![Spacer](images/spacer.gif)
![Spacer](images/spacer.gif)
![Spacer](images/spacer.gif)
|
|
|
|
Search
08/02/2015 Chet Vahovius, DPM
Obamacare and Podiatry
As a licensed insurance agent who specializes in health insurance and a retired podiatrist, I want to offer my opinion about the trend that I see in healthcare. I think that this may have a larger impact on podiatry because so many podiatrists work in solo and small practices.
The writing is on the wall that the ACA (Obamacare) is going to cause large changes in the practice environment. This is due to the fact that insurance companies are losing money on these plans due to the absence of underwriting (health questions). As written, the law encourages unhealthy patients to join these plans for services and then to leave once the expensive medical care is complete. For example, a pregnant woman can join a Gold plan on Jan 1st, have the baby on the 3rd, and cancel coverage on February 1st. Of course there is a penalty, but is not substantial enough to force healthy patients to join these plans.
In the past, the companies would ask health questions of patients to exclude the high risk people who would cost them money. This is now illegal. The only alternative for insurance companies, outside of bankruptcy, is to reduce the number of physicians on the plans (also known as thinning the panel). The effect of this rationing is to reduce costs by delaying care e.g surgeries, tests, office visits.
Another disturbing trend is the recent consolidation of several large insurance companies e..g Anthem, Humana, Cigna. This consolidation will increase their ability to force price concessions and/or thin panels.
What is the solution for you? First of all, you need to objectively evaluate your practice's profit margin and come to terms with whether your margin in decreasing or is stable. If it was falling like mine was, you will either need to start investigating a radical career change or reduce your personal expenses substantially (e.g. sell the expensive cars, home, and boat). As has been stated many times before, group practices can offer efficiency of scale that may be helpful. However, I would be wary of accumulating any debt in the process because there won't be any guarantee that you will get on or stay on the panels. I would also be wary of hospital based clinics. I have read that they currently receive more money from Medicare than private physician owned clinics. However, what will the hospital do to the physicians if Medicare implements payment parity?
Finally, the most important thing to understand is that you are not in complete control of your practice. There are greater forces that are attempting to get their way in this marketplace. I fear that too many physicians personalize these struggles and often turn to destructive coping mechanisms to handle their perceived personal failure. It is never a good time for negativity. It is a good time for objective preparation.
Chet Vahovius, DPM, Enterprise, AL
Other messages in this thread:
08/05/2015 William Deutsch, DPM
Obamacare and Podiatry (Chet Vahovius, DPM)
Chet Vahovius lays it out pretty well. The private practice is being phased out. Participation with various panels is tenuous. The podiatrist is being marginalized and those who provide ethical care are being squeezed by reduced payments, high deductibles that cause patients to forego elective treatment and the failure of insurers to see the preventive value of timely foot care.
Dr. Vahovius also indicates that patients are gaming the system as have physicians in the past. Insurers will find ways to force legislation to prevent the losses such gaming entails.
The concierge model or refusal to accept insurance coverage is a big step for most private practitioners. Those big billers who make the most of diagnostic services will probably find themselves either audited into non-existence, or find coverage for diagnostic services reduced or eliminated when provided by podiatrists. It was apparent in reviewing the services provided by the highest CMS podiatry billers that podiatric care was almost completely absent from the services provided by those billing in the high six figures or seven figures. It's just a matter of time before that avenue is closed.
So the question in my mind is whether or not simply being a podiatrist is enough in today's health care market? I really think that it isn't and that a medical license is necessary to insure the survival of the profession and the professional. As podiatry care is being farmed out to the orthotist and the PA and podiatric assistant what's left for the licensed podiatrist?
Apparently Dr. Vahovius sought relief out of the profession. I'm sure many doctors are viewing their options and possibly honing their entrepreneurial skills in the event a successful living is no longer available in podiatry.
It would also be wise to study how podiatry fared in countries where national health insurance has been the model for many years.
PPACA was implemented with little concern for the physician as its aim was to get more bodies covered and to eliminate pre-existing condition exceptions for those needing the most care. While that goal was met somewhat, at what cost to the quality of care and to those physicians providing the care?
