Health care law changing behavior

[TheTrueCentrist]

usatoday.com/news/washington/story/2011-12-05/Medicare-prescription-drugs-health-care-law/51663580/1?loc=interstitialskip

WASHINGTON – More than 2.65 million Medicare recipients have saved more than $1.5 billion on their prescriptions this year, a $569-per-person average, while premiums have remained stable, the government plans to announce today. …

And, as of the end of November, more than 24 million people, or about half of those with traditional Medicare, have gone in for a free annual physical or other screening exam since the rules changed this year because of the health care law.

 

[bbarrick8383]

24 million people have gone in to get exams…wonder what will happen if the number of doctors decreases like some have said.

 

[SamH]

24 million people have gone in to get exams…wonder what will happen if the number of doctors decreases like some have said.

How many got exams before the law took effect?

As for “lowering costs” who paid for those 24 million “free” exams?

 

[Ridgerunner]

24 million people have gone in to get exams…wonder what will happen if the number of doctors decreases like some have said.

There is more to it than this. The emphasis truly is shifting, and very quickly, to “well patient care”. Lots and lots of people who previously could get treatment under medicaid no longer can, and Medicare is not far behind. If the “doctor fix” is not made (a way to deceive the public about the true costs) Medicare people will find a lot more doors shut to them in 2012. The reimbursement formulae have shifted so that the big money really is in well patient care.

So, what does that really mean? Well, sure, if you go in for a routine checkup, you will find plenty of medical takers, as long as they find nothing wrong with you. That’s where the money now is. Medical providers are shedding patients with chronic conditions, disabilities, or “lifestyle” negatives such as obesity or tobacco use. Why? Because such people take up more physician time relative to the reimbursement. Under present formulas, doctors are actually penalized in pay if they put someone in the hospital.

So, yes, recent changes have been a boon for people who want to go to the doctor to be expensively or inexpensively tested and told there is nothing wrong with them, or perhaps to lose a modest amount of weight or to get more exercise. For people who really need medical care badly, it is rapidly becoming a very bad situation, and, as I said before, it is likely to get worse.

 

[TheTrueCentrist]

There is more to it than this. The emphasis truly is shifting, and very quickly, to “well patient care”. Lots and lots of people who previously could get treatment under medicaid no longer can, and Medicare is not far behind. If the “doctor fix” is not made (a way to deceive the public about the true costs) Medicare people will find a lot more doors shut to them in 2012. The reimbursement formulae have shifted so that the big money really is in well patient care.

So, what does that really mean? Well, sure, if you go in for a routine checkup, you will find plenty of medical takers, as long as they find nothing wrong with you. That’s where the money now is. Medical providers are shedding patients with chronic conditions, disabilities, or “lifestyle” negatives such as obesity or tobacco use. Why? Because such people take up more physician time relative to the reimbursement. Under present formulas, doctors are actually penalized in pay if they put someone in the hospital.

So, yes, recent changes have been a boon for people who want to go to the doctor to be expensively or inexpensively tested and told there is nothing wrong with them, or perhaps to lose a modest amount of weight or to get more exercise. For people who really need medical care badly, it is rapidly becoming a very bad situation, and, as I said before, it is likely to get worse.

And you have evidence of this malpractice?

 

[Charlotte408]

WASHINGTON – More than 2.65 million Medicare recipients have saved more than $1.5 billion on their prescriptions this year, a $569-per-person average, while premiums have remained stable, the government plans to announce today. …

That is weird because over here every night on the news its some different company being protested because they are trying to put the costs of the healthcare changes onto the workers…

The union has organized numerous boycotts, strikes and other actions during the negotiations, which Mehta-Neugebauer said has only resulted in proposals from management that would “increase the burden of health care costs on workers…and increase workloads that would jeopardize worker safety.”

sanfrancisco.cbslocal.com/2011/02/10/23-hotel-workers-arrested-in-sf-hyatt-regency-protest/

(crying: the unions wanted free healthcare but lo’ they have to pay for it))

And, as of the end of November, more than 24 million people, or about half of those with traditional Medicare, have gone in for a free annual physical or other screening exam since the rules changed this year because of the health care law.

