Comments on: Congress halts the Medicare cuts http://www.kevinmd.com/blog/2006/12/congress-halts-medicare-cuts.html medical blog Sun, 22 Nov 2009 14:15:05 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2006/12/congress-halts-medicare-cuts.html/comment-page-1#comment-70601 Anonymous Fri, 19 Jan 2007 06:00:00 +0000 http://clients.emmense.com/kevinmd/2006/12/congress-halts-the-medicare-cuts.html#comment-70601 I don't accept Medicaid for 2 years now and almost don't have Medicare patients left. I do however have several patients that are willing to pay me cash for the office visits - is that legal? <br/>I haven't officially terminated my agreement with Medicare. Am I allow to charge the patient upfront for the visit considering that I am not going to charge Medicare for it? <br/>And as far as the last reply - go ahead and see the Nurse - you'll be paying me so much more later for the treatment of the complications of innovative enough treatment you had received their. I don’t accept Medicaid for 2 years now and almost don’t have Medicare patients left. I do however have several patients that are willing to pay me cash for the office visits – is that legal?
I haven’t officially terminated my agreement with Medicare. Am I allow to charge the patient upfront for the visit considering that I am not going to charge Medicare for it?
And as far as the last reply – go ahead and see the Nurse – you’ll be paying me so much more later for the treatment of the complications of innovative enough treatment you had received their.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/12/congress-halts-medicare-cuts.html/comment-page-1#comment-69725 Anonymous Tue, 19 Dec 2006 21:49:00 +0000 http://clients.emmense.com/kevinmd/2006/12/congress-halts-the-medicare-cuts.html#comment-69725 Physicians are unfortunately the cause of the escalation in your health insurance bills for employees and there is no way that any physician will be able to dream of running a practice medicare free in the coming years. Also, the impossibility of making money on medicare reimbursements is a farce. You simply don't know how to run your practice efficiently. Learn to use a computer. Don't have so many personnel on board. Do some real work yourself! Police your own profession and stop asking legislatures and Congress to feel sorry for you and enact tort reforms to give you a license to be negligent. The country is getting tired of hearing your crying. You created the third party reimbursement system so that you could hide behind it and not have to explain to people why you were charging so much. Now all you can do is whine that someone is cutting your fees. We need to dump the physician monopoly on health care and let the nurse practitioners and physician assistants take your place in primary care anyway. You really aren't innovative enough to do the job the way it should be done. Physicians are unfortunately the cause of the escalation in your health insurance bills for employees and there is no way that any physician will be able to dream of running a practice medicare free in the coming years. Also, the impossibility of making money on medicare reimbursements is a farce. You simply don’t know how to run your practice efficiently. Learn to use a computer. Don’t have so many personnel on board. Do some real work yourself! Police your own profession and stop asking legislatures and Congress to feel sorry for you and enact tort reforms to give you a license to be negligent. The country is getting tired of hearing your crying. You created the third party reimbursement system so that you could hide behind it and not have to explain to people why you were charging so much. Now all you can do is whine that someone is cutting your fees. We need to dump the physician monopoly on health care and let the nurse practitioners and physician assistants take your place in primary care anyway. You really aren’t innovative enough to do the job the way it should be done.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/12/congress-halts-medicare-cuts.html/comment-page-1#comment-69529 Anonymous Mon, 11 Dec 2006 17:23:00 +0000 http://clients.emmense.com/kevinmd/2006/12/congress-halts-the-medicare-cuts.html#comment-69529 Pediatric ophthalmology is very poorly reimbursed by Medicaid in Maryland. Many peds ophtho practices just will not accept those patients having eaten their fair share of no-pay but high liability care. That is the choice, or fold up shop, which I have also seen.<br/><br/>The states that have let their Medicaid systems become nothing more than state-sponsored insurance fraud schemes deserve investigation by the Federal government. There seems to be no shortage of funds to pay the agency workers and the managed care contractors; everyone but those delivering the care. Pediatric ophthalmology is very poorly reimbursed by Medicaid in Maryland. Many peds ophtho practices just will not accept those patients having eaten their fair share of no-pay but high liability care. That is the choice, or fold up shop, which I have also seen.

