Crisis in Alaska. It’s ready to spread to the rest of the country if Medicare reimbursement continues to be cut. (via Medpundit)
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When I did my internship in Flint Michigan years ago there was a similar problem for a slightly different reason. The problem then was that, with GM being a major employer in Flint, and the healthcare benefits being so good, the doctors didn’t want to even bother with the paperwork for Medicare patients. But that also tended to have its ups and downs, as the health of GM itself went up and down.
All physicians reading this post should immediately drop out of Medicare. The only way things will ever change is if the feds have a crisis situation where their AARP electorate can’t get medical care.
that will never happen because
1- doctors are bad at unionizing;
and
2- weare so busy chasing our tails seeing enough patients to cover our growing expenses, that getting out of medicare will mean an immediate and drastic financial change for the worse.
Sadly, if medicare cut rates in half tomorrow, doctors would still be forced to just accept it. This is what aetna/oxford/HIP/blue cross have already figured out, and what medicare is learning fast.
bad situation for doctors now, and VERY bad situation for those who will be treated by the generation of doctors training in the next 10 yrs (ie. no primary care docs – only those who do cosmetic treatments etc.)
1. is true but not need not matter if doctors individually possess the courage to do what they must do without the comfort of the herd.
2. feels far more true than it is. Many who make the leap to ditch Medicare find that they also lose a lot of administrative expense and stress that enables them to focus on providing better quality care to fewer patients but with continued reasonable revenue because they do with less space, fewer employees, etc.
If you combine downsizing of your practice expenses with a smaller mortgage and an interesting hobby to displace starvation anxiety which arises with free time–then it becomes very doable. A smaller house and older car are small prices to pay for freedom, so small that anyone who shies at such a paltry fee is completely undeserving of freedom and I think deserves whatever gruel the master choose to slop out to him.
Other professionals in much more crowded markets and smaller investments in their education have better sense than to let their fees float down to break even levels having learned that it is better to maintain a fair value on your labor and have some free time than to be busy on a profitless treadmill.
It really is sad, not just the medicare situation, but everything as it is now, including HMO problems. Doctors spend YEARS in school getting their expensive educations and when they finally do set up practice, people think they make such a bundle of money. They never take into account that there are so many expenses that go with practicing medicine.
Malpractice insurance, employee salaries along with the cost of providing medical coverage and other benefits for employees. What’s worst is that most employees, today, don’t do a dollar’s worth of work if they can help it. If an employee is a smoker, they spend more time on smoke breaks than the average non-smoking employee, there is boon-daggling, personal calls on office time, (incoming and outgoing personal telephone calls, taking care of personal business on company time, for example) games being played on the computer instead of the work of the business being done. Unfortunately, the few employees who have work ethics soon tire of the boon-dagglers until they get fed up and leave.
Employee theft on the job cuts into profits, incompetence, etc., etc., etc. is rampant, then there are the hypochondriac patients who are always making appointments for their imaginary problems, and if they are insured through an HMO, the doctor will not get paid any more for 20 visits a month than he would for one visit a month by the HMO as HMO’s pay a certain amount per patient each month. Then there are the caps on certain services, no matter what the cost to the doctor, clinic or hospital, the insurances will pay just a certain amount for the services.
Now, with the pending Medicare cuts, here we go again. There is no end to what doctors are expected to put up with in order to try to do what they wanted to do and is the reason for all the time and money spent in getting their degrees and setting up their practices.
No, I’m not a doctor, I’m just one of the “little” people who work in the profession alongside of the professionals (MD’s, RN’s, ARNP’s, PA’s, and others). I see and hear what is going on and it is going to get very messy if things continue going in the direction they’re now going.
“All physicians reading this post should immediately drop out of Medicare.”
I agree. Unfortunately, Medicare is to physicians as crack is to the addict. It is hard to break an addict’s habit, but I think there will be a cut-point at which level enough physicians will leave and cause a significant disruption in patient care that CMS will have to change the rules back in the favor of the physicians. On second thought, the above is just wishful thinking.
“Many who make the leap to ditch Medicare find that they also lose a lot of administrative expense and stress that enables them to focus on providing better quality care to fewer patients but with continued reasonable revenue “
It’s an interesting thought, but in the metro NY area, where I practice, medicare is (sadly) the BEST payer with the LEAST administrative burden, compared to aetna/oxford/HIP/united (united is by far the worst).
I will repeat that the only way doctors will be able to afford to practice is to be able to balance bill. If the federal government and cannot afford to pay for the massive entitlements it has promised, the only choices are to raise taxes massively (NOT) or limit benefits while cost-sharing with beneficiaries. Cost sharing will encourage patients to decide just what is important and ask a lot more questions about risks and benefits before passively agreeing to every probe, image, and blood-letting suggested by their caregiver. There is a point where doctors will “just say no”. I have already done this with Medicaid and capitated managed care plans. Many primary care physicians in my area do not accept Medicare and a few have gone to a concierge model. There is so much demand for medical services that we must not lose sight of who is ultimately in control. It is you!
Happyman:
If one focuses on top notch service, the person who will value that the most, and is therefore the best payor, is the patient.
In my area, one of the poorest in the nation, many practiontioners, most in a few specialties, a few in each, accept no third party contracts collecting fees they set from patients. That means they can’t accept Medicare at all because of the unjust balance billing rule. Letting a third party who neither provides nor is in need of the service is just stupid. How much is it worth to get a flat fixed? Nothing if you don’t have flat.
Go ahead and be a victim if your want to. But it is a choice, one freely made by you. There are options.
The paradox is that the choice is not accept third party control of the practice is necessary to focus a practice on quality and to make of a practice primarily a moral enterprise, rather than money driven. While it seems more charitable to treat people for what the third parties pay, and may once have been so, now it means having to shape the practice around their policies to stay afloat, rather than around the real needs of patients–body and soul.
A crisis. Is it really?
It seems that the problem is there being not enough providers to provide services that when paid for through Medicare do not cover the costs of providing those services. Why is that a crisis? Why does that surprise anyone? Medicare thwarts normal competitive market activity. They fix prices in that they limit the maximum amount that can be charged for a particular service to 115% of their “allowable” rate in each region. If the allowable or the maximum rate for those not accepting assignment is below prevailing costs, well that is just tough. So the inevitable results: market failure. Worse, the government seeks to “empower” beneficiaries as unpaid enforcement agents that prevent anyone who could offer some services at the Medicare rate and others at a necessarily higher but potentially competitive rate from doing so. With Medicare, it is all or nothing, with an onerous two-year opt-out. They even require practitioners who do not accept any payments from Medicare at all to make contracts with their patients who are Medicare-eligible to acknowledge that they will receive nothing from the government for any claim filed related to their services. So the government robs the taxpaying beneficiary of his benefit and undermines the local markets that provide services: your tax dollars at work.
Medicare demands the lowest rates for services. That is inherently anti-competitive. Cash should get the best rate. Insurers should be charged based on their performance (and patients accordingly). If you use a plan that pays fairly and just as importantly, quickly, you should enjoy better rates, and the reverse should be true.
The DHHS and the CMMS deserve a public roasting for this. What they are doing is nothing less than theft of fair return of benefits for taxes paid. If they did this with Social Security, some government employees would rightly fear for their jobs. So why no outrage here? Largely because the beneficiaries have never felt any pain. Perhaps it is time that changed, since that is the kind of thing that prompts political action.
Anonymous : 1:46 PM, I couldn’t have said it better!
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