William Deutsch, DPM, Valley Stream, NY
08/05/2015 Joseph Borreggine, DPM
Obamacare and Podiatry (Chet Vahovius, DPM)
This recent PM News post was quite interesting with respect to the viability of a podiatric practice in the Obamacare insurance environment. I also enjoyed reading the form letter included as a response that was written by Michael Rosenblatt, DPM.
I must agree with both Drs. Vahovious and Rosenblatt. Time is ticking and the reality of our future as a profession is upon us. These last 5 years have been challenging to say the least.
I saw from the recent on-line PM News poll last week that our profession is feeling the financial pinch and revenues are dropping, as compared to last year, for 33% of the DPM's polled. I am a part of that statistic.
With ever increasing co-pays, deductibles, and out-of-pocket expenses burdened on the patient population at-large, the facts are simple: making a living in medicine is getting more and more difficult.
I believe that with ICD-10 coding it will get worse. With the recent CMS response on the ICD-10 policy being posted on PM news along with the APMA news and Codingline, I fear that there will be many more predicted initial rejections of claims after Oct 1, 2015. This is will compound the already existent problem of the downward trend in revenue collection in medical practices. ICD-10 must be delayed until we know that it will work for real.
This ICD coding change, in turn, will hurt more the independent practitioner, such the podiatric physician, as compared to the corporate or employed physician since they will be insulated by the salaries they get as opposed to fee-for- service.
I have investigated switching careers and even considered getting a degree as a nurse practitioner or a physician assistant, but the expense involved in restarting a career at my age (52) would be cost-ineffective.
So, it looks like I will have to weather the storm along with the rest of the profession who are in my same situation.
I just hope I can come through it with some financial nest egg and have the ability to retire, if not, then I hope Social Security will still be there when its time. I hear that Medicare after these last 50 years and having 55 million lives insured through in the program will be broke in the year 2030.
Again, the future of medicine as an independent practitioner is bleak.
Joseph Borreggine, DPM, Charleston, IL
03/10/2014 Michael Rosenblatt, DPM
Letter to Patients About Obamacare and Podiatry
Recently a number of people have been writing me to ask about the format of a letter they can use for their patients to inform them about the changes in Obamacare. So, rather than individually answer them, I thought I would publish it in PM News. I also included it in Español
Challenges You Will Face with the New Affordable Care Act
You have no doubt read about some of the new issues that will be raised with Obamacare. Some of our patients have already started to see those challenges with their other doctors. An example of this is that many primary care doctors are now switching to “boutique” practices, which require that you pay them a large yearly fee in order to remain their patient. The alternative is that you may have to find another doctor. If this has not yet happened to you yet, you should probably expect it. This has become a trend.
We don’t anticipate requiring that for you, for now. But Government now provides a high level of care at bargain prices for people who have pre- existing conditions. Without discussing the morality or kindness of this, it is a fact that healthcare costs are bubbles. If you try to push them under, they will pop up in another place.
You became that “other place.” The money to fund this will come from you. Government is already planning a 6% reduction in payments for various managed care insurance plans in 2015. That is only the first. Many more are yet to come. This means that many services you ordinarily had covered will no longer be covered by Medicare. It also means that for tens of thousands of Medicare recipients, your monthly Medicare premium will increase yearly. You should also expect your deductible and co-insurances to increase.
Many podiatry patients have expected the trimming of their nails and calluses, what we call “routine foot care” (RFC) to be covered by insurance and Medicare. Unfortunately, that is history. In order to stay in business, we will be now be billing you a fair and reasonable fee for those and some OTHER services that you used to get Government to pay for. We ask your understanding. You can try to find other podiatrists who will “find a way” to get these services covered. This is dangerous. Doctors are losing their practices, their licenses and going to jail for even attempting this. I’m sure you don’t expect us to try this. The cost to us is too high. Government will vigorously prosecute this, which they regard as Medicare fraud. We will ask you also to sign a form for this which is called the “Advance Beneficiary Notice” each time you obtain this care. This is not our policy. It is required by Government.