And this makes absolutely NO sense to me. I’m on medi-cal. It’s free for us. Always has been. Nothing is changing as far as we are concerned. Why would people suddenly be excited and use something they’ve already had?

Unless…what they meant to say is that the amount of people who are on medi-cal has risen, because of the changes (it’s easier to get the assistance) therefore resulting in more visits to the doctor.

 

[SamH]

And you have evidence of this malpractice?

Besides you who said it was malpractice?

news.heartland.org/newspaper-article/survey-doctors-dropping-out-medicare

A new survey of Texas doctors, conducted by the Texas Medical Association, indicates more Lone Star State physicians are severing all ties with the federal Medicare program, possibly as a reaction to anticipated cuts in physician payments.

John Graham, chair of the health care studies department at the Pacific Research Institute in San Francisco, believes the Patient Protection and Affordable Care Act is going to increase the trend of doctors dropping out of Medicare and refusing to treat Medicare-covered patients.

“ObamaCare has really exacerbated this trend,” Graham said. “The data from Texas shows that what doctors are doing there is really in line with the number reports coming from the Mayo Clinic and others showing that doctors are not going to take Medicare patients anymore. I think that the reports from the Texas Medical Association and others probably are actually understating the situation.”

articles.nydailynews.com/2010-10-04/news/27077343_1_medicare-patients-medicare-beneficiaries-medicare-payment-advisory-commission

Jacobs is one of a growing number of doctors opting out of Medicare or restricting the number of Medicare patients they’ll treat because they deem reimbursement rates too low. The doctor said he knows of about a dozen colleagues who’ve made a similar move.

“I’m seeing a trend of more experienced doctors dropping Medicare,” said Irene Zelterman, a geriatric care manager in Park Slope, Brooklyn. “Some of my clients are forced to go to a doctor who maybe isn’t my first choice.”

The trend could accelerate further if Congress doesn’t act soon. If nothing is done by Dec. 1, Medicare will proceed with an across-the-board payment cut to doctors of 23%.

“This would be a real catastrophe,” said Cecil Wilson, president of the American Medical Association, which is lobbying lawmakers hard to prevent the cut.

A recent American Medical Association survey of 9,000 doctors who care for Medicare patients found one-in-five had already chosen to limit the number of Medicare patients in their practice, citing the ongoing threat of future cuts and low payment rates. Among primary care doctors, the percentage was much higher, nearly one-third.

Apparently Obama Care is changing the way health care is handled.

 

[Ridgerunner]

And you have evidence of this malpractice?

Legally, at least, it isn’t malpractice to refuse patients.

Unlike Sam, I haven’t looked for published verification. I just know it’s happening because my wife is an RN in charge of the healthcare of a great number of disabled people, who usually have a lot of problems, and my daughter is an NP who knows the directives she and other NPs as well as physicians have been given. The new formula has a name, but I can’t remember what it is. But basically, it encourages frequently pointless “well care” and discourages treatment of the truly ill, especially those with chronic conditions who develop additional problems. That really tends to throw the disabled out in the cold.

It’s because the time needed to deal with sick people is longer than it is to deal with well people (no surprise there) and the reimbursement does not adequately compensate for that greater amount of time.

Older people, of course, are much more prone to chronic conditions than are younger people. It takes more time to competently treat them than it generally does for younger people. Obama and Pelosi did promise, as we know, to reduce Medicare expenditures by $500 billion, and perhaps they weren’t just blowing smoke in saying that.

I’ll have to admit I didn’t see it coming, though my wife sure did. Looking back on it, I can recall how everybody was hyped on “well care”…all that talk of how all kinds of money was going to be saved through an emphasis on “prevention” and “healthful practices”. She said all along that it was a prelude to increased dumping of those with chronic conditions, and it appears she was right, because that’s what’s happening right now.

I have recently been re-reading Gibbon, and, while the history itself is interesting, some of the tangential information is as well. Been reading a book on the Napoleonic era as well, and tangential information about health in that is also interesting.

