Published - December 2010

By Dave Jakielo

Let’s Review 2010 and Prepare for 2011

This has been a roller coaster year in the wild and wacky world of Healthcare. Let’s examine the highlights and low points of 2010.

Congress/Medicare threatened to cut physician reimbursement by over 20 percent. Then they decided to delay the cut. Then it was decided to impose the cuts. This was followed by yet another delay and the pattern continued.

I have a suggestion for getting Congress to fix the SGR. Congress should reduce its staff in direct proportion to the proposed Medicare payout cut. Whatever percentage the Medicare conversion factor is reduced by, should be followed by an equivalent cut in Congress. If a 20 percent cut is imposed upon physicians, then 87 members of the House of Representatives and 20 Senators should lose their jobs. Perhaps my suggestion sounds ludicrous, and if it does, hopefully it seems about as ludicrous as the proposed Medicare fix. I don’t mean to rant and rave about the attempt of Congress to rectify the healthcare problems, but they definitely have gone too far.

Some of the healthcare reform mandates were necessary and certainly have merit. Congress passed landmark legislation to provide healthcare to the uninsured. I am certainly in favor of that. They also closed the various loopholes in coverage such as pre-existing conditions and removal of lifetime maximums. These are also good things. While I’m in favor of expanding healthcare coverage, there are still quite a few stumbling blocks in the current healthcare plan.

Deductibles continue to rise. That means that if you are normally a healthy individual and only go to the doctor for your annual checkup or have had treatment that cost less than your deductible, you are basically now being forced to pay a lot of money for services you may never need. My deductible is currently at $2,500 and my medical bills never amount to more than the deductible.

I know I should feel thankful for my health, and, of course, I am. But I have to admit that there is a part of me that can’t help feeling like the $7,000 plus I pay in premiums is funding something other than my medical care, like the insurance companies’ lobbyists. Those lobbyists are probably funneling the money to Congress as an incentive to overlook the high premiums and high deductibles that seem to be among the very few aspects of healthcare that haven’t been modified.

The insured population is being forced to foot this exorbitant bill while the doctors’ ability to provide good medical care is being curtailed. Why would anyone even want to become a doctor today? According to the Association of American Medical Colleges there will be a shortage of 39,600 physicians by 2015 and by 2025 the estimated shortage is 63,000. The vast number of currently uninsured people who will soon be entitled to coverage coupled with the large of population of baby boomers who will be eligible for Medicare during the next decade is part of the cause of this problem. About 32 million uninsured folks will be entitled to coverage as the mandate takes effect. In 2011 the first of the 78 million baby boomers turn 65 and will start to require more services as they age and obtain Medicare coverage. Given the provider shortage and the increasing demand, in the next few years it may be easier to win the power ball lottery than to be seen by a Primary Care Physician.

What else can we expect in 2011? Here are some of my predictions.

Small businesses’ healthcare premiums will be higher than the national debt. Your insurance broker will be happy to point out that you can cap your annual increase at 20 percent as long as you raise your deductible to $174,000 dollars, which by the way is the salary of a United States Congressman. The lines of people waiting to be seen in the nation’s emergency rooms will make everyone at Disney World during a school holiday break feel like they have a Fast Pass for every attraction.

OK so maybe all of the above won’t come true, but we are in for an interesting ride in the wild and wacky world of healthcare reform.

Dave Jakielo, CHBME, is an International Speaker, Consultant, Executive Coach, and Author, and is president of Seminars & Consulting. Dave is past president of Healthcare Billing and Management Association and the National Speakers Association Pittsburgh Chapter. Sign up for his FREE weekly Success Tips at Dave can be reached via email; phone 412-921-0976.

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