In Deus Nos Fides

Conservative healthcare provider. Views my own and don’t reflect that of my employer. Constitutionalist. Treating each patient as unique. risk/reward. No DM’s.

[Paleoncologist @PaleoOnc]

I used to say ... the patient and the doctor were naturally aligned ~against~ the hospital "before"

The doctor was truly independent of the hospital, and the hospital *needed* the doctor's patients (and the ancillary revenue that lay behind that)

So if the doctor insisted the patient stay one more day
#1 The hospital had zero leverage to force that
-and-
#2 They were afraid of the upsetting the doctor who could admit the next patient somewhere else

Once the hospital employed the physician, that all evaporated. Now the patient has no ally when they are in the hospital

Because if the doctor breaks too many rules, they won't be working there long. And little by little, all the Hospitalists that are there are tools of administration

We can argue about whether doctors should own hospitals. There may be a conflict of interest. Maybe not.

But if the premise is that there is one ... they should have made the opposite true too

Hospitals should NOT OWN doctors.

That is not in the interest of good patient care.

[Keith Newton @KeithNewton]

If the government has a problem with doctors billing for fraudulent visits, they should go after the doctors doing so rather than removing options to provide optimal care from the rest of us.

When patients have a clinic visit and procedure on the same day, their doctor currently has to indicate those services are meaningfully separate in order to be fully reimbursed for both. For example, during a routine follow up you decide a knee injection would be the next best step.

That will no longer be an option with a proposed Medicare change. The patient will have to come back on another day for the injection for the doctor to get full payment.

The pretext is that this will prevent doctors from adding on a clinic visit when they only really intended to do a procedure. Which, again, currently requires the doctor to submit a fraudulent bill to the federal government.

The actual reason takes a page from insurance companies. When you make care more difficult to obtain, less of it is administered. Saving money at the patient’s expense.

And since insurance companies tend to use Medicare rule changes as justification for their own rule changes, I’d be surprised if they weren’t influential in this.

[Jonathan Clemens, PA-C @jpclemens]

Anyone non-medical who's supported Dr. Oz's proposed changes to a -25 modifier is clearly a paid influencer. There is just no good reason for random people to support that as a cost cutting measure.

That's not necessarily bad, as the response to that stupidity is to point out that "facility based" billing is a much juicier target to go after.

I wouldn't put it past Team Trump to raise a methane-filled trial balloon just to get a nonpartisan group of medical professionals to point to the real problem. They do seem to play 4D chess pretty competently.

[Paleoncologist @PaleoOnc]

Look how quickly people become
Marxists when it comes to healthcare

And here we all got caught up in it, arguing it … as if it makes sense.

It doesn’t.

Marx’s labor theory of value has been soundly discredited until it comes to healthcare and all of a sudden Right wing pundits act like they just discovered Das Kapital and found the way to save money

The “value” of healthcare is not the overhead of the building and the office staff.

And the waste doesn’t come from counting that twice

The value is the physician who can only do one thing at a time … and each thing has real value

And the waste will come from the patient’s time and lives when they are asked to come back another day

@DrOzCMS
@w_terrence
@DC_Draino
@BuzzPatterson
@CMSGov

[Dr. Dustin | Skincare & Health Expert @drdustinportela]

All you paid shills supporting cuts to Medicare modifier 25.

If the hard costs of providing an evaluation and completely separate procedure are greater than the reimbursement from Medicare to perform that service, what do you think the outcome will be?

How will those practices survive?

How will seniors find doctors to care for them?

[In Deus Nos Fides @cdubs1967]

@Milajoy You know nothing about which you tweet. Money grab.

[Dutch Rojas @DutchRojas]

Paid partnership" is doing a lot of work in this post.

The visit isn't "built into" the procedure. The global package covers deciding to do that procedure. Modifier 25 is for a separate problem.

Two problems, two pieces of work.

Who's paying you to cheer for cutting independent doctors?

[In Deus Nos Fides @cdubs1967]

@sqsehrish 1050

[Lars Mapstead @LibertarianLars]

Want cheaper college?
Stop subsidizing it.

Want cheaper healthcare?
Stop subsidizing it.

Want cheaper homes?
Stop subsidizing mortgages.

Want cheaper groceries?
Stop subsidizing sugar and corn.

Want fewer homes wrecked by floods?
Stop subsidizing building in flood zones.

[In Deus Nos Fides @cdubs1967]

@On3 @TJ3rd_ Admitted cheater. Sleazy coach who deserves no respect.

