DocFix Cliff

Last time we looked, Kelley noted that - once again - the government had chosen to kick the "doc fix" down the road. The "doc fix" is the temporary patch necessary to keep physicians' Medicare (and by extension, every other 3rd party) reimbursements from crashing to the ground.

As Peter Suderman points out, the "doc fix" is inherently unfixable because, well:

"The way the doc fix developed is somewhat convoluted ... The formula tied total spending on physician payments to inflation, in hopes of keeping physician spending from growing faster than the economy as a whole ... If the doc fix is allowed to occur this year, physicians face a 26.5 percent cut in Medicare fees."

The end result is that, by not realistically addressing the problem, it gets larger and larger, so that (for example), the "doc fix" today represents $25 billion. While that may seem small potatoes in comparison to the overall debt, it's still a pretty good chunk of change that may or may not go into doctors' pockets.

Your doctor's pocket.

[Hat Tip: HotAir]

Unintended Consequences (Part XXIV)

Our government’s attempts to control all aspects of our lives have numerous unintended consequences. In healthcare, one of these is directly related to the government’s staunch refusal to fix the Medicare Fee Schedule (which in turn affects other reimbursement arrangements) and to develop payments for medical treatments that actually cover the cost of the care being delivered: inadequately staffed medical offices.

The latest news is that the government is going to enact another "doc fix" to the fee schedule. The "fix" is that there will once again not be a cut (it will be moved to next year), but there will once again not be an increase, either; the fee schedule will remain fixed where it has been for over a decade.

The history of the doc fix is covered very well by Anthony Wilson and Hanna Dubansky. In their post “The Sustainable Growth Rate Formula: Then, Now … and Forever?” Anthony and Hanna provide a helpful timeline of the Doc Fix's many versions, from 2003 under President Bush, through this year under President Obama. It's very helpful background towards understanding the Sustainable Growth Rate formula (SGR), which drives so much of this.

Due to the continuing instability of payments since February 2003, physicians have been unable to financially plan for their business needs. When a business is faced with a continuing money crunch it has two choices: increase income or decrease costs. As medicine has a fixed payment (revenue) as determined by the SGR, physicians cannot increase revenue by increasing prices because the government has determined the cost of the procedure. Thus, they are left with one avenue: cut costs. In any business, payroll accounts for up to 30% of overhead and is one of the (if not the) largest costs. Now, a physician has a choice: does he cut his own salary or does he reduce his staff? 99.99% of the time, the physician will reduce staff. It is happening to more and more of my colleagues: physicians are letting go of managers and taking over the management of the offices to “save money”. Additionally, they are freezing or reducing wages for the remaining employees.

Now it does not take a business maven to predict what will happen. When a service industry that makes money based on the volume of people served begins to make drastic cuts in its personnel, how will that affect the quality of the business? The business will need to continue to see the same number of customers to maintain its current revenue level, but with fewer employees. And what is the number one complaint about doctor’s office? Long wait times:

* Industry average for a specialist is over three months.

* Long wait times in the office; appointments are set in 15 minute increments, but it takes closer to 25 minutes for a physician to complete an appointment.

* Finally, long wait times on the phone trying to talk to someone about your medical condition, your bill, or if your test results are ready.

Simply put, very few physicians' offices in America have adequate staff to deal with the demands. Add to that low pay, long hours, and (often) arrogant doctors and it is amazing that any medical office has staff at all.

So, the unintended consequence of not having a fee schedule that accurately reflects the cost of medicine today is a medical system that is unable to meet its core purpose - medical care - in an efficient manner. Physicians have decided that administration is the area to cut, leaving only medical personnel to man the fort.

But, Kelley, you may ask, why do I need that manager or billing office or scheduler if I only want to find out if I have strep throat or mono? Because the actual medical treatment done by the physician is only one small piece of the overall appointment life-cycle:

* People to make the appointment, check you in and verify your insurance

* Billing folks to make sure you’re up to date on any payments due and process your claim after the appointment

* Medical personnel to get you to the proper room and make sure all the coding is correct for your insurance claim

* A practice manager to make sure all the government regulations are met (OSHA, HIPAA, and HITCECH to name a few), and that the staff is appropriately trained

As in any system, if one of those components is removed, then the entire system will not work as efficiently. If the cog that ensures that the entire system works correctly is removed, then the system will eventually grind to a halt.

