On January 1st doctors treating Medicare patients will get a 30% cut..."fiscal cliff".

[madfloridian]

From NPR:

A Huge Pay Cut For Doctors Is Hiding In The Fiscal Cliff

Every year Congress has stopped a huge cut at the last minute. I don't feel confident about this year.

Included in the fiscal cliff is a 30 percent pay cut to doctors who treat Medicare patients. It's set to kick in on Jan. 1. Lawmakers from both parties say they want to prevent the cut. But the cut is part of a plan Congress put in place 15 years ago to contain healthcare costs, then proceeded to postpone again and again.

..."So instead, Congress passed a bill to ignore the formula that year. Instead, they raised doctors' fees. And then for the next year. And the next...

The formula is cumulative. So if you ignore a 4 percent cut two years in a row, the following year the formula will call for an 8 percent cut. And so on. The formula now says doctors' pay should be cut by 30 percent next year — which means that $160 Dr. Murrow made for treating Chris Veres's grandfather should, according to the formula, be only about $120.

There is more from the Bioethics site about the way all health care will be affected if nothing is done.

Health Care Along the Fiscal Cliff

How will this affect health care?

In short, health care will see a big cut in federal dollars. The biggest component that affects health care is from sequestration (“sequester cuts”). In 2011, Congress began budget negotiations to reduce the federal deficit and raise the debt ceiling limit. A sort of stalemate had occurred because Democrats wanted to raise the limit and then separately discuss reducing the deficit through raising taxes while the Republicans wanted to use the limit as a negotiation point to reduce the deficit through federal spending cuts. In exchange for raising the debt ceiling and to encourage negotiators to reach a compromise plan, Congress passed the 2011 Budget Control Act. This law threatened draconian budget cuts—$1.2 trillion total—to automatically begin in January 2013 if no budget deal was reached. Sadly, no deal happened then and no deal is being reached now with less than ten days remaining in the year.

The Congressional Budget Office and economic pundits believe that falling off the cliff will be destructive to the economy overall. For example, the sequestration splits cuts equally between military and non-military spending,. For 2013, this is a cut of 8.2% or $109 billion. Many of the changes will dramatically affect U.S. health care. The Budget Control Act cuts 2% of all Medicare expenditures each year from 2013-2021. In 2013 alone, the projected decrease is approximately $11 billion dollars. The automatic 8.2% reduction means that the National Institutes of Health (NIH) would lose $2.5 billion, the Centers for Disease Control & Prevention (CDC) would lose $490 million, and the Food and Drug Administration (FDA) would lose $318 million. However, Social Security, Medicaid, Children’s Health Insurance Program (CHIP) Supplemental Nutrition Assistance Program (SNAP—formerly food stamps), child nutrition and other programs are exempt from the cut. On the military side, while the Veteran’s Administration (VA) is safe from cuts, the military TRICARE health program would also be cut by 2%.

The most immediate and dramatic cut is a 27% reduction in Medicare reimbursement rates.In real money, this amounts to $25 billion dollars less going to health care providers and hospitals. This cut comes from the creation of the sustainable growth formula (SGR) that was part of the 1997 deficit reduction deal. The SGR links physician payments to economic growth as a way to limit the increase in physician payments. However, soon after passage, the rate of growth in health care costs outstripped growth in the rest of the economy. The formula did not take into account a growing population, more expensive care, and patients using a higher volume of services. Thus, instead of providing a measured annual increase in funds, the SGR actually calls for a decrease in funds. To prevent these dramatic cuts, each year Congress has voted to stay the cuts for one year.

Seniors are feeling uneasy with just cause. Also included is the Chained CPI, a method of figuring COLA that will include all services.

It's not comfortable to hear the words of David Plouffe. His words are not reassuring. He recently told a college group that Medicare and Medicare are the "main drivers" of the deficit.

[dkf]

1. Lawmakers have been trying to address health care costs for years but then never have the fortitude

To follow through.

But it's been seen as a problem for a long time.

Reality bites.

[madfloridian]

3. Yes, now they will finally do it.

It will show seniors their place in the importance of things in America.

[dkf]

6. We spend 4 times the amount on seniors as we do on kids. Seniors vote, kids don't.

If anything it's depressing how little we value our kids.

27% of kids under 18 are in poverty compared to 12% of seniors who also do better than 19-64 (working age) at 19% poverty.

http://www.statehealthfacts.org/comparebar.jsp?ind=10&cat=1

[madfloridian]

8. I have a lot I could say to that.

But it would not matter, so I won't.

