The sequester if you don’t remember, started in April and since that time doctors and hospitals are getting paid 2% less from Medicare.  For one doctor’s office that may not sound like a big sum of money but for a hospital it is big.  So keep that in mind that all hospitals are getting paid 2% less on their Medicare claims and have been for months.  In addition they have to deal with the outpatient/inpatient billing nightmare as even as a patient, you don’t know if you are admitted or not and it’s complex billing situation and hospitalists deal with it all the time.

What's Bugging Hospitals–Not Obamacare As An Entirety But Rather the 2% Loss of Reimbursement Due to Sequester and CMS Rules Lacking Better Models Along With CMS Dissolving Annual Payment Increases

Ok so next chapter, we have the sequester cuts and now they get it from another angle, from the insurers who are also on Medicare Advantage plans deducting that 2% cut.  Now what even makes tempers fly even more was that in April about the same the sequester hit, CMS gave the insurers who provide Medicare Advantage plans a 3.3% rate hike, so they get a raise and instead of a cut for 2014,  and then turn around and take 2% from the doctors and hospitals now.  Did you read that right, they are getting 3.3% more and then keeping 2% from what they pay doctors and hospitals.

Insurers claim the sequestration cuts along with the rate cuts and taxes under the healthcare reform law is forcing them to scale back, but anyone see any health insurers not pumping a big quarterly profit..no.  Now in 2014 there is a reduction in premiums coming forth after the increase given this year, so members will pay lower premiums.  That is why doctors are being fired.

United Healthcare Firing Thousand of Doctors Caring For Medicare Advantage Plan Patients in Connecticut, Florida and Rhode Island-Attack of the Business Intelligence Killer Algorithms…

This might look to be a slow ending to Medicare Part D as it seems United is seeing it that way with firing doctors who take care of Medicare Advantage patients so the scramble begins with doctors and patients.  United is firing them, and now Aetna is wanting to expand their Medicare Advantage network in the same area United is firing doctors, does that make sense when Aetna filed a form with the SEC stating that the rates for Medicare Advantage were going to be a challenge?  Look at them with their models at times that make no sense. 

Back to the 2% Aetna and United are the two aggressive carriers passing the 2% cut back to the hospitals and doctors, who else. I don’t know about you but I have about heard enough from CMS and their budget, their cuts, their penalty programs and last but not least the non qualified folks trying to create the websites and data services for insurance exchanges. Congress should just flat out realize these are costs that are not going away and all of this is pitting people and departments against each other that should no be there and patients and doctors suffer over this bull shit.  Read this post on this Senator who thinks that algorithms that change our behaviors are the cure alls too, boy is he duped big time. 

Sure there is room for improvements in costs and we need to go after flat fraud as well, but this is getting bad and I’m flat tired of reading in the news about the fairy tale studies insurers and their groups like the Lewin Group owned by United and others put out promising “trillions” in savings as it’s flat out not there without hurting people.  Go to the footer and watch the first video on how you get sucked in with all of this and insurers do it to elevate profits and I have no problem with companies make a dollar but not this way with Algo Duping and running a government agency around chasing it’s tail all the time, as they have shown they can’t do it.

As I said back in 2009, Health IT would eat up our current HHS Secretary and it is as Algo Duping is alive and well and government is duped and duped again, even to the point to where Congress is buying in on a lot of this “marketing” promising big savings that are a farce, and then come back and blame sick patients and over worked doctors, sometimes the insurers are paying doctors “less” than Medicare itself.  HHS Secretary is so Algo Duped she seems to think that all you need is an app and everything is solved. 

HHS Secretary Sebelius Still Looking for Tech Breakthroughs To Save the Day

It’s time to get past the phony marketing here and get a real perception on what is taking place out there.  All these big savings are a pie in the sky and the less you read of some of bogus marketing news and press releases you see, the better off you are. These frigging experts simply do not exist, watch the video at the link below and see what I mean.  

Relying on Experts When They May Not Exist–Many Intelligent and Smart People But Do We Have Misconceived Paradigms-TED

We have one huge perception problem in the US and it’s not getting any better with an Algo Duped HHS and CMS agency.  BD


Healthcare providers are threatening to sue insurers that pass along a 2% rate cut imposed on their Medicare Advantage plan payments under the federal budget sequestration law.
Hospitals, physician groups and post-acute care providers accuse the Medicare Advantage plans of breaching contracts by unilaterally reducing payments. They are considering legal action by the end of this year to block the cuts, said attorneys who represent provider groups. Federal spending on the Medicare Advantage program totaled about $135 billion last year, so the dispute is over 2% of a large pot of money.

Medicare Advantage insurers say they have to pass along the cuts because they're increasingly squeezed by reduced payments because of sequestration and Medicare spending reductions included in the Patient Protection and Affordable Care Act.

A March report from the Government Accountability Office found overpayments to Medicare Advantage plans of up to $5.1 billion in years 2010 to 2012, heightening political pressure to reduce payments to the plans.
The plans had been facing a 2.3% cut for 2014—until the CMS reversed course in April and gave them a 3.3% rate hike. Nevertheless, the ACA still mandates a $156 billion payment reduction to Medicare Advantage plans over 10 years.

http://www.modernhealthcare.com/article/20131012/MAGAZINE/310129973

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