Surprise: Health Overhaul May Mean Longer ER Waits

[Conan71]

http://news.yahoo.com/s/ap/20100702/ap_on_bi_ge/us_med_er_crowding

Damn, more facts they flat-out lied about didn't want us to know prior to passage:

Nope gotta hurry and pass the damn thing before one more person dies.  Don't say I didn't warn you.

"CHICAGO – Emergency rooms, the only choice for patients who can't find care elsewhere, may grow even more crowded with longer wait times under the nation's new health law.

That might come as a surprise to those who thought getting 32 million more people covered by health insurance would ease ER crowding. It would seem these patients would be able to get routine health care by visiting a doctor's office, as most of the insured do.

But it's not that simple. Consider:

_There's already a shortage of front-line family physicians in some places and experts think that will get worse.

_People without insurance aren't the ones filling up the nation's emergency rooms. Far from it. The uninsured are no more likely to use ERs than people with private insurance, perhaps because they're wary of huge bills.

_The biggest users of emergency rooms by far are Medicaid recipients. And the new health insurance law will increase their ranks by about 16 million. Medicaid is the state and federal program for low-income families and the disabled. And many family doctors limit the number of Medicaid patients they take because of low government reimbursements.

_ERs are already crowded and hospitals are just now finding solutions.

Rand Corp. researcher Dr. Arthur L. Kellermann predicts this from the new law: "More people will have coverage and will be less afraid to go to the emergency department if they're sick or hurt and have nowhere else to go.... We just don't have other places in the system for these folks to go."

Kellermann and other experts point to Massachusetts, the model for federal health overhaul where a 2006 law requires insurance for almost everyone. Reports from the state find ER visits continuing to rise since the law passed — contrary to hopes of its backers who reasoned that expanding coverage would give many people access to doctors offices.

Massachusetts reported a 7 percent increase in ER visits between 2005 and 2007. A more recent estimate drawn from Boston area hospitals showed an ER visit increase of 4 percent from 2006 to 2008 — not dramatic, but still a bit ahead of national trends.

"Just because we've insured people doesn't mean they now have access," said Dr. Elijah Berg, a Boston area ER doctor. "They're coming to the emergency department because they don't have access to alternatives."

Crowding and long waits have plagued U.S. emergency departments for years. A 2009 report by the Government Accountability Office, Congress' investigative arm, found ER patients who should have been seen immediately waited nearly a half-hour.

"We're starting out with crowded conditions and anticipating things will only get worse," said American College of Emergency Physicians president Dr. Angela Gardner.

[guido911]

Check this vid out; and she is a urologist (as opposed to primary care):

[nathanm]

Her numbers don't make sense. She says her overhead is $350 an hour, yet the AMA says a urologic surgeon's overhead ought to be around $137 an hour. Since she claims that she has to see 20 patients an hour to meet that overhead, that means she's only getting $17.50 per patient, which is less even than what she gets for inserting a catheter.

The reimbursements for the common urologic procedures I could think of are all over $60, with the exception of manual manipulation of the bladder, which is worth $20. Obviously, surgical procedures are reimbursed at significantly higher rates.

A visit from an established patient which does not require the physician to actually see the patient and takes approximately five minutes of staff time is reimbursed at about $20. The same patient, in a situation that requires a straightforward medical decision and a problem-focused history or exam and takes about 10 minutes of a physician's time is worth $40. If instead it is a low complexity medical decision and takes 15 minutes of physician time Medicare reimburses at about $67. It goes all the way up to $140 if they have to get a comprehensive history and it's a complicated problem that requires no diagnostic tests. Obviously, tests are also billed if they are needed.

Basically, she's full of it, since even the worst-reimbursed thing her office does is compensated at a rate higher than she claims.

At first, I felt a little bad for Martha Boone, although I was skeptical of her math. It is difficult to be a doctor these days, what with being squeezed from all different directions. Now I'm mad at her that she made me spend an hour of my day refuting her moronic claims.

[guido911]

Oh, she's lying. Got it. Let's see, she stops seeing Medicaid patients (doctors en masse are going to stop seeing Medicare patients) and she claims she is uprooting her medical location to decrease her overhead. I guess you believe this is some sort of an elaborate ruse to denigrate Obamacare?

If you are going to make factual observations about a profession from a layperson's perspective, please link to the source of that information. That way, others can examine your source.

[nathanm]

If you are going to make factual observations about a profession from a layperson's perspective, please link to the source of that information. That way, others can examine your source.

Seriously? You can't bother to do a simple Google search to look up the Medicare reimbursement schedule?

To sate your laziness:

Requirements for various levels of office visit
AMA CPT Lookup (search for "outpatient visit")
Medicare Fee Schedule Search (search for the range of HCPCs between 99201 and 99215 for outpatient visits)
Discussion regarding proper coding of outpatient visits to ensure being paid for all services rendered

The overhead figure (link to zip file containing excel spreadsheet) is claimed by HHS to be from the AMA also.

And yes, I suspected it was a ruse given that I was pretty sure my government isn't quite dysfunctional enough to pay less than $20 to see a physician. Combine that with the Heritage logo there on the video, I figured I should probably verify the doctor's claims. Turned out, I was right to doubt her.

[Hoss]

Seriously? You can't bother to do a simple Google search to look up the Medicare reimbursement schedule?

To sate your laziness:

Requirements for various levels of office visit
AMA CPT Lookup (search for "outpatient visit")
Medicare Fee Schedule Search (search for the range of HCPCs between 99201 and 99215 for outpatient visits)
Discussion regarding proper coding of outpatient visits to ensure being paid for all services rendered

The overhead figure (link to zip file containing excel spreadsheet) is claimed by HHS to be from the AMA also.

