House Healthcare Reform Bill Passes

[NYCHoosier]

Did we decide to not debate this on here anymore? (I thought I saw that sentiment in another post, but I may be confused). If so, no debating. But, I thought you'd like to know...

http://online.wsj.com/public/article...373535753.html

Should be interesting to see what happens in the Senate.

[rainbabies]

I saw this as breakng news last night. :/

I'm looking for details on the $400 billion cut from Medicare over the next decade. If someone finds it, please post a link.

[rainbabies]

I'm looking for details on the $400 billion cut from Medicare over the next decade. If someone finds it, please post a link.

holy crap. i'll be interested in seeing that.

I found this, Medicare comments in the middle:
http://online.wsj.com/article/SB1000...055918380.html

Yes, I realize it is an opinion piece.

[GrayMatterWife]

Yes, please, please: the same people who operate Medicare and Social Security at a deficit, let's put them in charge of 20% of the economy. Let's put in charge the same people who couldn't operate the Cash for Clunkers program at a profit, who are going to take a bath on billions in the CIT bankruptcy, and who think that investing in Chrysler was a good idea for a return on the money. The people who couldn't manage to not screw up getting H1N1 innoculations properly and timely distributed seem like the perfect choice to manage health care. Let's spend a trillion dollars (low estimate) that we don't have and create a system whereby doctors will be disinclined to accept government insurance programs and will create an entitlement that will never, ever go away. And, let's be lead into "improving" health care by Obama--the same guy whose wife got a cushy,$300K+ a year job (for which she had no qualifications) at U of Chicago med (in exchange for State Senate earmarks to that institution), and managed to wreck the hospital so badly that the number of underprivileged they served dropped significantly. It's like no one has bothered to see what sanctimonious, condescending "community activitism" has actually produced (an unmitigated failure). This is what happens when you put people in charge who have no idea what they're doing and have absolutely no business sense about the situation. But "Yes, We Can!" sounded like they really knew what they were talking about, I guess.

Obama is just arrogant and badly unqualified (since smooth-talking and poetry really don't count for much past the camera, as it turns out), but that is almost forgivable. He actually believes his own PR. Congress knows better and they are being a bunch of tone-deaf idiots. It will be interesting to see what happens in the Senate. I just hope this mess gets dragged out to February--hopefully, that will put any final vote close enough to the 2010 elections to cause the politicians to actually consider what their constituencies want. Just loved Obama's threat/pitch to his home team made yesterday: "You're damned if you do, you're damned if you don't. So why don't you choose to be damned for doing?" Excellent reason to vote for this bill. Learn that art of persuasion at Harvard or in the backalleys of Chicago politics?

Now the jobs recovery is going to be stalled for forever. No one is going to be creating new jobs that they will be punished for, any time soon.

The Dems have broken so many promises on getting this thing rammed through that I've lost track of the count. The primary one, of course, is the complete joke that it will not increase the deficit. Or the promise of transparency. Or bipartisanship. Or no tax increases. Or a focus on economic recovery and creating a job-creating environment. Every time I hear Obama speak, I want to vomit. He's so full of crap. Everytime I see Nancy Pelosi, I want to ask: "So, will Botox be included in this wonderful bill, since you seem to think so much of it?"

just my two cents.

[radwife]

I downloaded the 1990 page bill and DH and I read some of it. I highly doubt these representatives read the entire thing let alone understood it. I agree that something needs to be done for healthcare, but 1900 pages of a bunch of junk with some needed improvements tossed in there is not the way. Unbelievable.

Here's the details of the vote: http://politics.nytimes.com/congress...7?ref=politics

[DCJenn]

The entire content is available online.

Jenn

[PrincessFiona]

Nellie,

Here is one link from July
http://www.cms.hhs.gov/apps/media/pr...&cboOrder=date

Sadly, some of these have gone through. Thomas got an email of information from the IDSA about the fact that after January he will no longer be able to bill for hospital consults. What a joke THAT is! At least 50% of his practice IS hospital consults. The clinic visits are at least half follow-ups from the hospital. Basically, Medicare will pay for chemo for a 95 year old with end stage cancer but won't pay for a consult for ID for a 65 year old in the hospital for a hip replacement or something. This forces new billing/coding crosswalks that will be a major headache and will not offer equal reimbursement.

Basically, this will force specialists to either stop seeing medicare patients, provide shorter, potentially lower quality care than they already get or will make it so that now docs have to come up with new code to bill things. As it is, the current recommendation is to bill not a consult but now as a new patient...this requires another H and P be placed in the chart and won't net savings for medicare. It will increase the paperwork.

