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It all starts with the sweeping power that the Senate bill gives to the Centers for Medicare and Medicaid Services. The agency will be given the authority to unilaterally write new rules on when medical devices and drugs can be used, and how they should be priced. In particular, the Obama team wants to give the agency the power to decide when a cheaper medical option will suffice for a given problem and, in turn, when Medicare only has to pay for the least costly alternative."
"The Senate health-care bill also exempts Medicare's actions from
judicial review, taking away the right of patients to sue the
government. Unlike existing Medicare coverage laws, patients won't have
the ability to appeal any of the decisions of this new Medicare
Commission. Ironically, private health insurers must comply with new patient
appeals rights under the Senate bill. The government has exempted
itself from the same sort of protections."
"Primary-care doctors who refer patients to specialists will face financial penalties under the plan. Doctors will see 5% of their Medicare pay cut when their "aggregated" use of resources is "at or above the 90th percentile of national utilization," according to the chairman's mark of Section 3003 of the bill....these penalties will put the referring physician on the hook for the cost of the referral and perhaps any resulting procedures."
"Next, the plan creates financial incentives for doctors to consolidate their practices. The idea here is that Medicare can more easily apply its regulations to institutions that manage large groups of doctors than it can to individual physicians. So the Obama plan imposes new costs on doctors who remain solo, mostly by increasing their overhead requirements—such as requiring three years of medical records every time a doctor orders routine medical equipment like wheelchairs."
"The plan also offers doctors financial carrots if they give up their small practices and consolidate into larger medical groups, or become salaried employees of large institutions such as hospitals or "staff model" medical plans like Kaiser Permanente. One provision, laid out in Section 3022, allows doctors to share with the government any savings to the government they achieve by delivering less care—but only if physicians are part of groups caring for more than 5,000 Medicare patients and 'have in place a leadership and management structure, including with regard to clinical and administrative systems.'"
"The impact of these provisions won't be confined to Medicare. Private insurance sold in the federally regulated "exchanges" will take cues from Medicare, since they're both managed from the same bureaucracy. Medicare will set the standard for medical care across the entire marketplace. Mr. Obama promised that under his plan people wouldn't have to change their doctors. But it's clear that doctors will be forced to change how they make their medical decisions."We welcome and encourage readers to comment on our content and engage in respectful conversation. Reader comments published here do not necessarily reflect the views or opinions of this publisher and we can't vouch for the accuracy or appropriateness of comments which are submitted from readers. It is assumed that the reader has permission to post comments.
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