I'm confused by some of the statements above. Am I missing something here?10. rdmoore2003 said "the computers will do it all". For those who think that technology is what gets doctors paid for their work, I invite you to read through the points I make on this page: http://www.medicalbillinglive.com/members/index.php?topic=6930.30 . One who knows how to bill properly is who gets the doctor paid. Wetware, not software.
I'm confused by some of the statements above. Am I missing something here?1. DMK said "People thought they were going to get free health care for all." The Affordable Care Act requires everyone to purchase health insurance or else pay a fine. How does that reality lead people to believe that there is going to be "free health care for all"? The reality is that someone (you and me?) is already paying big bucks for all the poor folks who use hospital ERs and then never pay anything towards their care. Theoretically, requiring everyone to have insurance will reduce this expense - which should be reflected in lower health insurance premiums. Probably won't be, tho.2. DMK said "The legal system indeed will hold all this up because you can't MANDATE a purchase of a private product." Actually, the United States Supreme Court ruled a few months ago on this issue. The Affordable Care Act was ruled legal, and the Federal Government can fine each individual that does not purchase health insurance. There is nothing more the legal system can do to hold this up. Given that the U.S. Supreme Court decided the issue, who is any lawyer going to appeal to?The Federal Government is not going to "force" anybody to purchase a private product. That is not, and has never been, the issue here. The reality is that the U.S. Supreme Court said it was legal for the Federal Government to "tax" you if you fail to purchase health insurance. At some point, it will be cheaper to purchase health insurance than to pay the fine.My first comment about people thinking they were going to get free health care is from listening to patients who come through our office. The general public does actually think they will get whatever they want, whenever they want, and not have to pay anything. When we start to to discuss what the ACA actually is, most people are shocked. That's not what they "heard" on the news or the story they "read" on the internet. Don't get me wrong, I think everyone should get to go to the doctor when they need to, and people shouldn't have to die because they can't afford the care they need. It's a well intentioned attempt to fix a problem, it just wasn't thought all the way through. The poor who use the ER are usually immediately enrolled into Medicaid (which we all pay for in one form or another) so their bill gets paid in some form for pennies on the dollar. That can't last forever as we all know. The middle class / working poor are going to suffer far more than the truly poor, who have had a "system" of sorts in place for a long time."Requiring" people to buy health insurance or be "taxed" IS a mandate. And they are already running up against religious groups who view insurance as "gambling" who refuse to buy insurance and will not pay the fine. I don't know the answer this problem, the concept is that if we ALL pay in and participate that costs will go down. But that's not logical, and doesn't take everything into account. My personal health insurance (I'm a business owner, not in a group, and have paid for my own high-deductible plan for many years) has doubled in price in the last 2 years, I'd consider dropping my health insurance but now I'd be taxed. My insurance company cites the upcoming expansion of health care and how they have to absorb all the people with pre-existing conditions as well as "increased physician fees".My big problem with the mandate or fine is that if people couldn't afford insurance before, how can they afford it now? And if there's no money in the family budget for insurance premiums, how can they pay the tax? Again, it's well intentioned, but not thought through. Your posts are great, and your points are very well stated and thought provoking. I keep coming at these issues from 4 different perspectives, as a provider of services, a patient, a biller, and as a business owner / tax payer. I'm surrounded with health care discussions every day, and the public perspective is truly fascinating.
1. DMK said "People thought they were going to get free health care for all." The Affordable Care Act requires everyone to purchase health insurance or else pay a fine. How does that reality lead people to believe that there is going to be "free health care for all"? The reality is that someone (you and me?) is already paying big bucks for all the poor folks who use hospital ERs and then never pay anything towards their care. Theoretically, requiring everyone to have insurance will reduce this expense - which should be reflected in lower health insurance premiums. Probably won't be, tho.
2. DMK said "The legal system indeed will hold all this up because you can't MANDATE a purchase of a private product." Actually, the United States Supreme Court ruled a few months ago on this issue. The Affordable Care Act was ruled legal, and the Federal Government can fine each individual that does not purchase health insurance. There is nothing more the legal system can do to hold this up. Given that the U.S. Supreme Court decided the issue, who is any lawyer going to appeal to?
The Federal Government is not going to "force" anybody to purchase a private product. That is not, and has never been, the issue here. The reality is that the U.S. Supreme Court said it was legal for the Federal Government to "tax" you if you fail to purchase health insurance. At some point, it will be cheaper to purchase health insurance than to pay the fine.
3. States can be granted waivers. If the Republicans had won the White House, granting waivers to each state requesting them would have been the quickest end-run around the Affordable Care Act. They didn't win the White House, so this approach will have limited, if any, use.4. Regardless of whether a State has requested and been granted waivers, or they simply refuse to comply - there is a deadline by which a State must fashion its response to the Affordable Care Act. Under provisions of the ACA, which was upheld by the U.S. Supreme Court, if the State does not comply by the deadline, the Federal Government can (and probably will) step in and implement its own healthcare exchange (a "market" where anyone can buy reasonably-priced health insurance). Given that the U.S. Supreme Court has already ruled on this issue, to whom are the lawyers going to appeal to stop the Federal Government from doing what the U.S. Supreme Court said it could do?
