Reuters/Phil McCarten (think IN pictures @1WORLD Community)
SitiWanMahani - Kira-kira 70 % peratus daripada 104,000 doktor California dilaporkan meran-cang untuk jauhkan diri daripada pertukaran insurans kesihatan negeri , satu langkah yang boleh memberi kesan besar ke atas pelaksanaan Akta Penjagaan Mampu.
Sebagai negeri di seluruh kerja negara ini untuk mendaftar Amerika di ACA, satu soalan yang tinggal adalah apa jenis pesakit akses doktor akan mempunyai apabila liputan mereka tendangan masuk Menurut Presiden Persatuan Perubatan California, Dr Richard Thorp, penduduk di situ dapat mencari pilihan yang terhad pada permulaan tahun baru.
Thorp memberitahu Washington Pemeriksa sebab utama bahawa 7 daripada 10 doktor California memulaukan pertukaran Obamacare itu disebabkan oleh kadar rendah bayaran balik Medicare/Medicaid negeri ini, yang biasanya 30 % peratus di bawah mereka di bahagian-bahagian lain di negara ini.
Sebagai contoh, Medicare biasanya membayar doktor $ 76 untuk lawatan kembali - pejabat, tetapi di California doktor hanya menerima $ 24. Pembedahan pembedahan buah, sementara itu membayar antara $ 500 dan $ 700, manakala doktor di California menerima $ 160 untuk prosedur.
“Kita memerlukan pengiktirafan bahawa kita melakukan suatu khidmat kepada masyarakat,” kata Thorp. “Tetapi kita tidak boleh melakukannya secara percuma. Dan kita tidak boleh melakukannya rugi. Tiada perniagaan yang lain akan berbuat demikian.”
Kadar bayaran balik Medi-Cal California telah lama menjadi titik yang melekat untuk doktor, tetapi apabila syarikat-syarikat insurans mendedahkan kadar mereka akan terikat dengan program Medicaid negeri ini, ramai doktor menolak keras.
Untuk membuat perkara yang lebih mengelirukan, beberapa pemimpin persatuan perubatan memberitahu Pemeriksa bahawa banyak doktor disenaraikan sebagai peserta dalam Dilindungi California, pasaran insurans di negeri ini, tidak menyatakan bahawa mereka akan menerima pesakit dari pertukaran.
“Mereka boleh disenaraikan sebagai sebenarnya yang mengambil bahagian, tetapi tidak mengikut kehendak mereka sendiri,” kata Donald Waters, pengarah eksekutif Alameda -Contra Costa Persatuan Perubatan.
Walaupun jumlah tidak diturunkan pada masa ini, perasaan yang sama seolah-olah perkara biasa di kalangan doktor di New York. Pada bulan Oktober, satu tinjauan 409 doktor oleh New York Negeri Persatuan Perubatan mendapati bahawa 44 % peratus daripada doktor negeri tidak mengambil bahagian sebagai pembekal BPR, manakala tambahan 33 % peratus belum membuat keputusan.
Seperti di California, doktor menunjuk ke arah kadar bayaran balik yang rendah untuk mempertahankan kekurangan penglibatan mereka.
“Ini begitu buruk direka bahawa banyak doktor takut untuk mengambil bahagian,” kata Dr Sam Unterricht, presiden masyarakat perubatan 29,000 anggota, kepada New York Post. “Ada banyak rintangan. Doktor tidak tahu apa yang mereka akan mendapat bayaran.”
Sementara itu, usaha yang kedua-dua parti untuk selama-lamanya pembaharuan bagaimana Medicare doktor dibayar telah terhenti di Kongres. Menurut CNN, Penggubal undang-undang dari Kewangan Dewan Negara dan Dewan Cara dan Bermakna jawatankuasa telah bekerja pada undang-undang yang akan membeku pembayaran melalui 2023 sebelum melaksanakan dasar yang termasuk menimbulkan dan bonus. Undang-undang juga akan mengubah kaedah pembayaran balik Medicare ke dalam satu sistem yang nikmat “nilai lebih kelantangan.”
