I know. I know. Medicare is the insurance that all of us love to hate. But being both an internist and geriatrician, I have learned to see the good side of the sometimes annoying government program for several reasons:
1. Medicare’s fee schedule. It’s bad, but not that bad. Sure, Medicare’s fee schedule has only increased 3.1% over the past 12 years, while practice costs (based on the Medicare Economic Index) have increased 30% during that period. But are other insurances that much better? For many insurance plans, the gap between Medicare and private insurance fee schedules is only 5-10%, and it is rarely more than 35%.
2. Medicare patients are nicer. Elderly patients, who make up 85% of Medicare, are generally felt to be more respectful, more compliant, and more likely to show up and be on time for an appointment. Since most elderly are retired, their schedules are flexible for appointments and they have more time to follow our recommendations, especially when it comes to diet and exercise.
3. Medicare patients have more interesting problems. The multiple chronic problems that elderly patients have can be challenging, but they are also more interesting to deal with than dozens of sore throats and URI’s. Good physicians respect a challenge.
4. Medicare patients are seen more often. This may seem like a negative, and it may be for surgeons, but since the average Medicare patient needs to be seen more often, you can have a full primary care practice with fewer patients in a practice that takes Medicare. The average Medicare patient has 6-7 primary care visits per year, versus 2-3 for younger patients. With a smaller panel of older patients, you can make the same income but know your patients better.
5. Medicare patients can be sent wherever we want to send them. No prior approvals! All of us have had to deal with managed care plans that require you to send patients for labs only to LabCorp or only to Quest. Other plans limit the place of service for everything from X-rays to hospitalization, and require a prior approval for everything. With Medicare, you can choose to use whatever hospital, lab or diagnostic facility you want.
6. Medicare rules are published and transparent. Yes, Medicare is very bureaucratic and rules-driven. But unlike private insurance, you can look up any Medicare rule. Any time you don’t get paid for doing something, there is a reason. Private insurances consider all of their rules and code edits proprietary (a trade secret) and they won’t tell physicians or patients what they are. For example, some insurances won’t pay for an echocardiogram with a diagnosis of hypertension, and some will. Medicare’s website will tell you if they will, but with commercial insurances it is trial and error. They could also decide in the middle of the year to stop covering echocardiograms for that diagnosis and they will almost never tell you.
7. Medicare can be more profitable. I know this sounds counter-intuitive. But, as noted above, Medicare covers tests and procedures without prior approval. As your practice gets bigger, you can add more appropriate tests and procedures and make better income for your practice, clinic or surgi-center, rather than just for your hospital or diagnostic facility.
8. Medicare patients can go anywhere in the country. So when your patients travel, you don’t have the hassle of spending hours getting prior approvals for out of network care. On the downside, Medicare is completely invalid outside of the United States, so make sure your patients get a travel policy when they vacation internationally.
9. Medicare has small deductibles and co-insurances for physician care. Most of my non-Medicare patients now have a $500 to $5000 deductible for physician services. Medicare Part B’s deductible is only $147. After paying that deductible, Medicare covers labs and X-rays at 100% and other physician services at 80%. But the vast majority of seniors in Arapahoe and Douglas County have Medicare Advantage or Medigap plans. These plans usually completely cover the $147 deductible and the 20% copay, so that your patient has to pay nothing out of pocket. Who among us loves chasing the patient months later for deductibles and copays that patients thought were covered by their insurance?
10. Medicare is efficient. Most of you will be surprised by this but Medicare runs on an administrative budget of less than 2%. This means Medicare spends 98 cents out of every dollar on health care (doctors and patients). For private insurances, this number is usually 75 to 80 cents of every dollar.
Floyd B. Russak is an internal medicine physician.
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