Could there be a “hook” under that financial bait ?

When it comes to Medicare/Medicaid payments… Congress has played “games” for years… for those of us old enough ..we remember Medicare HMO… initially get more money/pt than normal Medicare expenditures/pt… after a few years… Congress started pulling back the money… and/or not giving any increases… the HMO’s responded with reducing patient benefits, increases deductibles and copay… patients started dropping out and returning to regular Medicare… HMO… started pulling out of markets and before long .. Medicare HMO was nothing but a memory…

Then Congress got another “great idea” .. Medicare part C… which was Medicare HMO reinvented… and you can guess what happened over several years… and Medicare Part C was nothing but a memory…

Then Congress got another “great idea” … Medicare Advantage….  which was the same game they had tried before and brought in on line with Medicare Part D… we are now in the process of seeing .. what appears to be the waning days of this program as well.

Over the last several years.. we have seen more and more medical practices – especially certain specialities that are high Medicare folks utilization – because CMS reduced the allowables for what is paid for office based tests.. than what is paid for hospital based test.

In the metropolitan area that I live in.. 16th largest metro area in the country … I don’t think that there are any cardiologists or orthopedic surgeon left in office practice that is not owned/associated with a hospital.

Obamacare is focused on creating ACO ( Accountable Care Organization)… where the ACO is going to be at financial risk.. in theory they will be paid on a capitation basis. Some profess that these ACO’s will continue to form and expand even if Obamacare is repealed or replaced.  It is believed that hospitals will be the majority of these ACO’s.. at least in the end.

Can you see the monies provided to these ACO’s going down the same path that the three Medicare (HMO,C,Advantage) have taken? One can only manage the quality of care will be provided and will we have any options?

One Response

  1. When you leave it to government to take total care of your health and soon to be everything else, this is what happens. Politicians start anything just to be elected or re-elected. This is how government works. Either start something that can fix the problem quickly, or the government will promise something to work and fix the problem in 40 years. Most of them will be dead in 40 years, and it will probably be repealed in 2 to 4 years!

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