A primary care doctor dedicates his practice to treating the poor and realizes it can’t be done despite his best efforts:
He is leaving because he can’t deal with the constant financial hardship, of fighting with insurance companies, figuring out how to make the cash go further when the payers are late, and how to break even. He takes medicare and medicaid, because in his neck of the woods, they are some of the best payers. He is leaving because he can’t keep up with the endless fighting over claims, and can’t afford to hire someone to do it for him. He is leaving because he can’t afford to hire someone else to beg insurance companies for pre-authorizations. He can’t afford the mandated EMR, can’t afford the “team” approach required for the patient centered home, and he fears he will go bankrupt trying to follow other of the latest government mandates. He can’t keep up with ICD-10.
Some readers of this blog wonder why physicians continue to put up with the abuse and accept the terms that Medicaid and Medicare dictate.
Maybe someone’s listening because more doctors are either going cash-only or packing up and leaving primary care.
Those doctors will be fine wherever they end up. The patients however, won’t be so fortunate.
Related posts:
- What happens if the safety net clinics start refusing to see Medicare or Medicaid patients?
- A Medicaid-majority patient panel
- Medicaid cancer screening
- California is cutting Medicaid payments
- The Feres doctrine applied to Medicare and Medicaid?
- Cutting Medicaid payments
- Grading the payers
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{ 7 comments }
Concierge/private medicine is looking better and better. It would also help if patients/customers took a more responsible role in maintaining their own health, their most valuable asset.
Chuck Brooks
FutureWare SCG
I practice in Las Vegas, where the iron grip of some insurers (Sierra, United Health) has made medicare my BEST payor. Of course, with the recent switch to Palmetto, medicare isn’t even paying me which=pain.
I suppose that means that “single” payor might even benefit me, since I am so poorly reimbursed by private insurers.
And nurses are NOT going to pick up the slack. The math doesn’t work for any primary care provider.
http://getbetterhealth.com/nurses-may-not-fill-the-primary-care-shortage-were-not-suckers/2008.11.07
Medicare has been the best payer in the NYC area for at least the last 5 years (as long as i've been in practice). In some cases, commercial insurers pay even less than mediCAID (ghi, hip, oxford, blue-cross).
But the thing that irritates me most about the devolution of primary care is the so-called "team" approach. All of these idiots outside actual patient care think it's a great idea to expand the "team" with useless individuals just sucking off medicare resources and providing no value. In some cases they actually complicate care & worsen outcomes. Sadly, visiting nurses is a good example, pertaining to the elderly. They get paid big bucks from medicare & add NOTHING to the care of the patient, with rare (or no) communication with the primary doctor.
What needs to happen with primary care is as follows:
1) Put the DOCTOR back in charge again.
2) Pay him enough to hire a good nurse, biller, and social worker. These are really all the ancillaries that an efficient office needs.
3) Reinforce to patients that they have some responsibility for their own health & well-being.
4) When in doubt, see (1)
It’s sad to say, but the days of the solo or two physician practice are probably numbered. You need at least some level of economies of scale to survive today. My group has 6 physicians and 4 midlevels, which allows them to afford someone like me who can negotiate with insurance companies and handle day to day operations. As a result, my docs are well compensated.
I think it is time for the AMA to get a back-bone and start to stand up for our rights. This organization is such a weak respresentation for our profession…they have allowed so much of our rights and respnsibilities to be controlled by others (insurance companies, government) and have allowed the physician extenders and for profit clinics in pharmacies to take away some of the responsbility that was regulated the role of the physician. We physicians need to stand up for our rights. We aren’t forced to accept medicare or medicaid. If EVERY doctor refused to care for or see any of these patients FOR JUST ONE WEEK…things would change very quickly. But we all have to work together and STAND STRONG. Once we band together and force the issue and show the government that we can bring health care to a standstill we will never get our of the clutches of others telling us what to do and depending on them to reimburse us for our services months after those services were rendered. Perhaps once we do this, we will become a proud profession who can serve the health of our patients instead of being held hostage by the insurance companies and the poor payments of medicare and medicaid. mark my word, if we don’t do something SOON, the new crop of physicians will choose speciality training and concierge medicine and there WILL BE NO ONE to care for the people who need us most.
If we withheld our services for one week, by statue or executive order you would find that the rules would change such that when you enroll as a provider for Medicaid and Medicare, you agree to never withhold services (ie strike) and that you are subject to permanent termination and substantial fines should you do so. The government more and more panders to the idea that health care is a right, not a commodity. If health care is a right, then those who provide it are slaves and do not themselves have any rights.
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