Doctors and Universal Healthcare
Healthcare News and Actions June 7, 2023
Happy Wednesday Healthcare Advocates
Please enter requests for research using the comment button at the bottom. Remember our advocacy educates our representatives and lets them know what we want them to do for us.
Now that the debt crisis is behind us let’s turn our representatives' attention back to reforming healthcare for our benefit.
Universal Healthcare and Doctors
I received a note from Jessica Cravens yesterday asking how doctors will be paid under Improved Medicare for All (HR 3421). She is the author of “Chop Wood, Carry Water” and I highly recommend her newsletter.
This question arises regularly and for good reason. Medicare Part B (not Medicare Advantage) has had reimbursement rates to doctors that are often low. Some of my friends have doctors who now refuse to take Medicare patients at all. So doctors are concerned that if the payments are low now, how will they make a living under the new Improved Medicare For All?
Major networks of providers or hospitals will be able to negotiate a more global budget and we won’t cover that today.
The answers below address those doctors that will choose to be paid in a fee for service environment. It is a multi-part answer and addresses many of the expenses doctors currently have together with the the mechanisms that will be put in place to assure that fees are fair.
Summary
Here are some of the ways doctor expenses will decrease under Improved Medicare for All
a) Today doctors waste a significant amount of time and money with insurance billing. The new system will have one insurance company and one coding system
b) They won't need a large staff to manage denials and pre-authorization
c) Billing and payments will all be electronic
d) Malpractice insurance expenses will decrease dramatically.
e) Regional oversight boards are designed to assure fair payments for services
Details
Here are some of the details of the items above.
WASTED OVERHEAD RELATED TO INSURANCE
Doctor offices and sometimes doctors waste a tremendous amount of time with insurance companies. There are denials for service, pre-approvals resubmission of claims that have been denied, readjusting coding for services to make sure the insurance company covers the service that was actually performed. Each insurance company has their own method of determining what is medically necessary. In some states it can be based on the insurance company's claims experience. and not what a doctor ordered. This can waste time and money and sometimes harm patients.
Some physician offices have 2 or 3 full time staff to handle the insurance back and forth. It can still take hours each day away from the doctor and the patient as well as the billing staff. NPR found that on average insurance companies deny about 17% of claims but some companies can be as high as 80%. I have evidence from providers that insurance company reps keep tabs on how many claims they have denied and some treat it as a game. There are even newer AI platforms, I've reported on that can deny hundreds of thousands of claims monthly (no humans really involved).
There will always be some claims that are questionable but the Medicare for All plan is that if the doctor ordered it then the claim should be valid and paid.
MALPRACTICE EXPENSE
Malpractice insurance has an impact on the physician's costs
Now, at the low end it is about $3k per month for a low risk practice and about $20k/month for surgery (in Florida). Most of that goes away since claims for malpractice are for future medical payments, in general, and that will be covered under universal healthcare.
REIMBURSEMENT
Medicare reimbursements are usually below market. So let's address that because you need the changes I've mentioned above together with a method to determine a fair reimbursement so that the system works.
HR 3421 (IMFA) has a plan in place to create effective and fair fees for service. When determining fees the law will demand that the following are part of the evaluation process
1. Electronic billing and payment
2. Quality of provider status
3. Review of payments under Title XVIII of the Social Security Act; and most important
4. The healthcare insurance system will be managed by regional offices. Each regional office will arrive at fee levels. They will do that in consultation with representatives of physicians practicing in the area to make sure they are adequate. The regional director will establish a physician practice review board to assure quality, cost effectiveness, and fair reimbursement for physician delivered services and items.
The last one is really important because local doctors get to tell the directors how much is enough!!!