Most American’s believe that the money crunch to physicians will incentivize them to work harder for the fewer dollars. The opposite is true: physicians will not increase the number of patients that they see to make more money, they will simply cut overhead, which in this case is personnel, to ensure that their salary stays the same. The loser in all this is not the doctor, it is the American public.

The Doc Fix ISN'T in... [UPDATED AND BUMPED]

[Please scroll down for update]

As we've mentioned before, proponents of ObamaCare© planned to try a little sleight of hand with the numbers:

"In order to avoid "adding one dime to the deficit", Obamacare ... had to play shell games with the funding. One way was to cut pay to doctors who treat Medicare patients by 21%.

In doing so they stripped billions out of the cost of Obamacare by projecting a $200 billion savings ... The game plan was to add those billions back in via a separate bill termed "doc fix."

Of course, this "savings" was anything but, since the trick was to just add those dollars back in under a different budget line. The assumption was that there would be no actual cut. But we all know what happens when we "assume:"

"President Barack Obama is asking Republican lawmakers to approve billions of dollars in new spending to avert a scheduled 21 percent cut in payments to doctors who treat Medicare patients."

It's interesting that, as usual, PresBo is attempting to make this a Republican problem; last time I looked, it was his party that controls congress (and its purse strings). In other words, he decided to play chicken with the lives of some of our most vulnerable citizens, and then blinked.

On the one hand, the folks pushing ObamaCare© want us to believe that it will add nothing to the (record breaking) deficit, while on the other doing nothing to actually control costs. The result is that they failed to plan for the very real possibility (now reality) that their little legerdemain would fall flat. Faced with mind-boggling debt, responsible legislators simply put up the stop sign.

It's true that both parties have played this game before, but it's also true that the stakes have never been this high. That's what you get, one supposes, when "you have to pass it to see what's in it."

UPDATE: In the comments, Bob mentions that he "was under the impression the Medicare cut went into effect 6/1 when Congress went home rather than voting another extension. The doc fix was supposed to be part of the COBRA subsidy and unemployment benefits package."

Great point, so I asked our resident Guru, guest-blogger and Medical Office Manager Kelley Beloff for an explanation:

"On June 1st the extension of 2009 fee schedule ended and the 2010 fee schedule, with a 21% percent cut went into effect. However, CMS suspended processing all claims for 10 business days, that is until June 15th, in the hope that Congress would again, for the third time this year, extend the 2009 fee schedule. For example, it was extended on January 15 to April 1. Congress did not extend in time to stop the April 1st deadline and CMS held all claims the first 10 business days in April. At the last minute, the extension was passed for June 1 and now we are in the same situation we were in on the first of January and again on April 1 of this year. At this time, it does not look promising that the bill will pass. If it does not pass, then CMS will process all claims from June 1 on based on the reduced 2010 fee schedule. My revenue cycle has been a roller coaster this year; I cannot count on revenue coming in in a timely manner."

Commercial Hypocrites

Remember these guys?

"Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars ... convened by the American Medical Association, has no official government standing."

Well, they have a new Mediscare ad out with this dire warning:

"Medicare payments to doctors are scheduled to be cut by 30% in January. It means doctors may have to limit the number of Medicare patients they see, or even stop seeing them altogether ... Tell your representatives in Washington to stop the cuts." [ed: this is available on YouTube, but I won't give them the hits by linking to it]

And yes, this is the same American Medical Association that rallied in support of ObamaCare©, which explicitly counts on leaving the cuts in place.

Their hypocrisy is actually even more profound, when one considers that last year, the "American Medical Association [opposed] the Medicare "doc fix" included in the tax extenders bill House Democrats [were] preparing."

At least they were consistent, though: earlier this year, "[a]t a hearing of the House Energy and Commerce subcommittee on health, the American Medical Association called for scrapping the SGR" (Sustainable Growth Rate, aka "Doc Fix).

