Sequester Cuts: Payments to Medicare Doctors

Due to the sequester, doctors face a 2% cut in Medicare reimbursements:

The bottom line is that doctors who treat Medicare beneficiaries will only be reimbursed 98 cents on every dollar for a vast array of services. Reimbursement for low-income beneficiaries is exempt.

...The cuts could make it harder for patients to get care, [AMA President Jeremy] Lazarus added. "One in five Medicare patients already is facing difficulties in finding a doctor to take them. If you cut their pay, this access problem will only get worse."


Another doctor says:

"At some point, we will do what we have to if it means keeping the practice afloat," said [internist David] Wilt. "This includes reducing the number of patients whose payments are too low for us to run our business."

If the private insurance companies do the same, as often happens, things could get even worse for elderly patients:

"Small practices, especially in rural areas, are small businesses that run on razor thin margins...These cuts will force them to make a choice. Do we keep seeing the elderly or do we keep our practice afloat."

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    Money matters, people don't (5.00 / 7) (#1)
    by Dadler on Sun Mar 03, 2013 at 12:24:08 PM EST
    This country announces loudly and clearly its operating paradigm every day: humans, don't you dare think for a second, not for even a millisecond, that you matter more than money.

    The ONLY way, logically, a nation can be having this discussion about he best way to commit national suicide, is if that nation has fully internalized a self-hatred that places things and currency above human life.

    That is where we are.

    Sadler you are so right (5.00 / 2) (#4)
    by samsguy18 on Sun Mar 03, 2013 at 04:07:40 PM EST
    I work for an academic institution ...they are supposed to be more patient centered....medicine except for the county run hospitals are corporate America personified...the CEO 's and their MBA minions are all about the bottom line... ...obamacare will not fix this culture of greed !

    Afraid it is beginning to look like (none / 0) (#7)
    by Militarytracy on Sun Mar 03, 2013 at 04:49:14 PM EST
    You are right

    Oops sorry Dadler (none / 0) (#5)
    by samsguy18 on Sun Mar 03, 2013 at 04:08:16 PM EST
    You're right Dadler (none / 0) (#13)
    by cal1942 on Sun Mar 03, 2013 at 07:58:42 PM EST
    Gee, 2%.  A lousy 2%.  Just incredible.

    Every doctor should be required, as part of licensing, to treat x number of Medicare and Medicaid patients.

    I remember one of the AMA arguments against Medicare was that doctors would no longer have the "fun" of adjusting fees according to an elderly patient's income.

    Prior to Medicare, I remember some elderly people dying because they couldn't afford needed medical care.  My question was, where were all the fairytale doctors having "fun" making fee adjustments?

    I thought it was one of the more ridiculous arguments against Medicare.  Downright childish.


    2% is a large part of the margin, (5.00 / 1) (#29)
    by Green26 on Mon Mar 04, 2013 at 11:59:00 PM EST
    i.e. operating profit, for some healthcare organizations, such as rural hospitals. Operating margins/profits are 4%, and medicare payments average 40%, for rural hospitals in Indiana. Thus, loss of 2% will be half of the profits from medicare for those hospitals. Using the 40% average as the medicare portion of a hospital's business, the profits of those hospitals will decline by 20% overall. If your salary was cut by 20%, would you see that as insignificant? In Indiana, it is expected that the 2% reduction will lead to a loss of almost 11,000 jobs.

    The average person (none / 0) (#30)
    by samsguy18 on Tue Mar 05, 2013 at 07:57:32 AM EST
    Does not understand the Medicare reimbursement formula....ithe bureaucratic nightmare will continue to grow to compensate for the cuts and the patient and those professionals who look after the patients will take the hit....

    Same threats doctors make whenever any cut (5.00 / 2) (#2)
    by ruffian on Sun Mar 03, 2013 at 12:51:34 PM EST
    to Medicare is proposed. I am interested in seeing how many will follow through. I don't agree with the sequester, but maybe the silver lining is the chance to put the threats to the test.

    also same threats made over Obamacare (5.00 / 2) (#3)
    by ruffian on Sun Mar 03, 2013 at 01:01:24 PM EST
    waiting for my rightie friends to post this on Facebook as a example of how see, Obama is right, the sequester is a catastrophe! I won't hold my breath.

