers to careers in primary care, has been blocked by Republicans:

“When the government set out to help 32 million more Americans gain health insurance, Congress and the Obama administration acknowledged that steering more people into coverage had a dark underside: If it works, it will aggravate a shortage of family doctors, internists and other kinds of primary care. So Page 519 of the sprawling 2010 law to overhaul the health-care system creates an influential commission to guide the country in matching the supply of health-care workers with the need. But in the eight months since its members were named, the commission has been unable to start any work. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Medicaid: Will The Cost Of Expanding Eligibility Be Overwhelming?

Medicaid has been front and center this week as President Obama addressed the National Governors Association, and several governors testified before the House Energy and Commerce Committee. Obama told the governors that he supports the Wyden-Brown bill, which would accelerate the availability of waivers under the Affordable Care Act (ACA), so that states would not have to first create health insurance exchanges under the law, and then have the right to dismantle them and replace them with other mechanisms to achieve coverage goals of the law without additional cost to the federales. (See Wyden-Brown fact sheet.) The sponsors’ home states, Oregon and Massachusetts would otherwise have to dismantle parts of their own health reform efforts in order to align with the federal mandates. (Wyden has been a longer-term proponent of experimentation and innovation in health reform.) 

The mini-med waivers granted to states (in addition to those granted to corporations and unions) are just one example of interim steps needed to harmonize federal and state health reform. When in 2014 mini-med plans will no longer be permitted at all under the federal health reform law, there will either need to be a significant dislocation of the underinsured “Young Invincibles” in Massachusetts and underinsured employees in capped health plans elsewhere in the country, or a change in the law.

Similar difficulties await state Medicaid programs, which will be faced with expanded eligibility, and other state agencies, which will need to set up exchanges per the ACA. The cost associated with eligibility expansion will be overwhelming — or maybe it won’t. There are, of course, expert opinions across the board on the financial impact of health reform on state budgets. As the saying goes, “Where you stand depends on where you sit.” Some reports inflate state expenses by not accounting for the fact that the federal share of Medicaid expansion covers 92 percent of the total. Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

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