ACTION 1
Use RESISTBOT (text SIGN PKNMZV to 50409) or call or email your congressional representative and senators (their contact info is in the References Section) and tell them something like:
“ My name is [name] and I live in [zipcode] and I am your constituent. I am glad to learn that HR 3421, Improved Medicare For All, will set up regional centers advised by local physicians to ensure that there are sufficient facilities and providers to meet local needs at fair reimbursement rates. This is a giant step forward to eliminating medical deserts in underserved and rural communities. It will cover all of us, cradle to grave, no copay, no deductible, no maximum. It also includes long term care, reproductive care, gender care, and do it for far less than we pay now - per the CBO. You owe this to all of the businesses in your constituency who will pay less as well as to every student, parent, worker, and retiree. “
Reproductive News
Thanks to Jeri Zeider at Rogan’s List for this heads up.
STOP THE CDC FROM PROMOTING FAKE PREGNANCY CLINICS
With abortion bans spreading across the country post-Dobbs, we’re seeing a growing focus on so-called “crisis pregnancy centers”, facilities that present themselves as assisting pregnant people but primarily aim to dissuade them from accessing abortion. These institutions are sometimes filling the service gaps in family planning where clinics that offered abortions used to be. But they do not offer the same level of care or services and often attach strings to what they do offer. They often harass women who want to choose an abortion and misleading, inaccurate and false information to those who are looking for help. Yet they are being included in directories maintained by divisions of the Centers for Disease Control and Prevention for family planning services.
If that weren’t enough THEY ARE NOT HIPPA COMPLIANT AND WILL NOT PROTECT YOUR PERSONAL INFO. They have been known, in Washington, to sell/provide your personal information to others that harass pregnant women.
ACTION 2
Let’s add our voices to the activists who want to make sure no one is misled and tell the CDC to remove recognized “crisis pregnancy centers” and any other facility that provides medically inaccurate and misleading information from the National Prevention Information Network database.
You can email them at npin-info@cdc.gov or call them at 800-232-4636.
References
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
https://www.commoncause.org/find-your-representative/addr/
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Organizations to Contact
NARAL - Pro Choice America
Planned Parenthood
Physicians for a National Health Plan
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water Resistbot write up
Alan,
I retired last year from a psychology practice and was on Medicare and Medicare Advantage panels. So my first point is that there are additional healthcare providers who would be included. Providers is a term that includes all of us.
In addition to low fees, Medicare would need to solve another big hassle that has turned off many providers. Applying to be empaneled in much more onerous than joining an insurance panel, which is done via shared accrediting sites, like CAQH. Medicare provider applications are excessively lengthy and it takes many months for them to be reviewed.
Returning to the fee issue, though, that’s a big deal. Once Medicare sets its fees, you’re stuck. That’s it, except for supplemental insurers, and then we would still have the same administrative mess with them. I don’t think it would go away. I haven’t checked into it, but I think Canada would be an example of such a two-tiered coverage situation. You have government insurance, with some access problems. Then you have private insurers as an alternative. I wonder if you can point to other countries and their experience of at least partial success, once an insurance system is established.
Last and not least, we would all have to pay extra taxes for Medicare for all. We would probably still save money except for wrenches thrown into legislation by lobbyists who resist universal healthcare.
With all of that, would providers be able to unionize so that they could at least have some bargaining power? I expect that they would unionize by profession, so that MDs would have a different union than social workers, for instance, and then you have turf struggles. An example is that under existing Medicare, I don’t think that psychologists have hospital privileges comparable to psychiatrists. And, some lower tiers of degrees and licensing must be supervised by a higher tier, which is often wasteful and unnecessary.
Moving onto the hospital system or inpatient care, we would probably have to provide some sort of government assistance to facilities whose staff and service levels have been hollowed out by private equity.
The long of it is that this would be a complex implementation over a transitional period, and we wouldn’t be able to get it done without Democratic control of the House, the Senate, the White House and the Supreme Court. And, we would still need the voting public to support universal healthcare in overwhelming numbers while they are bombarded by messaging that would instill fear, uncertainty and doubt. It may be awhile.
That’s the glass half empty scenario, at least. How do we further fill that glass so that the whole system would be more ready to transition?