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Ten facts you may not realize about Medicare
October 30, 2007
Good news! Humana and Wellpoint are raking it in from Medicare! That just makes me incredibly happy for them!
Hmm…. Something seems askew, doesn’t it? Here is my reality of Medicare:
- The only reason I accept Medicare is out of a sense of duty. I feel that we can’t ignore the elderly. The fact is, Medicare reimbursement rates are too low for a primary care physician to survive on. I have been able to get by so far only via increased efficiency leading to higher volume (and I see other insurers to offset Medicare).
- Medicare’s “low overhead” is a false overhead. The government infrastructure needed to support medicare is not taken into consideration in the same way that insurance company costs are considered. Those who say “Medicare for All” is a solution because of its low overhead, don’t take this into consideration. Come on, do you really expect the government to be more efficient at anything?
- Medicare rules prohibit “up front pricing.” I cannot openly state any prices that are not in line with what I am charging medicare, nor can I give a discount to a patient without insurance. If I give a discount, I am accused of “defrauding Medicare.”
- If I opt out of Medicare, I must do so for 2 years.
- I cannot have a mixed Medicare/Concierge medical practice. I cannot charge anybody anything above and beyond Medicare’s reimbursement. Even if I want to offer extra services that are far above and beyond, I cannot pass the cost on to any Medicare patients. If I want to do a practice with innovative solutions for payment, I have to get rid of Medicare.
- The “welcome to Medicare” preventive care package is a joke. The details are so complicated that it is nearly impossible to be sure you are complying.
- The Medicare “pay for performance” initiative (PQRI) is even worse.
If “Medicare for all” were made law, I would quit medicine and become a talk-show host (or work at a fairgrounds somewhere). Seriously, the exodus from medicine would be unprecedented.- 99% of physicians have not coded every chart exactly right for medicare and so are at risk of being audited and nailed for Medicare fraud. Bad Doctors!
- If you rearrange the letters of “Medicare” you get “Dime Care,” which pretty much approximates the average reimbursement.
On the bright side, this is an election year coming up. Now the politicians are going to totally solve this problem for us. Thank goodness for that!
(4 votes, average: 5 out of 5)
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October 30th, 2007 at 12:41 pm
Dr. Rob, I think you meant “can’t” ignore the elderly. And I agree with you, but a sense of duty won’t always keep the doors open and the rent paid.
October 30th, 2007 at 12:46 pm
Yes. I fixed it. Thanks. The bottom line is: I would be more profitable without Medicare.
October 30th, 2007 at 3:05 pm
Well said, Dr. Rob. I predict that more and more PCPs are going to stop accepting Medicare or any insurance for that matter. Insurance will be for catastrophic events only. The trick is to have a “concierge practice” that doesn’t gouge the patient - where the wealthier voluntarily subsidize the poor (a reasonable sliding scale based on income), and docs don’t require in-person visits for billing. About 50-80% of outpatient medicine can be taken care of via phone and email with patients who are known to the PCP. This frees up office time for folks who truly need to be seen. In this model, a doc can provide good care to about 1000 patients/year and make a nice salary without overworking. We need to create a new first tier of healthcare - enabled by IT solutions with patients in the payer seat. I could go on but think I’ll pause here.
October 30th, 2007 at 3:11 pm
You know Dr. Rob, I have to ask this question. For us that are on Medicare we can all tell you that medicare is not a free program. but, obviously our doctor’s are not getting the money, so where is it going? Part B (which pays our doctor’s, not hospital) is 93.50 per month and will increase the first of next year. Most of us also have supplemental ins. that cost far more than Part B. Obviously, if I took that 93.50 per month and sent it directly to my family doc. it would more than be adequate for the 4 times per year I see him. Then I could take the 268.00 that I pay a month in supplemental ins and send it to the specialists I see a few times per year, it seems everyone would get more out of it.
It feels like we (patients) are getting blamed for all this when we dont have a clue as to what is going on. When we are paying over 5,000.00 per year (part B and supplemental) in what is supposed to pay for doctor visits, and another 850.00 a year for Part D, not to mention what happens when we reach the donut hole, or our monthly prescriptions co-pays, even before we reach it. We are left wondering why it is that our medical expenses take almost our entire retirement, and still seems to not be good enough.
Is the Part B money being switched over and actually used to pay for Part A (hospital coverage) or just what is happening? I will be first to admit that I have used many medicare dollars, but mostly against Part A.
Also, is it an option to op out of Part B and supplemental, and send that money to our doctors directly and still keep the hospital coverage of Part A? Is this an option that would strengthen the bridge that seems to be dividing us?
October 30th, 2007 at 8:58 pm
Um…by the way….
I think…
I’ve heard….
That “healthcare for all” in the US is not going to be medicare for all….
It is going to be the “VA for all”.
Perhaps being a consultant or employee for the Gov would not be so bad, eh?
October 31st, 2007 at 9:49 am
Dotors stop your wiening and heal thy self. Your analog record system is over 100 years old and it doesn’t work any better now then it did 100 years ago. Get with the program and stop resisting the change to a digital system that will improve your productivity. My son is headed to medical school next year and I assure you that when a patient comes into his office his vitals will be digitally recorded. I believe medicine is an art and a science. Old doc’s get the art part and forget how powerful the science part can be. Even my auto mechanic records my auto repairs in a digital format.
October 31st, 2007 at 9:59 am
First off, I don’t wien. I do whine from time to time, however.
Second, you clearly have not read my profile. I am one of the strongest advocates of computerized medical records around. I have had computerized records for the past 10 years and have lectured around the country for it. Our practice has been nationally recognized for our use of computers.