As the saying goes, we already know what the AMA is, now we're just haggling over price.

The (Doc) Fix is in....Or is it?

FoIB Holly R tips us that the so-called "Doc Fix" is in, meaning that (as we discussed over the weekend) providers' fees have once again been spared the axe:

"Congress agreed to a one-month delay in Medicare payment cuts to doctors yesterday, giving a short-term reprieve to a looming crisis over treatment of the nation’s senior citizens."

Except that it really doesn't. Let's ask Kelley Beloff, our resident Medical Office Manager, what this really means:

"What was passed was the extension of the current fee schedule that was supposed to expire today, to go to the end of this year. However, we are still facing a 29% cut on Jan. 1, 2011. That was not in this piece of legislation. While history is not always an indicator, Congress has let cuts go into effect at least 3 times since the cuts were started in the mid 1990's. I am anticipating the cut to go through on Jan. 1, 2011.

As to physicians opting out of Medicare. Now is the time to opt out. In fact I have sitting on my desk the CD with the forms in it to opt out of Medicare. Once the New Year begins, the physician is locked in for another year. So the physician has to ask himself, does he feel lucky, do I opt out on the chance the cuts will go into effect, or do I stay in and hope that Congress reverses themselves. My guess is that physician's will not opt out in the numbers predicted and continue to see Medicare patients, though on a more limited basis."

Gee, good news all around.

Thanks, Kelley!

The "Doc Fix:" Jury-rigged

We reported yesterday that the perennial "Doc Fix" was scuttled, but that appears to have been premature:

"After a week of partisan wrangling, the Senate on Friday passed legislation to spare doctors a 21 percent cut in Medicare payments looming for months. But the last-ditch effort came too late."

At issue is the fact that, although the upper chamber voted to temporarily extend last year's reimbursement rates, its little brother can't approve its own version until (at least) next week. And since our august legislators lost their little game of chicken with the 21% cut in those rates, CMS has no choice but to process claims from the last few weeks under the drastically lower numbers.

As our favorite Medical Office Manager noted earlier, her (and presumably her colleagues') "revenue cycle has been a roller coaster this year; I cannot count on revenue coming in in a timely manner." Now she can't even count on what that revenue will be.

Never fear, though, all these providers will have to do is to resubmit each and every claim, and wait with anxious anticipation for those additional dollars to roll in.

Meanwhile, the "D'oh! Award" goes to the AMA, which opined that the "continuing financial uncertainty may lead some doctors to stop taking new Medicare patients."

Ya think?

Latebreaking: The "Doc Fix" still broken, more

It was just a week or so ago that we pointed out that the so-called "Doc Fix" wasn't:

"The assumption was that there would be no actual cut. But we all know what happens when we assume ... If it does not pass, then CMS will process all claims from June 1 on based on the reduced 2010 fee schedule."

Well guess what?

The Washington Post is now reporting that "[t]he Senate effectively rejected a slimmed-down package of jobless benefits and state aid late Thursday ... The measure would protect doctors from a steep cut in Medicare rates scheduled to take effect [today]."

The bill would also have extended the notorious COBRA/ARRA subsidy, which has since expired.

Are we on the verge of seeing actual financial discipline out of Poppa Washington?

Doubtful, but hope (and change?) springs eternal.

More Medi$cams?

While we've spent a lot of time talking about the so-called "Doc Fix," it appears that perhaps we need to "Fix Doc," as well:

"California-based Prime Healthcare Services buys financially troubled hospitals and turns them around ... She says Reddy told doctors how to diagnose patients he had never seen."

Ooops.

Now, one may argue that this is simply a game between how Medicare reimburses depending on how a procedure is coded, but:

"He encouraged the physicians to stop documenting syncope, which is fainting or dizzy spell, and instead use the term autonomic nerve dysfunction, which reimburses at a higher rate."

