Why Care Under The Affordable Care Act Will be Unaffordable

By GabbyPA Latest Reply 2012-10-08 19:22:30 -0500
Started 2012-10-03 09:02:48 -0500

By Diabetes Health Magazine. http://www.diabeteshealth.com/read/2012/09/28...

By Author/Contributor, Richard Amerling, MD
Sep 28, 2012

Richard Amerling, MD

Several recent articles should dispel any remaining notion that care provided under the so-called Affordable Care Act will in fact be affordable. Just the opposite is true.

The Wall Street Journal reported that when physicians sell their practice to hospitals and become hospital employees, services they provide to patients become significantly more expensive. The reason for this, simply put, is that overhead is much higher, and third parties reimburse at a higher rate for exactly the same service. Another way to say this is that hospitals are less efficient than a private office. And, as I have pointed out, physicians are considerably less productive when working for a salary, as opposed to fee-for-service. This was an entirely predictable outcome. Yet, health planners behind the ACA pinned their hopes for cost containment on exactly this consolidation occurring. The ACA promotes Accountable Care Organizations; groups of “providers” and administrators who will assume financial risk for caring for patients assigned to them, by accepting a lump sum payment to cover all their medical needs. ACOs are the latest version of managed care, and will have similar problems. They will have a strong financial incentive to cherry pick healthy patients; those with serious problems will end up in emergency rooms and hospitals, where care is much more costly.

Several recent articles should dispel any remaining notion that care provided under the so-called Affordable Care Act will in fact be affordable. Just the opposite is true.

This brings us to the most recent article from the New York Times, which shows that when hospital emergency rooms and physician practices adopt electronic health records, reimbursements for physician services goes way up.

Read more: http://www.diabeteshealth.com/read/2012/09/28...

8 replies

IronOre 2012-10-04 22:47:31 -0500 Report

The ADA very much supported the passage of Obama Care . . . that it why I want nothing to do with them.

Just Joyce
Just Joyce 2012-10-03 23:42:07 -0500 Report

Medicare fraud has been going on for years and now they are cracking down. Doctors and hospitals have been getting away with this for years. A doctor quit at the hospital where I worked because he was told if he didn't bill medicare for patients he didn't see he would be fired. He filed a complaint with Medicare and there was an investigation. The hospital was billing medicare for deceased patients and got into trouble.

The fact of the matter is healthcare is expensive. Insurance companies are in the business to make money as are doctors offices and hospitals. You are charged for everything a hospital does for you including the bed pan and tissues. It is like an a la carte menu in a restaurant.

There are people and families who cannot afford health care, and they have a right to medical care. If you look at states, there are medical plans you can get into. In my state it is called Primary Adult Care. PAC will cover the hospital bill for medical emergencies. PAC will not cover the emergency physician bill or any other bills for hospital stays. PAC does not pay for any specialists. Even this is better than not having any health care. There is another government program that you pay for but it is far less than paying an insurance company. I think in some cases you can have Medicaid. You are not eligible at all if you have Medicare.

I think if people read the law itself you would get a better understanding of what the Affordable Care Act states. Even still this law can be amended at anytime which is why I am not too concerned about it or in panic mode.

Ms. DAT 2012-10-03 14:45:45 -0500 Report

Well it is true that Medicare look very closely at documentation from health care providers. I've had that experience
Medicare will take back every red penny paid for health care that is/was provided through any genre that provides health care.
Any Professional person providing care/ teaching must be highly careful about what they document. That includes on social communities.
Fraud is being reported every day and society today is sue friendly for malpractice.

Too many Medical recipients have also taken advantage of the system that caused those who really need it to be affected. It kinda angered me to see how people abused the system such as equipment/Home Health Care Nurses and so on. There are so many people who need care and can not get it.

So here we are complaining and upset about the Medicare/Medicaid System who many hard working middle class people paid into who now need it but not able to get these benefits without jumping through high hoops.

True Professionals do not desire to take advantage of the system like so many has done just to get out of working. Now with these new diagnosis I am learning a whole new system for Medicaid and besides I am too young for Medicare. Some insurance is better than not having none at all because the death toll will raise amongst people with multiple health issues by suicide. Nowadays not to many doctor's will treat you without some kind of insurance.

The E.R.'s/Urgent Care also charge you for opening a box of tissue and the treating physicians will provide basic treatment and tell you to follow up with your primary physician and if you don't have one they will refer you to one and it will be in your best interest to go to that follow up appointment.
Everything have a sticker with a code on it.

This is a real hotttt subject so I am going to let this go for now!

I am quite sure some one will read this and have more comments but I know what I am saying.

Have a great day everyone!!!

Nick1962 2012-10-03 12:15:20 -0500 Report

I suspect this is one of the reasons so many diabetics walk away with so little education. Every minute of a doctor’s time should in theory be billable. Education on an individual level can take time so there is no “standard practice” single diabetic education package. Under current rules, he loses that money unless he takes the risk of upcoding.
I’m still not sure I understand how the AHCA makes health care affordable by forcing you to buy insurance.