DPC physicians and patients take note!
An aspect of Alexander-Murray will exacerbate an under-appreciated flaw in ACA requirements for plans considered “catastrophic plans.”
Alexander-Murray will allow anyone to have a “catastrophic plan” as such plan is defined by ACA. ACA limits enrollment in these plans to enrollees under 30 years of age or enrollees who have a waiver. Alexander-Murray would do away with these limitations. So far so good.
Another ACA limitation on these plans — found in ACA section 1302(e) — is that the plans will provide no benefits until the enrollee’s annual out of pocket limit has been reached, except that the plan must cover “at least 3 primary care visits.”
This will harmful to patients of DPC practices and is bad policy. It essentially forces primary care to be handled in-network — great for the insurance companies but not for the patients orthe doctors.
Ideally the requirement should be struck from ACA. Alternately, a small change along the lines of this or something similar [in brackets] might help fix this problem:
(B)the plan provides—
(ii)coverage for at least three primary care visits, [unless the enrollee is separately contracted with a direct primary care physician, in which case the plan will refund to the enrollee an amount equal to the value of such coverage.]
Two more items to pitch into “the AMA is utter Garbage” file:
- The AMA supports resuscitating the dead-end failure that is the “Affordable Care Act.” Patients have seen soaring premiums, deductibles, and medical costs, while at the same time often losing access to their doctor and other medical facilities of their choice. Physicians have suffered continued suffocation by ACA red-tape. But the AMA supports propping up this disaster of a law and throwing more good money after bad.
- AMA looks for gold in mining patient and physician data. Why is the AMA advocating against the best interests of doctors and patients? Follow. The. Money. The AMA has discovered it is more lucrative to sell patients and doctors out than to support their interests. Since 1983 the AMA has been making millions of dollars per year from the CPT monopoly it secured in a secret deal with the feds back in 1983. CPT has metastasized into the EHR fisaco that now plagues nearly every office and facility. Now the AMA is hoping to find another pot of gold by mining the data CPT helped to create… patient and physician medical data to be exact. How much can the AMA make of the data? Who knows, but you can read more about the new initiative here: https://healthitanalytics.com/news/ama-launches-integrated-healthcare-big-data-analytics-platform.
Danger, Will Robinson! Danger!
Robert Nelson MD of the Georgia Chapter, Free Market Medical Association, writes in:
The fatal flaw, or poison pill, of our entire healthcare system, is that we’ve tried in vane to make it a system.
We set aside everything we knew about human behavior and motivation and behavioral economics and pretended it didn’t exist. We based interventional policy on myths such Roemer’s Law. We tied it to employment by using the tax code. We handicapped markets with McCarran-Ferguson. We handicapped Physicians and other providers with HIPAA. We perverted insurance with all manner of mandate such that it violated every principle of what insurance is supposed to do. This has created Health insulation rather than health insurance.
Then the geniuses thought they can fix it with HMO and then PPOs and now ACOs and all the rest of the alphabet soup that they serve up. All of this has one thing in common and that is price opacity. We have not had a market failure we’ve had one giant pricing failure. We put healthcare on an island and treated it differently and treated it weirdly and regulated it excessively.
Many have gotten wealthy but patients are suffering and doctors are demoralized.
Anthony Wunsch writes:
Well all, I have written many an article on the pitfalls fo EHR systems, cost versus reward, interoperability among providers from different systems and networks, time spent doing data entry rather than patient interaction. When first required this industry spent $450 billion to meet meaningful use requirements phase one, and created a $10 billion per year support need. And that was phase one which completely left out the actual medical care, then phase two came and they said oops we forgot some things, billions more wasted to update, and then phase three and now the just kidding phase.
It was technology introduced backwards, it went to market and used the end users as the beta tests. And as the financing mechanism for those beta test. Any other technology the developers would have funded the development and brought it to market after being perfected, (relative term for technology).
In the end the industry ate the cost and passed it on to patients in the form of higher costs, with not an ounce of evidence it was going to decrease cost or improve care.
And in the end the whole push was so we could move into population health management; please don’t get me started on that rant.
ACA regulations drive costs up and mandates punish those who try to say “no.”
2. Hospital hidden pricing.
Insurers are complicit with hospitals in blocking patients from price shopping. Insurance CEOs want you to believe you need their product to avoid price gouging but often the opposite is true. Middlemen profit when no one knows the price.
3. Pharma costs.
Ubiquitous third-party payment keeps Rx prices (and premiums) soaring. And the PBM crony capitalists are blocking the pharmacist from telling you that the cash price is often lower than your insurance co-pay.
4. They can.
It’s time for patients and doctors to say “no” to the cartels and demand real options.