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IN pictures @1WORLD Community)
JohnnyAdam – Kira-kira
70 % peratus daripada 104,000 doktor California dilaporkan merancang 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
