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Politics : The Obama - Clinton Disaster -- Ignore unavailable to you. Want to Upgrade?

To: DuckTapeSunroof who wrote (28390)	3/30/2010 10:40:46 AM
From: TideGlider	Read Replies (1) \| Respond to of 103300

I think the writer has forgotten the plan to forgive the loans !

To: DuckTapeSunroof who wrote (28390)	3/30/2010 10:42:57 AM
From: longnshort	Read Replies (1) \| Respond to of 103300

no competition on interest rates. so now we get more 'women's study' majors who owe 120,000 and can't get a job.

To: DuckTapeSunroof who wrote (28390)	3/30/2010 7:52:45 PM
From: Hope Praytochange	Read Replies (2) \| Respond to of 103300

ObamaCare Rules For Paying Doctors Might Spur Exodus By DAVID HOGBERG, INVESTOR'S BUSINESS DAILYPosted 06:52 PM ET Dr. Geralyn Ponzio, a primary care physician in New Jersey, closed her private practice this month. Numerous factors contributed, including inadequate reimbursement from insurers and Medicare, but President Obama's health care overhaul played a key role. "It was a very big part of it," she said. "They said they were going to pay primary care physicians more, but I didn't believe it. I was also worried that, eventually, we'd be required to take Medicare and Medicaid patients." Two ObamaCare provisions affecting how physicians are paid may accelerate a trend of more doctors such as Ponzio leaving the profession. New Payment Rules Under the health care law, insurers that participate in the exchanges must develop "a payment structure that provides increased reimbursement or other incentives for improving health outcomes" via practices such as quality reporting, effective care management, care coordination, and medication and care compliance initiatives. The health and human services secretary and a panel of experts will determine the payment guidelines. For Medicare, the health care law empowers the HHS secretary to develop a "payment modifier" that will increase Medicare reimbursements for quality care. The secretary "shall establish appropriate measures" for quality. "If you don't go by these guidelines you won't be able to bill Medicare or the insurance companies that participate in the exchanges," said Dr. Richard Armstrong, a general surgeon and member of Doctors 4 Patient Care, an advocacy group that opposed ObamaCare. Some physicians worry that complying with these new quality measures could add to the administrative hassles that are already hurt ing their ability to spend time with and do what is best for patients. "There are going to be doctors that are going to leave because these (changes) will result in more regulation for them," said Dr. Hal Scherz, an Atlanta pediatric urologist and president of Doctors 4 Patient Care. "It puts them in a position where they cannot do their job ... that's why doctors will retire. They'll be fed up with the fact that they'll be told what to do and they'll be concerned that if they don't follow the guidelines, they'll have to make a decision whether to do the right thing or go to jail." Reimbursement issues were rated "most unsatisfying" by more than 54% of doctors surveyed in 2008 by the Physicians Foundation. Managed care issues and Medicare/gov't regulations were not far behind, with 51.6% and 45.8%, respectively. Seventy-nine percent of doctors said ObamaCare makes them less optimistic about the practice of medicine, according to a survey by Sermo and AthenaHealth (ATHN). Two-thirds said they would consider dropping all government insurance programs. A recent New England Journal of Medicine survey found that about one-third of physicians would mull leaving the profession. Forty-five percent of physicians expressed similar thoughts in a 2009 IBD/TIPP poll. A Sermo survey found that 26% of physicians were considering closing their solo practices. Merit Pay For Docs Some physicians, however, say the payment reforms are a boon. "Most of these things don't hit for a few years, so they won't immediately change the practice of medicine," said Dr. Daniel Fass, a radiation oncologist in Rye, N.Y. "It's an attempt to address quality and utilization in medicine. I think they are something to look forward to. It will foster evidence-based medicine; everybody wants to see higher-quality outcomes. At the same time, it will reduce the explosion in the growth curve of health care costs." Dr. Doris Robitaille, a family practitioner near Austin, Texas, ended her solo practice this year and later traveled to Haiti to provide health care after the earthquake. "I'd rather be a servant to the people than be a slave to the insurance companies," she said. But she doesn't blame ObamaCare. "When people asked me about health care reform, I'd reply: 'I would vote for anything different than what we're doing now. The status quo is such a crisis.'" Huge Shortages Loom A study by the Association of American Medical Colleges projected a U.S. shortage of 124,000 physicians by 2025. And that doesn't account for the tens of millions of new patients — and possible pickup in early doctor exits — due to ObamaCare. Data from the American Medical Association reveal a trend among physicians to retire earlier. A 2007 survey by Merritt Hawkins & Associates found an increase from 2004 in the number of doctors age 50 to 60 planning to retire in the next three years. "A lot of doctors aged 55 to 65 are going to say enough," said Doctors 4 Patient Care's Scherz. "That's unfortunate, because at 55 to 65 we are at the peak of our careers, we're the best mentors to the young doctors out there." Others suggest that paying for quality will help doctors get back to providing care the way they want to. "It all depends on how it is carried out, but the underlying approach has got to be seen by doctors as favorable," said Stuart Guterman, assistant vice president for payment system reform at the Commonwealth Fund. "Instead of having to focus on what procedures are most profitable, you're now being paid for things that allow you to help your patients most." Ponzio is not convinced that the quality measures will improve physician satisfaction. "What if they require average blood sugar for my diabetic patients? That puts the onus on me when the responsibility is not mine entirely, a large part of it is the patient's. If the patients don't take their medications and check their blood sugar and then have bad outcomes, I'd get penalized for that."