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Posted: 10/21/2016 9:20:45 AM EDT
Ah yes... MACRA.
Paying for "quality" care, but putting the onus entirely on the doctors. Because compliance with therapy doesn't matter, right? The patient has no free will of their own... right? Yeah. 
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Posted: 10/21/2016 9:28:33 AM EDT
[#1]
Quoted:
Ah yes... MACRA. Paying for "quality" care, but putting the onus entirely on the doctors. Because compliance with therapy doesn't matter, right? The patient has no free will of their own... right? Yeah.
Link There is so much I want to say based on what I see in our small hospital, but I don't even know where to begin. |
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Posted: 10/21/2016 9:34:40 AM EDT
[#2]
See...Pelosi was right....they needed to pass the legislation so they could see what was in it. How could they have predicted that taking money out people's pockets would impact how they participate in the Healthcare system?
Anymore, to think that the Washington insiders aren't deliberately steering this nation off a cliff is on the verge of being criminally naive. |
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Posted: 10/21/2016 9:43:47 AM EDT
[#3]
Quote HistoryQuoted:
There is so much I want to say based on what I see in our small hospital, but I don't even know where to begin. Quote HistoryQuoted:
Quoted:
Ah yes... MACRA. Paying for "quality" care, but putting the onus entirely on the doctors. Because compliance with therapy doesn't matter, right? The patient has no free will of their own... right? Yeah.
Link There is so much I want to say based on what I see in our small hospital, but I don't even know where to begin. This. If didn't have 20 years in, I'd do something else. |
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Posted: 10/21/2016 9:46:53 AM EDT
[#4]
Quote HistoryQuoted:
This. If didn't have 20 years in, I'd do something else. Quote HistoryQuoted:
Quoted:
Quoted:
Ah yes... MACRA. Paying for "quality" care, but putting the onus entirely on the doctors. Because compliance with therapy doesn't matter, right? The patient has no free will of their own... right? Yeah.
Link There is so much I want to say based on what I see in our small hospital, but I don't even know where to begin. This. If didn't have 20 years in, I'd do something else. I am pushing my fiancee to look at doing concierge medicine once done with residency. Nothing that touches government money. |
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Posted: 10/21/2016 9:47:38 AM EDT
[#5]
I'm sure dirt cheap doctors from India will be willing to do the work.
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Posted: 10/21/2016 9:55:13 AM EDT
[#6]
This is a potential disaster for our rural community. We don't have the numbers to make this work, statistically.
On top of that, we are the last bastion of care. If a diabetic patient, (for example), is non-compliant, the Endocrinologist simply fires him, removing the non-compliant patient from his statistical pool. Guess where he ends up? That's right, with me. I have nowhere to send him. Fun times. Maybe I'll go to gunsmithing school. I already have a lathe and a mill |
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Posted: 10/21/2016 9:55:21 AM EDT
[#7]
For the TL:DR crowd.
MACRA's goal — to create a payment system that promotes better quality of care for patients and spends taxpayer money wisely — is sound. However, the necessary infrastructure to achieve that goal — meaningful quality measures and viable APMs — is not yet in place. If MACRA is implemented according to the arbitrary timeline set by the administration, it could force doctors to abandon private practice for salaried positions or leave practice altogether — neither of which would be good for patient care. So, yes, we all should care how doctors get paid. |
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Posted: 10/21/2016 9:58:44 AM EDT
[#8]
Quote HistoryQuoted:
I am pushing my fiancee to look at doing concierge medicine once done with residency. Nothing that touches government money. I have a buddy that went cash only/ concierge GP a few years ago. He was hurting for about a year until his client list started to grow. Now he's doing pretty well, is almost always busy, and his staffing costs are 1 receptionist and 1 nurse. Previously I think he said he had to have 3 office staff and maybe 2 nurses. Definitely the way to go if you're in an area that 1) can afford it and 2) is accepting of cash only services. |
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Posted: 10/21/2016 10:00:25 AM EDT
[#9]
With medicare just a few years from no money, what did you think would happen. I'm well versed in Medicare and even the money they collect for a hospital stay is nothing.