But here's where the story takes an odd twist:

"The Federal Bureau of Investigation (FBI) is looking into the billing practices of ... Prime Healthcare Services, following reports that it allegedly overbilled Medicare for rare and serious conditions at high rates"

I find this odd because one would think that this falls under the purview of HHS Secretary Shecantbeserious, not J Edgar Hoover. It's true that the FBI has been involved with the Maxim Healthcare case, but that's in addition to HHS and related agencies.

In fairness, we haven't heard Prime's side of the story, nor do we know just how wide-spread the (alleged) practice is. One wonders whether this is the tip of an iceberg, or common business practice. As we saw in the LabCorp case, what HHS calls "fraud" may really be nothing more than breaking arbitrarily-set rules.

[Hat Tip: FoIB Holly R]

From Bad to Worse...

The 2015 Open Enrollment begins in a couple of weeks, and carriers, agents, HHS and all the rest are busy gearing up for it.

That's the good news.

Sort of.

Here's the reality: if you're thinking about buying on the ObamaTax Exchange, be sure your LifeLock plan is paid up:

"IRS Warned about Protecting Taxpayer Information on Health Exchanges ... The IRS must do more to ensure that federal tax information submitted to the ACA exchanges is protected and prevent its unauthorized disclosure"

Or else ... what? It's not like the current administration has a track record of going after its own (cf: Secret Service, Benghazi). And it's also not like there's an alternative: if you qualify for - and wish to use - a subsidy, you're going through the Exchange. For better or worse.

But mostly worse.

On the other hand, once you have that brand new subsidized health insurance plan, you'll have plenty of opportunity to use it.

Or maybe not. As FoIB Jeff M tips us:

"Over 214,000 doctors won't participate in the new plans under the [ObamaTax] ... Reimbursements under Obamacare are at bottom-dollar - they are even lower than Medicare reimbursements"

As we've noted, doc's can't afford to keep eating their losses, and there's no Doc Fix for the ACA. It's possible, bordering on likely, that more providers will opt out than actually participate.

Welcome to the future of American "healthcare."

MVNHS© Docs: Strike One!

The so-called Doc-Fix is (once again) on hiatus; Congress keeps kicking this particular can down the road, in a (no doubt futile) attempt to make it go away all by itself. But as we continue hurtling toward full implementation of ObamneyCare©, it's worth noting that the system upon which it's modeled seems to be hitting a breaking point.

To wit:

"The British Medical Association ... said two thirds of its members support industrial action which could cripple hospitals and GP surgeries throughout the country."

That amounts to about 87,000 docs and med students.

The "industrial action" to which the BMA is referring is a threatened strike by doctors over planned cuts to their pension plans. It seems that the Much Vaunted National Health System© isn't any better (and is, in fact, arguably worse) at reining in costs than their former colonists.

By the way, the Telegraph claims that the average value of a doc's pension is over $2.6 million.

Not too shabby.

But I'm sure that has no effect on the budget shortfalls.

Pardon me Doc: Chart, Please?

Folks following along at home may recall the infamous "Doc Fix" that was touted as a way to control rising health care costs. Briefly: for the past dozen or so years, Medicare has been slated to cut physician reimbursements by 21%. And every time it comes up, it gets delayed...so far.

But that hasn't stopped the proponents of ObamaCare© from (disingenuously) pointing to these "savings" as a means of paying for that train-wreck. How do we know that the numbers are fudged? Well, Cato's Michael Cannon knows that a picture (or, in this case, a chart) is worth tens of millions:

As Michael explains: "the administration proposes to delay these cuts until 2014 at a cost of $54 billion. As shown by the black line, the administration proposes to pay for this additional spending by reducing the rate of spending growth in other areas of Medicare by $62 billion over the next 10 years. Note that only 6 percent of these Medicare "cuts" will occur in 2012 and 2013. The other 94 percent of the "cuts" will come after the administration has spent the $54 billion it wants to spend. Note also that the vast majority of the "cuts" would take effect after Barack Obama is no longer president." [emphasis added]

Perfidy, thy name is PresBo.

Your (Examination) Table is Ready...

We've been writing about the coming wave of "concierge" medicine for over six years, so this is nothing new to our readers:

"New data from a national survey of nearly 14,000 physicians ... found that 9.6 percent of “practice owners” were planning to convert to concierge practices in the next one to three years."