The states that have let their Medicaid systems become nothing more than state-sponsored insurance fraud schemes deserve investigation by the Federal government. There seems to be no shortage of funds to pay the agency workers and the managed care contractors; everyone but those delivering the care.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/12/congress-halts-medicare-cuts.html/comment-page-1#comment-69522 Anonymous Mon, 11 Dec 2006 05:46:00 +0000 http://clients.emmense.com/kevinmd/2006/12/congress-halts-the-medicare-cuts.html#comment-69522 The sad thing is that the majority of insured children seem to have Medicaid as their insurance plan, at least here in Texas. My pediatric ophthalmology partner sees lots and lots of it. It is sad that so many people have so many children they cannot afford, and even then nobody wants to see them on Medicaid. The sad thing is that the majority of insured children seem to have Medicaid as their insurance plan, at least here in Texas. My pediatric ophthalmology partner sees lots and lots of it. It is sad that so many people have so many children they cannot afford, and even then nobody wants to see them on Medicaid.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/12/congress-halts-medicare-cuts.html/comment-page-1#comment-69521 Anonymous Mon, 11 Dec 2006 05:35:00 +0000 http://clients.emmense.com/kevinmd/2006/12/congress-halts-the-medicare-cuts.html#comment-69521 The above poster is absolutely correct. Medicaid people are some of the most "entitled" people around. I just love it when they refer to medicaid as "their insurance". Like they are really paying for it. The above poster is absolutely correct. Medicaid people are some of the most “entitled” people around. I just love it when they refer to medicaid as “their insurance”. Like they are really paying for it.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/12/congress-halts-medicare-cuts.html/comment-page-1#comment-69518 Anonymous Mon, 11 Dec 2006 03:52:00 +0000 http://clients.emmense.com/kevinmd/2006/12/congress-halts-the-medicare-cuts.html#comment-69518 That last post is true. Medicaid burdens a practice in many ways. The reimbursement per code is very low. The agencies are late to pay, often taking many months to pay claims. Where the service has been farmed out to managed-care contractors, the claims are frequently not paid at all. No-shows are typically 40% of all scheduled appointments, leading wasted office appointments that cannot be recouped. And the clientele frequently are difficult and demoralizing for both office staff and doctors to deal with. And in many cases, the medical problems are complicated and time consuming, and where additional specialist consultation is needed, it is almost impossible to find an accepting specialist with whom to coordinate patient care. I get many more requests from attorneys' offices wanting affadiavits of disability for Medicaid patients (who generally have no disability) even though there was never any complaint of disability during the visit and the purpose of the visit was not for disability determination.<br/><br/>Any smart doctor in private practice needs to keep a tight rein on the number of Medicaid patients admitted to the practice. (I think it is unwise to allow more than five percent.) You should not believe that Medicaid patients somehow work their way off Medicaid and onto better insurance plans as their life circumstances change for the better; that is rarely the case. That last post is true. Medicaid burdens a practice in many ways. The reimbursement per code is very low. The agencies are late to pay, often taking many months to pay claims. Where the service has been farmed out to managed-care contractors, the claims are frequently not paid at all. No-shows are typically 40% of all scheduled appointments, leading wasted office appointments that cannot be recouped. And the clientele frequently are difficult and demoralizing for both office staff and doctors to deal with. And in many cases, the medical problems are complicated and time consuming, and where additional specialist consultation is needed, it is almost impossible to find an accepting specialist with whom to coordinate patient care. I get many more requests from attorneys’ offices wanting affadiavits of disability for Medicaid patients (who generally have no disability) even though there was never any complaint of disability during the visit and the purpose of the visit was not for disability determination.

Any smart doctor in private practice needs to keep a tight rein on the number of Medicaid patients admitted to the practice. (I think it is unwise to allow more than five percent.) You should not believe that Medicaid patients somehow work their way off Medicaid and onto better insurance plans as their life circumstances change for the better; that is rarely the case.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/12/congress-halts-medicare-cuts.html/comment-page-1#comment-69514 Anonymous Mon, 11 Dec 2006 00:32:00 +0000 http://clients.emmense.com/kevinmd/2006/12/congress-halts-the-medicare-cuts.html#comment-69514 Anyone in private practice primary care who sees medicaid patients either works 14 hours per day and makes less than $100,000 or skimps on quality of care or documentation. It is mathematically impossible to have a primary medicaid practice. Given the demand for services from medicaid patients, if you start accepting them, your office will be flooded.<br/><br/>This creates a horrible dilemma for young doctors or people just starting a practice. You have to decide whether you will be worked to death for pennies, or starve for a few years while you build up a practice of insured patients. The tricky part is the fixed costs. You can't just decide to work 8 hours a day and make $80,000 because you have to cover your malpractice, rent and staffing. <br/><br/>Although doctors are bad businessman, they aren't idiots. If you make them into indentured servants, they will find a way out and leave you with people who aren't smart enough to adapt. Those people who are left will not be the cream of the crop that the public has come to expect.<br/>b Anyone in private practice primary care who sees medicaid patients either works 14 hours per day and makes less than $100,000 or skimps on quality of care or documentation. It is mathematically impossible to have a primary medicaid practice. Given the demand for services from medicaid patients, if you start accepting them, your office will be flooded.

