The Project To Restore America

If you turned on the news over the holiday weekend, chances are you saw something about the looming disaster called Obamacare. This is because, as the Heritage Foundation put it, "Last week, the Obama Administration attempted to spin its announcement of a one-year delay in Obamacare's employer mandate as an effort to implement the law 'in a careful, thoughtful manner.' Don't be fooled. Even Democrats have admitted the law has turned into a massive 'train wreck,' with delays, glitches, and problems aplenty." Meanwhile, Michael Ciampi, a family doctor in Maine was able to reduce his prices and improve service by no longer accepting health insurance. I strongly encourage you to read this article explaining Ciampi's own personal attempt at health care reform. Dr. Ciampi shared with us an important letter he sent to close friends and family when he decided to change the structure of his practice. Here is what it said… Maine Doctor Shares Reasons for No Longer Accepting Health Insurance or Medicare By Michael Ciampi Monday, July 08, 2013 We have decided to make some radical changes in our practice. I have a feeling people may be very curious to know why, so I thought I would give an in-depth explanation. My father got out of medicine in 1999 in part because of an ever increasing amount of paperwork and requirements put on him by the government and insurance companies. Unfortunately, since he retired, they have gotten exponentially worse. We have to spend a lot of time and money filling out forms, maintaining very expensive software systems, and constantly dealing with prior authorization requests, and appealing denials for services that we have provided in good faith, etc. We have never been able to accept Medicaid patients because that population in general requires a lot of intense care, but the state (under both Democrat and Republican administrations) pays little or nothing. With their rules and requirements, we would have actually lost a fair amount of money for every patient we would have seen on Medicaid. It has been easier for us to see established patients who go on Medicaid for free, and hope they get regular insurance back at some point in the future. Medicare has been a little better, but they have not increased their reimbursement rates in about 10 years or so. Every 6-12 months, an automatic formula, the SGR (Sustained Growth Ratio?), which was established by Clinton/Gingrich, mandates that Medicare rates be reduced in order to keep Medicare spending flat. Each time a cut is looming, Congress, usually at the last minute (or sometimes a few weeks retroactively), postpones the cut. Each time they do, the next time it comes up, the cut is even deeper. This past New Years, with the whole fiscal cliff fiasco, the cut would have been over 26%. It was postponed, but will likely be close to 30% the next time it comes up at the end of the year. We are currently being paid 30 cents on the dollar by Medicare. Our revue has been flat for 10 years. Our expenses have gone up by at least 30% or more. With no end of this vicious cycle in sight, we cannot make any long term plans. We work to cut our overhead as much as we can, but we are getting to the point that we cannot anymore if we are to meet all the regulatory requirements placed on us, and still pay our employees, pay for their insurance, and maintain a practice that people would want to come to (You can only lower the heat so much). The commercial insurance companies are not much better. They base most of their payments on Medicare rates. They pay more, but they also require us to do more paperwork to get the money. All these things have been going on for years. They have made it very hard to stay in practice. The upcoming implementation of Obamacare was the last straw for us, both financially and ethically. When we established our independent practice, we joined the Maine Health Physicians Health Organization. It started as a collaborative so that small practices could do collective bargaining with big insurance companies, and to share experience and resources. The organization has changed. Instead of working for the physicians, they take the view that the physicians work for them. This organization now requires all member to be part of the "Accountable Care Organization" (ACO) model which was established under Obamacare. We believe that it is immoral and we will not participate. Because of this, we are being forced out of the organization. FYI: The way an ACO supposedly works is that for every patient that consents to be in this program, Medicare gives Maine Health (Maine Medical Center's parent organization) a lump sum of money per year. If the doctors and Maine Medical Center spend less than that sum on the patient, they split the profit. If they spend more, the doctor and MMC must pay Medicare the difference. We cannot afford to take on this risk given that our profit margin is non-existent. The stated goal of this program is to save money by forcing the hospitals and doctors to take better and more efficient care of patients. What is more likely to happen is that doctors and hospitals will start cherry picking only the healthiest patients to take care of, and do everything they can to limit the amount of medicine and care they give to the oldest and sickest of patients. We refuse to cooperate with such a system. We have done a lot of research and thinking. We looked at the concierge model, where a patient pays $1500-$2000 per year to a doctor as a retainer fee, then has to pay for visits on top of this. If you succeed, it is very profitable, but that is not what we were comfortable doing. After having worked as an employee of a hospital owned practice in the past, and hearing how unhappy my colleagues are that continue to work in "big box" medical practices, I would never go back to that. They are not treated with respect by their administrative overlords. They are constantly being pushed to see more and more patients and charge as much as they can. This may be good for the practice's bottom line, but it is not what I would consider good medicine. I even talked to a doctor at the VA about their system, but they have it even worse. ------------ Advertisement ---------- Obama's big new scandal? One of America's most widely read financial journalists says a huge new scandal is working its way through the Obama administration. He says this scandal could ruin Obama's entire presidency, and will bring about the most dramatic changes to American life in more than 50 years. See the full analysis, free of charge, here… ------------------------------------- We decided that the right thing for us was to go to the direct pay model. It is really the way medicine had worked for thousands of years, up until the past few decades. It will reduce our overhead a great deal. We do not expect to get rich doing this, but we are hopeful that we can do well enough to stay in business and be happier. I know this is a long rant, but I thought it better to give more details than less. I have done my best to make this as non-political as possible. Both parties are to blame for the situation. That being said, I am convinced that Obamacare will make it much worse. In fact, I believe that it was actually designed to fail. When it does, and there are no more insurance companies left in business, and we truly have a health care crisis, they will institute socialized medicine. Some may welcome this, but those systems do not work, and many countries that have them, including Canada and Great Britain, are trying to find ways to increase privatized health care. It is my intention to skip this entire mess, and start working for patients directly right away. I am done with my rant. ____________________________ The Project to Restore America Every email is important to us. We can't always respond individually, but we read and consider everything. Please email your question, comment or complaint to john@theprojecttorestoreamerica.com or wendy@theprojecttorestoreamerica.com. I continue to ask people just what has been disclosed by Snowden? Is there any real information or is this the Orwellian "Goldberg" hate day thingy? Regards. – Anonymous Grenell comment: NSA officials have said Snowden has disclosed only 1% of what he stole from classified U.S. Government computers. Nevertheless, he has already released, among other items, detailed information on our intelligence gathering operations targeting international organizations and countries – as well as specific details about equipment used and the locations of offices targeted. The leaked details have clearly damaged our intelligence gathering techniques and may have imploded some of them altogether. Current and former U.S. government officials, like myself, are hesitant to comment in detail about the implications of the classified leaks because we are sensitive to not further damage our intelligence strategies. Snowden is not a traitor and did not take the easy way out. He cannot come back to America right now and that is devastating. He is a patriot who risked his life so we could be aware of the links on how crooked and twisted the government has become. Someone needed to do what he did and we should praise and thank him. Remember the American Revolution! – Kathy Bidwell comment: Ric Grenell will address another aspect of the Snowden discussion. Since approximately 70% of our young people believe Snowden is a hero, and the majority of both liberals and libertarians do as well, Grenell will dissect how this plays into our foreign policy decisions. Keep an eye out for the sequel to the Hero Versus Traitor discussion this week. 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