Andrea DeSantis DO, FAAFP

Family Physician, community preceptor, chronic disease management research. I advocate to eliminate health care disparities & expand primary care. My views.

[Andrea DeSantis DO, FAAFP @adesantisb]

Rest In Peace John Morphet. A beautiful soul died last week. He was depressed and sick and the place he turned to for help did not treat him as it was an out of network hospital for his insurance. He committed suicide 2 days later. #SinglePayer might have saved him

[Andrea DeSantis DO, FAAFP @adesantisb]

@edwards183 @DrDiGiorgio Agree. Making profiteering illegal and funding hospitals with operating costs, removes the temptation for all owners, physicians included.

[Andrea DeSantis DO, FAAFP @adesantisb]

Nope, never have. My entire career I have committed myself to taking care of lower income folks, and so the only way to do that is to work for a large hospital system, FQHC, or other community clinics which operate on a loss. However, I know quite a few people who have private practice, and they struggle with the administrative mess of our current system. Single Payer is about simplification and Streamlining the payment, spreading risk to everyone and creating lower cost access in outpatient arena. Impatient access is already mandated by law to not be able to turn anybody away. All the unfunded care gets past along to us through higher prices and subsidies. The taxpayer is getting hosed by the current environment.

[Andrea DeSantis DO, FAAFP @adesantisb]

Total Medicare spend is roughly 1.2 trillion with roughly half going to traditional Medicare (~ $500 billion), and slightly more going to the advantage plans (~ $520 billion) The denominator I used was 500 billion for traditional Medicare. 3% of that goes to the MAC overhead. Medicare advantage gets 520 billion and roughly 15% of that goes to their overhead and profits. Then, to make matters worse, they cost more per capita, but it is estimated each person gets less services. CMS has operating costs as well, which comes to about 1.2% of total Medicare spend so add 0.6% to the 3% and there’s your total traditional Medicare administrative spend. Again, this is my napkin math, but if someone wants to double check, I’m happy to see the data.

[Andrea DeSantis DO, FAAFP @adesantisb]

@Janeajnet @SethBorman @cpeedell @DrDiGiorgio @MarkRuffalo That’s true for just about any industry in the US.

[Andrea DeSantis DO, FAAFP @adesantisb]

@Janeajnet @SethBorman @cpeedell @DrDiGiorgio @MarkRuffalo That is true but does it take into account the cost of living and office and billing costs? I don’t know for sure, but I’m fairly certain it is not a direct comparison.

[Andrea DeSantis DO, FAAFP @adesantisb]

@DrDiGiorgio @kleib323 Medicare Advantage plans sure have. They spend more per capita than traditional Medicare, and are extractive and obstructive. They also take care of less medically, complicated patients.

[Andrea DeSantis DO, FAAFP @adesantisb]

MA plans certainly do that. Traditional Medicare pays 80% of the billed amount. The bills in House and Senate call for improved Medicare, meaning pay 100% of billed contracted amount direct to the clinician without patient copayments or obstructive mischief from the for profit insurance companies running the MA plans.

[Andrea DeSantis DO, FAAFP @adesantisb]

@DutchRojas @DrDiGiorgio Correct, these Medicare administrative contractors or MACs operate on a 3% overhead. CMS operates on a 1.12% overhead so half of that plus the 3% is roughly 3.6% overhead for traditional Medicare. Compare that to the 15 to 17 % overhead of the medicare advantage plans.

[Andrea DeSantis DO, FAAFP @adesantisb]

I’m all for strengthening our borders with policies that are realistic and appropriate. Treating fellow humans as criminals while turning a blind eye to other factors like the cheap labor many industries benefit from seems disingenuous. Ask yourself why hasn’t the legislation moved forward? When things don’t make sense, following the dollars usually gives us the answers.

[Andrea DeSantis DO, FAAFP @adesantisb]

@mcuban Are they leaving both Medicare Advantage plans, traditional Medicare, or both? Would be a good thing to look at as the MA plans are restrictive and logistically challenging to work with due to prior auth, formularies and narrow and shifting networks.

[Andrea DeSantis DO, FAAFP @adesantisb]

@DrDiGiorgio If you’re talking Medicare Advantage then Touché. Traditional Medicare overhead estimates are ~3% from what I’ve come across. Medicaid at 7% and private insurers at 18+%.

[Andrea DeSantis DO, FAAFP @adesantisb]

@GossyPi @TucoRamirez2766 @DrDiGiorgio @MarkRuffalo Government funded privately run. Same plan for everyone, including our lawmakers.

[Andrea DeSantis DO, FAAFP @adesantisb]

If it’s DPC I agree. DPC is retained in both Medicare for All bills in the House and Senate. Other practices who want to take the Medicare payments will also enjoy the streamlined and simplified payment method. Both options retain physician practice autonomy. Both will entice more docs to go onto private practice again and into lower economic areas as now they get paid for every patient in a more predictable manner.

[Andrea DeSantis DO, FAAFP @adesantisb]

We docs have very little say already. Medicare and Medicaid currently set the fees. All other private payers pay what they pay. With little regard to what is billed. The equalizer will come when your office no longer has to hire so many FTE’s just to process prior authorization and fund their billing and accounts receivables. It also frees up time on our end to see more patients. Some projection models have Physicians making about the same if the Medicare fees are maintained, and Medicaid becomes obsolete, which pays far less on the Medicare dollar. The devil will be in the details, which is why all physicians need to come together in a single voice to negotiate adequate pay and the ability to unionize, if and when universal finance reform happens.

[Andrea DeSantis DO, FAAFP @adesantisb]

@kbean511 @DrDiGiorgio @MarkRuffalo Like Medicare is now, just for everyone at any age.

[Andrea DeSantis DO, FAAFP @adesantisb]

@BadAndy167 @mcuban Insurance and other large integrated pharmaceutical companies are making billions a quarter. Admin costs eat up an estimated 23%. Docs get 6%. It’s not the doctors, at least it’s not most doctors that see patients.

[Andrea DeSantis DO, FAAFP @adesantisb]

@ppyrek1 @ReallyJone @elonmusk #4 is correct.

[Andrea DeSantis DO, FAAFP @adesantisb]

@ppyrek1 @ReallyJone @elonmusk Replace it with a universal health plan