    Most doctors (5.00 / 3) (#6)
    by samsguy18 on Sun Mar 03, 2013 at 04:16:35 PM EST
    Will absorb the cuts however the executives and  the MBA types will just increase their bonus package at most institutions

    That is (none / 0) (#10)
    by Ga6thDem on Sun Mar 03, 2013 at 07:29:35 PM EST
    the most unfortunate truth. If you read the time article about healthcare in America I would love to hear what you have to say.

    I did read it.... (none / 0) (#31)
    by samsguy18 on Tue Mar 05, 2013 at 08:05:31 AM EST
    Healthcare in this country is in crisis......Obamacare has imade it worse we need a single payer system like Medicare....those individuals getting rich on the misery of the poor disadvantaged and unemployed  are in control....

    Unfortunately, the worst is yet to come (5.00 / 2) (#33)
    by MO Blue on Tue Mar 05, 2013 at 10:47:40 AM EST
    By the time the powers that be (both Rs & Ds) are through, regular people will be paying for junk insurance and only the rich and politicians will be able to get actual health care.

    Obama care is about (none / 0) (#34)
    by samsguy18 on Tue Mar 05, 2013 at 11:51:28 AM EST
    Medicaid for we the peasants....and with the state of the economy , scare tactics,  and  the double digit underinsured uninsured  unemployed in this country it might just work....of course the political elite , politicians , the rich and Hollywood will have access to the best....institutions  like the largest private practice in this country ....Mayo Clinic.....

    The cuts to Medicare in the sequester (5.00 / 2) (#32)
    by MO Blue on Tue Mar 05, 2013 at 10:43:59 AM EST
    are small in comparison to the cuts to Medicare proposed in Obama's Grand Bargain, his proposed 2013 budget or Simpson/Bowles latest and greatest proposal. Obama referenced Simpson/Bowles on Medicare in his state of the union.

    New (5.00 / 4) (#9)
    by lentinel on Sun Mar 03, 2013 at 07:21:22 PM EST
    entree to the lexicon of Orwellian euphemisms.

    What do you call the beginning of the gutting of medicare and social security?

    "Entitlement reform".

    And Paul Ryan is still hot on his idea (none / 0) (#8)
    by Anne on Sun Mar 03, 2013 at 06:53:32 PM EST
    to voucherize Medicare and send seniors into the private market to see what kind of coverage they can get for whatever amount the vouchers are for - or use the voucher to stay in traditional Medicare.

    Fired up as once-unimaginable spending cuts start to slice the federal budget, Republicans are launching a new phase in their austerity campaign -- resurrecting the party's cost-cutting plan to turn Medicare into a voucher-like system for future seniors.

    Despite public uncertainty Saturday about the $85 billion in so-called sequester cuts, Republicans now believe they have momentum to ask Americans to make tough choices on Medicare, as rising healthcare costs combine with an aging population to form a growing part of future deficits.

    What no one wants to talk about, of course, because it gets in the way of their agenda, is that health care costs have actually been coming down, and Medicare is still delivering far more actual care for the dollars spent, than anything the private sector could hope to deliver.

    Any plan to partially privatize Medicare is a plan to end Medicare - because that's what it would mean in the end.

    6 months (5.00 / 1) (#11)
    by Ga6thDem on Sun Mar 03, 2013 at 07:30:51 PM EST
    on private insurance that a voucher could buy would send a lot of seniors into bankruptcy.

    Wouldn't that depend on the size of the voucher?? (none / 0) (#14)
    by jimakaPPJ on Mon Mar 04, 2013 at 12:07:59 AM EST
    Or am I just being picky.....

    Well (5.00 / 1) (#26)
    by Ga6thDem on Mon Mar 04, 2013 at 01:59:01 PM EST
    they've already said the voucher amount is 6K which will buy you very little insurance at 65+

    Have :"they?" (none / 0) (#27)
    by jimakaPPJ on Mon Mar 04, 2013 at 07:01:31 PM EST
    I haven't seen any number cast in concrete, of course you have because it suits you to rag on Ryan.


