Finding a doctor who accepts Medicare

Good luck, and the problem is about to get much worse. Thank declining physician reimbursements:

According to the Oregon Medical Association, 23.7 percent of primary care practices in the state are already closed to new Medicare patients, up from 11.8 percent in 2004. Only one in four of the physicians surveyed by the OMA said they would continue to accept new Medicare patients if rates went down as projected next year.

This is about “rich” doctors complaining about money, as I wrote in an op-ed in August. This is about sustaining a business, and you can’t practice medicine if you go bankrupt:

Jevnikar said physician’s practices are no different from other businesses, in that they have to pay for electricity, gas, water and staff salaries. Those costs could be difficult for smaller operations to manage if the reimbursements are cut.
“It’s really about practice expenditure and sustaining your bottom line as far as maintaining your business, or being able to stay in business to provide care.”

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  • Sick of it

    “It’s really about practice expenditure and sustaining your bottom line as far as maintaining your business, or being able to stay in business to provide care.”

    I think it’s time to abandon the higher calling crap. One of the football movies (North Dallas Fory? The Longest Yard?) featured a frustrated conversation between a football player and his coach. The player said (paraphrasing) “Coach, whenever I call it a game, you call it a business. Whenever I cal it a business, you ask where is my love of the game?” Bingo.

    My country treats me like a functionary who must accept the least that I will take. If I took a nickel a patient, they’d cut it to four cents. Figure it out.

    OK, America. It’s a business. But don’t ask me to behave like it’s a calling. Pay me for what I do, find someone else to do it, or live without.

    I’m in business to earn a living and care for my family. I do that by selling my medical expertise. And availability of patient care is my problem any more. Nor will I give lip service to the concept by pretending that I am worried about what Medicare cuts will mean to others. I object not because others may have trouble accessing care. I object because I’m not America’s property, and I don’t work for peanuts.

  • Anonymous

    Medicare is bankrupt. Paying doctors 10% less or even 100% less won’t change that. Whether or not this cut goes through, the entire system is going to implode in the next few years. No politician is talking about that. See Greenspan’s new book – Medicare is the greatest threat to the country’s financial health. And the “reform” that will occur after the next election will only add to the medicare roles and worsen the problem. I’m getting out now. I’ll watch from the sidelines. Taxes are going up.

  • Anonymous

    And, in the case of Oregon, don’t forget failure of tort reform. Oregon had the opportunity to pass tort reform as a Constitutional amendment in 2004. It was voted down. The people of Oregon decided it was more important to sue doctors than to have doctors.

    They got their wish.

    If they want access to a doctor, I suggest they go to Texas, where they passed tort reform and the Board can’t keep up with the increase in applications. The Corvallis-Albany area has a population over 150,000. It’s home of Oregon State University. Portland is about an hour away. The Pacific coast is about an hour away.

    They should have no trouble attracting doctors for quality of life.

    Oregon reimbursement is particularly low compared to the rest of the country. You would think Medicare is monolithic, but it’s not. Rules and pay rates vary across the country. It’s hard to affect payment rates, but they could have passed tort reform.

    They didn’t. Now they can’t find doctors. Forget Medicaid, that’s a lost cause. Now Medicare patients can’t find doctors. Specialty care is fading out, and Medford can barely keep trauma going. When they go, there’s no Level 1 coverage between Portland and Sacramento. Forget about obstetrical access in Eastern Oregon or in Reedsport. You might as well make hotel reservations in Portland when your due date comes near.

    So…..they got what they asked for.

  • Anonymous

    Texas physician applications haven’t even kept pace with the population increase. So how exactly do they have more access?

    California has draconian tort reform, and Kevin just posted an article on how Medicaid patients can’t find a physician.

    Guess that blows your theory out of the water, eh?

  • Anonymous

    No, it shows how little you know. Texas applications went up by about fifteen hundred a year. Whether it’s keeping up with the population is irrelevant. It happened after tort reform.

