More on what Medicare reimbursement cuts will do. “When such cuts are imposed, the usual response is to either order more procedures so as to not reduce overall revenue reimbursements received by the practice or to cut back on the Medicare load by refusing to take on more senior clients. Medicare patients are, generally speaking, the highest-maintenance patients for a number of reasons. Their age makes them vulnerable to more ailments and time isn’t as much a pressing factor, which means they can make more appointments. In fact, many top docs already are reducing their Medicare patient load or refusing to accept new Medicare patients. Therefore, as you turn 65 and retire, you might find it difficult to find a regular family physician unless you already have an established relationship with a practice or a doctor.”

More here: “Villarreal said the cuts would make it even more difficult to maintain a practice in the Valley, which already is medically underserved.

‘As much as I don’t like to say it, (medicine is) still a business, and we have to pay our bills,’ she said. ‘To break even, some doctors will have to see more patients.’

And that means even longer waits.

‘Some already wait for two to three hours sometimes,’ Villarreal said. ‘Some doctors are seeing 60 or 70 patients a day.’

Others might stop accepting new Medicare patients, the American Medical Association predicts. An AMA survey reported that 38 percent of U.S. physicians will stop taking Medicare patients if the cuts take effect.

‘The result will be less and less access to care,’ Gunby said.”

email

Comments are moderated before they are published. Please read the comment policy.

  • Anonymous

    “”When such cuts are imposed, the usual response is to either order more procedures so as to not reduce overall revenue reimbursements received by the practice”

    Perhaps the real reason for “defensive medicine”?

  • Anonymous

    “Perhaps the real reason for “defensive medicine”?”

    Oh please – try what we’ve been saying all along – defensive medicine is practiced to keep us from being sued. If there were tort reform – caps, tightening of the rules as to who could be sued, health care courts, whatever – then you’d see less defensive medicine. Reimbursement rates have nothing to do with this.

  • Anonymous

    10:04, you don’t seem to get it.

    Most doctors make nothing on defensive medicine behavior; testing and consultation are done by others, those suppliers get paid, but the referring doctor gets nothing. Usually the diagnosis has to justify the test ordered, you can’t just order testing unless there is some justification in the clinical record.

    The point of the story is that doctors will have to book more appointments per day to offset the cuts in reimbursement per visit that Medicare wants to impose, that, or quit taking Medicare. That has nothing to do with defensive medicine. It usually means shorter office visits, though. TANSTAAFL, you know.

  • Anonymous

    Anon 7:48/10:04:

    “When such cuts are imposed, the usual response is to either order more procedures so as to not reduce overall revenue reimbursements received by the practice or to cut back on the Medicare load by refusing to take on more senior clients”

    What is the basis for this statement? Where is evidence to back this statement up? The fact is this quote is from a columnist (Mr Heaster) who appears to be giving his personal opinion. When he sites evidence to back up his statement then he will have more credibility. Here is my “personal opinion” (as a doc who sees patients). As much as I don’t want to I may need to limit my new medicare patients if this cut goes into affect and more so if the future cuts go into effect. This is not something I want to do this is something I have to do. This cut has nothing to do with our increasing expenses. Also, I have NEVER EVER ordered a test to just increase my bottom line. It is unethical….period. On the other hand I have ordered many “just in case” tests over the years for as much “medical-legal” reasons as medical reasons. Again this is my personal observation. But then again as a doctor who works with patients on a daily basis I think my “personal opinion” carries a little more weight than a news columnist (that is until he shows evidence to back up his statement).

  • Anonymous

    Unless of course they are referring to their own MRI center for example.

    As to the point of the story, you got it half right. For some reason you keep missing this part:

    “When such cuts are imposed, the usual response is to either order more procedures so as to not reduce overall revenue reimbursements received by the practice or”

    Which leads one to wonder whether all those extra tests claimed to be a result of litigation fears are really something else altogether. Don’t blame me if you don’t like what he said – tell the KC Star.

  • Anonymous

    12:30, do you require equal factual basis from those who assert defensive medicine is caused by litigation fears, despite no hard evidence to support that claim?

    Why does your “personal observation”, which is designed to push measures that will increase your bottom line, merit any more weight than this gentleman’s?

    Short answer – it doesn’t. Both of you are operating on nothing more than rank opinion.

  • Anonymous

    “Why does your “personal observation”, which is designed to push measures that will increase your bottom line, merit any more weight than this gentleman’s

    Can you read?
    This gentleman is a columnist. He gives no evidence to support his argument anymore than you do (or me for that matter). The difference between him, you (I presume), and me is that I actually work in the field. This is something I deal with on a daily basis. If experience and training counts for nothing in your opinion then ignore what I have to say….period.

    PS: Real professionals do not increase their bottom line at the expense of their patients (clients). This includes all professions including law.

  • Anonymous

    A doctor cannot increase his revenue from Medicare patients by ordering more tests. The STARK LAW prohibits any doctor to send a patient to any imaging center, lab,
    Physical therapy, home health agency etc in which he has any financial stake. Most of us don’t have in house lab because of the very strict and not cost effective CLIA requirements.

  • Anonymous

    “Which leads one to wonder whether all those extra tests claimed to be a result of litigation fears are really something else altogether. Don’t blame me if you don’t like what he said – tell the KC Star.”

    Do any of you jokers have any clue how we bill (the KC star clearly doesn’t)? In this era of the “medicare fraud” witch hunt if anything I underbill. Like most docs I wouldn’t consider having my own lab for the reason explained above. Even though having a central lab by which my patients get there tests would make a heck of a lot of more sense than having them going through two dozen labs spread throughout the city and then hope the test results actually get back to me. Talk about a prescription for disaster.

  • Michael Rack, MD

    “A doctor cannot increase his revenue from Medicare patients by ordering more tests. The STARK LAW prohibits any doctor to send a patient to any imaging center, lab,
    Physical therapy, home health agency etc in which he has any financial stake”
    The Stark regulations are a little more complex than that, at least as they pertain to the field of sleep medicine. A doctor can own up to 40% of a sleep lab and refer patients to that sleep lab. And even if a doctor doesn’t have ownership of a sleep lab, he can make money by refering patients to a lab and pocketing hefty reading fees (for reading the sleep studies). Even my comments are an over-simplification of the Stark regulations; a lot depends on whether the sleep lab is part of a hospital or whether it is an independent diagnostic and testing facility. I don’t think Stark stops self-referral, but it does necessitate good legal counsel. Disclaimer: please don’t think that I am getting rich off of my sleep lab (of which I am a less than 40% owner), I had to cosign several loans and leases and my sleep lab could well drive me to bankruptcy.

  • Anonymous

    “I had to cosign several loans and leases and my sleep lab could well drive me to bankruptcy.”

    I can sympathisize but you clearly have a great monetary incentive to utilize that lab with self referrals whether you realize this consciously or not.

  • Anonymous

    Re anon 1:45

    “I can sympathisize but you clearly have a great monetary incentive to utilize that lab with self referrals whether you realize this consciously or not.”

    Did you ever think that Dr Rack (who I assume is a pulmnologist who specializes in sleep medicine) saw an extreme shortage in sleep labs and decided to do something about it? My own city with a metropolitan population of over 1 million has only two sleep labs. People wait upwards of 6 months for an appointment. Sleep apnea is very much underdignosed. Sleep studies are labor intensive and I would be surprised if they were that well reimbursed (though I don’t know that answer). Once again someone putting in their two cents who knows little about the subject.