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Posted: 10/21/2016 10:02:24 AM EDT
[#10]
Quote HistoryQuoted:
For the TL:DR crowd. MACRA's goal — to create a payment system that promotes better quality of care for patients and spends taxpayer money wisely — is sound. However, the necessary infrastructure to achieve that goal — meaningful quality measures and viable APMs — is not yet in place. If MACRA is implemented according to the arbitrary timeline set by the administration, it could force doctors to abandon private practice for salaried positions or leave practice altogether — neither of which would be good for patient care. So, yes, we all should care how doctors get paid. The FSA doesn't care how doctors get paid... they don't even care if you get paid at all, just so long as they get theirs. I can't tell you the number of patients I get in the ER who have a primary care physician, or established specialist for their problem/condition... and yet they come to the ER. On occasion, they'll admit "I owe him $250, so he won't see me." or "they want money to be seen, and I just don't have that." It's all I can do not to look at them and say "so you think I work for free, is that it? I'm not worth paying? WTF!" |
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Posted: 10/21/2016 10:05:41 AM EDT
[#11]
Just used this to lose a liberal friend on why this is just another move to the march of socialized medicine by destroying our current system. She was ecstatic and said doctors get paid too much, she went into the usual stick of class warfare and identity politics.
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Posted: 10/21/2016 10:11:56 AM EDT
[#12]
Quoted:
Ah yes... MACRA. Paying for "quality" care, but putting the onus entirely on the doctors. Because compliance with therapy doesn't matter, right? The patient has no free will of their own... right? Yeah.
Link Simplest Explanation: Medicare is going broke. They can't afford to pay for the increasing numbers of patients, more expensive treatments, longer lifespans (requiring them to pay over a longer period of time for those expensive treatments). More (and younger) people going on SS Disability (then being eligible to get Medicare...without paying in over over time). So... Rather than say 'we need more money'...they say 'we're going to pay 'differently''...and lie and say it's going to save money and increase quality. Then, when Doctors get disgusted and retire early, stop taking Medicare and fewer Med Students graduate, it will be a 'crisis' as people can't get services...but of course, that isn't the GOVERNMENT'S fault..... Then, they socialize medicine (all Health Care is government funded....and Docs, etc are salaried employees) or single payer ("National Health Insurance")...either way, they can 'hide' how fucked up the current Medicare system is by raising taxes.... |
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Posted: 10/21/2016 12:53:35 PM EDT
[#13]
Quote HistoryQuoted:
Simplest Explanation: Medicare is going broke. They can't afford to pay for the increasing numbers of patients, more expensive treatments, longer lifespans (requiring them to pay over a longer period of time for those expensive treatments). More (and younger) people going on SS Disability (then being eligible to get Medicare...without paying in over over time). So... Rather than say 'we need more money'...they say 'we're going to pay 'differently''...and lie and say it's going to save money and increase quality. Then, when Doctors get disgusted and retire early, stop taking Medicare and fewer Med Students graduate, it will be a 'crisis' as people can't get services...but of course, that isn't the GOVERNMENT'S fault..... Then, they socialize medicine (all Health Care is government funded....and Docs, etc are salaried employees) or single payer ("National Health Insurance")...either way, they can 'hide' how fucked up the current Medicare system is by raising taxes.... Quote HistoryQuoted:
Quoted:
Ah yes... MACRA. Paying for "quality" care, but putting the onus entirely on the doctors. Because compliance with therapy doesn't matter, right? The patient has no free will of their own... right? Yeah.
