Mayo Clinic dropping some Medicare patients!

[andymays]

http://www.bloomberg.com/apps/news?pid=20601087&sid=aHoYSI84VdL0

Excerpt:

Dec. 31 (Bloomberg) -- The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won’t affect other Mayo facilities in Arizona, Florida and Minnesota.

Obama in June cited the nonprofit Rochester, Minnesota-based Mayo Clinic and the Cleveland Clinic in Ohio for offering “the highest quality care at costs well below the national norm.” Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians, in a telephone interview yesterday.
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http://hotair.com/archives/2010/01/04/mayo-clinic-dropping-medicare-patients/

Excerpt:

Barack Obama hailed the Mayo Clinic system as a model for health-care reform last summer — until Mayo opposed ObamaCare as a reform solution. They warned at the time that the bill passing through Congress would make Medicare and Medicaid reimbursements too low to pay for the costs of service and that providers would stop treating patients in those systems. Last week, that became a self-fulfilling prophecy of sorts:

[Saratoga_Mike]

http://www.bloomberg.com/apps/news?pid=20601087&sid=aHoYSI84VdL0

Excerpt:

Dec. 31 (Bloomberg) -- The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won’t affect other Mayo facilities in Arizona, Florida and Minnesota.

Obama in June cited the nonprofit Rochester, Minnesota-based Mayo Clinic and the Cleveland Clinic in Ohio for offering “the highest quality care at costs well below the national norm.” Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians, in a telephone interview yesterday.
------------------------------------------------------------------
http://hotair.com/archives/2010/01/04/mayo-clinic-dropping-medicare-patients/

Excerpt:

Barack Obama hailed the Mayo Clinic system as a model for health-care reform last summer — until Mayo opposed ObamaCare as a reform solution. They warned at the time that the bill passing through Congress would make Medicare and Medicaid reimbursements too low to pay for the costs of service and that providers would stop treating patients in those systems. Last week, that became a self-fulfilling prophecy of sorts:

Dems are right on Medicare. Most of the cuts come from Medicare Advantage and specifically the fee-for-service plans. All those plans do is give the elderly, one of the wealthiest segments in society (note I said wealth, not income), richer benefits than traditional plans. I don't want to pay for it. In addition, hospitals will receive lower payments in certain areas (e.g. DSH payments). At the same time, the hospitals will receives tons of incremental revenue from newly insured patients who previously were cared for and the revenue was written off as bad debt (bad debt has been the biggest headwind for the hospitals over the past 4 yrs). Reimbursement to home health companies and oxygen players can easily be reduced without impacting access to care.

It used to be Reps recommended reducing Medicare payments (think mid 90s) and the Dems would demagogue the issue. Now it's all been reversed. It's disgusting. The Republicans should be ashamed of themselves.

I think the Medicare Advantage and the few other Medicare reductions are the only thing I agree with in the healthcare "reform" plan. The rest of it does absolutely NOTHING to slow the rate of growth in hc costs. Oh I also think the pre-existing condition issue should be addressed.

If you don't think we should slow the rate of growth in Medicare spending, we'll never get the budget in balance.

[witchdoctor]

There are many factors causing doctors to drop Medicare. First, since 2003 I believe, there have been mandated cuts in Medicare payments to doctors. Each year, we have to lobby our Congressmen to keep these cuts from taking effect. This year with the deficit, it has been decided to enact those cuts which amounts to 21%. In addition, in my specialty, they are cutting in office testing (ECHOs, treadmills, etc)which would result in a 1.5 million dollar drop in our office. Interestingly, we were paid $380 per ECHO in our office whille the hospital got $500 for the same test. Under the new plan, we would get less than $300 per test but the hospital now gets $600 for the same test. This is driving cardiologists to join hospitals to blunt the loss income. In addition, if you make a mistake on your charges(there are over 1000 pages of rules regarding how to determine charges), the government can fine you $10,000 per occurance. To prevent having these fines, we have bought a computer program that checks our reports to make the charges are right. In addition, we have 5 coders that double check the reports to make sure that the reports past muster.

