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Old 02-24-2013, 08:56 AM   #1
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Florida doesn't have enough doctors for Medicaid expansion, lobby group says

Who'da thunk you need doctors to expand medical coverage?

TALLAHASSEE Brace yourself for longer lines at the doctor's office.

Whether you're employed and insured, elderly and on Medicare, or poor and covered by Medicaid, the Florida Medical Association says there's a growing shortage of doctors — especially specialists — available to provide you with medical care.

And if the Florida Legislature goes along with Gov. Rick Scott's recommendation to offer Medicaid coverage to an additional 1 million Floridians — part of the Affordable Care Act that takes effect next January — the FMA says that shortage will only get worse.

"Florida needs more doctors and it needs more nurses, and it needs them working together in teams," said Rebecca O'Hara, a lobbyist for the FMA.

About 15 million Floridians have health insurance today, and Obamacare, which requires most adults to have coverage by January, could add as many as 2.5 million more. One million would come through a potential expansion of the federal-state Medicaid program that Scott announced this week he was backing. The others would be the result of new mandates requiring employers and individuals to have insurance or be fined.

Currently, the state has 44,804 doctors, but about 5,600 of them are expected to retire in the next five years. And even though Florida has opened three new medical schools in the past dozen years, the state isn't producing as many doctors as it needs. Scott's budget this year has $80 million to fund programs to train 700 new residents a year, in hopes they'll remain in the state.

Of all patients, people covered by Medicaid may have the hardest time finding a doctor; only 59 percent of the state's physicians are taking new Medicaid patients, according to a Kaiser Health News study.

Committees in both the House and Senate have been meeting for the past two months to discuss implementation of the Affordable Care Act. On March 4, they expect to see two major studies by the Office of Economic and Demographic Research, one that looks at the overall economic impact of the health-care overhaul and another that simply examines Medicaid expansion.

Scott, however, has already made clear how he feels about that.

On Wednesday, he unexpectedly announced that he had reversed his earlier, adamant opposition and now wants a three-year expansion that would cover single adults and families earning up to 138 percent of the poverty line; the costs would be fully covered by the federal government. If the expansion is re-approved after three years, the federal government is committed to paying no less than 90 percent of the cost.

House and Senate leaders will begin their budget deliberations in the coming weeks, which will include the decision over new residency slots, along with the debate over whether to expand Medicaid. Many lawmakers have expressed opposition.

Sen. Joe Negron, R-Stuart, who chairs the Senate committee studying the AFA, said lawmakers have heard concerns about a potential physician shortage, but he said he did not believe that would be a "determining factor" in the committee's decision over whether to expand Medicaid.

One reason, he said, is the responsibility for coverage may soon be falling to private health insurance companies or physician groups.

The federal government this week gave Florida preliminary approval of a plan that would put most of Florida's current 3.3 million Medicaid recipients — and any added via expansion — in some form of managed care, either HMOs or doctor-run networks, by 2014. In order for HMOs or the provider service networks to get state-approved contracts, they must prove they can provide "adequate" care, which means patients must be able to see a doctor in a reasonable time.

"It's their responsibility to have network adequacy," Negron said of the private providers. "So, they'll be responsible for making sure people can get care with network physicians."

Negron also noted that the amount doctors will be paid for seeing Medicaid patients is rising, which may prompt more physicians to take them. As part of the health care law, primary-care doctors will be paid as much for a Medicaid patient as they are under Medicare, a 73 percent increase.

Health care advocates who back the expansion say they aren't worried either.

Greg Mellowe, policy director for health advocacy group Florida Chain, said the state needed to carefully watch the situation as it develops, but added, "We don't believe that there is a crisis brewing."

Mellowe noted that many uninsured already receive care — often in emergency rooms, which is more expensive — that hospitals aren't paid for. If many of these patients have insurance coverage, he said, hospitals may see an opportunity to shift resources to primary care settings.

Lawmakers are slated to return to Tallahassee the week of March 4 for the beginning of the 2013 legislative session. The studies from the state economists are also due at that time.

Negron said until the state can look at that information, it was impossible to say what direction the Legislature would take.

"It will be a judgment call to make on the right way to proceed for Florida's families and businesses," he said. "I just think it's too early to tell where either the House or Senate will come down on this."

http://articles.sun-sentinel.com/201...al-association
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Old 02-24-2013, 09:32 AM   #2
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You know what that article tells me? There are thousands, if not millions of jobs in the US that are unfilled. People complain about the employment numbers. I say, learn a trade that not just any monkey can do.

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Old 02-24-2013, 09:40 AM   #3
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You know what that article tells me? There are thousands, if not millions of jobs in the US that are unfilled. People complain about the employment numbers. I say, learn a trade that not just any monkey can do.
Stop with that common sense BS! Good ideas like that don't fit the crying game agenda!

And really? Florida can't handle adding another 2 million to the people covered by health insurance? These numbers are such bullshit anyway...for this simple reason: just because you suddenly have healthcare does NOT mean that you'll suddenly run out to the doctor. There are healthy people with and without insurance that don't go to the doctor, so spare me the pure "numbers" game.
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Old 02-24-2013, 11:32 AM   #4
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Man, you guys are so smart! I don't know what all these idiots over at Forbes are thinking, they should be listening to yall!

Oh, I forgot, unlike you guys and the leftist, these guys have an AGENDA..


Health Care Future Bright for Nurses, Stinks for Doctors


There are lots of losers in President Obama’s effort to remake the U.S. health care system, and chief among them are the doctors. But there are also winners, especially nurses and physician assistants (PAs). Indeed, nurses and PAs win big in part because doctors lose badly.

Surveys repeatedly show doctors are fed up with low reimbursement rates from Medicare and even lower from Medicaid, which have increasingly led doctors to no longer see new patients in those government-run plans. For example, a recent Texas Medical Association survey found that “34 percent of Texas doctors either limit the number of Medicare patients they accept or don’t accept any new Medicare patients.” Even more do not accept patients with Medicaid.

Then there’s the heavy-handed regulations and requirements from both government and private health insurers. Complying with all those requirements and paperwork creates expensive and time-consuming administrative burdens. And to top it off, there’s the looming shadow of a high-cost lawsuit if things don’t turn out well.

And that’s all before ObamaCare kicks in, which will exacerbate every one of those problems. So it’s little wonder that there are physician shortages, especially in lower-paying primary care, and those shortages are only going to get worse if ObamaCare succeeds in getting an estimated 32 million more Americans insured.

The increased demand for medical care and lower reimbursements—which is one of the primary ways ObamaCare will try to hold down costs—is a recipe for a mass exodus of doctors willing to practice medicine. As “Physicians Practice” reported in August from its physician survey: “Nineteen percent say they plan to move to another position in the same field. An equal amount says they plan to leave medicine—not to retire, but to pursue something new.”

So who will provide the needed care if the doctors exit? Enter the nurses and physician assistants.

If ObamaCare withstands the Supreme Court challenge and Republicans fail to “repeal and replace” it, more nurses will be called on to provide more care that historically has been provided only by physicians—a trend that is already happening.

As the PBS NewsHour reported last May: “The scope of what nurses can do medically has also been growing for the past decade, at a time when the pool of primary care, or family doctors, has been shrinking. … And more and more are working on their own, especially in poor inner-city neighborhoods and rural areas, where there are few doctors in private practice.”

The U.S. Bureau of Labor Statistics (BLS) predicts that the registered nurse (RN) will be the fastest growing profession between 2008 and 2018. And the profession is financially rewarding. The BLS estimates that the average salary for a registered nurse in 2010 was $67,720, or $32.56 an hour. In 2009 the average salary was $63,750, or $30.65 per hour. That’s about a 6 percent increase in a bad economy when millions of Americans were just thankful to have a job.

However, as in all professions, some segments do better than others. A recent survey of 3,000 nurse practitioners conducted by “Advance for NPs and PAs” found full-timers earned $90,770 in 2010. But nurse practitioners in emergency departments earned on average $104,549. Good salaries considering that Medscape reports that nearly half of family physicians, with all their additional training and educational expenses, made between $100,000 and $175,000 in 2010.

Because ObamaCare will never bend the health care cost curve down—as the president repeatedly promised it would—something will have to give. And doctors’ reimbursements will be on the amputation table.

Those payment cuts will surely be politically messy. Just look at the current fight over Medicare reimbursements. Yes, Congress is trying to stop the scheduled 27 percent cut in physician reimbursements—part of a 1997 law that says if Medicare grows faster than a certain rate, physician reimbursements must be cut to balance it out. Because Congress postpones the cut every year, the scheduled cut keeps getting bigger.

That means doctors have received no significant Medicare increase in more than a decade, even though their costs to provide care go up every year. In effect, the Medicare reimbursement problem has resulted in a 20 percent cut in inflation-adjusted dollars. But what is an unacceptable cut for physicians could be an attractive increase for lower-earning nurses and PAs, many of whom are willing to take the lead on providing more comprehensive care.

While it may make sense to expand nurse and PA responsibilities, that decision should be made from the bottom up, in the context of doctors and nurses looking for ways to provide quality patient care at a reasonable cost. It should not be the result of top-down micromanagement and price controls that leave health care providers scrambling to find a way to exist under Washington-imposed regulations. Yet that’s exactly what ObamaCare will do.

http://www.forbes.com/sites/merrillm...for-doctors/2/
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Old 02-24-2013, 12:28 PM   #5
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Surveys repeatedly show doctors are fed up with low reimbursement rates from Medicare and even lower from Medicaid, which have increasingly led doctors to no longer see new patients in those government-run plans.
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As part of the health care law, primary-care doctors will be paid as much for a Medicaid patient as they are under Medicare, a 73 percent increase.
Which is it?
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Old 02-24-2013, 01:43 PM   #6
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What it means is that under bam bam bama care & his communist rule...........

Practicing American doctors on USA soil are going to be loosing $$$$$$$.
Since their is no fat ass bankster to bail them out, they are going to be forced out of private practice.
Shut the fuck down.

So when you get sick or shot with a 9mm galock or a S&W 44 magnum & arm or leg blown off.......
The real good doctors are going to be long gone.
What you will have is a fucking retard kid that was working the counter of Pep boys or Autozone yesterday & now going to be administering drugs & amputate & steal your body parts & sell to the highest bidder in China.

So don't get the fuck sick.
Don't die.
Don't go to the doctor in 2014 or after.
Because bam bam bama will find a way to kill you yet.



BR
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Old 02-24-2013, 03:01 PM   #7
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What it means is that under bam bam bama care & his communist rule...........

Practicing American doctors on USA soil are going to be loosing $$$$$$$.
Since their is no fat ass bankster to bail them out, they are going to be forced out of private practice.
Shut the fuck down.

So when you get sick or shot with a 9mm galock or a S&W 44 magnum & arm or leg blown off.......
The real good doctors are going to be long gone.
What you will have is a fucking retard kid that was working the counter of Pep boys or Autozone yesterday & now going to be administering drugs & amputate & steal your body parts & sell to the highest bidder in China.

So don't get the fuck sick.
Don't die.
Don't go to the doctor in 2014 or after.
Because bam bam bama will find a way to kill you yet.



BR
Or Wait Lines:

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Old 02-25-2013, 07:42 AM   #8
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So which is it?

I remember an awful lot of crying about the fact that there wasn't even a NEED for Obamacare, since "everyone already had access to healthcare." Meaning 100% of the people. So the system was covering it all and chugging along fine. Right?

BUT NOW....

The OTHER argument seems to be that if we add "ALL THESE PEOPLE" to the roster that the doctors won't be able to handle the extra workload. Even though...according to the original article...they'll be compensated more. This argument seems to indicate that maybe not everyone had the access they needed without Obamacare.

Uhhhh....pick one.

