Medicare

Observation status: When you’re not a hospital inpatient

Physician
February 8, 2014

Two decades ago, a decision was made by Medicare policymakers that carotid endarterectomies would not be allowed. Their claim was too many were being done costing Medicare money. The following year, data revealed a sharp rise in debilitating strokes, so wisely, surgical criteria was developed recommencing the use of this quality-of-life saving operation.

For years, there have been other misjudgments against Medicare patients that are only now becoming apparent. Let me clarify …

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Why Medicaid patients use the emergency department for primary care

KevinMD
January 3, 2014

A study from Science found that those on Medicaid in Oregon made 40% more visits to the emergency department.

The Oregon Health Insurance Experiment included about 90,000 low-income people and assigned 30,000 of them to Medicaid by lottery. It’s essentially a naturally-occurring randomized controlled trial.

The result seems to have caught the public policy experts by off guard:

“I suspect that the finding will be surprising to many in the policy …

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Why physicians are hesitant to take Medicaid patients

Policy
November 18, 2013

In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients.

Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% …

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How to respond to a Medicare audit: 17 tips from a lawyer

Policy
November 9, 2013

Although you may speak of a “routine” Medicare audit, there is really no such creature. This is like saying you have a “routine IRS audit.” The fact is that there is some item you have claimed as a Medicare provider or the amount of claims Medicare has paid in a certain category that has caused you or your practice to be audited.

Having too many claims for level five CPT codes …

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What do we do with the extreme elderly?

Physician
October 10, 2013

A 100-year-old woman is brought to the emergency room by a concerned friend because she can no longer get out of bed to get food or go to the bathroom. Other than being unwashed and a little confused, she is fine. Her electrolytes are pristine, her electrocardiogram the definition of normal, her blood count and chest x-ray perfectly mirror the expected physiology for her age. Even her urinalysis is normal. …

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Primary care doctors need 35 hour work weeks

Physician
July 11, 2013

Jeff Goldsmith recently opined on why practice redesign isn’t going to solve the primary care shortage. In the post, Goldsmith explains why a proposed model of high-volume primary care practice — having docs see even more patients per day, and grouping them in pods — is unlikely to be accepted by either tomorrow’s doctors or tomorrow’s boomer patients. He points out that we are replacing a generation of workaholic boomer …

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To the patients who resent greedy doctors

Physician
October 16, 2012

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Good, it’s about time that these greedy doctors get smacked down for being the financial rapists that they are.  Medicine in this country is the biggest, most destructive SCAM going on today. Doctors think they are entitled to RIDICULOUS amounts of money for simple routine procedures.
– Johnathan Blaze

It is generally agreed upon that the more one values a good or service, the …

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How America’s healthcare system will keep you sick

Physician
October 7, 2012

Have you ever worried about how you’re going to get healthy these days? Has your doctor recommended diet and exercise? Well, if you’re like millions who are struggling to find health, you’re going to need a lot more than just diet and exercise. You’re going to have to fight like crazy against a mind-set of disease that’s paradoxically disguised as health care.

America’s healthcare system – health insurance companies, government health …

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Billing an established patient visit as a consultation

Physician
November 13, 2011

Until recently, there was a financial difference between performing a “consultation” and a “new patient visit” for office visits (Medicare stopped paying for consultations at a higher rate than new patient visits in 2010).

In specialists’ offices, patients often got billed for the more expensive “consults” when in fact the visit was not a consultation at all.  Let’s just use this understanding as the brief background for what I’m about to say.

I …

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Human capital makes doctors special

Physician
September 9, 2011

If you’ve ever been sick, especially with anything serious, you quickly realize that doctors, nurses and their ilk are an unusual and precious resource.

First you have to find smart people with personalities willing and able to put up with a lot of guff in the service of their fellow man.  Then they have to be willing to (usually borrow, and) spend tens or hundreds of thousands of dollars for …

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Internal medicine is dead, will concierge physicians thrive?

