How will the vote fall out on HCR this weekend?

Also, DF brought up that this should cause a higher demand for doctors, but there wasn't anything in the bill about increasing the # of med students

I would think if there is an increase in demand it would especially be for primary care providers, as hopefully the currently uninsured will now be able to seek primary or preventative care (elsewhere than in the ER). The bill will help primary care doctors take on this extra population by increasing Medicaid payments to Medicare payment rates. It will be interesting to see if that pay rate increase will increase supply to meet the demand. As I understand it, many PCPs have had to leave the field because they simply couldn't afford to keep their doors open on Medicaid payouts. I hope this will help them. I will also be interested if more med students will consider going into primary care if it's increasingly possible to make a decent living

[poky]

I will also be interested if more med students will consider going into primary care if it's increasingly possible to make a decent living

Discussed this with some of DHs classmates last night; they think pay would have to go up a LOT (or become a LOT more equitable with specialty pay rates). They don't seem to think that making medicaid match medicare will be enough by itself to encourage more students to choose primary care.

[Thirteen]

From what I understand, the HCRA will not be adjusting PCP salary to match demand, or inflation. The demand is going to skyrocket, making less and less time with each patient possible. In addition, with school loans, who will want to be PCP after all us said and done? They are going to be at salary mid-level, with CRNAs and PAs. DH could gave made more as either one of those positions, with less time spent on education, and less debt. He did a lot of research on this whole bill, and is very disappointed with how it will be treating the PCPs as well as the specialists.

[Sheherezade]

What parts of the bill is he concerned about? I'm legitimately confused by some of these comments because I am unfamiliar with the parts of the bill you are discussing. Are these payment changes in the pilot program section? Or is this the reduction of payment to Medicare payments to hospitals (that the hospital association negotiated)? Please point me to the PCP changes that you are discussing.

I can see the concern about growing demand with a lot of newly insured people. I'd imagine these folks are the people that are currently crowding the ERs for primary care. I'd wait to see what happens; when DH was in med school his specialty choice was also shaped by the *huge push for primary care* . Years of talk about that. In the end, 10 years later.....look where we are. I honestly think a lot of the issues with primary care come not from availability but from a system that is designed to treat the whole patient via specialists in individual visits. Take this from a woman that has been referred by primary care to specialists 4 times this year for minor problems. That's just how our system is currently run; the culture has to change if we are going to get our care beyond prevention from one stop.

The payment provision to which I was referring is in Section 1202 of the Reconciliation Bill. The HB made the rate parity permanent. The Reconciliation Bill, for budget score issues I presume, provides for additional federal funds only through 2014. It creates a funding cliff like the one facing Medicare now. That's unfortunate, IMO, but I at least think it's a step in the right direction towards increased Medicaid payments to PCPs. I'd be curious why that's objectionable to a PCP.

Angie, I also agree that the issues with primary care seem systematic as opposed to just a matter of money.

[Sheherezade]

I'm familiar with that piece. That increases payment to PCPs for Medicaid patients, right? I've read it was partially designed in anticipation of practices turning away new numbers of Medicaid patients because they were (before) the lowest reimbursing care. I also don't see how that decreases physician compensation. Is that what others are referencing as well? I can see how it wouldn't entice people to PCP positions but I don't see that it harms the status quo.

The only "scary" bit I've found is the IPAB creation. Scary because of what it COULD recommend in the future. Congress would have to vote to block its actions - but isn't that similar to agency law already? Hospitals are exempt from their actions until 2020. After that, I suppose they can universally cap Medicare if Congress doesn't act to stop them. Not that that has been proposed or anything -- but they would have the power to do so.

[SuzySunshine]

Ok, I've read mostly everything that people have recommended I read - I still don't understand how this affects us - the providers! My DH is going to finish training in June 2012 - some things in this bill go into effect around that time. Is he going to be able to find a job? Are hospitals going to be hiring? Or are they going to be freezing because they don't know what the next round of ramifications will bring?

I'm really frustrated that everyone seems to be really behind this or really against it but no one is looking at the long term ramifications. Like Sandy said there is going to be a PCP shortage - how is that going to be fixed? What is going to be the motivation for people like my husband to go through 8 years of residency/fellowship if their reimbursements are decreased so much its not worth it. There are already not enough neurosurgeons in this country because of malpractice insurance and the types of surgery they can do based on facilities, etc.

I don't know - I've had my head in the sand to this point because there wasn't really anything the common person could do about it. But my friends fb status updates in the last 36 hours are just killing me. I just want to scream at the people who think doctors are going to be the solution and/or the problem when they have NO idea what it really takes to become a doctor both in time and in debt.

