Stanley Feld M.D., FACP, MACE Menu


Things Happen When No One is Looking

Stanley Feld M.D.,FACP,MACE

I wish you all a Happy and Healthy New Yew Year.

I have not written blogs during the holiday season because I figured no one would pay attention to what is happing in healthcare.

President Obama figured the same and snuck in a few things to continue to destroy the healthcare system.

Obamacare “innovative programs” seem to be going nowhere. The Obama administration continues to insist that all is going well.

The money spent is being wasted. The taxes for the funding of Obamacare’s 6.7 million enrollees is increasing as it attempts to increase enrollment to 9 million down from the original enrollment goal of 12 million.

I received a note from a reader who said Obamacare is here to stay. It is what it is. We should try to repair Obamacare rather than repeal it and replace it.

In my view Obamacare cannot be repaired. It was created to destroy the healthcare system. President Obama’s goal is to replace Obamacare with a government controlled single party payer system.

 The result will be to control and restrict access to care and ration care. It is a step on the way to restrict citizens’ freedoms.

Every week indications of Obamacare’s failures appear but are kept under the public’s radar.  The Obama administration spins the facts and the mainstream media’s regurgitates that spin.

 The Obamacare signup figures as complied by as of 12/30 2014 are very different that the administration’s spin to the media that the open enrollment period is going great.

Obamacare’s enrollment is still 1 million below estimate at this point

Confirmed 2015 QHPs: 7,403,558 as of 12/29/14
Estimated 2015 QHPs (Cumulative):
11/21: 610K (462K HCgov) • 11/28: 1.02M (765K HCgov) • 12/05: 1.80M (1.35M HCgov)
12/12: 3.26M (2.46M HCgov) • 12/15: 4.70M (3.52M HCgov) • 12/19: 8.52M (6.40M HCgov)
12/23: 8.65M (6.50M HCgov) • 12/30: 8.84M (6.54M HCgov)

state-level projections

 HHS finally announced that approximately 87% of Americans who selected 2015 health insurance plans through in the first month of open enrollment are receiving financial assistance to lower their monthly premiums. This percentage of subsidy awards is higher than in the same period last year.

The number is significant because, should the U.S. Supreme Court decide against the Obama administration in the King v. Burwell case it is scheduled to hear in March, consumers living in the 37 states relying on the subsidies from could lose their premium subsidies.

Another problem is even with the subsidy the people who received them cannot afford the insurance deductible. They do not seek medical care.

HHS has yet to disclose if it has a contingency plan should a ruling come down that only those who buy Obamacare insurance through state exchanges are eligible for coverage subsidies.

The CMS Innovation Center was established by section 3021 of the Affordable Care Act (Obamacare) for the purpose of testing “innovative payment” and service delivery models to reduce healthcare expenditures while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits.

To date the CMS Innovation Center has awarded $2.6 billion through September 2014 to hospitals, doctors and others through nearly two dozen programs that tested new ways to deliver healthcare and pay for it.

“Results of those programs some underway since 2011including more than 60,000 providers and 2.5 million patients in Medicare, Medicaid and the Children's Health Insurance Program, are largely not yet available, the Innovation Center said in its second report to Congress.”

The ICD-10 diagnostic and procedure codes were to be implemented two years ago. It appears to be going nowhere because it is too complicated. President Obama will probably delay it again.

The change toICD-10 from ICD-9 has been pushed forward at least three times. It is too complicated. It is designed to commoditized medical treatment and eliminate physician judgment. Codes have been increase from 18,000 (complicated enough) to 68,000. Neither physicians nor their unsophisticated computer systems can comply correctly.

The Obama administration is still pushing for its execution and wasting money yearly. Physicians cannot and will not comply with this government regulation.

 It is destined to fail at a tremendous waste of taxpayers’ dollars.

President Obama promised the AMA he would fix the defective Medicare Sustainable Growth Rate formula( GRF) for calculating Medicare reimbursement to physicians. As a result of that promise the AMA supported President Obama’s healthcare reform bill.” 

The GRF is not fixed yet. Congress delays the reductions in reimbursement due to this defective bureaucratic formula  each year and adds the percentage reduction in physician reimbursement to next year’s reimbursement reduction.

This year physicians can expect another 4% reduction for a total of 32% since 2002.  We will see if congress fixes this defective formula this year.  

On January 1, 2015 physicians are going to experience a series of pay cuts from CMS.  If functional electronic medical records are not implemented physicians will experience additional reimbursement reductions from Medicare and Medicaid.

Physicians are struggling to deal with new measurements to improve quality and deal with a myriad of new changes in Medicare and Medicaid rules and regulations.

Two years ago in order to attract more physicians to accept Medicaid to care for the growing number of enrollees in Medicaid, Obamacare increased Medicaid reimbursement by 40%. The increase in reimbursement was to last only until January1, 2015 and then revert to the 2012 reimbursement schedule.

Those pediatricians, family practitioners and internists were faked out once more by Obamacare and President Obama’s promises.

The biggest pay surprise to physicians will come when the old reimbursement returns. Poor Americans on Medicaid will suffer when they cannot find a physician.  

No other segment of the health care industry faces penalties as steep as these and no other segment faces such challenging implementation logistics,” Dr. James Madara, the AMA’s CEO wrote to the Obama administration.  “The tsunami of rules and policies surrounding the penalties are in a constant state of flux due to scheduled phase-ins and annual changes in regulatory requirements.”

 The cascade of rules and regulations will affect every specialty of medicine. The only thing left is for physicians to quit participating in government programs.

Then government can force medical license renewal to be tied to participation in government healthcare programs.

Where is physicians’ choice and freedom? There is currently a physician shortage. If physicians quit medicine and surgery what will happen to patient care?

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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