This creates a horrible dilemma for young doctors or people just starting a practice. You have to decide whether you will be worked to death for pennies, or starve for a few years while you build up a practice of insured patients. The tricky part is the fixed costs. You can’t just decide to work 8 hours a day and make $80,000 because you have to cover your malpractice, rent and staffing.

Although doctors are bad businessman, they aren’t idiots. If you make them into indentured servants, they will find a way out and leave you with people who aren’t smart enough to adapt. Those people who are left will not be the cream of the crop that the public has come to expect.
b

]]> By: ismd http://www.kevinmd.com/blog/2006/12/congress-halts-medicare-cuts.html/comment-page-1#comment-69502 ismd Sun, 10 Dec 2006 17:11:00 +0000 http://clients.emmense.com/kevinmd/2006/12/congress-halts-the-medicare-cuts.html#comment-69502 The circus a'int over - it's only going to get worse. We're still scheduled to get a 10% reduction across the board in 2008. The circus a’int over – it’s only going to get worse. We’re still scheduled to get a 10% reduction across the board in 2008.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/12/congress-halts-medicare-cuts.html/comment-page-1#comment-69499 Anonymous Sun, 10 Dec 2006 16:19:00 +0000 http://clients.emmense.com/kevinmd/2006/12/congress-halts-the-medicare-cuts.html#comment-69499 The pre-meds should seriously consider other fields.<br/>As for med students, the same should apply, or at least consider a career path that does not depend on third-party-based compensation for outpatient work. Good luck finding that.<br/><br/>This will eventually prompt those who can quit to do so. Good luck to them. (A resident I worked with as a fellow is doing just that next year, along with her neurologist husband--not even ten years into their practice careers).<br/><br/>For those who remain, dumping Medicare may be the only viable option where there is a remaining patient base with private insurance to support a practice. For Medicaid, which to many doctors is a state-sponsored form of fraud against practitioners, I would think the future is very bleak.<br/><br/>Inevitably, access will be reduced. Where Medicare is a dominant payer, practices that cannot survive on those terms will do what any small business does when market conditions preclude viability; they will close up shop.<br/><br/>Loosening the immigration floodgates won't help any; operating costs are uniform within most markets, no matter where you come from. And alternative providers? Same thing. The pre-meds should seriously consider other fields.
As for med students, the same should apply, or at least consider a career path that does not depend on third-party-based compensation for outpatient work. Good luck finding that.

This will eventually prompt those who can quit to do so. Good luck to them. (A resident I worked with as a fellow is doing just that next year, along with her neurologist husband–not even ten years into their practice careers).

For those who remain, dumping Medicare may be the only viable option where there is a remaining patient base with private insurance to support a practice. For Medicaid, which to many doctors is a state-sponsored form of fraud against practitioners, I would think the future is very bleak.

Inevitably, access will be reduced. Where Medicare is a dominant payer, practices that cannot survive on those terms will do what any small business does when market conditions preclude viability; they will close up shop.

Loosening the immigration floodgates won’t help any; operating costs are uniform within most markets, no matter where you come from. And alternative providers? Same thing.

]]> By: Anonymous http://www.kevinmd.com/blog/2006/12/congress-halts-medicare-cuts.html/comment-page-1#comment-69497 Anonymous Sun, 10 Dec 2006 14:29:00 +0000 http://clients.emmense.com/kevinmd/2006/12/congress-halts-the-medicare-cuts.html#comment-69497 "With Medicare as the ONLY payor in his long term scheme, doctors won't HAVE the option of not accepting Medicare"<br/><br/>Fortunately, I will have the option of quitting (retiring). I feel very very sorry for all the poor residents, med students, and pre med students out there. “With Medicare as the ONLY payor in his long term scheme, doctors won’t HAVE the option of not accepting Medicare”

Fortunately, I will have the option of quitting (retiring). I feel very very sorry for all the poor residents, med students, and pre med students out there.

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