Emerald Coast Pain Blog

A lot has been discussed in the media recently about the upcoming changes to the healthcare system. Obviously, none of know for sure what to expect but we in the healthcare field have been told to expect some changes. One of the changes to expect is the exchange system. It is a rumor that most companies are hoping to “dump” their employees on these exchanges and just pay some basic fee for doing so. If the exchanges are anything like what has been developed in California then things are going to get dicey. The California system is modeled on a four tier structure with a platinum level down to a bronze level. The patinum level covers 90% of patient costs minus co pays and deductibles which could add up to a few thousand dollars, while the bronze covers 60% of costs minus co pays and deductibles. Between these two are a gold and silver level with 80 and 70 percent coverage respectively. Professional advisors have been warning those of us in the healthcare field that because people want to save money, most people will pick the bronze plans which carry high deductibles and much higher co pays. This is going to mean that physicians and hospitals are going to need to start heavily collecting deductibles and co pays upfront since insurance may not cover much of anything until the deductible is met and then only 60% of costs after that. Although patients think most doctors make enormous amounts of money (some do, most don’t), dotcor who work with insurance and aren’t subsidized haven’t seen a pay increase sine the late 1990’s, if anything, we have been fighting off decreases. Thus, you as the patient are going to see much more agreesive bill collecting starting next year as costs are shifted to you. Obviously, some people will be on the same insurance plans as before and will not see much change, at least initially, but the process is expected to shift costs to individuals over the years for all insurances, including medicare. Another issue coming up is the possibility that employers will offer employess a mini-med plan that covers the basics, just enough to be compliant with the new healthcare laws, but nothing else. Large companies with low wage employees are already seeing such plans. These plans are probably better than what the employees of some of these companies had before, i.e. nothing, but it will give them a false sense of security since nothing beyond basics are covered. We have already seen such plans where office visits are covers but not much else. The patient has pain but with this type of insurance, nothing can be done to truly correct the problem.

Issue 2: Denials. Starting in 2011, we started seeing an increase in prior authorizations and denials from insurance companies, even medicare. The insurance companies are planning to make getting anything that is non-emergent very difficult to get. For example, we used to be able to get synvisc injections for patients with knee pain who had medicare but now those same patients have to have five things done prior. The premise is that if they creat enough hopes that people will just give up. We have already seen this where the patient would rather just pay for the MRI with cash then have to under go 6 weeks of physical therapy which would cost three times the MR just to have the insurance company pick up part of the MRI costs. I have heard from patients that their insurance companies have told them to get what they need done this year because big changes are coming with more requirements before things get done. It is the politically correct way of rationing healthcare, in that you can eventually get what you want done but you will have to jump through various hoops first.

Issue 3: Medicaid
The government is planning to greatly increase medicaid. Now I’m not sure how many people out there are on medicaio, but not many doctors accept medicaid. In fact, I am currently the only one in the area (from Tallahassee to Pensacola) that accepts medicaid. Medicaid pays very poorly and I accept it because these people need someone to help them but even I can only accept so much. For example, medicaid pays the doctor $20 for an office visit. Let’s say a doctor can see five patients an hour if he really rushes (I see four an hour). This means he could bring in $100 an hour, sounds great right? Well, after he pays for the staff, the taxes, the electric, the lease, etc, he is actually losing money because it probably costs around $120 per hour to run the office. This is why few people accept medicaid. So who is going to care for all these people on medicaid? We don’t know. The insurance companies are coming out with medicaid HMO pland but almost no one is on them. One of my patients couldn’t see me any longer because of the change to a medicaid HMO plan. They may be able to find a primary doctor but finding a specialist is going to be very hard.

Issue 4: Pre-existing diseases
The whole purpose of this healthcare plan was to get people on insurance who have pre-exisiting diseases right? Well, the patients I have will siginificant pre-existing diseases still can get insurance. Why, it is too expensive. The beauty of the healthcare law is that no one can be denied insurance but the insurance companies can still charge more for pre-exisitng diseases. The insurance for these people is over a grand per month but don’t worry because since it is so expensive, you can opt out without paying a penalty since it is too much of your gross income.Thus, the people with pre-existing diseases may still be out of luck but at least they won’t be taxed because of it.

Eventually people will get used to the new system. More and more doctors will open up cash based practices or they will find some other way to supplement income. Also, the future of healthcare is that most new doctors will be employees of larger enities such as hospitals. This may be good and bad since a doctor who is an employee is going to do the least they have to do to get their paycheck and thus healthcare cost will go down but if you want something done that is not a simple fix, they may be unwilling to take the risk since their are still liable with malpractice issues. Thus the doctor of the future will be in the worst situation where they can still be personally sued for what ever they do but they have no incentive to do anything aggressive to help the patient. Thus, you as the patient will get more of the “I don’t know” answers from your doctors as they push you off if you don’t improve with there simple treatments. You will have fewer options as the doctors who are employees are required to refer you within their company’s system so that money is kept within the company even if they know a better doctor elsewhere could help you more. Thus, your options will get more and more limited. As the country drifts into socialism with healthcare, it will be more and more like europe and canada where you can get simple things done fairly easily, just don’t get really sick becasue you’ll be waiting or paying cash.

It’s going to get interesting