Physician
April 29, 2010

by Steven Knope, MD

For the last several years, writers in the New England Journal of Medicine and the Journal of the American Medical Association have authored doomsday editorials about the prognosis of primary care medicine. There has been much discussion about the fact that internists and family practitioners cannot keep pace with rising overheads and falling reimbursement under the traditional third-party payment system.

Paraphrasing a recent …

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Primary care is burdened by excessive paperwork

Physician
April 28, 2010

by Charles R. D’Agostino, MD

We’ve all seen the headlines –- “Primary Care Physicians Becoming a Scarce Breed”, “Wait Times for Appointments Increasing”, “Primary Care in Crisis” –- and have heard the pundits pontificating on the deteriorating state of primary care.

But rarely do we hear what’s happening from physicians on the front lines, those actually seeing patients. Consequently, with direct access to the primary care trenches, replete with an overworked …

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Why the Mayo Clinic is refusing to see Medicare patients

Policy
January 25, 2010

Medicare, the government insurance company for everyone over age 65 (and for the disabled) pays fees to primary care physicians that guarantee bankruptcy.

Additionally, 70% of hospitals in the United States lose money on Medicare patients. That’s right, for every patient over age 65, it costs the hospital more to deliver care than the government reimburses. That is why Mayo Clinic has said it will not accept Medicare payments for primary …

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How much time do doctors spend on paperwork?

Physician
May 29, 2009

A common complaint is that doctors these days are spending more time doing clerical tasks.

Examples include filling out pre-authorization forms, talking to health plans for pre-certifications on imaging studies, and spending time jumping through bureaucratic hoops. Generally, you do not need a medical degree to do these tasks.

Bob Doherty points to a study that gives some numbers to back up the claims. Primary care doctors spend about 3.5 …

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Once you hit Medicare age, good luck finding a primary care doctor

Policy
April 8, 2009

Almost 30 percent of Medicare beneficiaries have trouble finding a new primary care doctor.

Expect that number to rise dramatically in the near future, as the number of Medicare beneficiaries balloons, and the amount of primary care physicians plummets.

The whole scenario is a perfect example of how poor physician access makes medical coverage practically worthless.

Contrary to popular belief, Medicare’s paperwork requirements and …

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Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine

Policy
March 5, 2009

For those who don’t know, every piece of work that a doctor performs is quantified and measured.

The base unit of physician work is known as the relative value unit (RVU). Most physician salaries are determined by the amount of RVUs a doctor produces in a given year, and in most cases, can range between$35 and $45 per RVU in primary care, depending on geographic location and …

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When primary care refuses to accept Medicare

Policy
December 9, 2008

It’s never a problem, until it affects you.

Baby Boomers are going to be Medicare beneficiaries within the next few years, and some are finding out how difficult it is to find a primary care doctor.

Nationwide, about 30 percent of Medicare patients had difficulty finding a primary care physician during the past year.

As one patient puts it, “I must have made 12 calls before …

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Buy a condo, concierge medicine included

Uncategorized
November 13, 2008

In the tough real estate market, luxury condominiums have to be creative with marketing:

Along with butler and concierge service, spa and sauna, buyers who purchase homes at the new luxury high-rise the Mansion on Peachtree receive two years of service from MD on Call, a mobile medical practice that treats patients in their homes.

Doctors from the service can see patients in their homes, and offer “everything from a throat culture …

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Geriatrics shortage

Uncategorized
August 12, 2008

Niko Karvounis writes on the geriatrician shortage. As baby boomers approach Medicare age, finding doctors to coordinate their care is becoming more challenging. This is due to the same reasons exacerbating the primary care shortage.

Money, as always, is the answer. Not only financial incentives for medical students to choose the field, but the resources for medical schools to institute geriatrics into the curriculum.

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The entitled

Uncategorized
June 28, 2008

What’s wrong with American healthcare in a nutshell: “How does it reflect upon American culture today when obviously affluent families try to persuade doctors to defraud Medicare? How are we going to cut costs in an era of so-called consumer-driven healthcare which implies that patients and their families are the ones directing care? It is cases such as this one that really make me angry when the public blame …

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