That said, the new RAC laws that are taking effect 1/1/2010 are even more draconian. :bang: :bang:

[Saratoga_Mike]

There are many factors causing doctors to drop Medicare. First, since 2003 I believe, there have been mandated cuts in Medicare payments to doctors. Each year, we have to lobby our Congressmen to keep these cuts from taking effect. This year with the deficit, it has been decided to enact those cuts which amounts to 21%. In addition, in my specialty, they are cutting in office testing (ECHOs, treadmills, etc)which would result in a 1.5 million dollar drop in our office. Interestingly, we were paid $380 per ECHO in our office whille the hospital got $500 for the same test. Under the new plan, we would get less than $300 per test but the hospital now gets $600 for the same test. This is driving cardiologists to join hospitals to blunt the loss income. In addition, if you make a mistake on your charges(there are over 1000 pages of rules regarding how to determine charges), the government can fine you $10,000 per occurance. To prevent having these fines, we have bought a computer program that checks our reports to make the charges are right. In addition, we have 5 coders that double check the reports to make sure that the reports past muster.

That said, the new RAC laws that are taking effect 1/1/2010 are even more draconian. :bang: :bang:

Doc payments aren't being reduced by 21%.

[Saratoga_Mike]

Here you go...from thehill.com (12/19/09):

"Doctors will get a slight reprieve when President Barack Obama signs the defense spending bill the Senate passed Saturday morning, at least. That legislation blocks the pay cut for two months (referring to doc pay cut), giving Congress a little time to do something more substantial. Congress has passed a series of short-term fixes nearly every year this decade, a tactic the Senate was poised to repeat. "They're entitled to more than that and we agree," Reid said."

There is no way in hell doc payments will be reduced by 21%, 10% or even 5%. Won't happen. It will be fixed - probably through more deficit spending.

[witchdoctor]

This is from our lobbists.

Given the single-mindedness of Congress to pass healthcare reform bills by year-end, there has been unwillingness on the part of House and Senate Leadership to attach anything to the bills that isn’t specifically geared toward keeping the votes they need for passage. However, once the Senate healthcare reform bill passes later this week (barring something catastrophic), the next step is a conference committee to iron out differences between the House and Senate versions. This may provide an opportunity to include cardiology-specific legislation. Another possibility early next year is to help Cardiology when Congress re-examines the SGR issue. This month the House and Senate passed a two-month patch to prevent the implementation of the 21.2-percent cut to all providers covered under the 2010 PFS with the intent of taking it up before March 1. But in reality any legislative vehicle is a potential carrier for us—remember that the temporary SGR patch was included in the Defense Appropriations bill, for example. To recap the current legislative efforts, which are all still in play:

a. HR 4371, the Gonzalez bill: introduced December 16 with an impressive 55 original co-sponsors. The bill would hold cardiology codes at 2009 rates, negate the nuclear bundling hit and mandate a study of the practice expense methodology (language attached).

b. Sen. Arlen Specter (D-PA) has an amendment that would delay implementation of the non-payment of consult codes for a year. The 2010 PFS would replace the consult codes with office visit codes, which will be a nightmare for practices to implement and also will reduce reimbursement yet again for Cardiology.

c. Chairmen Henry Waxman (Energy and Commerce), Charlie Rangel (Ways and Means) and Pete Stark (W/M health subcommittee) sent a letter to HHS Secretary Sebelius asking that CMS phase in the nuclear bundling, which resulted in a 36-percent cut in reimbursement.

CMS ANNOUNCEMENT: Medicare will hold claims for the first 10 business days of January (January 1 through January 15) for 2010 dates of service. They also added a cryptic “…be on the alert for more information about other legislative provisions which may affect you.” In past years, when Congress stepped in at the last minute to stop the SGR cut, CMS did not delay claims payment. It may be that Medicare is not prepared as in past years, or it may be that they are expecting a change in the consult codes, nuclear bundling, something else or nothing at all. Given what CMS has let happen to Cardiology this year, frankly CAA wouldn’t be surprised by much



Mike

Congress keeps telling us, don't worry, we will take care of you. They then pass laws that give us a repreive each year. It seems that they are playing Chicken with us each year and people are getting mad about having to grovel each year to keep the cuts from happening. In addition, CMS is holding up payments for at least 10 days this year. They did this in 2007 and we didn't get paid for 6 weeks. Even though they didn't pay us, our staff still wanted to be paid. That sure caused a cash flow problem.

Doctors feel they are getting jerked around and are just tired putting up with it.

[Saratoga_Mike]

This is from our lobbists.