That's nearly 1 in 10 practitioners, which is pretty significant. The usual suspects are cited: low Medicare and private reimbursement rates, which are only getting worse under the ObamaTax. And the so-called "Doc Fix" continues to hang as an albatross around the future's neck.

What's even more frightening, though, is that the phenomenon seems to be specialty-independent; that is, it's not just primary care, but surgeons and oncologists and, well, the list goes on. Which makes sense: health care is (pretty much) health care, and someone has to pay for it.

Which brings us to the uptick in concierge-style medicine. Some 20 percent of docs already restrict "the number of Medicare patients in their practice and one in three primary care doctors – the providers on the front lines of keeping the cost of seniors’ care low – are restricting Medicare patients." So if you can't get into your primary care doc, good luck getting a referral to that cardio guy you need to see.

Concierge-style medicine seeks to get around that problem by having patients contract directly with the provider. Of course, this will work better for some practice areas than others, primary care being the most obvious. How - or even if - this would work with, say, surgeons or radiologists seems unclear at this point. On the other hand, it was essentially the premise (and "promise") of HMO's. On the other hand, we've seen how those have worked out over the past decades.

The biggest problem right now is the threat that HHS Secretary Shecantbeserious will pull another mandate out of her...um... pocket and render the whole point moot.

Cuts, Cuts Everywhere

While we've often discussed the (so-called) Doc Fix, Medicaid is also facing severe budgetary problems. To address these, legislators in the Evergreen State recently passed a bill that would cut off coverage for non-emergency ER visits:

"Starting April 1, Medicaid will no longer pay for [unneeded ER] visits, even when patients or parents have reason to believe they're having an emergency."

On the one hand, this seems fairly drastic, but on the other, the ER should be for, well, emergencies. The tension here is, of course, how is a lay-person supposed to know the difference between, say, a panic attack and a heart attack?

The WSJ has more:



UPDATE/ADDENDUM: In the comments, FoIB NotWithStanding makes a VERY good point:

"Emergency departments are barred from federal law from turning people away without stabilizing them ... The Washington Medicaid plan would simply not pay the emergency providers for care rendered during "unneeded" ED visits, doing nothing to penalize people for coming in unnecessarily"

The reason they're forbidden from turning folks away is a little something the Feds call EMTALA, or the Emergency Medical Treatment and Active Labor Act. As NWS points out, this becomes a damned-if-you-do/damned-if-you-don't scenario for the provider.

But hey, health care's free, right?

Hey AMA: How's That "Hope and Change" Workin' Out for Ya?

Today's the day:

"Doctors slated to have their Medicare reimbursements cut 21 percent on April 1 got a reprieve from the Centers for Medicare and Medicaid Services, which is delaying lowered payments until after Congress reconvenes ... The agency ...has ordered that claims submitted on or after April 1 be held for an added 10 days before being paid."

Still counting on that "doc fix?"

How's this instead?

Bye, Bye Grandma!

We've written about Grandmothered plans (most recently here), focusing primarily on individual major medical policies. But these rules also apply to group plans, and the clock's ticking on them, too.

Grandmothered plans are those which were issued after ObamaCare was established, but were given a "hall pass" from many of its mandated "benefits." Much like the Doc Fix that kicked Medicare's provider reimbursement cuts down the road, Transitional Relief was ObamaCare's safety valve that allowed these plans a temporary reprieve. For the past several years, group clients have been able to re-cast their renewal date to continue to take advantage of it.

In theory, this will be last time (since no one really knows what's going to happen under the next administration). But, carriers are soldiering on; I received this in email today from United Healthcare:

"For many customers, there are significant cost implications in the change from Transitional Relief to ACA compliant plans ... you may be interested in changing your renewal to Dec. 31, 2017 ... This allows you to take advantage of the extension of Transitional Relief and keep the coverage you like for the maximum period currently allowed by law"

'Course, I'm old enough that I remember this.

In the event, UHC (and, of course, other carriers) is contacting its group clients to offer them a bit of relief.