Clearly, for millenia, people have often died young, much more than now. That allows us to claim wonderfully longer average lifespans. But just as clearly, death at early ages was almost entirely due to two things: Violence and communicable diseases. But it is just as clear that if people survived into middle age, they pretty much lived as long and in as good health as we do, with some exceptions largely related to communicable diseases or conditions that we would now describe as physiologically based “chronic illnesses” in which the patients were often killed by preposterous treatments like bleeding, violent purges or ingestion of ground-up jewels. But on the whole, their lifespans were no different from ours today, and their health was little different, generally.

So one really does have to wonder how much “well care” really extends life spans.

But Sebelius has decreed that chemical abortifacients are to be free under Obamacare. So I guess it’s all okay.

 

[Suudy]

Unlike Sam, I haven’t looked for published verification. I just know it’s happening because my wife is an RN in charge of the healthcare of a great number of disabled people, who usually have a lot of problems, and my daughter is an NP who knows the directives she and other NPs as well as physicians have been given. The new formula has a name, but I can’t remember what it is. But basically, it encourages frequently pointless “well care” and discourages treatment of the truly ill, especially those with chronic conditions who develop additional problems. That really tends to throw the disabled out in the cold.

I too can confirm this. My wife is an RN, and she’s working with the medical director on a program for the RN’s to call their chronic patients and get them in for regular checks before they call 911.

Most of these patients are on MediCare (or some other program that the state of Washington has–I can’t remember the name), and usually wait until they are very ill, call the RN, describe a serious condition, and eventually are counseled to call 911. Then they fail to show up for the followup that the ER doctor suggests. And the cycle continues.

Now, whether or not this is “pointless ‘well care’”, I’m not sure. In discussions with my wife, this program is targeted at the people are the worst at this. And in many cases, I suspect that the “well care” will prevent ambulance rides and ER visits. One quick anecdote. My wife took a call from an elderly patient suffering from dizziness and trouble breathing. She went through the whole usual triage, and recommended the patient come in immediately for an appointment. The patient couldn’t drive, so they called the “cabulance” to bring her into the office. After the appointment, it was determined that the patient had run out of her heart medication, didn’t call to get a refill, and went 3 days without it. A simple call to the clinic to request a refill and a request for delivery (which my wife’s clinic does from the in-clinic pharmacy for homebound and elderly patients), would have prevented the “cabulance” to and from the patient’s home, a checkup, the doctor’s time, and my wife’s time. It is this kind of cost savings that can be had through “well care” checks.

 

[seekerz]

And you have evidence of this malpractice?

I’m wondering, 'cause the last I checked in my area, the hospitals are still full of seniors and I haven’t heard of docs refusing to admit patients. Quite the contrary: doctors seem to be still busily ordering every procedure and test they can remotely justify on their hospital patients - and the more they do the more they get paid because each encounter is a separate charge. That’s where the real money is for doctors, which is why specialties which include ‘procedures’ (usually the surgical specialties) are so attractive.

 

[seekerz]

I too can confirm this. My wife is an RN, and she’s working with the medical director on a program for the RN’s to call their chronic patients and get them in for regular checks before they call 911.

Most of these patients are on MediCare (or some other program that the state of Washington has–I can’t remember the name), and usually wait until they are very ill, call the RN, describe a serious condition, and eventually are counseled to call 911. Then they fail to show up for the followup that the ER doctor suggests. And the cycle continues.

Now, whether or not this is “pointless ‘well care’”, I’m not sure. In discussions with my wife, this program is targeted at the people are the worst at this. And in many cases, I suspect that the “well care” will prevent ambulance rides and ER visits. One quick anecdote. My wife took a call from an elderly patient suffering from dizziness and trouble breathing. She went through the whole usual triage, and recommended the patient come in immediately for an appointment. The patient couldn’t drive, so they called the “cabulance” to bring her into the office. After the appointment, it was determined that the patient had run out of her heart medication, didn’t call to get a refill, and went 3 days without it. A simple call to the clinic to request a refill and a request for delivery (which my wife’s clinic does from the in-clinic pharmacy for homebound and elderly patients), would have prevented the “cabulance” to and from the patient’s home, a checkup, the doctor’s time, and my wife’s time. It is this kind of cost savings that can be had through “well care” checks.

