to provide or not to provide – that is the question !

This has been my first full week running my friends’ business http://www.pharmaciststeve.com/?p=3949

I am now COO/CFO of this very large HME company with 50 odd employees and operating in some 5 states.. I am still trying to get all the significant data points and wrap my head around it.

For those of you not involved in the HME business… that industry is now dealing with competitive bidding.. We don’t deal with blood glucose monitor supplies, but it is my understanding that the allowable has been cut by 75% and it is my understanding that the only source that can sell a product below the allow amount is made in CHINA..  I don’t know about you.. but having blood glucose monitoring based on a product out of CHINA.. does not give me the warm fuzzes. But the FEDS have elected to either force Medicare pts to use such products and/or force the American manufacturers to reduce their price.. in order to be able to sell product. So much for our free enterprise system.. and is this a hint at where Obamacare will attempt to control overall costs of providing healthcare to our citizens.

The staff member that does the billing for the home HME  arena for the company .. told me the other day.. that the billing in that section of the business is 20% -25% Medicare and that because of Medicare cuts.. that entire section will probably experience a 10% reduction in gross revenue. At some point this year.. I am going to  have to sit down and look at which products that do not provide a direct/indirect net profit and evaluate if the business continues to provide a particular product or service.. and/or stop taking assignment on providing the service/product.

My predecessor appeared to believe that any dollar in revenue – regardless of what it costs to provide the service/product  – was a good deal… I guess that old retail philosophy “It doesn’t matter if you lose money on selling a product… you will make it up in volume ” applied here.

We already know of physician’s practices that are limiting the number of pts in their practice …that have Medicare/Medicaid and certain insurance program.

I just wonder how many other healthcare providers are going to be forced into going thru such evaluation in the not so distance future.. as Obamacare gets implemented.. and – mostly likely – gross expenditures for healthcare skyrocket and Congress reacts with reducing what is paid for a particular product/service and/or implement capitation and keep lowering the capitation rate annually.

There was talk with the implementation of Obamacare that there would be “death panels”.. while no one expects this to happen on a patient by patient basis.. but Obamacare calls for

The Patient Protection and Affordable Care Act, commonly called Obamacare, called for the establishment of a Patient-Centered Outcomes Research Institute.

The new institute’s purpose is to carry out “comparative clinical effectiveness research,” which is defined in the law as evaluating and comparing “health outcomes” and “clinical effectiveness, risks and benefits” of two or more medical treatments or services.

The purpose of the research is purportedly for the government to determine which treatments work best so that money is not spent on less effective treatments.

And we all know that everyone responds equally to a specific product/service/treatment.. there is no variation between homo-sapiens.

How many pts who does not respond to the “best therapy for the lowest price”.. either going to have to pay out of pocket to try a different therapy and/or watch their health deteriorate while they go thru .. what is probably going to be a laborious, foot dragging, appeal process… and what will their final outcome be… transversing this new system.

As I have said before.. most likely the only people that will be satisfied with this new system .. is the ones that don’t have to use it..

 

 

2 Responses

  1. Obamacare came about because people were disgusted with the current state. I’ve been speaking about this since the early 90’s. Paul Revere is our hero- but what do we do from here?
    Since Bush- Senior citizens are happy. Or aren’t?

    I tried to buy a deductible policy $12K and they would sign up me and kids, but not my husband.

    I finally bought a policy for $750 a month that includes nothing but a $5000.00 deductible. No Rx. Seriously $750 a month for nothing.-except if we were in some terrible accident.

    Every other insurance company denied us. My husband is 54.

    Obamacare with it’s provisions to insure the uninsurable (Kevin) and all of those other low lifes. Like me and my 3 kids.

    Maybe when this new ruling takes effect, I can get a good night’s sleep.

    I wonder- why should all the regulations only pertain to old folks.

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  2. We are seeing the strategy of Obamacare…CUT…CUT…CUT to the providers. How can you have a healthcare system with NO providers? You mentioned diabetic strips and the local HME provider in my town stopped doing strips for medicare patients. My company(idiot Wal-Mart) still does it and we had one rx a few days ago where we lost $550. Wal-Mart believes they will make up for these loses by getting the customer in the store and the customer will buy something else. This may have worked up until now. It will take time for the bean counters to crunch the numbers determine that Medicare and strips are no longer feasible. I have no idea how many years it will take them to reach that conclusion.
    We baby boomers can now see the future of our Medicare healthcare. It looks frightening. The docs will stop taking Medicare. We will have to pay out of pocket. But, we baby boomers are such a large part of the population and when it comes voting time, the politicians will have to pay attention to us. So, makes you wonder how long Obamacare can last or how long the government can squeeze suppliers until everything ‘hits the fan’.

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