Based on recent quotes I've seen, this is definitely an offer they shouldn't refuse.

Shecantbeserious and the Uncertainty Bubble [UPDATED]

UPDATE: Definitely see Mike's more in-depth analysis of this idiocy.

Apparently, she just can't help herself: ObamaCare© applies to everyone, except it doesn't. Then the doc fix is in, except it isn't. ObamaCare© will insure millions of children, except it won't.

And the list goes on.

The newest twist is the (potentially illegal) usurpation by the Fed's of states' rights to regulate health insurance. In a blatant move to wrest those powers, without any apparent statutory justification, HHS Secretary Shecantbeserious has set her sights on rate increases:

"In a new HHS regulation ... if a health insurance company’s “proposed rate increase equals or exceeds a defined threshold, it would be considered ‘subject to review.’ The review process would then determine if the increase is, in fact, unreasonable.”

That threshold, by the way, is 10%.

Are you kidding me?

Here's the problem: by assigning an apparently arbitrary ceiling on costs over which insurers have little (if any) control, coupled with the draconian MLRs (medical loss ratios), insurers are hobbled. If they raise rates to cover costs, they face expensive regulatory battles. By law, they can't just "eat" the expenses, so they'll seek the path of least resistance: phased plan withdrawal. What will that look like? Well, come 2014, they won't be able to decline applicants for health issues. But for the next three years, you're going to see underwriters with guns pointed squarely at their heads, the result of which will be that marginally healthy folks will be declined or offered extremely unattractive rates.

Why is that?

Simple: if carriers know that they can't count on making up the difference next year, they'll impose them beforehand. The result: fewer folks insured, paying more premiums for less service (hey, those home office CSR's are cost centers, not revenue producers).

Way to go, Kathy!

MVNHS© Puts Seniors in the Crosshairs

How's this for a headline:

"[MVNHS©] 'in peril' if health reforms fail"

Now, one might be forgiven for wondering exactly what kinds of "reforms" British docs might be considering. After all, they don't have to worry about the "Doc Fix,"or being put out of business.

Their issue is that the Much Vaunted National Health Service© pays scant heed to the needs of actual patients, demanding greater "responsibility for commissioning health services." In other words, they're facing exactly the sort of problem about which Bob wrote last month:

"The doctor does not get to decide which services are best for the patient, nor are they allowed to set a price for their time."

Which brings us once again to that eternal question: why would we want to model our health care system on the MVNHS©, as ObamneyCare© obviously does?

The Creation of Obamacare's Individual Market Mess

It has been four years since insurers submitted their initial rates to buy market share in Obamacare's individual market. Back then insurers were using assumptions that the segment would grow through government forcing people to purchase their product, existing policyholders coming over from "crappy" insurance plans, the promise of enforcing the rules, huge transfers of funds from competitors, and large sums from taxpayer funded subsidies.

Nevermind the ginormous turd of a website, the bigger problems occurred when those in power issued major changes - literally weeks into the first open enrollment. Some problems have continued because of a lack of enforcement. Others have come from bipartisan Congressional changes that were signed by President Obama.

The first was a reprieve for those already insured who found out that "if they liked their plan" they couldn't keep it. These transitional plans (Grandmothered) kept a large number of healthy folks out of the Obamacare markets when HHS issued a rule allowing people to retain their medically underwritten insurance.

The second problem was the expansion of - but no policing of - "hardship waivers". There are a plethora of waivers people can take advantage of. Some are legit. Others, not-so-much. The most egregious (IMO) is the exemption for Christian Health Care Sharing Ministries (HCSM). HCSM's aren't insurance products. They don't have mandated benefits nor do these Ministries pay in to the Obamacare taxes and fees. Don't get me wrong, if it's the right fit for a person they should look at it as an alternative. My objection is the double standard that Obamacare considers this "good" but a mini-med/limited benefit plan is considered crap.