Soon, even basic healthcare services that you had covered by insurance will revert to your own wallet. It is impossible for us to get into political discussions with our patients. There are also enormous changes for us, which include requiring complete re-structuring of our numerical coding systems, which cost us money, time and effort. Being in private practice is enormously difficult and challenging.
The question most patients are asking is: “Who will pay?” The answer is you. The only option you have is to make certain political changes to your thinking and voting. We cannot counsel you on that. That is up to you. But understand that the alternative is that you will pay a much greater percentage of your own care. This is a new-global change that will come all through American health care. This note is offered with respect and appreciation to our patients.
Thank you for your understanding.
En Español:
RETOS Te enfrentarás CON LA NUEVA LEY DE ASISTENCIA ASEQUIBLE
Sin duda han leído acerca de algunas de las nuevas cuestiones que se plantearán con Obamacare. Algunos de nuestros pacientes ya han empezado a ver a esos desafíos con sus otros médicos. Un ejemplo de esto es que muchos médicos de atención primaria están ahora cambiando a prácticas de "boutique" , que requieren que se les paga una gran cuota anual para poder seguir siendo su paciente. La alternativa es que usted tiene que encontrar a otro médico. Si esto aún no ha sucedido todavía , probablemente debería esperar . Esto se ha convertido en una tendencia.
No anticipamos que exige que para ti , por ahora. Pero Gobierno ofrece ahora un alto nivel de atención a precios de ganga para las personas que tienen condiciones preexistentes . Sin entrar a discutir la moralidad o la bondad de esto, es un hecho que los costos de salud son burbujas. Si intenta empujarlos bajo , van a aparecer en otro lugar .
Usted se convirtió en ese "otro lugar . " El dinero para financiar esta vendrá de usted. Gobierno ya está planeando una reducción del 6 % en los pagos por diversos planes de seguro de atención médica administrada en 2015 . Eso es sólo el primero. Muchos más están por venir . Esto significa que muchos de los servicios que normalmente había cubierto ya no estarán cubiertos por Medicare. También significa que durante decenas de miles de beneficiarios de Medicare , su prima mensual de Medicare aumentará anualmente. También debe esperar que su deducible y co - seguros aumenten.
Muchos pacientes de podología han esperado que el recorte de las uñas y los callos , lo que llamamos "cuidado rutinario de los pies " (RFC ) para ser cubierto por el seguro y Medicare. Por desgracia , eso es historia . Con el fin de mantenerse en el negocio , vamos a estar ahora está cobrando una tarifa justa y razonable por esos y otros servicios que ha utilizado para conseguir Gobierno a pagar. Le pedimos su comprensión. Usted puede tratar de encontrar otros podólogos que " encontrar un camino" para obtener estos servicios cubiertos . Esto es peligroso . Los médicos están perdiendo sus prácticas , sus licencias y va a la cárcel por intentar siquiera esto. Estoy seguro de que usted no espera que intentemos esto. El costo para nosotros es demasiado alto. Gobierno perseguirá vigorosamente esto, que consideran el fraude al Medicare . Le pediremos también que firme un formulario de este que se llama el "Aviso al Beneficiario por Adelantado " cada vez que se obtiene esta atención. Esta no es nuestra política . Es requerido por el Gobierno.
Pronto, incluso los servicios básicos de salud que usted había cubiertos por el seguro volverán a su propia cartera. Es imposible para nosotros entrar en discusiones políticas con nuestros pacientes. También hay grandes cambios para nosotros , que incluyen requerir completa re- estructuración de nuestros sistemas de codificación numérica , que nos costó dinero, tiempo y esfuerzo. Estar en la práctica privada es enormemente difícil y desafiante . La pregunta la mayoría de pacientes se preguntan es: "¿Quién va a pagar? " La respuesta es usted. La única opción que tiene es hacer ciertos cambios políticos a su forma de pensar y votantes. No puede asesorar al respecto. Eso depende de usted. Pero entiendo que la alternativa es que usted tendrá que pagar un porcentaje mucho mayor de su propio cuidado. Este es un cambio nuevo - mundial que llegará a lo largo de salud estadounidense .
En la presente nota se ofrece con respeto y aprecio a nuestros pacientes.
Gracias por su comprensión .
|
|
|
|
|