5. Bureaucracies move at glacial speed. There will probably be delays in implementing the healthcare exchanges and other parts of the ACA just because of the slowness with which bureaucracies move. It is hard to see how legal wrangling will delay anything, given that the U.S. Supreme Court has spoken on the issue
6. tallmanusa said: "In a democracy, the majority, even by 1%, decides the issue ...". First, we are a Republic, not a democracy ("I pledge allegience to the flag, and to the Republic for which it stands"). Second, because we are a Republic, not a democracy, the court system serves in part to protect us from the "tyranny of the majority" There are many instances in which the majority has spoken, yet the court has given the victory to the minority. Never could understand why the "tyranny of the minority" is any more desireable than the "tyranny of the majority", but ... In the case of the ACA, and regardless of what the majority may wish, the U.S. Supreme Court has ruled in favor of the Federal Government's position.
7. If a biller is doing a proper job, they are going to catch coding mistakes on the part of the doctor. Either he did not code for work that was actually done (a good biller can catch that, if doctor did "A", that means he also had to do "B", but he hasn't coded for that), or he coded the work incorrectly. With a paper fee slip or superbill, you can send that piece of paper back to the doctor and have him make the changes on it. Then, what the biller bills for matches exactly what the doctor has written on a piece of paper. There will never be any question of the biller billing for things the doctor didn't order. Consider an EMR. How do the required changes outlined in this point get made? Biller talks to doctor, maybe by phone. Doctor says, "Oh, thanks for the heads up. Go ahead and make the necessary changes before you send your file off to the clearinghouse" - and then forgets to make (or is locked out of making) changes to the EMR to reflect the new charges the biller submits. Now, in an audit, the biller has billed for things that are not present in the patient's electronic chart. That is a big no no for billers, and penalties can be stiff. Not having a paper trail that matches exactly between what the doctor did and what the biller billed is laying the groundwork for some potential problems that not many people seem to be discussing.
8. tallmanusa said: "Doctors have to adopt EMR by 2015". A bit more complicated than that. A doctor who doesn't meet Medicare requirements by 2015 will have Medicare payments reduced by 1%. That increases to 2% in 2016, 3% in 2017, 4% in 2018, and maybe up to 95% depending on future adjustments. This is a big non-issue for doctors who are not Medicare providers. If these penalties are actually imposed, I think we will see a significant exodus of doctors from the Medicare program. Maybe to be replaced by PAs taking over the care of Medicare and Medicaid patients.
Exactly.. I've already seen this. I have ONE client left in my billing company to transition OUT of Medicare. My consulting clients are mostly those transitioned or will be transitioned out of Medicare and Medicaid.
9. tallmanusa said "offer EHR to every provider, as Obamacare mandates it". First, the ACA does not mandate the use of EMRs. It simply reduces payment to Medicare providers as discussed in the previous point. Second, EMRs add about 1 1/2 hours to the work-day of those doctors that I know are using them. EMRs have never been about increasing efficiency (they don't). They are about collecting patient outcomes so that the Federal Government can aggregate them, data mine them, and come up with best practices for any given health issue. Each doctor who chooses to use an EMR gives up about 1 1/2 hours of income every day just so the government will be able to collect this data (I've talked with data aggregator companies that are doing this right now). Be careful about possible backlash if you don't make sure your potential client knows this before he takes on an EMR for the first time. If you oversell the benefits to the doctor of an EMR (the benefits accrue to the government, not the doctor), you may lose him as a client.
Once again, Linda, you astound me with your common sense and knowledge of this industry, and your ability to put it in terms without emotion. (Something I can't seem to do, I'm pretty emotional about our income!)
Linda - you seem to be saying that it is not a tax - the ACA "penalty" for not purchasing health insurance. I don't have time to look it up right now, but I believe that was the pivot point of Chief Justice Roberts' opinion. I think I remember the analysts saying that the genius of Roberts' opinion was that he carefully laid out all of the reasons why the Federal Government could not force folks to purchase something under the Commerce clause (this sets very clear boundaries on what liberal Federal governments can try to foist on the public in the future, but there has not been much focus on that part of the opinion). Then Roberts affirmed the right of the Federal Government to levy taxes. Basically, he said that the Federal Government had no constitutional ground to force you to buy something, but they could penalize you with a tax for not buying it. If I remember correctly, there were mighty squeals when the opinion was released, and all of the sound-bites were hauled out where Obama - selling the idea to the public - kept insisting that the penalty was not a tax. And then the ACA survived the U.S. Supreme Court only because Roberts labeled the penalty a tax, and then said the act was constitutional because the Federal Government has a constitutionally-given power to tax. The President sold the act on the basis that he was not raising taxes, and then Roberts ruled in his favor by ruling that the penalty was indeed a tax. Does any of that sound familiar to you?
DMK - thanks for the heads-up about some religeous folks equating buying insurance to gambling. Hadn't heard that one before. Wonder if these folks also do not have car insurance.
Chances are you haven’t read all thousand pages of the Patient Protection and Affordable Care Act.If you did chances are you are one in a million. Give yourself a high-five.