Link Simplest Explanation: Medicare is going broke. They can't afford to pay for the increasing numbers of patients, more expensive treatments, longer lifespans (requiring them to pay over a longer period of time for those expensive treatments). More (and younger) people going on SS Disability (then being eligible to get Medicare...without paying in over over time). So... Rather than say 'we need more money'...they say 'we're going to pay 'differently''...and lie and say it's going to save money and increase quality. Then, when Doctors get disgusted and retire early, stop taking Medicare and fewer Med Students graduate, it will be a 'crisis' as people can't get services...but of course, that isn't the GOVERNMENT'S fault..... Then, they socialize medicine (all Health Care is government funded....and Docs, etc are salaried employees) or single payer ("National Health Insurance")...either way, they can 'hide' how fucked up the current Medicare system is by raising taxes.... Notice how those Accountable Care Organizations (ACOs) haven't produced the savings they were supposed to? That's because the people MOST DIRECTLY responsible for creating the demand (and making the decisions) aren't paying the bill. And that would be the patients. Used to be, when patients were spending their OWN MONEY, they shopped for price, value, and convenience. They still do for all sorts of consumer goods... and that works out just fine. Routine medical care and elective operations/decisions should be no different. You can't apply that to emergencies, of course... but most medical care isn't "emergent." |
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Posted: 10/21/2016 1:07:58 PM EDT
[#14]
Typical soviet response. More forms, more reporting, more spreadsheets.
This should be good for another couple of thousand Federal jobs. |
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Posted: 10/21/2016 1:12:41 PM EDT
[#15]
Quote HistoryQuoted:
Notice how those Accountable Care Organizations (ACOs) haven't produced the savings they were supposed to? That's because the people MOST DIRECTLY responsible for creating the demand (and making the decisions) aren't paying the bill. And that would be the patients. Used to be, when patients were spending their OWN MONEY, they shopped for price, value, and convenience. They still do for all sorts of consumer goods... and that works out just fine. Routine medical care and elective operations/decisions should be no different. You can't apply that to emergencies, of course... but most medical care isn't "emergent." Quote HistoryQuoted:
Quoted:
Quoted:
Ah yes... MACRA. Paying for "quality" care, but putting the onus entirely on the doctors. Because compliance with therapy doesn't matter, right? The patient has no free will of their own... right? Yeah.
Link Simplest Explanation: Medicare is going broke. They can't afford to pay for the increasing numbers of patients, more expensive treatments, longer lifespans (requiring them to pay over a longer period of time for those expensive treatments). More (and younger) people going on SS Disability (then being eligible to get Medicare...without paying in over over time). So... Rather than say 'we need more money'...they say 'we're going to pay 'differently''...and lie and say it's going to save money and increase quality. Then, when Doctors get disgusted and retire early, stop taking Medicare and fewer Med Students graduate, it will be a 'crisis' as people can't get services...but of course, that isn't the GOVERNMENT'S fault..... Then, they socialize medicine (all Health Care is government funded....and Docs, etc are salaried employees) or single payer ("National Health Insurance")...either way, they can 'hide' how fucked up the current Medicare system is by raising taxes.... Notice how those Accountable Care Organizations (ACOs) haven't produced the savings they were supposed to? That's because the people MOST DIRECTLY responsible for creating the demand (and making the decisions) aren't paying the bill. And that would be the patients. Used to be, when patients were spending their OWN MONEY, they shopped for price, value, and convenience. They still do for all sorts of consumer goods... and that works out just fine. Routine medical care and elective operations/decisions should be no different. You can't apply that to emergencies, of course... but most medical care isn't "emergent." But ACOs were supposed to be the new hot thing. The idiots in charge didn't realize they created a program that penalized already efficient systems and gave a benefit to bad systems to get efficient. Morons. |
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Posted: 10/21/2016 1:52:39 PM EDT
[#16]
Good bye medicare accessibility to mental healthcare.
Who thinks that the mental health providers want reimbursement based on patient satisfaction... hey you want a drug addict or a personality disorder patient to have a say in how much money you get for your services? |
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Posted: 10/21/2016 2:05:31 PM EDT
[#17]
Quote HistoryQuoted:
The idiots in charge didn't realize they created a program that penalized already efficient systems and gave a benefit to bad systems to get efficient. Morons. They're Smarter than Us... 