[dkf]

9. I added the poverty numbers to my post. It also shows the elderly are the most prioritized demo.

They do the best...better than people who are of working age.

[madfloridian]

10. Well then, that settles it.

Let's cut the doctors' pay.

Makes loads of sense.

[dkf]

11. Howard Dean has a better solution but Obama won't touch it.

That leaves this type of cuts. I hardly think they will go through with it though. Seniors have the money, the clout, and the voting rates to get what they want. In the end that will be all our government does...provide for the elderly.

[cliffordu]

12. I can't wait till you hit 68.

Better have your own safety net.

[dkf]

13. I plan to.

But if you all have your way I will be in decent shape while watching the younger ones struggling to provide for me. So be it.

[RKP5637]

26. I think mandatory executions at 50 would solve it all! n/t

[dkf]

28. Too bad we don't have mandatory savings plans that the government can't touch.

[RKP5637]

29. That, is an excellent idea, dkf!!! Also, SS should be untouchable!!!

[dkf]

32. SS was never meant to be untouchable as a pay as you go plan.

The number of changes it's had over time is pretty significant. Generally it improved benefits, but that was when the demographics were working for us.

[RKP5637]

33. Yep, it is quite lopsided now. n/t

[dkf]

34. The history is quite interesting as it has adapted with changes in society.

http://www.ssa.gov/history/briefhistory3.html

[RKP5637]

35. Very very interesting!!! Thanks!!! n/t

[Yo_Mama]

22. But most of their income comes from SS

Which is a program that current retirees, at least, have fully prepaid.

I'm pretty sure there's something wrong with the stats, but I'd have to look some things up and there is no time. As a society, we spend a great deal on education and care for the young. If you included tax expenditures like EITC and the child tax credit and the child care tax credit plus schooling expenses I think you'd come up with a very different number.

[dkf]

27. Here are the numbers...

http://www.urban.org/UploadedPDF/412600-Kids-Share-2012.pdf


Report: Federal Spending On Kids Declines For First Time In 30 Years

For the first time since the early 1980s, the federal government will spend less on American children this year, the Urban Institute's latest "Kids' Share" study (pdf) finds.

"In 2012, federal funding on children is projected to decline significantly," the researchers conclude in their report. "State funding is uncertain, but with states still recovering from the recession, it will be challenging for them to fill the gap caused by the drop in federal funding. As a result, there may be cutbacks in services and benefits for children in 2012."

Between direct spending and things like tax credits, total expenditures are expected to fall from $450 billion to $445 billion. But all of this is happening as federal spending expands in general.

Perhaps one of the most illuminating figures is how spending on children compares to other things. The institute, a non-partisan think tank that analyzes problems faced by cities, reports:

"Children's 10 percent share in 2011 compares to the 41 percent spent on the elderly and disabled via Social Security, Medicare, and Medicaid; 20 percent on defense; 6 percent on interest payments on the debt; and 23 percent on everything else."

http://www.npr.org/blogs/thetwo-way/2012/07/19/157042695/report-federal-spending-on-kids-declines-for-first-time-in-30-years

[DustyJoe]

2. ughhhhh

I have an abdominal aorta aneurysm repair scheduled Jan 15th.

I hope the surgeon doesn't know about this.

[madfloridian]

4. They have stopped it just in time for years. This year, I don't know about that.

They don't sound inclined to do so.

[madfloridian]

5. BTW best of luck on your surgery.

I hope things go well.

[CountAllVotes]

7. Please have that taken care of

and try not to worry!!

My grandmother died from this problem and I know how serious it is!

I hope you feel better and are 100% well soon!

[Honeycombe8]

14. Many drs will stop taking Medicare patients. People in small cities, towns, rural...

will be left without having many, or any, doctors to go to locally.

[madfloridian]

15. We fought hard about it in years past. Now I have heard almost nothing.

Neither party seems inclined to do anything to stop it this time.

[dixiegrrrrl]

39. That explains why our doc raised office rates 32% last month!

I just now got my Medicare Summary for the last visit.

the old rate was 65.00
the new rate is 107.
Medicare pays 76.00 of the NEW rate, and the balance is my co-pay.

So, if my doc's rate for office visit is cut 30%...( crunching calculator) the new rate will be....75.00 which is still a 10.00 increase over the "old" rate before doc raised it.

actually, since I rarely visit doc, I will pay the entire thing because my deductible goes up in Jan. to 147.00.
Usually I see doc once a year.
So am paying for Medicare B premium, which went up,
and increased duductible,
and increased office visit charges.