Given the single-mindedness of Congress to pass healthcare reform bills by year-end, there has been unwillingness on the part of House and Senate Leadership to attach anything to the bills that isn’t specifically geared toward keeping the votes they need for passage. However, once the Senate healthcare reform bill passes later this week (barring something catastrophic), the next step is a conference committee to iron out differences between the House and Senate versions. This may provide an opportunity to include cardiology-specific legislation. Another possibility early next year is to help Cardiology when Congress re-examines the SGR issue. This month the House and Senate passed a two-month patch to prevent the implementation of the 21.2-percent cut to all providers covered under the 2010 PFS with the intent of taking it up before March 1. But in reality any legislative vehicle is a potential carrier for us—remember that the temporary SGR patch was included in the Defense Appropriations bill, for example. To recap the current legislative efforts, which are all still in play:

a. HR 4371, the Gonzalez bill: introduced December 16 with an impressive 55 original co-sponsors. The bill would hold cardiology codes at 2009 rates, negate the nuclear bundling hit and mandate a study of the practice expense methodology (language attached).

b. Sen. Arlen Specter (D-PA) has an amendment that would delay implementation of the non-payment of consult codes for a year. The 2010 PFS would replace the consult codes with office visit codes, which will be a nightmare for practices to implement and also will reduce reimbursement yet again for Cardiology.

c. Chairmen Henry Waxman (Energy and Commerce), Charlie Rangel (Ways and Means) and Pete Stark (W/M health subcommittee) sent a letter to HHS Secretary Sebelius asking that CMS phase in the nuclear bundling, which resulted in a 36-percent cut in reimbursement.

CMS ANNOUNCEMENT: Medicare will hold claims for the first 10 business days of January (January 1 through January 15) for 2010 dates of service. They also added a cryptic “…be on the alert for more information about other legislative provisions which may affect you.” In past years, when Congress stepped in at the last minute to stop the SGR cut, CMS did not delay claims payment. It may be that Medicare is not prepared as in past years, or it may be that they are expecting a change in the consult codes, nuclear bundling, something else or nothing at all. Given what CMS has let happen to Cardiology this year, frankly CAA wouldn’t be surprised by much



Mike

Congress keeps telling us, don't worry, we will take care of you. They then pass laws that give us a repreive each year. It seems that they are playing Chicken with us each year and people are getting mad about having to grovel each year to keep the cuts from happening. In addition, CMS is holding up payments for at least 10 days this year. They did this in 2007 and we didn't get paid for 6 weeks. Even though they didn't pay us, our staff still wanted to be paid. That sure caused a cash flow problem.

Doctors feel they are getting jerked around and are just tired putting up with it.

There should be in permanent fix, I agree. I was just making the point that the 21% cut will never happen.

I'm somewhat familiar with RACs for hospitals (I assume you're referring to enhanced auditing). In the case of hospitals, I think it's a good idea. How will it work for docs?

[witchdoctor]

http://www.medicare.gov/Publications/Pubs/pdf/11349.pdf


In therory, RACs are great. Unfortunately, in the real world, there are problems. The idea is that Medicare wll recover payments that were incorrectly paid out.

Most of the recovered payments are due to problems with coding. In my specialty, the hospital gets paid 4 times more if a cath is done as an inpatient than if it is done as an outpatient. Medicare has over a 1000 pages defining what makes up outpatient vs inpatient. These are not always intuiitive. If a RAC decides that you have submitted the wrong code, then the hospital has to pay back all the money it received. You can appeal but it wil cost you about $2000 per case. The RAC keeps 10-15% of the money it collects. The RAC we have last year in the demostration project ruled that over 98% of heart caths were missed coded.

This basically adds another level of cost for the hospital. My sister works as a nurse in South Carolina and has seen 2 small hospitals go bankrupt due to RACs. In Tulsa, there are 3 hospitals that are barely making it and this could put them out of business. (thank God, I don't work for any of these.)
Do I think the Government will let a bunch of hospitals go under. I doubt it but they are going to have to come up with a new way to support these hospitals.

As for me, there is not a direct effect of RACs on me other than not getting upgrades in cath lab equipment and having to spend 3 hours one night a month in coding class learning the rules of the game. There was an article that I can't find now that there is a movement in Congress not to pay doctors for services rendered if the RAC determines that the admission was missed coded.

Too bad they can't make it more simple.