I see no problem in trying to get to people before they get sicker and need more expensive emergency services. That’s how the system should work; as the old adage goes: prevention is better than cure. If doctors were being asked to go against medical guidelines, I’m pretty sure there would be some loud noises going on right about now.

 

[SamH]

I’m wondering, 'cause the last I checked in my area, the hospitals are still full of seniors and I haven’t heard of docs refusing to admit patients. .

So you think your personal observations carry as much or more weight than studies conducted by the AMA?

 

[seekerz]

So you think your personal observations carry as much or more weight than studies conducted by the AMA?

I didn’t notice any such citations given in the thread I was responding to. If I overlooked that I’m sorry. Generally speaking though, I think the selfishness of: ‘there won’t be enough for all’ is a lamentably pathetic (and selfish and self-centered and uncaring and un-Christian…) excuse for continuing to accept what was the status quo in health with regard to accessibility.

 

[SamH]

I didn’t notice any such citations given in the thread I was responding to. If I overlooked that I’m sorry. Generally speaking though, I think the selfishness of: ‘there won’t be enough for all’ is a lamentably pathetic (and selfish and self-centered and uncaring and un-Christian…) excuse for continuing to accept what was the status quo in health with regard to accessibility.

Don’t let anything like facts get in your way of thinking.

Just because there was a change doesn’t mean it made anything better and pointing out how it has actually made things worse is hardly and self-centered and uncaring and un-Christian.

 

[seekerz]

Don’t let anything like facts get in your way of thinking.

Is that a personal tip you’re sharing, Sam?

Just because there was a change doesn’t mean it made anything better and pointing out how it has actually made things worse is hardly and self-centered and uncaring and un-Christian.

That was not what I said. I said accepting the status quo with regard to access to health care is …all those adjectives.

 

[Trader]

I must be in a good mood today, because I saw the title of this thread as a hopeful sign. To reduce the cost of health care we need to change behavior.

We need the near 25% of adults who still smoke after 47 years of official government warnings to change their behavior.

We need the more than 50% of Americans who are overweight to change their behavior.

We need the sexually promiscuous who are spreading diseases and failing to provide for the children they produce to change their behavior.

We need the drug abusers who are intentionally putting poison into their bodies to change their behavior.

Unfortunately, the health care reform law takes us in the opposite direction. It is modelled on the financial failure called Medicare that snuffs out the virtues of a free market which has incentives to avoid risk, to innovate, to reduce fraud, and disrespects the concept of subsidiarity. With govenment insurance the sexually promiscuous, drug abusing, morbidly obese chain smoker pays no more than the person who makes none of those foolish, immoral, or criminal choices. Instead of providing incentives for good choices, it provides subsidies for bad choices.

 

[SamH]

Is that a personal tip you’re sharing, Sam? .

Just an observation based on what was written in your post.

That was not what I said. I said accepting the status quo with regard to access to health care is …all those adjectives.

Of course it’s not what you said - it’s what I said.

 

[Ridgerunner]

I’m wondering, 'cause the last I checked in my area, the hospitals are still full of seniors and I haven’t heard of docs refusing to admit patients. Quite the contrary: doctors seem to be still busily ordering every procedure and test they can remotely justify on their hospital patients - and the more they do the more they get paid because each encounter is a separate charge. That’s where the real money is for doctors, which is why specialties which include ‘procedures’ (usually the surgical specialties) are so attractive.

Things may well vary from place to place. But around here, hospitals are anything but full. Hospital care is enormously expensive, and reimbursements end quickly. That’s why nursing homes are rapidly becoming the “hospitals” for the chronically (and terminally) ill.

And yes, testing pays well, unless it involves very complex testing. Then it doesn’t.

And general surgeons would mightily dispute the assertion that surgical specialties are well paid across the board. Neurosurgeons, yes. Orthopaedic surgeons, yes. General surgeons, (the guys who take out your appendix or gall bladder) no.

 

[Ridgerunner]

I must be in a good mood today, because I saw the title of this thread as a hopeful sign. To reduce the cost of health care we need to change behavior.

