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Fri Feb 15, 2013, 09:14 AM

Last night, I met a business owner who is very angry at Obama.

This is NOT an ACA slam ! Just trying to understand so I can defend it better.

I met a very angry owner of a home respiratory service last night. Naturally his
customers are almost exclusively seniors. So, to sell his service, he relies on telling people it
is covered by medicare (20% copay). He also relies on the government reimbursing
him for his cost plus profit.

He said that "Obamacare" (insert snarl) will be cutting 51% of his medicare reimbursements.

After researching this, it is true that reimbursements for home health care services will be cut
under ACA, but couldn't find any specific numbers on home health care services such as
his to prove what he was saying.

Assume the 51% cut is true, it sounds to me that niche companies like his will be hurt by ACA. He has no other source of clientele to make up the profit since the vast majority of people who need oxygen are seniors.

So, what are his choices? Jack up the price and hope seniors can afford more out-of-pocket or have coverage under
a supplemental plan? If that doesn't work, go out of business because the future Medicare reimbursement my not even cover the cost to operate?








Oxygen Therapy
Part B covers the rental of oxygen equipment. If you own your own equipment,
Medicare will help pay for oxygen contents and supplies for the delivery of oxygen
when all of the conditions below are met:

• Your doctor says you have a severe lung disease or you’re not getting enough oxygen.
• Your health might improve with oxygen therapy.
• Your arterial blood gas level falls within a certain range.
• Other alternative measures have failed.

Under the above conditions Medicare helps pay for the following:
• Systems for furnishing oxygen
• Containers that store oxygen
• Tubing and related supplies for the delivery of oxygen and oxygen contents

In 2012, YOU pay 20% of the Medicare-approved amount.
http://www.medicare.gov/Pubs/pdf/10116.pdf

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Response to Laura PourMeADrink (Original post)

Fri Feb 15, 2013, 09:24 AM

1. It sounds like he was gouging. n/t

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Response to Ian David (Reply #1)

Fri Feb 15, 2013, 09:42 AM

5. Maybe. Guess you would have to know how

much it costs to procure and deliver oxygen.

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Response to Ian David (Reply #1)

Fri Feb 15, 2013, 09:54 AM

6. medicare reimbursements are low

I know two doctors with private family practices who lose money on every medicare patient. But they want to provide the personal care they can give with their own practice. These are doctors who do not have a fancy lifestyle or much income from their practice (e.g. literally less income than they pay their insurance administrator and one skips her paycheck often to have enough money to pay her staff). They tell me you need to run a "production line" practice to not lose money from medicare. That means the doctor sees the patient for 8-10 minutes no matter what the problem then bring in the nurse or ship them off to a specialist.

The idea behind the limits on in-home care is that hospitals or doctors offices can run a production line cheaper than providers can do in-home care. So reimbursements have been cut more for in-home care. Sucks for in-home providers and those who really need in-home care but does reduce cost. We have a few years coming where providers and patients are going to need to adjust to the ACA (lower profit and less/costlier care).

I personally want to see the "we'll get you a free scooter" people go out of business and we develop an effective way for the "production line" doctors to get a scooter to anyone who really needs one. And a higher co-pay will get some people on the edge of needing one to pay a little more attention to their health rather than make their life easier with a scooter. I won't be getting medicare for 10+ years, and every wasted dollar now is less medicare money then. If the guy in the OP is gouging, then he needs to stop. Either way he needs to deal with it (become more efficient, go out of business, make less money)

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Response to Ian David (Reply #1)

Fri Feb 15, 2013, 10:30 AM

13. Which they all do......I worked for a dentist that tripled his cost to his

medicad patients to recover costs from the government. Needless to say he spent time in jail, and he lost his license to practice dentistry. Yah. He was a horrible man.

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Response to Laura PourMeADrink (Original post)

Fri Feb 15, 2013, 09:28 AM

2. You have to be in a situation incompatible with life.

Quote:
• Your arterial blood gas level falls within a certain range.
• Other alternative measures have failed.
end

A lot depends on that "certain range." 96% is incompatible with life.
In other words, the figure doesn't have to change much for you to be actively dying.
Perhaps this is a good way to give the Republicans and debt-oriented what they want and die quickly.


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Response to Laura PourMeADrink (Original post)

Fri Feb 15, 2013, 09:34 AM

3. Medicare-approved amount

" —In Original
Medicare, this is the amount a doctor or supplier
that accepts assignment can be paid. It may be
less than the actual amount a doctor or supplier
charges."

In other words he can't get what he thinks he should vs what the government will pay for.

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Response to Laura PourMeADrink (Original post)

Fri Feb 15, 2013, 09:41 AM

4. Oh, I bet he is pissed!

My first wife worked for one of these vultures providing oxygen. HE closed the business a little over a year ago claiming it was no longer profitable. Truth is, he has been raping the Medicare system for years. He is also a pharmacist, owns a drug store, and has been scamming Medicare money to enrich himself. He would continue sending prescriptions to customers (via mail) even after they had called to cancel the prescriptions, as long as Medicare would continue to pay for it. Even if the people had died, he would keep sending the prescritions until Medicare refused to pay for them. And yes, he is a republican piece of shit.
He closed the doors to the oxygen business without warning, and after 23 yrs of service, at age 56, my former wife lost her job, and was given no severance. Not a dime. Then he tried to get her to work for a friend of his 40 miles away, for $9/hr, so he wouldn't have to pay his share of her unemployment benefit. That little scam didn't work. I hope he loses everything and dies in poverty of a very painful disease!
I've been telling everyone in our small town of his greedy antics, and he has lost a ton of business.....just when he was ready to retire! Ha! He's a fucking scumbag!