    Remember, I have maintained a desire for a single payer system modeled on Medicare paid for by a national sales tax, so it isn't like I'm defending a voucher.

    Of course, at this time, the supplemental insurance for my spouse and me is around $4500. At $6K each that's a cool $16,500.

    Would that purchase a policy?? I don't know. Nobody knows.


    That's (5.00 / 2) (#28)
    by Ga6thDem on Mon Mar 04, 2013 at 07:28:27 PM EST
    the GOP plan last year.

    Actually I do know what insurance costs because I have had to pay my own. A 6K voucher for a 65+ year old would get you a policy that pays 70% of your costs with probably at $7500 deductible. So pretty much you would be on your own for most of your medical costs and then there's always preexisting conditions that won't be covered etc.


    Not "picky", just silly ... (none / 0) (#15)
    by Yman on Mon Mar 04, 2013 at 08:45:56 AM EST
    They're not going to save money by sending people into a much more inefficient private system, unless the size of the voucher is significantly less than their current costs.

    What do you mean, "unless?" (5.00 / 2) (#16)
    by NYShooter on Mon Mar 04, 2013 at 10:56:18 AM EST
    Of course, the amount allocated will be significantly less than the going rate today.

    But, through the magical alchemy of the "markets" the 86 year old, wheelchair-bound, respected client will, with just a slight bit of due diligence, be able to smoke out those hidden, Nobel prize winning doctors who will perform the same service at ¼ the going rate.


    And, as an extra bonus, (5.00 / 2) (#17)
    by NYShooter on Mon Mar 04, 2013 at 11:08:37 AM EST
     Mr. G. Eezer will save so much money that (because he probably can't do much sex any more) he'll be able to do the next best thing, toss in a couple of colonoscopies, just for the fun of it.

    Of course (none / 0) (#18)
    by jbindc on Mon Mar 04, 2013 at 11:21:37 AM EST
    Much of the "health care costs have actually been coming down" statistics are based on the fact that many more people are not using health care because of loss of jobs and loss of insurance.

    That's not the explanation for the (none / 0) (#19)
    by Anne on Mon Mar 04, 2013 at 11:55:54 AM EST
    reduced costs in Medicare, and that's really what I was commenting about - my apologies if I wasn't specific enough.

    See here for more (bold is mine):

    Medicare spending per beneficiary grew just 0.4% per capita in fiscal year 2012, continuing a pattern of very low growth in 2010 and 2011. Together with historically low projections of per capita growth from both the Congressional Budget Office and the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary, these statistics show that the Affordable Care Act has helped to set Medicare on a more sustainable path to keep its commitment to seniors and persons with disabilities today and well into the future. The success in reducing the rate of spending growth has been achieved without any reduction in benefits for beneficiaries. To the contrary, Medicare beneficiaries have gained access to additional benefits, such as increased coverage of preventive services and lower cost-sharing for prescription drugs.

    I could be wrong, but I believe the "costs" that our sorry-excuses-for-legislators-and-leaders are getting all hysterical about are the costs to the government, and they've continued to act as if Medicare is a runaway cost train, even in the face of Medicare being successful in lowering costs.  And even in the face of Medicare being able to use more of its dollars for actual care and benefits than the private sector has ever been able to do.

    Why would that be?  Why would they keep beating that drum?  

    Golly, I wonder...


    One of the reasons (5.00 / 1) (#25)
    by NYShooter on Mon Mar 04, 2013 at 01:12:15 PM EST
    I'm kind of interested in Warren Buffet's expanded interest in the news business is that maybe, just maybe, the American public will begin to receive factual information on the issues that most affect them. I mean, why else did the 1% 'ers buy up all the media outlets and put shills like Rove, Ailes, Limbaugh, and Murdoch out there as the Corporate mouthpieces from whence the public gets its "news?"

    I know we like to make fun of the low-information, self destructive folks who seem to always vote against policies that would benefit them, and vote for those that would harm them. But, it's a little easier to understand when you realize that the only information they get is from very rich, and very smart, Corporate Enemies of Humanity like the ones I mentioned.