Reformasi tidak mungkin untuk lulus Kongres tahun ini, bagaimanapun, bermakna rundingan akan sampai ke 2014.
Bagaimana yang akan menjejaskan penyertaan doktor di California dan bahagian lain di Amerika Syarikat adalah tidak jelas, tetapi jika doktor terus bertahan , pesakit dapat mencari pilihan mereka pakar-pakar perubatan mengecut, membawa kepada peningkatan waktu menunggu dan kurang mendapat doktor mereka.
“Pendaftaran tidak bermakna akses, kerana tidak ada doktor cukup untuk mengambil kadar yang rendah Medicaid,” Alex Briscoe, pengarah kesihatan untuk Alameda County Penjagaan Kesihatan Agensi Perkhidmatan di California, berkata kepada Pemeriksa. “Tidak cukup doktor penjagaan utama, tempoh.”
70 percent of California doctors plan to boycott
Obamacare exchanges . . .
About 70 percent of California’s 104,000 doctors are reportedly planning to stay out of the state’s health insurance exchange, a move that could have significant impact on implementation of the Affordable Care Act.
As states across the country work to enroll Americans in the ACA, one question that remains is exactly what kind of doctor access patients will have when their coverage kicks in. According to the president of the California Medical Association, Dr. Richard Thorp, residents there could find limited options at the start of the new year.
Thorp told the Washington Examiner the primary reason that seven-out-of-10 California doctors are boycotting the Obamacare exchange is due to the state’s low Medicare/Medicaid reimbursement rates, which typically land 30 percent below those in other parts of the country.
For example, Medicare typically pays doctors $76 for return-office visits, but in California doctors only receive $24. A tonsillectomy, meanwhile, pays out between $500 and $700, whereas doctors in California receive $160 for the procedure.
“We need some recognition that we’re doing a service to the community,” Thorp said. “But we can’t do it for free. And we can’t do it at a loss. No other business would do that.”
California’s Medi-Cal reimbursement rates have long been a sticking point for doctors, but when insurance companies revealed their rates would be tied to the state’s Medicaid program, many physicians balked.
To make matters more confusing, multiple medical association leaders told the Examiner that many of the doctors listed as participants in Covered California, the state’s insurance marketplace, have not stated they’d accept patients from the exchange.
“They may be listed as actually participating, but not of their own volition,” said Donald Waters, executive director of the Alameda-Contra Costa Medical Association.
Although numbers have not been revealed at this point, a similar feeling seems commonplace among doctors in New York. In October, a survey of 409 doctors by the New York State Medical Society found that 44 percent of the state’s physicians aren’t participating as ACA providers, while an additional 33 percent were undecided.
As in California, doctors pointed towards low reimbursement rates to defend their lack of involvement.
“This is so poorly designed that a lot of doctors are afraid to participate,” said Dr. Sam Unterricht, president of the 29,000-member medical society, to the New York Post. “There’s a lot of resistance. Doctors don’t know what they’re going to get paid.”
Meanwhile, bipartisan efforts to permanently reform how Medicare doctors are paid have stalled in Congress. According to CNN, Lawmakers from the Senate Finance and the House Ways and Means committees have been working on legislation that would freeze payments through 2023 before implementing a policy that includes raises and bonuses. The law would also change Medicare’s reimbursement method into a system that favors “value over volume.”
The reforms are unlikely to pass Congress this year, however, meaning negotiations will extend into 2014.
How that would affect doctor participation in California and other parts of the United States is unclear, but if doctors continue to hold out, patients could find their choice of physicians shrink, leading to increased waiting times and less access to their doctor.
“Enrollment doesn’t mean access, because there aren’t enough doctors to take the low rates of Medicaid,” Alex Briscoe, health director for Alameda County Health Care Services Agency in California, said to the Examiner. “There aren’t enough primary care physicians, period.”
READ MORE: http://on.rt.com/thfo37
