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Doctors Differ In Diagnosing Supreme Court Ruling

Joe Cantlupe, for HealthLeaders Media, July 5, 2012

Adding an estimated 19 million people into Medicaid by 2014 also may strain payments to physicians, which currently come in at only slightly more than half of what private insurance pays, according to the conservative Heritage Foundation. The lower payments already discourage doctors from accepting Medicaid payments, says G. Keith Smith, MD, an anesthesiologist in Oklahoma City, OK, who opposes the Supreme Court decision. "It is a disaster for physicians," Smithsays. "It's incredible how much more difficult it will be [for physicians] to see Medicare patients. Many will opt out. We're all scratching our heads and not making any headway. This is so dysfunctional."

In addition, Smith says, many physicians oppose the Independent Payment Advisory Board to contain cost growth in Medicare. As IPAB cuts reimbursements, seniors will experience growing access problems. Congressional committees continue to examine the IPAB.

In the meantime, the Supreme Court's decision to leave Medicaid coverage up to the states clearly will impact physicians and their workload. Before the court's decision, hospitals and providers were expecting millions of low-income and disabled patients to join Medicaid's ranks. Now, Republicans are ramping up efforts to thwart state involvement in Medicaid.

"I think physicians generally want to provide quality healthcare and I think there are going to be barriers," says Michael Fleming, MD, FAAFP, chief medical officer for Amedysis, a provider of home and healthcare based in Baton Rouge, La. Fleming described himself as generally neutral about the Supreme Court decision.

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4 comments on "Doctors Differ In Diagnosing Supreme Court Ruling"


R Daniel King (7/7/2012 at 11:05 AM)
The Center for Medicare and Medicaid Service has utilized price controls and regulations to control costs and quality respectively. Price controls for centuries have cultivated poor quality, fraud, lost talent, shortages, surpluses, organized crime etc. And federal regulations have extinguished innovation in the delivery system masked by the innovation in industries not subjected to price controls but sell great innovation in medical technology and drugs to the delivery system. Price controls have caused the quality chasm identified in the 1999 Institute of Medicare Report, and to this day, poor quality is still a cash cow as CMS uses savings from price ceilings to reimburse preventable medical errors (minus a few). When Intermountain Health System focused on preventing medical errors, it took a loss on every Medicare patient because CMS price ceilings underpay excellence. Price ceilings have caused a shortage crisis in primary care physicians. Plus, the limits in income contributes to the "less than stellar" medical school applicants in recent decades as the talented students choose price control-free careers. Price floors have resulted in overpayments to cardiologist (recently and painfully corrected) creating years of surpluses and waste. The same for CT scans because CMS's pricing system is slow to respond to technological advances that lowered costs while increasing value. Decades of CMS underpaying excellence has made excellence a cultural misfit in the nation's inefficient, quality challenged healthcare delivery system with few exceptions. And decades of government rewarding failure has filled the quality chasm with a culture of failure that ObamaCare puts on government steroids which makes ObamaCare a dead program spending just like Maine's Dirigo Health, Tennessee's TennCare, and Hawaii's employer mandates.

Tyco Brahe (7/6/2012 at 11:14 AM)
For those who decry government intrusion: The government ONLY has to step in when the private sector has failed. Medicare, SS, Medicaid are ALL programs that the government was forced to [INVALID] because the private sector ignored vulnerable populations. This healthcare reform law is the same. If 1/6th of the country weren't left uninsured because private insurance cost so much, the government would not have to step in. As for expanding Medicaid, just because some doctors don't take medicaid doesn't mean no doctors will. In fact, city hospitals and community health centers ALL take medicaid. If doctors won't take the insurance, watch nurses and PA's suddenly start getting the right to give direct primary care. You cannot leave a large chunk of America without care just because doctors won't take government insurance. The rules will all change. This is all a bump in the road to single-payer medicine. All the other developed countries have figured it out. We will too. Insurance companies and provider greed have forced the hand of the government.

Jay A. Hendrickson, M.D. (7/5/2012 at 5:02 PM)
The reason we are in the current Healthcare predicament is because of governmental intrusion. Where has the government stepped in to a business and made it more efficient, streamlined and overall better? That is correct- NEVER!!!!! As a physician I refuse to work for free, as I did during residency and fellowship. Medicaid pays about 9 cents on the dollar here in California. I can not run a practice without getting pain for the work that I do for the patients. Expanding Medicaid is USELESS. How many physicians, other than University physician, even take Medicaid? None in my area! I also find it amazing how some physicians are happy with this Federal Law. It is equivalent to having a prostitute teach your children abstinence- it makes no sense. As far as the AMA is concerned, I have not been a member for over 10 years now and 80-85% of my colleagues agree with me as only 15-18% of physicians are members. So all of you that think this is a good law, then you can see those patients for free, because your reimbursement will be ZILCH!!!!