We need the near 25% of adults who still smoke after 47 years of official government warnings to change their behavior.

We need the more than 50% of Americans who are overweight to change their behavior.

We need the sexually promiscuous who are spreading diseases and failing to provide for the children they produce to change their behavior.

We need the drug abusers who are intentionally putting poison into their bodies to change their behavior.

Unfortunately, the health care reform law takes us in the opposite direction. It is modelled on the financial failure called Medicare that snuffs out the virtues of a free market which has incentives to avoid risk, to innovate, to reduce fraud, and disrespects the concept of subsidiarity. With govenment insurance the sexually promiscuous, drug abusing, morbidly obese chain smoker pays no more than the person who makes none of those foolish, immoral, or criminal choices. Instead of providing incentives for good choices, it provides subsidies for bad choices.

I think you will find, soon, that those people who have unapproved lifestyle habits (except sexual promiscuity, of course) will be on the outside of the healthcare world, looking in. Well, also excepting those who enjoy political power or favor, of course.

Nevertheless, one does need to wonder at least a little about a society that purports to “change the behavior” of its citizens, particularly if the “change” does not clearly lead to any societal or even individual benefit and presents no clear and present danger to anyone. Do we, like the giddy early Bolsheviks somehow think we are going to abolish illness and death by fiat or overblown optimism based on anecdotal science? Yes, studying well people will definitively establish…that they’re well.

It is well known that members of contemplative religious orders enjoy remarkably good health and long lifespans. But does that mean that the government should therefore impose Carmelite-like behavior on everyone? A single cup of vegetable soup for Thanksgiving, perhaps. Or perhaps instead a bowl of boiled nettles. After all, the inhabitants of the Gulag lived on that, didn’t they, and their BMIs were wonderfully low. And if the inhabitants of the Gulag smoked manure in the absence of tobacco, well, there are no statistics kept of the hazards of the former, so perhaps that can be permitted.

It truly does astonish me that in a supposedly free society there are so many who so readily revert to what is essentially a secular Puritanism, and upon such uncertain premises. If we can’t be allowed to be overweight, then what can we be allowed with any certainty? To follow the dictates of the state, one supposes.

 

[seekerz]

I think you will find, soon, that those people who have unapproved lifestyle habits (except sexual promiscuity, of course) will be on the outside of the healthcare world, looking in. Well, also excepting those who enjoy political power or favor, of course.

Nevertheless, one does need to wonder at least a little about a society that purports to “change the behavior” of its citizens, particularly if the “change” does not clearly lead to any societal or even individual benefit and presents no clear and present danger to anyone. Do we, like the giddy early Bolsheviks somehow think we are going to abolish illness and death by fiat or overblown optimism based on anecdotal science? Yes, studying well people will definitively establish…that they’re well.

It is well known that members of contemplative religious orders enjoy remarkably good health and long lifespans. But does that mean that the government should therefore impose Carmelite-like behavior on everyone? A single cup of vegetable soup for Thanksgiving, perhaps. Or perhaps instead a bowl of boiled nettles. After all, the inhabitants of the Gulag lived on that, didn’t they, and their BMIs were wonderfully low. And if the inhabitants of the Gulag smoked manure in the absence of tobacco, well, there are no statistics kept of the hazards of the former, so perhaps that can be permitted.

It truly does astonish me that in a supposedly free society there are so many who so readily revert to what is essentially a secular Puritanism, and upon such uncertain premises. If we can’t be allowed to be overweight, then what can we be allowed with any certainty? To follow the dictates of the state, one supposes.

There is a middle-ground (I’m growing to live the middle more everyday) between state-mandated ‘behavior change’ - not that behavior change works very well as an approach to health - and unfettered obesity. It’s called empowerment - given the opportunity to both acquire knowledge of health preservation AND the opportunity to provide (name removed by moderator)ut to the discussions and the policies that flow from them - most individuals and communities can come to sensible solutions that approximate to their values without placing undue strain on limited health resources.

I reject the notion that freedom is limited to living one’s life in blissful, irresponsible ignorance of the consequences to self or to society as a whole.