And they say there is no inflation.

[Honeycombe8]

41. Interesting. I was wondering if that would happen. Didn't the economic wizards who cut the benefits

think that this might happen?

Wow, what a huge increase for those who have to pay the whole thing. This is so screwed up.

[coalition_unwilling]

16. Isn't Plouffe just such a douche canoe? Here's another main driver of the deficit:

insufficient taxes on the rich.

FFS.

[madfloridian]

17. I did a google search for anything to verify Plouffe's words.

I found nothing. Nearly all point to the Bush tax cuts and two wars. Our nation has never cut taxes like that with two wars going on.

[Oilwellian]

36. Here's the video

[madfloridian]

37. Thanks, I meant to verify if Plouffe's words were correct.

I could not find anything that said Medicare/Medicaid were the "main drivers". I wonder where he got those talking points he was feeding to college students?

[shintao]

18. This goes back to who we elect

I am not concerned with the doctors, they are averaging $350,000. according to Med scape, and a lot of their business is private insurance anyway.

Everybody else should be upset with what the capitalist delivered as health care. When you start voting in people that actually have a socialist bone in their back, you can get started on National Health Care and put this painful problem behind us.

Just by going to National gasoline at $2.00 a gallon we can completely fund 100% National Health Care in America. It is a damned disgrace to be richest country and not care for our own people, while caring for everybody else's.

[madfloridian]

20. I do feel concern for the doctors.

Part of that concern is for those who will have trouble finding a doctor should these cuts pass.

Neither party seems to be willing to stop these cuts.

I am concerned for the doctors because cutting their pay that much will stress already stressed-out seniors even more.

[madfloridian]

19. Reid says not enough time left to fix things.

http://www.businessweek.com/news/2012-12-27/reid-says-congress-lacks-time-to-resolve-budget-talks

"The Senate has a vote on an unrelated issue scheduled for today. House members aren’t in Washington; Republicans are scheduled to hold a conference call later today.

“We are here in Washington working while the members of the House of Representatives are out watching movies and watching their kids play soccer and basketball and do all kinds of things,” Reid said. "

[PoliticalBiker]

21. Let those cuts happen

You know what a doctor makes?
They can afford it. It is only on the patients that use Medicare/Medicaid. It doesn't effect those with private insurance.
The stipulation has to be though that they cannot deny medicare/medicaid patients. If they accept them now, they must continue to accept them.

The problem with our out of control medical costs are not the patients, it is the cost of the service... the providers. Having to pay for extravegant salaries of executives, the drive for unlimited profit and the over-valuation of their service they actually provide. $15 for a 325mg asprin tablet, $2500 for a 15min consultation session with a specialist, $1500 for an ambulance plus $800 for doctor, etc...

Those costs have to come down if we are to get a grip on health care in this country

[madfloridian]

23. "It is only on the patients that use Medicare/Medicaid."

Well, then.

[PoliticalBiker]

24. Your Point?

The cuts to the providers are only for those that use Medicare/Medicaid.
Private insurance users are unaffected.
Reducing government dollars while maintaining services.
One thing that needs to be insured though is that those providers don't stop taking medicare/medicaid patients.
I don't think that provision is in the legislation... THAT will cause problems - reduction in availability of services.

[madfloridian]

25. How would you force providers not to drop or stop taking patients?

[Blue_In_AK]

38. That's already been a huge issue in Anchorage

where very, very few family practice doctors will take new Medicare patients and some doctors even drop their existing patients when they turn 65. It got so bad that a couple of doctors got together and opened two clinics specifically for Medicare patients.

[PoliticalBiker]

40. That may be an option

Perhaps the ACA provision to set up pools for patients will provide another avenue.

At any rate, the cost or price providers charge for their services needs to go down.... dramatically. Contrary to the medical groups and most republicons, we DO NOT provide the best medical in the world. We are in fact rather low on the scale... 17th or 20th among developed nations, depending on the survey if memory serves. We ARE however, 1st in how much we SPEND on the 17th or 20th best medical care... far and away 1st.

[Barack_America]

31. You think that's what Medicare actually pays for those services?

Even before the cliff?

[Barack_America]

30. Some hospitals won't make it.

Sorry to say, but it's true.

Medicare patients tend to be some of the most complex patients in the healthcare system, requiring fairly high levels of care, particularly when hospitalized. Many hospital systems are teetering on the brink as it is, but if they face these reimbursement cuts, that will be it for many. It's not as if they're going to turn seniors and the disabled away, or reduce the care offered to them.