Reimbursement

Every so often, a visitor from afar (usually from Canada or Great Britain) will comment on the plight of the American health care system and the advantages of their “nationalized” health service. Yes, we certainly have our share of troubles here in the US. And if the current news is any indication, the upcoming election is shaping up to bring more uncertainties for the medical profession - regardless of which political party we are talking about.

A recent blog on ZDNet mentions a survey of Dutch citizens who are generally happy with their form of health care, which is primarily a government-sponsored system with some private carriers (similar to the system implemented in Massachusetts). All people are required to carry insurance, in some cases with government subsidies, relieving employers of the burden of (more…)

Once again we were saved from another Medicare cut at the last minute. This is really getting old. The only consolation is that for once it is getting more press coverage than in the past, mostly with the (correct) slant that these cuts will ultimately hurt Medicare beneficiaries. Several Republican senators changed their votes from their previous positions on HR 6331 to yes after receiving a lot of flack from their constituents, many of them physicians.

Someone (a Fox News follower) said, “There must have been a reason that those senators voted against it.” Well, yes, apparently there was. (more…)

The new federal pay-for-performance pilot program may prove to be short-lived.On December 20, 2006, President Bush signed into law the Tax Relief and Health Care Act of 2006 (TRHCA). A broad tax reform omnibus that also included a number of key health care measures, the bill authorized the establishment of a pay-for-performance program known as the Physician Quality Reporting Initiative (PQRI). According to the website of the Centers for Medicare & Medicaid Services, PQRI establishes a financial incentive of up to 1.5% of the total allowed charges for covered Medicare physician fee schedule services for eligible professionals whose performance meets a designated set of quality measures.

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Why is the cost of healthcare going up when doctors’ reimbursement keeps going down?If doctors are getting paid less and less by managed care insurance companies, why is the cost of healthcare rising exponentially in the country? Just look at the stock returns of these same insurance companies. And while physicians on average have seen about a 95% decrease in reimbursement in the last ten years, compare this to the compensation of the CEOs of these companies: $358 million for one CEO of a health insurance company.

If you add the total compensation of the top ten insurance company CEOs, this equals 1/900 of the total healthcare expenditure of the United States. In other words, 1/900 of all the money spent on healthcare in the US goes to ten people.