And yes, I suspected it was a ruse given that I was pretty sure my government isn't quite dysfunctional enough to pay less than $20 to see a physician. Combine that with the Heritage logo there on the video, I figured I should probably verify the doctor's claims. Turned out, I was right to doubt her.

Sure hope Gweed does more research than this for his day job....

[nathanm]

Sure hope Gweed does more research than this for his day job....

Silly Hoss, research is for clerks!

[guido911]

Seriously? You can't bother to do a simple Google search to look up the Medicare reimbursement schedule?

To sate your laziness:

Requirements for various levels of office visit
AMA CPT Lookup (search for "outpatient visit")
Medicare Fee Schedule Search (search for the range of HCPCs between 99201 and 99215 for outpatient visits)
Discussion regarding proper coding of outpatient visits to ensure being paid for all services rendered

The overhead figure (link to zip file containing excel spreadsheet) is claimed by HHS to be from the AMA also.

And yes, I suspected it was a ruse given that I was pretty sure my government isn't quite dysfunctional enough to pay less than $20 to see a physician. Combine that with the Heritage logo there on the video, I figured I should probably verify the doctor's claims. Turned out, I was right to doubt her.

You really believe she would go to all that trouble to make that silly point? Just wow. This doctor was critical of the rate of Medicaid disbursements (months and months of waiting) which, as you may know, negatively impacts on how a business can even operate. Do yourself a favor, open a business, perform the work, and then try to survive while you wait upwards of a year to get paid. Factor in that you have employees that need to get paid on time or they will leave (or sue you). That was a big point this doc was making that you simply ignored.

Also, do you dispute that doctors are turning away Medicare/Medicaid patients at present? If so, you have your head buried in the sand. I have direct, first hand knowledge of what is going on in this business both from the inside and out and what she is complaining of is really taking place. He!!, when I worked in hospitals back in the early 90s, Medicare reimbursement and its timeliness was a serious issue. 

Finally, as to her asserted hourly overhead rate, unless you know what her business model is and: 1) what she is paying in rent; 2) what she is paying her employees; 3) what benefits she provides her employees (health/dental 401k); 4) whether she is factoring into this amount the cost of her medical malpractice coverage; 5) whether she outsources her lab/x-rays or performs the same in her office; 6) whether she factored in outpatient surgical procedures she performs in her office, or any other numerous categories that are not included in that spreadsheet, just citing to a general overhead schedule is essentially apples and oranges. 

[Hoss]

Silly Hoss, research is for clerks!

Yeah, thought about that when I said it.  Although as a matter of their schooling, them there law-yers are taught how to research... 

Well, at least I thought so.

[nathanm]

You really believe she would go to all that trouble to make that silly point? Just wow. This doctor was critical of the rate of Medicaid disbursements (months and months of waiting) which, as you may know, negatively impacts on how a business can even operate. Do yourself a favor, open a business, perform the work, and then try to survive while you wait upwards of a year to get paid. Factor in that you have employees that need to get paid on time or they will leave (or sue you). That was a big point this doc was making that you simply ignored.

Also, do you dispute that doctors are turning away Medicare/Medicaid patients at present? If so, you have your head buried in the sand. I have direct, first hand knowledge of what is going on in this business both from the inside and out and what she is complaining of is really taking place. He!!, when I worked in hospitals back in the early 90s, Medicare reimbursement and its timeliness was a serious issue.  

Finally, as to her asserted hourly overhead rate, unless you know what her business model is and: 1) what she is paying in rent; 2) what she is paying her employees; 3) what benefits she provides her employees (health/dental 401k); 4) whether she is factoring into this amount the cost of her medical malpractice coverage; 5) whether she outsources her lab/x-rays or performs the same in her office; 6) whether she factored in outpatient surgical procedures she performs in her office, or any other numerous categories that are not included in that spreadsheet, just citing to a general overhead schedule is essentially apples and oranges.  

It's a reasonable cross country average calculated by the AMA that covers all of the categories that you cited. If she chose to locate in a building with abnormally high rent, that seems like her problem to me. She should go out of business if her costs are out of line. That's the way capitalism works.

If she performs X-Ray and lab services in house, she gets paid for doing that work also, making her claimed $17.50 average per-visit revenue even more ridiculous. Her statements just don't add up. Even if I'm charitable and say she wasn't including medical malpractice in that, that's another fifty bucks an hour. That gets her close, but if she's only billing $20 per visit, she's not seeing patients. She should be getting at least $40 for most visits. The $20 level is reached by having the nurse take vitals. The $40 level is reached by having the patient give a history about the problem. If her staff can't code properly, that's not the fault of Medicare.

I agree that timeliness is an issue, but she only asserted that with respect to Medicaid, which is administered by the states. I can't really do anything about it if the State of Georgia mismanages the program, seeing as how I live in Tulsa.

[guido911]

Silly Hoss, research is for clerks!

That's what I do for a living. I quit day to day litigation practice and focus entirely on appellate and legal argument matters. As part of my practice, and how I unfortunately live, I want to know exactly what an opponent or any other person uses as their authority in order to fully understand their position. I almost always provide as a courtesy any factual bases for an argument, that way it does not appear that I am talking out of my a$$ and at the same time give some credibility to my positions.

[nathanm]

That's what I do for a living. I quit day to day litigation practice and focus entirely on appellate and legal argument matters. As part of my practice, and how I unfortunately live, I want to know exactly what an opponent or any other person uses as their authority in order to fully understand their position. I almost always provide as a courtesy any factual bases for an argument, that way it does not appear that I am talking out of my a$$ and at the same time give some credibility to my positions.

Huh, I can't say I've noticed a lot of supporting links in your posts. That's fine, this isn't formal debate. It's just odd that you once again presume I'm just making stuff up. It's getting old.