I just had my very last moment as a democrat over this. Officially, I am without a party...I had an argument with a friend because she said doctors are GREEDY and should see patients out of the privilege to do so, not for pay. Right...and I'll tell the repairman who just charged me $100 for the 10 minute fix on my washing machine last week that he should do it for free because it's the right thing to do or refuse to pay all of the bill. My husband personally would never not see a patient based on their ability to pay. I don't know about other docs.

One of my closest friends here is a die-hard dem who called me in tears when Obama won. Her husband is a specialist here. Guess who is not happy with the way things are shaping up now?

Oh well....

Doctors are between a rock and a hard place. If they ask to be paid for their consults they are greedy...if they don't fight it, they are idiots.

It's too bad our government can't actually do something right. I'm so disgusted. Imagine what a government sponsored healthcare program would look like in America...it's scary. It would be one thing if the people putting this together actually had a few brain cells.

Kris

[PrincessFiona]

Last week, Coding News outlined highlights of the proposed Medicare Physician Fee Schedule, printed in the July 13 Federal Register. Today, we’ll look more closely at some of the black holes–such as the reimbursement hit practices will take when they must charge E/M visits instead of consults. But we won’t ignore shining little lights such as a payment boost for the ‘Welcome to Medicare’ exam.
CMS is projecting a record 21.5 percent rate cut, and proposes halting payment for consult codes in 2010. Instead of reporting consult codes, you’d report new or established patient office visit or hospital care (E/M) codes for these services, and CMS would increase payments for the existing E/M codes.
To determine the impact of this change, you’d have to compare the reimbursement from the new fee schedule office visit fees vs. the current office consult fees, as well as the new hospital visit E/M charges vs. the current hospital consult fees, says Quinten A. Buechner, MS, MDiv, CPC, ACS-FP/GI/PEDS, PCS, CCP, CMSCS,president of ProActive Consultants in Cumberland, Wis.
Using this year’s figures, you’d lose between $16 to $45 for office consults that would now be coded as new patient visits, and you’d lose $30 to $100 for established office consults coded as E/Ms, Buechner says. A rough calculation shows that the additional E/M payments (proposed at 6 to 8 percent) may not cover the loss of consult money. This could cause pay cuts for specialists in particular, who bill consults more often than primary care physicians.
AUDIO: Do you use the 1995 E/M Guidelines? Then don’t miss the 4×4 rule.
Potential good news: Whether or not the pay cuts will actually become final is anyone’s guess. “Since far less draconian cuts have been reversed by Congress over the past seven years, and since the current plan in Congress and in the Obama Administration is to finalize a health care reform package by November, I expect that this issue will be addressed before the draft regulation takes effect,” says David C. Harlow, Esq., of The Harlow Group in Newton, Mass.
More MPFS Highlights (& Their Page Numbers)
1. The proposed conversion factor for 2010 is $28.3208, which results in the -21.5 percent payment update (page 663 of the proposed rule).

[GrayMatterWife]

I just had my very last moment as a democrat over this. Officially, I am without a party...

Kris: I say, don't give up on your party. There is nothing that says that ALL Dems have to buy into this crap. Almost forty of them didn't from the House. Make your party work for YOU and represent your values and goals. That's what we're trying to do with our party after the Bush years of fiscal irresponsibility. What would be truly a bipartisan success is for fiscally responsible Dems and Reps and Indeps to come together, to figure out a way to improve the system, rather than to turn it into a partisan feeding trough of power.

[rainbabies]

For several years, dh has talked about concierge medicine. He's even more interested in it, now.

[Vishenka69]

Doctors are between a rock and a hard place. If they ask to be paid for their consults they are greedy...if they don't fight it, they are idiots.

It's too bad our government can't actually do something right. I'm so disgusted. Imagine what a government sponsored healthcare program would look like in America...it's scary. It would be one thing if the people putting this together actually had a few brain cells.

My sentiments exactly. DH is also a big proponent of concierge medicine.

[GrayMatterWife]

My sentiments exactly. DH is also a big proponent of concierge medicine.

I completely understand the concierge medicine interest. I know a couple of Big City docs who do it and it works well. It just makes me sad that this is the most reasonable business solution. If widely popularized, it will create a two-tiered system of medical services--those for the haves, and those for the have-nots. And we all know where the most talented docs with the cutting-edge technologies will be.

Fifty years ago, there wasn't such a thing as medical insurance, like we have it now. You bought catastrophic coverage and paid for the smaller stuff out of pocket. This encourages better consumer evaluation of services and people are more cost-aware. And, it allows docs to do more sliding scales on their services. People who can pay, do, and people who can't pay as much, pay less. Now, docs are prohibited by Medicare from doing that. The only charity is at the discretion of the government for the governmentally insured.

[rainbabies]

If we have to pay out the wazoo for medical training, we're making the money to go with it.

yup.