    California has problems with Medicaid access. If they want to have problems with MediCARE access (the point of the article) they can overturn or vote out tort reform, they can experience Oregon’s problems real quick.

    Sort of blows YOUR theory, excuse me, I mean your lies, out of the water.

  • Anonymous

    What Oregon should do is remove the restrictions on opening new training facilities and completely divest itself from the CME. If this does not ensure “Oregon only” licensing capabilities for newly trained providers then such should be implemented via contract. States and voters must be proactive if they are going to stop this tide of patient abandonment by the providers for fiscal reasons or for not buying into the extortion of “tort reform (still nothing on keeping junk science clinical causation testimony out of the civil system).”

  • Anonymous

    “No, it shows how little you know. Texas applications went up by about fifteen hundred a year. Whether it’s keeping up with the population is irrelevant. It happened after tort reform.”

    Are you joking? The population increases, thus available jobs increase. Texas had a number of new hospitals being built during the height of the “crisis”, and they are now online. More jobs for physicians means more physicians coming to Texas. More patients means more jobs for Texas physicians.

    If it turns out there are more cars being sold in Texas now, is that due to tort reform? Or is it due to increased population? This is not difficult math, surely you can follow it.

    How many physicians has Oregon lost?

  • Anonymous

    How many has Oregon lost? I know a few personally.

    Oregon is having recruitment problems in Portland and Eugene, let alone rural Oregon.

    Texas passed tort reform in 2003, and licensure applications sent up from 2,500 to 3,000 immediately. Did Texas population rise 20% that year? By 2006, applications rose to nearly 4,500.

    Texas must have had one heck of a population growth to explain that rise. Funny how that rise started right after tort reform. You can blame it on phases of the moon or whatever you want. You’re a lawyer, lying and twisting facts is your stock in trade.

  • Anonymous

    Again, how many has Oregon lost? You don’t know, so your claims are pretty useless. Maybe Oregon still has more per capita. Maybe Oregon still has more physicians coming in every year. The point is you don’t know, because the only thing you know is what the insurance industry told you.

    You probably didn’t even know that the rate of new applications didn’t even keep up with the population increase in Texas. You probably don’t know how many doctors applied each year before tort “reform”. No, you heard something that agreed with your preconceptions and off you went.

    You’re really no different than the universal healthcare crowd in that you check your natural skepticism at the door whenever you hear something that you think agrees with wherever you want to go.

  • Anonymous

    The growth in the Texas licensure applications did not match the Texas population growth those years. The growth in Texas licensure application was vastly greater than the growth in Texas population.

    About a 12% population growth 2000-2006.

    http://quickfacts.census.gov/qfd/states/48000.html

    The licensure growth was 20-some percent just in 2006.

  • Anonymous

    You’re like the insurers. You don’t use the same time frames for your comparisons. It’s kind of like the insurers telling us how much they lost in 2003, while not mentioning how much they made in 1990-2000.

    Lies, damn lies, and statistics.

  • Anonymous

    You said (lied) that aplication growth paralleled population growth. In fact, it was flat until after tort reform. Then the numbers jumped up sharply.

  • Anonymous

    No, application growth actually trails population growth. Look at the last 10 to 15 years. Go to the US Census site. Why would you take just a single year as representative? Unless you were trying to massage the facts to fit your theory, that is.

  • Anonymous

    As you say, application growth has trailed population growth for some time. Tort reform is passed, and licensure applications shoot up, well in excess of population growth. The increase is so marked that the Board is having a hard time keeping up with the demand.

    The reason for the application increase in Texas is tort reform. The Board feels the same way about this trend. Thank you for making my point for me.

  • Anonymous

    You’re right. New hospitals coming online, more jobs, etc. all had nothing to do with it. The fact that states without “reform” increased in physicians means nothing.

    You should move to Texas. See you at the next “crisis”. Will you have forgotten this one by then? Will you cry anew?