Lack of enforcement continues to be a significant contributor. The primary culprit on the enforcement front stems from Special Enrollment Periods (SEP). While these have been tightened under the Trump Administration, the first three years under Obama was a free-for-all. In discussions with insurance company underwriters and executives, all had a similar response to how HHS policed SEP's. The short answer was, they didn't. As one insurer put it:

"They (Obama's HHS) rubber stamped everything. Politically they had to. Think of it this way. If someone was without insurance in January then was diagnosed with cancer in March they would have to wait until January of the following year to obtain coverage. These type of situations happen more often than you know. Imagine the backlash if people were diagnosed with major health conditions then were denied insurance due to Obamacare's own rules? The simple way to make it work was to allow people in, then place blame on insurers when rates went up."

A final problem is revenues. "Not one dime to the deficit" was BS. When you have an initial CBO score that uses 10 years of revenues but only 6 years of expenses and it barely is at breakeven we know it won't be true. Making matters worse, the expenses continue to exceeded expectations. The bending of the cost curve is going in the wrong direction. Instead of shoring up the costly overruns Congress does the opposite - cuts revenues. Look at this list of changes to Obamacare that are causing the fiscal crisis to rise:

• Doc-Fix Tax
• 1099 Repeal
• CLASS Act Repeal
• Defund of CO-OPs
• Risk Corridor Budget Neutrality
• Cadillac Tax Delay
• Delay of Medical Device Tax
• Delay of Health Insurance Tax

Every one of these revenue cuts had bipartisan support.

There are lots of nails in the coffin of the individual health insurance market. Many come from the sledgehammers that Obama's administration pounded. Some have come from a Republican controlled Congress.

Both sides continue to point fingers. Which brings me to something I was told as a young child. When you point a finger at someone remember that three fingers are pointing at you.

"Doc Fix" Fixed?

It would appear so, at least for now:

"The House ... approved a six-month plan to prevent a steep cut in doctors’ fees paid by Medicare, agreeing to a short-term solution that Speaker Nancy Pelosi called “totally inadequate” but said the House had decided to adopt after concluding that the Senate was hopelessly gridlocked and could do no better."

"[A] six-month plan."

AKA "Kickin' it down the road."

Or, as our resident Medical Office Manager has previously noted, physicians' "revenue cycle has been a roller coaster this year; I cannot count on revenue coming in in a timely manner."

Ho hum.

UPDATE: In the comments, Bob points out that, according to the American Medical Association (which represents almost 17% of physicians!):

"Additional results from our survey find that even with a temporary action, physicians say they will be forced to limit the number of Medicare patients they can treat. Our new survey shows that if Congress enacts a short-term delay of four to seven months, 54 percent of physicians say they will limit the number of Medicare patients they can treat. Even if Congress enacts a three to five year delay of the cut, 48 percent will limit the number of Medicare patients they treat."

Medicare and Cancer: Both Underwater

The first being metaphorically, of course:

"Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you're a senior covered by Medicare, the wait is eight weeks ... Top-ranked primary care doctor Linda Yau is one of three physicians with the District's Foxhall Internists group who recently announced they will no longer be accepting Medicare patients."

So why is our Medicare health delivery system beginning to look like the MVNHS©?

Well, when you have a limited supply and a (virtually) limitless demand, systems tend to end up that way. And if you think it's bad now, well, "that's not even taking into account a long-postponed rate-setting method that is on track to slash Medicare's payment rates to doctors by 23 percent Dec. 1."

The so-called "Doc Fix" is due in a few days, unless it's postponed (again). Hey, it's only (our) money, right?

The good news is that, if seniors manage to survive Medicare, they may also live long enough to benefit from some wonderful treats from the sea:

"Cyanobacteria live in every ocean and on every continent in both salt and fresh water. One species causes a rash known as swimmer’s itch; another blooms in lakes and reservoirs, expelling a neurotoxin that can be fatal to humans."

Ooops, that wasn't the good news. This is:

"(A) family of cyanobacteria called Symploca emits a toxin that attacks tumors."

Apparently, and this is still in the initial testing phase, these little sea assassins can target bone and breast-cancer cells (among others), destroying them without harming healthy cells or tissues. Unfortunately, it could be another 10 years before it can be approved and manufactured.

Keep your fingers crossed.