So of course they can't be idiots....they KNOW things 'cause they're professors and all kinds of smartified.... (Funny how very, very few...if any...'real' Docs...the kind that have to make a payroll for their staff, or are accountable to their employer...hospital or larger group...had ANY input into Obamacare, MACRA, etc. etc....yet they're the backbone of the health care system...)... |
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Posted: 10/21/2016 2:06:15 PM EDT
[#18]
Quote HistoryQuoted:
I am pushing my fiancee to look at doing concierge medicine once done with residency. Nothing that touches government money. Not sure how long she has left, but she should do it sooner rather than later, as all of the existing PCP's who don't retire will look there. Seriously get her to look into it as she will be able to care for her patients the way she wants to, not simply send them through the assembly line because the hospital or practice she works for needs her to see 18-20 people per day. |
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Posted: 10/21/2016 2:12:46 PM EDT
[#19]
Quote HistoryQuoted:
They're Smarter than Us...  http://www.youtube.com/watch?v=Adrdmmh7bMo
So of course they can't be idiots....they KNOW things 'cause they're professors and all kinds of smartified.... (Funny how very, very few...if any...'real' Docs...the kind that have to make a payroll for their staff, or are accountable to their employer...hospital or larger group...had ANY input into Obamacare, MACRA, etc. etc....yet they're the backbone of the health care system...)... Quote HistoryQuoted:
Quoted:
The idiots in charge didn't realize they created a program that penalized already efficient systems and gave a benefit to bad systems to get efficient. Morons. They're Smarter than Us... http://www.youtube.com/watch?v=Adrdmmh7bMo
So of course they can't be idiots....they KNOW things 'cause they're professors and all kinds of smartified.... (Funny how very, very few...if any...'real' Docs...the kind that have to make a payroll for their staff, or are accountable to their employer...hospital or larger group...had ANY input into Obamacare, MACRA, etc. etc....yet they're the backbone of the health care system...)... You have to pass it to know what is in it. 
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Posted: 10/21/2016 2:31:22 PM EDT
[#20]
Is this the dupe, or is the other mass exodus thread the dupe?
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Posted: 10/21/2016 2:32:11 PM EDT
[#21]
No one in government see a problem that it's 99% about patient follow thru and 1% Dr?
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Posted: 10/21/2016 2:50:49 PM EDT
[#22]
Quote HistoryQuoted:
Not sure how long she has left, but she should do it sooner rather than later, as all of the existing PCP's who don't retire will look there. Seriously get her to look into it as she will be able to care for her patients the way she wants to, not simply send them through the assembly line because the hospital or practice she works for needs her to see 18-20 people per day. Quote HistoryQuoted:
Quoted:
I am pushing my fiancee to look at doing concierge medicine once done with residency. Nothing that touches government money. Not sure how long she has left, but she should do it sooner rather than later, as all of the existing PCP's who don't retire will look there. Seriously get her to look into it as she will be able to care for her patients the way she wants to, not simply send them through the assembly line because the hospital or practice she works for needs her to see 18-20 people per day. 18-20? No, a pcp needs to see that many now to make money. The future is 25+ per day, I've already seen some groups moving to 12min appointments. Eventually I think there will be only two groups of doctors. Those that practice in large hospital groups and small cash/concierge docs. Anything in between is on borrowed time. |
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Posted: 10/21/2016 2:53:52 PM EDT
[#23]
Quote HistoryQuoted:
I am pushing my fiancee to look at doing concierge medicine once done with residency. Nothing that touches government money. Quote HistoryQuoted:
Quoted:
Quoted:
Quoted:
Ah yes... MACRA. Paying for "quality" care, but putting the onus entirely on the doctors. Because compliance with therapy doesn't matter, right? The patient has no free will of their own... right? Yeah.