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Response to Uben (Reply #4)

Fri Feb 15, 2013, 09:58 AM

8. Yikes. Wonder if others are the same way as this creep.

I wonder how the government decided how much to reimburse. Is someone there analyzing the true costs plus reasonable profit?
And, for situations like this, they determined that companies were bilking the government on oxygen delivery? And, that is what made Obama put it in his medicare cut?

I can't believe I am saying this, but it's hard to imagine that this won't affect the people who need the oxygen. And people who work for companies like this like your ex. Fewer service companies, higher prices, higher co-pays.

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Response to Laura PourMeADrink (Reply #8)

Fri Feb 15, 2013, 10:27 AM

12. There are other services in the area that provide oxygen....

...so no one has to go without their oxygen. I don't know the make-up of the other providers, so I cannot say if they are doing the same thing. They may be totally legit. This scumbag found several ways to undermine the Medicare system to enrich himself. Obama closed a few of these loopholes with the ACA, and these vultures are whining because he upset their money-train. Boo-hoo!
Medicare is still rife with corruption, but its a little better because of the ACA.
The government audits these businesses ever so often, and causes many to close because they don't follow regulations and fail to provide adequate paperwork to justify their claims. MEdicare provides yearly seminars to keep owners abreast of new guidelines, and if you do not attend them and assume its business as usual, you can go bankrupt in a heartbeat! A good example is "seat lift" chairs.
Medicare used to pay for these for patients who had a prescirption for one from a doctor. They stopped paying for them, or made it much harder to get one, because so many businesses were abusing it. I remember seeing ads on TV telling people they could get one at no charge to themselves. With some doctors in collusion with these vultures, it made it hard to regulate and costs ran into the billions. I just hope they can pass legislation to close more of these loopholes and save taxpayers more money.

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Response to Laura PourMeADrink (Original post)

Fri Feb 15, 2013, 09:56 AM

7. His 'niche' company overcharges.

He's pissed because he won't be able to get away with it anymore.

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Response to Avalux (Reply #7)

Fri Feb 15, 2013, 10:03 AM

9. My husband and I were talking about this last night. In so many ways, ACA

will affect business owners who care more about profits and less about people.

You can not make people care about their employees. They either do or they don't.

If employers cared at all, they would have been helping out with health care already.

These people are the most pissed off. Unfortunately, don't see them "seeing the light" that they
have been on a gravy train and it has finally stopped and they were wrong to be so greedy.

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Response to Laura PourMeADrink (Original post)

Fri Feb 15, 2013, 10:06 AM

10. Sounds like he was ripping people and the government off.

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Response to Laura PourMeADrink (Original post)

Fri Feb 15, 2013, 10:21 AM

11. Found that the that Medicare has already reduced it by 35% (in certain areas of the country).

Under this new payment mechanism, Medicare has already achieved savings of $202 million in the first year, paying an average of 35 percent less for items such as power wheelchairs and oxygen supplies without any reduction in access to needed medical care. Because of the health care law, the program will expand to additional parts of the country over the next several years. Through 2016, the CMS Actuary estimates that savings will reach $5.2 billion for the Medicare program (and $27 billion through 2022).

http://www.cms.gov/apps/files/aca-savings-report-2012.pdf Page 5

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Response to sinkingfeeling (Reply #11)

Fri Feb 15, 2013, 10:41 AM

14. wow that's amazing. We just have to be careful, it think, not to

cut so deeply into the reimbursement that it is no longer profitable to provide critical services. Geez, that sounds like a repuke. AHHHH Guess I wouldn't put power wheelchair in the same category as oxygen. I am picturing some poor old lady gasping for breath.

Like someone said up-thread, the future may be in more mass-production delivery. Maybe a company like Walgreens or CVS could start selling oxygen - just like a rack of propane for your grill

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Response to Laura PourMeADrink (Original post)

Fri Feb 15, 2013, 10:57 AM

15. Of course and as usual, the amount of 'profit' he's been taking is not mentioned, nor is the amount

of profit that will now be allowed. So perhaps this guy is just whining that he'd been 'making' 3 million and now will only 'make' 2. Don't know, but I do know that if he had a real complaint he'd be talking numbers, not verbiage.
During the crash of 2008/09 someone I knew told me they had to close their business. I was shocked that it had come to that. But all that really happened was their own profit decreased from 600K to 375K and according to the person, 'it is not worth me going to work for that amount of money'. So 'had to close' meant something else entirely. Could have remained open.

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Response to Bluenorthwest (Reply #15)

Fri Feb 15, 2013, 01:38 PM

16. Well, to be fair...it was just a 5 minute

conversation on the patio when I snuck out during Valentine's Day dinner. If he was really smart, he would have
sold out early on. His business just happens to be one that is probably 90+% dependent on senior clientele. But, instead
of realizing the reality of that situation...that he milked in for a long time, and the party was over...he chose to vilify President Obama.

I know and agree that 375k is plenty of money to live very comfortably in most places other than maybe LA and NYC. But, I don't know how I would feel to have my income cut so much. It wouldn't bother you?

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