You are right that we need to computerize. You just are accusing the wrong person of wiening.
October 31st, 2007 at 8:58 pm
For cathy:
You do have the option of opting out of Part B and could do as you suggest and apply your funds to your primary and specialist physicians. However lets say you are are admitted to the hospital for a bypass. Do you think the cardio/thorasic surgeon is going to accept the savings in premiums as payment in full? What about the horendous costs that chemotherepy can ring up? Without debating the merits of reimbursement problems to providers that is what insurance is for. Medicare and supplements are forms of insurance.
Even if your house is paid off, would you go without homeowner’s insurance and self-insure against fire? Of course not because you’re not willing to accept the financial risk but you can. Same with your health care.
October 31st, 2007 at 9:23 pm
Cathy, you hit a major nail on the head. If primary care is to survive and thrive a complete overhaul of the reimbursment scheme will have to occur. Right now, the field is being decimated by a medicare reimbursement scheme that favors, strongly, reimbermsent to procedures, surgeries and imaging type specialty physicians, at the expense of primary care. Medicare B has a fixed pot of money, for which primary care physicians, for the last 10 years, have recieved a smaller percentage growth.
The result has been hurried offices, double booking in an effort to stay “revenue neutral”. Procedural physicians can increase the number of expensive procedures to stay ” revenue neutral” as the value of all services continue to be cut. A primary care doc can only double book to a point., What’s left is a system where primary care docs, who are cognitive by nature, are not payed to cognate (they don’t have time), but rather to see the most patients in the least amount of time. You would be surprised how much a primary care doc could take care of in their clinic if they were paid enough to see you longer. Instead, referal to specialists lead the way, as there are 3-4 others in the waiting room. And by nature, specialists do procedures (which pay more), The cycle continues.
To break the cycle and save primary care, one needs to break the cycle of substandard reimbursment, when compared to specialists. Only then will medical students return and weill established practices survive and thrive and fully function in their cost saving abilities.
To break the cycle, you either need to increase funding (government), or pass on more costs to the patient. I have blogged about some of my ideas at my site.
http://thehappyhospitalist.blogspot.com/
October 31st, 2007 at 9:41 pm
One other thing Cathy. In my community, there is already a break from medicare. Many internists no longer accept new medicare patients because they cannot continue to pay their ever increasing practice expenses at a reimbursment rate 10 years behind the times. Medicare is set to decrease ALL physicians reimbursment by an across the board 10% cut January 1st, 2008, and plans to cut 35% or more over the next 5 years.
Can you imagine working at a job and having your employer tell you that they are planning on cutting your wage 40% in the next 5 years. Your gas bills continue to rise, your health insurance conintues to rise, your food bills conintue to rise, but your employer says, too bad, this is our rules. That is the state of medicare. It is no wonder less than 20% of medical students are entering primary care, a field, all ready being decimated, with margins so tight primary care docs acutally lose money every time they see you. We have a socialized reimbursment system with a capitalistic cost structure. The fixed top line is crossing the ever rising bottom line. In the business world, that spells bankrupcy.
Specialists have a very large buffer before they drop out of medicare because they are reimbursed at a much larger rate, compared with the time involved and compared with primary care time. They have the ability to do more procedures to counteract the decreased reimbursements. This is exactly what the trend has been over the last few years.
In my community, new access is becoming an issue. Imagine when those cuts finally go through, there will be a mass exodus of primary care docs from medicare, as they have already done with medicaid. Your insurance will be worthless. No one will accept it. We are trying to make lemonade without the lemons. There needs to be more money for primary care to survive. It is not greed. It is reality. Some primary care docs make less than highschool grads in unionized jobs who’s years of educational training is far inferior to the time required to become a board certified MD. The economics of the situation, by human nature, is killing the field of primary care. And money talks. And you know what walks.
November 1st, 2007 at 9:16 am
This is my (partial) understanding:
In my area, Medicare pays $0.35 on the dollar to the hospital in reimbursement–not to the docs, be they generalists, specialists or hospitalists. My hospital, where I work, serves the inner city poor, and it considers $0.35 on the dollar GOOD reimbursement, because . . .
Medicaid pays only $0.13-$0.14 cents on the dollar. And as you know, many poor and elderly are dual-eligible.
My own PCP doesn’t accept Medicare patients, though he will keep patients who have been seeing him for years before they got into the Medicare age range.
Knowing just this little bit, just this partial picture, put forth by these bloggers and responders, it seems to me we have to look critically at the health care reform proposals of the presidential candidates, and decide if their plans address these issues sufficiently well.
We are so very distracted by the Iraq war that we may fail to attend to the domestic policy proposals of the presidential candidates. As Dr. Rob says elsewhere in his blog, TO OUR OWN PERIL.
The boomers are going to HIT the healthcare system with blunt force in the next few years, and this issue will cripple them/the economy. It is critically important, financially and ethically, that we come up with some kind of fair healthcare for all program.
Those of you who blog, read and reply and who feel you can deal with the complexeties of this issue really should put yourselves out there. Contact candidates. Contact the media. Contact your professional organizations. You are all so smart—and I am not speaking in the usual humorous or ironic vein now—you need to say your piece to the people and organizaions which have clout. Please, do this.
Chris and Vic
November 4th, 2007 at 7:57 pm
[...] of a Distractible Mind: Ten facts you may not realize about Medicare - How a doctor feels about Medicare. I’ve got a friend on disability who, last i heard, was [...]
March 2nd, 2008 at 2:50 am
oot
i just imagine that many of our proffesional doctors running a blog like yours and delivered to us an important information/issue like this articles.
tx.