    I mean, even a Tea bagger would answer "yes" to the question, "would you like to pay half as much for health insurance that's twice as good?" That doesn't happen because the Republicans lie to the folks, and the Democrats don't call them out on it. When both parties, and the sources of information, are paid by the same Paymaster a little empathy is warranted for the non-Mensa voters out there.


    Healthcare costs are not coming down... (none / 0) (#20)
    by samsguy18 on Mon Mar 04, 2013 at 11:58:19 AM EST
    Job loss lack of insurance etc....doctors aren't making money ...their reimbursement fees are being slashed ...many of them .I can assure you the upcoding continues to increase.....institutions are making money.... most doctors are taking huge cuts.....there are some specialties that are procedure driven like orthopedics,dermatology and plastic surgeons make a lot of money....the rest of us our salaries are being cut or our contracts are not being renewed ....if the MBA types see you as too conservative code for you are not ordering a load of tests annecessary unecessary invasive procedures ......what really makes me angry is the MBA's are financially rewarded for every dime they save  on the backs of the doctors nurses and patient.....disgusting !

    Sorry a few errors (none / 0) (#21)
    by samsguy18 on Mon Mar 04, 2013 at 12:00:18 PM EST
    This stuff has me really upset...

    I don't blame you for being upset. (5.00 / 2) (#22)
    by Anne on Mon Mar 04, 2013 at 12:16:37 PM EST
    It just seems to me that both patients and the front-line providers - doctors, nurses, technicians - are being held hostage to the almighty dollar, and I don't see that changing unless and until we wake up and demand a single-payer system.

    A friend's husband is a respiratory therapist at a large hospital, and the stories he tells are enough to make the hair on your neck stand up.  Most shifts, there are just not enough therapists to adequately cover the whole hospital - he's had many nights when he just ran from the ER to the ICU to peds to med-surg: that's no way to provide good care, and it terrifies him.

    There are still millions without insurance, which is bad enough, but there are also millions who have insurance who still can't afford actual care because of the co-pays and deductibles on top of premiums.

    I don't have to tell you how unconscionable this is - you see it every day.  And we're going to see more of it - even as we see bigger bonuses and salaries and other benefits for insurance and hospital and pharmaceutical corporation executives.

    The austerity that both parties seem obsessed with imposing is only going to choke off economic growth and make things worse.

    I guess Medicare's great sin in that it's working well for seniors - the people it's supposed to serve - but the private sector wants to get its mitts on that money, and isn't going to give up anytime soon.


    I don't have to pretend, (5.00 / 2) (#36)
    by NYShooter on Tue Mar 05, 2013 at 05:57:16 PM EST
    and, I've found absolutely no difference in the level of care, Medicare vs. private insurance.

    Next canard?


    Don't have to pretend (5.00 / 2) (#37)
    by MO Blue on Tue Mar 05, 2013 at 06:07:10 PM EST
    No problem getting appointments for new doctors as a Medicare patient.

    Did have significant problems at 64 when thousands more was going out for premiums, copays and deductibles during my treatment for cancer than was coming in as income. At the time I was covered by my previous employer's (subsidized) retirement insurance.  


    Anne your absolutely Right ! (none / 0) (#23)
    by samsguy18 on Mon Mar 04, 2013 at 12:59:53 PM EST
    Quality healthcare is a right ....the single payer system will never happen while we have a corporate mentality...I do remember when MBA's were few ....you wouldn't believe how top heavy hospital management is  with this crew....They constantly blame the Doctors for the state and cost of healthcare...nurses are overloaded and patients are overcharged......Doctors unfortunately don't understand there is power in numbers ....the MBA types pick them off one one by one with innuendo and  isolation......I am hoping there will be  push back....the AMA is useless they  talk a lot and do nothing

    The Ivory Towers being built (none / 0) (#24)
    by samsguy18 on Mon Mar 04, 2013 at 01:06:44 PM EST
    Are  a contributing factor to the increase in healthcare costs...bigger isn't  better....I am sure if we followed the money we would see how building these monstrosities wasn't about the patient ......