[Steve Ferguson @lsferguson]

Explain to me like I'm 5 why way too many people drag on Social Security recipients who paid into Social Security their whole working lives yet are silent on illegal aliens getting everything FREE

[Dr. Dustin | Skincare & Health Expert @drdustinportela]

There is a coordinated paid campaign going on to promote Medicare cuts by CMS.
Surely someone out there got this offer, and turned it down. If that’s you DM me with details, your identity and privacy will be protected.

I’m curious who is behind the campaign and how much they are paying influencers to promote the destruction of Medicare.

[In Deus Nos Fides @cdubs1967]

@jackunheard Sorry Jack but it isn’t. This is disinformation. Do some research and maybe listen to the doctors in the field who have been dealing with this. Corporations and insurance companies have created this mess. All rules have been written in their favor to forgo the patient

[In Deus Nos Fides @cdubs1967]

@Riley_Gaines_ @DrOzCMS Please do research before thanking him. This will be a burden on both patients and physicians. It’s not the win you and others think it is.

[In Deus Nos Fides @cdubs1967]

@Yodertoter40 Take it to the Supreme Court.

[Dutch Rojas @DutchRojas]

CMS paid to write this 💩💩💩.

Bill, this is a paid partnership. You were paid to post it.

You invented a doctor, wrote his confession, and congratulated Dr. Oz for catching him.

Quite an investigation.

Your imaginary physician says the checkup is already built into the procedure fee, so the mole visit gets paid twice.

Here’s what you left out.

Medicare already includes the routine evaluation associated with a minor procedure in that procedure’s payment.

A physician cannot legitimately add a separate office visit just for deciding to remove the mole.
Separate payment requires significant, separately identifiable evaluation and management beyond the work already included in the procedure.

That distinction is the entire argument.

If a physician bills twice for work already included, enforce the existing rules.

If a physician performs additional, medically necessary work that qualifies for separate payment, calling it a scam doesn’t make that work disappear.

CMS’s proposed 2027 policy reaches those separately identifiable services. It would pay the highest-valued applicable service in full and cut the other applicable services by 50%.

CMS argues the payment valuations overlap.

Fine.
Identify the duplicated resources. Show the calculation.
Defend the reduction.

You skipped that part and wrote a little play about crooked doctors.

And the claim that decades of politicians walked past this until Dr. Oz arrived?

CMS’s own explanation says it proposed a similar policy in 2018 for the 2019 payment year and did not finalize it.

You could have learned that by reading the announcement you’re being paid to celebrate.

There is a serious question here: how do we pay accurately for distinct services while letting patients get necessary care in one visit?

You contributed an imaginary patient, an imaginary confession, and a paid standing ovation.

Next time, interview actual independent physicians. Let them write their own lines.

-Rojas out
(Not paid to post).

[Shannon Adcock 🇺🇸 @Shannon_A_IL]

Illinois House 47th Democrat nominee Erica Bray-Parker paid about $255,000 into the teachers’ pension system over 33 years.

She’s estimated to collect roughly $4.8 million.

Starting annuity around $115,000 a year, plus 3% compounded increases. Career earnings were about $2.85 million.

Why should taxpayers cover a payout nearly 19 times what she put in?
https://t.co/7fPmlrItuW

[Justin Albright @jalbright22]

@BuzzPatterson Dr. Oz found 'waste' and it happens to be the independent doctor treating you in one visit. Not facility fees. Not hospitals ignoring price transparency. Not MA upcoding. The doctor. Savings: about 0.1% of Medicare. That tells you who has lobbyists and who doesn't.

[Mary Talley Bowden MD @MaryBowdenMD]

Michael, I have no desire to wage war with CHD. But when you claim I have a “profound lack of understanding in civics” I feel compelled to point out that CHD’s revenue jumped 654% during the pandemic with an average annual revenue of $17MM+ the last 4 years with very little to show for it. It makes me wonder if there are 3rd parties influencing your position.

[Brandon Beal @BrandonBealMD]

I accept Medicare and Medicaid.

This proposal would have the effect of increasing costs, because care would be shifted from independent practices to larger health systems who charge facility fees and otherwise are reimbursed at higher rates and that would be passed along to patients.

Reducing payments by 50% while the physician fee schedule has decreased by 30% in real terms over the past 20 yrs would put smaller independent medical practices out of business.

Meanwhile larger hospitals systems would see these patients and charge more through facilities fees … also large healthcare facilities receive DSH payments (disproportionate share payments) to care for Medicare and Medicaid patients that small independent practices do not receive.

This would hurt those the most providing care in the most affordable care settings, outpatient. We should incentivize this type of care - instead we cut physician reimbursement and wonder why the hospitals charge so much and healthcare costs keep rising .