Link There is so much I want to say based on what I see in our small hospital, but I don't even know where to begin. This. If didn't have 20 years in, I'd do something else. I am pushing my fiancee to look at doing concierge medicine once done with residency. Nothing that touches government money. This isn't the half of it. Wait till you go through a ZPIC audit. CMS will deny your reimbursements, all the while telling you that if you stop treating, you'll never get another MC patient again. The audits are supposed to be concluded within 6 months, I think. I had a client who was help up for more than a year. There is no real appeal. The rules are what they say they are. If you catch them in a lie, they just change the rules. How many people can continue work, make payroll and pay the rent, all the while going for almost a year and a half without getting a substantial portion of their income. There is no way in the world I would be a doc dependent on big.gov today. Concierge medicine is the way to go. We'll return to the old days of paying with chickens and loaves of bread. |
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Posted: 10/21/2016 2:59:38 PM EDT
[#24]
Put "how will universal health care affect doctors salaries" into a google search.
The first site states that it will keep doctors from overcharging. 
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Posted: 10/21/2016 3:02:44 PM EDT
[#25]
Bring on the death panels.
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Posted: 10/21/2016 3:05:12 PM EDT
[#26]
If you don't give me my norco I'll give you a bad review and you won't get paid
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Posted: 10/21/2016 3:05:18 PM EDT
[#27]
I have insurance but still go to a primary care doctor or med express before straight to the ER. I literally went to medexpress Wednesday morning to be sent immediately to the er to have my appendix removed.
The ER asked why I waited so long. I said doesn't everyone wait until the ER s the last choice? The was quite a bit of laughter at my answer. This is why the system is messed up. People who don't pay come for the slightest reason to the ER while tax payers like me suffer till the last minute to avoid the insurance company overcharging me. |
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Posted: 10/21/2016 3:28:32 PM EDT
[#28]
In the healthcare industry we are calling this "Pay (fee) for Performance" opposed to the current "Pay (fee) for Service". Although this is causing major concern in the industry, we know that CMS is logical (yet aggressive) in their implementation timelines. The implementation deadline will be pushed, because it's logical. Just look up the history of the ICD-10 roll-out if you want to see how these things work.
This is not a problem. CMS will push the implementation date, possibly 2-3 times. But they will be "driving" the industry to performance based reimbursement. |
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Posted: 10/21/2016 3:41:36 PM EDT
[#29]
Quote HistoryQuoted:
In the healthcare industry we are calling this "Pay (fee) for Performance" opposed to the current "Pay (fee) for Service". Although this is causing major concern in the industry, we know that CMS is logical (yet aggressive) in their implementation timelines. The implementation deadline will be pushed, because it's logical. Just look up the history of the ICD-10 roll-out if you want to see how these things work. This is not a problem. CMS will push the implementation date, possibly 2-3 times. But they will be "driving" the industry to performance based reimbursement. They published their program information last week, it's 2171 pages long and scheduled to start Jan 1, 2017. That's beyond aggressive and is into aggravated stupidity territory. FYI, if anyone would like to read it it's available here. https://qpp.cms.gov/docs/CMS-5517-FC.pdf |
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Posted: 10/21/2016 3:51:28 PM EDT
[#30]
Quote HistoryQuoted:
They published their program information last week, it's 2171 pages long and scheduled to start Jan 1, 2017. That's beyond aggressive and is into aggravated stupidity territory. FYI, if anyone would like to read it it's available here. https://qpp.cms.gov/docs/CMS-5517-FC.pdf Quote HistoryQuoted:
Quoted:
In the healthcare industry we are calling this "Pay (fee) for Performance" opposed to the current "Pay (fee) for Service". Although this is causing major concern in the industry, we know that CMS is logical (yet aggressive) in their implementation timelines. The implementation deadline will be pushed, because it's logical. Just look up the history of the ICD-10 roll-out if you want to see how these things work. This is not a problem. CMS will push the implementation date, possibly 2-3 times. But they will be "driving" the industry to performance based reimbursement. They published their program information last week, it's 2171 pages long and scheduled to start Jan 1, 2017. That's beyond aggressive and is into aggravated stupidity territory. FYI, if anyone would like to read it it's available here. https://qpp.cms.gov/docs/CMS-5517-FC.pdf CMS be stupid. Never. 
