• New Zeal Blog

  • Advertisements

Thanks, Nancy: What the ‘Doc Fix’ Failure Means in the Real World

by SusanAnne Hiller

from BigGovernment.com

Aside from breaking her word to the AMA and physicians across the country, Democrat House Speaker Nancy Pelosi has effectively demolished doctor reimbursements for most of the healthcare industry.  The 21.2% Medicare fee schedule cut has taken effect, but what most do not realize is that the Medicare fee schedule is the gold standard for provider reimbursement fee schedules across the nation.


Essentially, where Medicare goes, insurers follow for the guidelines in covered services and baseline physician fee schedules for private payers as well as worker’s compensation and automobile insurance companies in most states, as well as Medicaid and Medicare itself.

What Pelosi has effectively done is saved the insurance companies who use the Medicare fee schedule millions of dollars of payouts to physicians on their claims–regardless if the patient is a Medicare patient.  I’m not seeing the insurance lobby out there right now, are you?  However, on the provider side, the doctor’s lobby groups are outraged at Pelosi’s failure and the damage this inaction will cause physicians–especially private–and force them to layoff employees to make up for the loss in reimbursements to cover their enormous monthly overhead costs.

Pelosi is completely ignorant of the doctor’s fee schedules and how their reimbursements are calculated.  In a multilayered approach and working with the Centers for Medicare and Medicaid Services (CMS), the AMA Resource-Based Relative Value Scale (RBRVS) is used and the AMA/Specialty Society Relative Value Scale Update Committee (RUC) makes annual recommendations regarding new and revised physician services to CMS and performs broad reviews of the RBRVS every five years.  These values have not been adjusted since the 21% fee schedule reduction took effect and for Pelosi to ignore the fact that the doc fix will actually cost doctors to see their patients because their fees will be reduced, but the cost of providing the services and the supplies needed have not gone down and in some cases, continue to rise.  Additionally, student loan payments have not been decreased by 21% for doctors, have they?

The only business segment to ultimately win is the insurance industry.

Real-world exit questions:  If you own a company and your revenue just got nicked by 21%, but your supplies and cost of services has remained the same, how long before you will have to layoff employees to cover your monthly costs?

Do people understand that private practice physicians take most, if not all, of their salaries on assignment?  Physicians must do this because of provider contracts and other variables, but their fees are not a guarantee of payment; claims can be denied in part or in full.  (Some lawyers take their fees on assignment, but it is their choice.)  And now, doctors are being used as political pawns by the Democrats.

Is it possible that the Democrats are attempting to push doctors into the union, say the SEIU?  Only those doctors who are in private practices, not employed by hospitals cannot unionize, so what’s next for them?

Nothing like having a bunch of bureaucrats who have no idea about healthcare, costs of providing services,  running a business, covering overhead, etc. in charge of your salary, covered services, and future.

Finally, this is clearly a Democrat problem, after all, “You won.”  And by that, Americans now understand that to mean that the Democrats are clearly the party of cry-babies, finger-pointers, and blame-shifters.  And job killers, because if your more than $800 billion stimulus and jobs bills actually provided jobs, we wouldn’t need unemployment extenders in current legislation.  Americans would actually be back to work, wouldn’t they, Nan?


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: