Reiterating: this is exactly why Blue Cross was vilified, and people angry about it were getting played by a lobbying group of some of the best-compensated professionals in America. Anesthesiologists getting paid more is not a consumer protection policy; it is the opposite of that, and it's wild that people think it might be otherwise.
Did you read what you posted? Because all you've cited is a bunch of complaints about the conversion factor and not the time factor. Medicare pays for the entire duration of the procedure. BCBS does not want to do that.
Again. Go through the CMS regs and show me where Medicare puts a hard cap on payment like BCBS was trying to do. I know that's a tall ask because, simply put, they do not.
> Go through the CMS regs and show me where Medicare puts a hard cap on payment like BCBS was trying to do
Where does it say CMS blanket approves? Because I’ll tell you this: if it does, I’m buying up some anaesthesiology practices. (They’re subcontracted within most hospital systems.)
It doesn't, and I've never made that assertion. However, Medicare and Medicaid both deny claims at a lower rate than private insurers. How frequently depends on where and when you look.
The guidelines however are important. BCBS wants to reject any claims for anesthesia out of hand if they exceed the average length of a procedure. Medicare does not. Because we all know that unexpected things never happen in the operating room.
After Anthem backed down I'd invest no matter what you find. Clearly: they run the health care system, and the public (including Kathy Hochul) is on their side!
I don't believe you're coming to this with a detailed understanding of the policy CMS has today or that Anthem was proposing. Sorry, at this point, unless you can cite a comparably specific source, I simply don't believe you, and we're probably at an impasse.
And you're coming at this from a profit doesn't drive up the cost of medical care which is in and of itself a pretty gross misunderstanding of what profit is. Again, did you read what you cited? That redditor is justifying the cap that BCBS wants to implement, not disproving that Medicare does not implement a time cap.
I'm not here to do your research for you. CMS regs and guidelines are a matter of public record. If you don't want to actually cite the comparable regs you claim exist that's not my problem.
fleeing to abstraction.
You're citing an insurance actuary who posted to reddit claiming no, it's not the for-profit insurance companies that are the problem, it's the corrupt doctors. That's absolutely fucking asinine. What next? A fox claiming it's the chickens that are the problem?
Unlike private insurance companies, the rules and regs that Medicare puts forth are a matter of public record and you're still unable to cite anything supporting your claim that Medicare puts a hard time limit on anesthesia reimbursement. So go ahead, stop waving your hands and start citing something. You do understand what time units are, right?
www.cms.gov
What's that? You're going to continue tilting at windmills and railing against the evils of overpaid doctors instead of showing anything that supports your specious claims about Medicare? Okay then.
Following this thread all I see is you aggressively asserting a certain viewpoint, with no substantiation. I have no stake in the game but if you're going to come out swinging with aggressive naysaying but zero substantiation, all I'm thinking is: "citation needed".
You haven't presented any research at all, so it's not clear to me how that could a valid rebuttal to anything I've said. You're talking about how "profit" distorts this system --- I agree, for what it's worth --- and it looks to me like you're just fleeing to abstraction.
It is a giant pain in the ass to pull up Anthem's original proposed policy, since it's been memory-holed everywhere, but if I manage to do it, I'll post it.
You're on HN right now campaigning against reference pricing! Like I said: this whole situation is wild. You've taken the side of people making like 20x more money than the insurers. Why?
Like: the whole system of Medicare reimbursement for anesthesia is based on a catalog of procedure-by-procedure base units. Medicare sets reference prices for procedures. You can just go look it up. I've got the XLS open right now. I don't understand what you're trying to argue here.
You get that, at the end of the day, this is about how much money anethesiologists take home, right? People on Twitter were talking about anesthesiology being withdrawn in the middle of procedures. Obviously, that's not a thing.
Of all the players in this system, the insurers are the only ones who have their profits capped by statute, across the board. If anesthesiologists make more money from a procedure, that comes out of your hide: it's reflected in your premiums and co-pays. Please, help me understand, why are you making a moral crusade out of paying your doctors more money? They don't need the money! America pays doctors 3-5x more --- THREE TO FIVE TIMES --- than Europe does.
https://www.asahq.org/about-asa/newsroom/news-releases/2023/...
Lots of stuff to go find at this search:
[medicare anesthesia upcoding]
Reiterating: this is exactly why Blue Cross was vilified, and people angry about it were getting played by a lobbying group of some of the best-compensated professionals in America. Anesthesiologists getting paid more is not a consumer protection policy; it is the opposite of that, and it's wild that people think it might be otherwise.