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Posted: 10/21/2016 4:02:42 PM EDT
[#31]
So we are doing more to hold doctors accountable to the government and can't do shit to hold teachers accountable?
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Posted: 10/21/2016 4:03:55 PM EDT
[#32]
Quote HistoryQuoted: Bring on the death panels. For Congress? |
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Posted: 10/21/2016 4:24:39 PM EDT
[#33]
I swear to God, I wish all the pricks, including Obama, who invented and pushed this turd called Obamacare would fucking die and burn in hell. And make no mistake, this is linked to Obamacare.
We had the greatest healthcare system in the entire world before that motherfucker Obama fucked it up just to give free healthcare to some of his black brethren. The 85% of people who were happy with the system are now being made to suffer in a hundred ways for the 15% who either couldn't afford insurance or just didn't want it. So burn in hell, all of them. |
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Posted: 10/21/2016 4:31:10 PM EDT
[#34]
Quote HistoryQuoted:
They published their program information last week, it's 2171 pages long and scheduled to start Jan 1, 2017. That's beyond aggressive and is into aggravated stupidity territory. FYI, if anyone would like to read it it's available here. https://qpp.cms.gov/docs/CMS-5517-FC.pdf Quote HistoryQuoted:
Quoted:
In the healthcare industry we are calling this "Pay (fee) for Performance" opposed to the current "Pay (fee) for Service". Although this is causing major concern in the industry, we know that CMS is logical (yet aggressive) in their implementation timelines. The implementation deadline will be pushed, because it's logical. Just look up the history of the ICD-10 roll-out if you want to see how these things work. This is not a problem. CMS will push the implementation date, possibly 2-3 times. But they will be "driving" the industry to performance based reimbursement. They published their program information last week, it's 2171 pages long and scheduled to start Jan 1, 2017. That's beyond aggressive and is into aggravated stupidity territory. FYI, if anyone would like to read it it's available here. https://qpp.cms.gov/docs/CMS-5517-FC.pdf Hahaha...obviously you haven't dealt with CMS a lot. That date will change within the next 6 weeks... This is not uncommon. |
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Posted: 10/21/2016 5:15:25 PM EDT
[#35]
Quote HistoryQuoted:
Hahaha...obviously you haven't dealt with CMS a lot. That date will change within the next 6 weeks... This is not uncommon. Quote HistoryQuoted:
Quoted:
Quoted:
In the healthcare industry we are calling this "Pay (fee) for Performance" opposed to the current "Pay (fee) for Service". Although this is causing major concern in the industry, we know that CMS is logical (yet aggressive) in their implementation timelines. The implementation deadline will be pushed, because it's logical. Just look up the history of the ICD-10 roll-out if you want to see how these things work. This is not a problem. CMS will push the implementation date, possibly 2-3 times. But they will be "driving" the industry to performance based reimbursement. They published their program information last week, it's 2171 pages long and scheduled to start Jan 1, 2017. That's beyond aggressive and is into aggravated stupidity territory. FYI, if anyone would like to read it it's available here. https://qpp.cms.gov/docs/CMS-5517-FC.pdf Hahaha...obviously you haven't dealt with CMS a lot. That date will change within the next 6 weeks... This is not uncommon. If you like your payment, you can keep your payment. 
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Posted: 10/23/2016 12:42:04 PM EDT
[#36]
Quote HistoryQuoted:
I swear to God, I wish all the pricks, including Obama, who invented and pushed this turd called Obamacare would fucking die and burn in hell. And make no mistake, this is linked to Obamacare. We had the greatest healthcare system in the entire world before that motherfucker Obama fucked it up just to give free healthcare to some of his black brethren. The 85% of people who were happy with the system are now being made to suffer in a hundred ways for the 15% who either couldn't afford insurance or just didn't want it. So burn in hell, all of them. This wasn't about giving anybody anything. Obamacare was about breaking the system, not fixing it. It is about COMPLETE control over your lives once Obamacare is replaced with single payer. Eventually everything you do or don't do will determine if you will receive that expensive surgery or xray or ct scan etc. |
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