I don't know, I just don't know.

[Sheherezade]

Cheri -

I posted a link for you on FB. Here it is again. http://www.ama-assn.org/ama/pub/heal...-passage.shtml

Also try poking around in Ezra Klein's post list at this page. http://voices.washingtonpost.com/ezr...health_reform/ He covers a lot of topics in the bill.

[radwife]

After hearing the many complaints that DH has made this month during his rotation in the ER. I found the link below interesting. I'm sure it's not the norm in every hospital emergency room but a large portion of patients that he has seen are homeless, drunk, and unemployed. Not to mention completely ungrateful and rude, but I digress... What I really wonder is how are you going to be able to assess a fine on these people? They don't have a home, work, and/or pay taxes. I'm pretty sure they will still get treated if they walk into the ER. I don't see how this penalty is at all going to help offset the ER costs at this hospital.


http://www.csmonitor.com/USA/Politic...-buy-insurance
Are there penalties if you don't buy insurance?

If you ignore this mandate and don’t get health insurance, you’ll have to pay a tax penalty to the federal government, beginning in 2014. This fine starts fairly small, but by the time it is fully phased in, in 2016, it is substantial.
An insurance-less person would have to pony up whichever is greater: $695 for each uninsured family member, up to a maximum of $2,085; or 2.5 percent of household income. There are exceptions. Certain people with religious objections would not have to get health insurance. Nor would American Indians, illegal immigrants, or people in prison.


Unrelated to the above, but I thought it was interesting that there are changes to the student loan industry coupled in with the healthcare bill. Can't wait to find out what other little gems are buried in there.

[poky]

I don't see how this penalty is at all going to help offset the ER costs at this hospital.

Despite the stories you're hearing, a LOT of the people who use the ER as primary care *do* have homes and/or jobs or both, just no insurance. Once they have insurance, they'll be more likely to go to a primary care doc before it gets bad, rather than wait and then go to the ER. No, this attitude shift will not happen immediately, and yes, it's possible that some ERs have disproportionate numbers of homeless that still won't have insurance, but overall, ER costs will go down eventually.

[Sheherezade]

All well and good, but the 21% cut is not part of this bill. That was enacted by changes to Medicare months previous to this and has been delayed through 2010 by an amendment on the unemployment extension bill last month. The 21% cut actually is on specialists by changing coding for medicare to eliminate consult codes. Specialist can no longer bill at a higher rate for their care when they consult. They have to treat their care the same as a PCP. I think that particular 21% cut was enacted to improve the lot of PCPs vs. specialists.

Maybe we are talking about a different cut back. I'm not sure if their are PCP cuts to Medicare in the HCRA. I don't think there are apart from the Medicare Advantage private insurance programs losing their federal subsidy.

[scrub-jay]

I don't know - I've had my head in the sand to this point because there wasn't really anything the common person could do about it. But my friends fb status updates in the last 36 hours are just killing me. I just want to scream at the people who think doctors are going to be the solution and/or the problem when they have NO idea what it really takes to become a doctor both in time and in debt.

ITA. I am so frustrated with FB status updates right now. How can they understand enough to form an opinion? And the common opinion about doctors being the solution - same as the stereotypes about being in medical school or residency and being RICH! No one understands, and as always it is incredibly frustrating.

[scrub-jay]

Unrelated to the above, but I thought it was interesting that there changes to the student loans industry coupled in the healthcare bill. Can't wait to find out what other little gems are buried in there.

I read about this briefly, *I think* it makes federal student loans all direct (from fed gov't) loans. As in: no more bank-administered federal loans. I don't think it changes private student loans...but I'm not sure. I have no idea how this relates to healthcare! Supposedly, this will save quite a bit of money for the fed govt.

[alison]

I'm not nearly informed enough to form an educated opinion on this, and will have to wait and see how this all shakes out. Having said that, my parents paid OUT OF POCKET when my mom delivered me and for all our medical care until I was around 10 years old. This shouldn't happen in a civilized society like ours.

When push comes to shove, I am not nervous about taxes nor what possible pay cut my dh may encounter. Affordable healthcare for everyone is a cause I can get behind.

[DCJenn]

The changes to the student loan process are fairly straightforward. Rather than people applying for Federal Student aid and having the Feds pay the bank (which of course took their administrative fees) the Feds are going to pay the borrower directly. Other than that, there's no real change to the program as it's always been a Federally administered program.

Jenn