And here's another thought...maybe doctors will have to work just a bit harder...ya know....NOT be 30 minutes late for their FIRST appointment at 8am. Maybe have their offices open beyond noon on Fridays. Things like that.
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Old 02-25-2013, 08:00 AM   #9
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We got a letter from our doctor, who happens to be our next door neighbor and a patient of mine telling us that as of Feb 28th, they will no longer take Medicare/Medicaid patients. My Dad and my brother with Down Syndrome are both on Medicare and will have to find another doctor. I asked him WTF, and he said they track all of their treatments and reimbursements, and that for three years, they have been losing money on every Medicare/Medicaid patient. They just can't afford to do it any more. The reimbursements keep dropping, but the cost of running a primary healthcare facility just keeps rising - especially the cost of insurance. I don't blame him. It's no fun to go to work and find out you got to pay to work your ass off that day. Multiply this by the hundreds of thousands of practicing doctors across the country, and seniors, in particular, are going to have trouble finding someone to treat them. It's kind of a hidden death panel. You give people insurance and then don't provide anyone to treat them! Something has to give.
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Old 02-25-2013, 08:16 AM   #10
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.....he said they track all of their treatments and reimbursements, and that for three years, they have been losing money on every Medicare/Medicaid patient.
So this was a problem even before Obamacare...yes?
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Old 02-25-2013, 09:51 AM   #11
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So this was a problem even before Obamacare...yes?
Yes, but it's already been made clear that the bulk of the cost savings under Obamacare are going to come from cuts to providers. Providers have been taking a beating for the last few years, and Obamacare is going to push thousands of them into retirement or at least out of Medicare/Medicaid. You can't run a healthcare system on the cheap unless you want to cut services. This is simply a back door way to cut services and blame it on the greedy doctors. Libs have gotten really good at finding small groups that have done well financially and, with the help of the media, pushing blame for their failures on these priveleged groups. It's a time-honored way of doing business in dictatorships - Every third-rate dictator in the world has his citizens convinced that all of their problems are due to rich America. The Dems have learned from that, and no matter how incompetent government gets, they can always find some rich people to blame for the ills of society.
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Old 02-25-2013, 11:26 AM   #12
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And here's another thought...maybe doctors will have to work just a bit harder...ya know....NOT be 30 minutes late for their FIRST appointment at 8am. Maybe have their offices open beyond noon on Fridays. Things like that.
Doctors need to work harder? Good luck with that.. it makes more sense for anyone to work less, when they take a pay cut. Although I am pretty sure that as a good komrade, you would take less money and work 15 hours a week more all for the common good.

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Yes, but it's already been made clear that the bulk of the cost savings under Obamacare are going to come from cuts to providers. Providers have been taking a beating for the last few years, and Obamacare is going to push thousands of them into retirement or at least out of Medicare/Medicaid. You can't run a healthcare system on the cheap unless you want to cut services. This is simply a back door way to cut services and blame it on the greedy doctors. Libs have gotten really good at finding small groups that have done well financially and, with the help of the media, pushing blame for their failures on these priveleged groups. It's a time-honored way of doing business in dictatorships - Every third-rate dictator in the world has his citizens convinced that all of their problems are due to rich America. The Dems have learned from that, and no matter how incompetent government gets, they can always find some rich people to blame for the ills of society.
One don't have to look far, many of us posted reports/articles about the problems associated with this type of healthcare. All you gotta do is look at anyone else's system and it's glaring (well, to a functioning brain anyway) right back at you.
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Fascism is a religion of the state. It assumes the organic unity of the body politic and longs for a national leader attuned to the will of the people. It is totalitarian in that it views everything as political and holds that any action by the state is justified to achieve the common good. It takes responsibility for all aspects of life, including our health and well-being, and seeks to impose uniformity of thought and action, whether by force or through regulation and social pressure. Everything, including economy and religion, must be aligned with its objectives.
Old 02-25-2013, 02:22 PM   #13
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Yes,
That's all you needed to put.

And WHOA.....did ya see who "thanked" you??? Wow...ol' Mr. "Romney by 7%"!!!
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Old 02-25-2013, 02:25 PM   #14
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Doctors need to work harder? Good luck with that.. it makes more sense for anyone to work less, when they take a pay cut. Although I am pretty sure that as a good komrade, you would take less money and work 15 hours a week more all for the common good.
Yea..."harder"...it was sarcastic...based on what I defined as "working harder."
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Old 02-25-2013, 02:55 PM   #15
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That's all you needed to put.

And WHOA.....did ya see who "thanked" you??? Wow...ol' Mr. "Romney by 7%"!!!
Yeah, I noticed that. If Obamacare had been completely in place by 2011, Romney probably would have won by 7%. This is gonna get ugly.
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