The Doctor Is Not In

Rasmussen Reports ^ | June 26, 2010 | Susan Estrich

[iowamark]

Not long ago, a close friend called me with an unusual request. She and her husband were looking for a new doctor to take care of them. What made it unusual was that they'd had the same doctor for years -- decades, actually.

What happened to "J," I asked. Did I miss something in my otherwise careful reading of the obits? Had he hung up his stethoscope?

None of the above. Her husband had turned 65 and was now eligible for Medicare. Good news -- except "J" is one of the increasing number of doctors who aren't taking "new" Medicare patients, or even old ones.

I remember the days when the health insurance industry used to advertise that Hillary Clinton would take your doctor away. She didn't. But a lot of people have lost their doctors anyway because of the PPO rules and, lately, because doctors just don't want to put up with the rates Medicare pays.

According to the Centers for Medicare and Medicaid Services, 97 percent of the doctors in America accept Medicare. But that is a very deceptive number. It doesn't mean that doctors will take new Medicare patients. According to another study, this one by the American Medical Association, 17 percent of the doctors they surveyed restrict the number of Medicare patients in their practices -- and that number for primary care physicians is 31 percent. Watch out!

Some doctors get around the Medicare limits by charging for "concierge" service. I kid you not. They charge an upfront fee for doing things like promptly returning your calls and providing top-notch referrals, things my own doctor (not a concierge) calls good medicine. Others just get rid of longtime patients when they turn 65.

In an era of double-digit unemployment, it's hard to feel sorry for people making six-figure incomes. On the other hand, many people who do work of lesser value -- that required much less education -- make far more.

I was looking at a hospital bill of my own (from when I collapsed on a street corner in New York City), and frankly, I was pretty horrified to discover that the doctor who read my brain scan and concluded that, thank God, there was no mass was paid less than the hairdresser who trims my hair. Don't get me wrong: I like my hairdresser and value his work. But my life doesn't depend on it.

And the doctor got more from my insurance company than he or she would have received from Medicare. I have private insurance. Doctors get paid, on average, 22 percent less from Medicare than they do from private carriers. And they're prohibited by law from billing you the difference.

Obviously, we need to do something -- actually, many things -- to rein in the skyrocketing costs of health care. As more of us get older and the number of uninsured decreases, those costs are only going to increase. But simply paying doctors less to do their jobs is not the answer.

Better prevention, better screening, fewer unnecessary tests and procedures, more coordination -- all of those are important steps. But there is something wrong when people like my friends reach their 60s and have to find new doctors because the ones who know them best won't take care of them anymore.

I told my friend to call my doctor, Larry. He's watching his income being slashed, but he's past caring. He is what another doctor friend of mine calls a "dinosaur" -- a doctor who puts patients first, even at his own expense, which is how things work today. I am grateful to have a dinosaur on my side. But I fear that his ilk is facing extinction, and we will all suffer for it.

[kaila]

No, a physician can go to jail if he accepts cash from a patient who is on Medicare.
I am not sure about the rules if a physician is non par ( does not accept Medicare).
The problem is, a lot of specialists, and internal medicine physicians have to have hospital priveleges.
A lot of hospitals require you to accept Medicare.
If a physician decides he no longer wants to be on Medicare- there is something like a 2 year time period after that decision that makes it a crime to accept money from Medicare patients.
It is just easier to be a Medicare provider, and not accept Medicare patients. You can still maintain hospital privileges, and if you have to treat a Medicare patient, you do not have to worry about accidentally charging them.

[Twotone]

A friend of my mother’s, who had many severe health issues, used to call Medicare & tell them not to pay the bill from our local clinic. It was laden with charges for tests & drugs she had not received. Pretty sad. One expects a higher ethical standard from the medical profession. At least, I do!

[ArmstedFragg]

Susan missed the most important feature of the new health bill. By cutting reimbursement rates for private insurance it’ll make Medicare’s rates the standard. Doctors who are dumping Medicare patients are just buying time. The ultimate goal is to reduce us all to the same low standard.

[kaila]

I used to do billing for a clinic.
We would have people come into our office complaining about their hospital bill.
They would complain that they never saw a certain specialist they then received a bill for.
But the fact was, they did receive care from that specialist, they just did not know, understand, or remember.
One such type of forgotten specialist is the infectious disease doctor. No one can remember this physician seeing them in the hospital, but he does see them- recommends antibiotics, and monitors the drug levels. I would get many complaints about this- but the fact is they got better due to this consultant.
I am sure that bills can be inaccurate. I do not think malicious intent is there in the majority of cases.

[GadareneDemoniac]

When I go to the Doctor, the clerk always asks me about insurance. I say “private pay”, because I have a really high deductible, don’t go to the Doctor much, and don’t trust how much info is given to the insurance companies even though they aren’t going to pay one red cent toward the bill.

So — what’s to keep me from continuing to say “private pay” when I hit 65? Of course, if they want to spend megabucks at the hospital, I can “remember” that I have Medicare.

[awin]

your comment is not accurate...

[kaila]

Your age is going to give you away.
In order to get away from the age issue, you would have to lie about your age on your registration forms.
If it is a physician you already now see, your real birthdate is in your chart.

[downtownconservative]

"..He is what another doctor friend of mine calls a "dinosaur" -- a doctor who puts patients first, even at his own expense."

And what is the ultimate outcome of that? Extinction. Prof Susan fails to consider that being a doc is a business and cannot long endure in the red. Even big non-profits like Mayo cannot sustain operations while continuously bleeding red ink.

Where does USC/FOX find such talent??

[GreyFriar]

Thanks for posting this. Perhaps Ms. Estrich will have more of the veil pulled from her eyes as she deals with medicare

[Graybeard58]

Before I started on medicare the first of this month, I asked my doc if I was going to have to find a new doc because of that. She just said, "not at all, I have a lot of medicare patients".

I had an appt. a few days ago and I had been used to paying $75.00 for an office call, my former employer's insurance plan pays nothing on office calls. Since I am new to medicare, my deductible hadn't been met yet, so I had to pay the max that medicare would have paid, that number was $63.99. After my deductible is met I will be paying 20% of that figure.

A difference of $11.00 in what my doc gets is not a lot but she did say she has lots of medicare patients.

It a fairly big operation with 4 docs working there plus nurses, a nurse practitioner and various staff - lots of overhead. I'm sure that accepting medicare patients is factored in to the fee structure, in other words, younger patients are picking up the slack caused by us old coots. Don't jump on me about it, I didn't invent the social security/ medicare/ medicaid monstrosity, nor do I participate willingly.

I have a private pension plus social security, plus 401k that I alone paid into and converted upon retirement, my wife still works and gets a very healthy pay check.

My former employer requires me to be on medicare or I lose all my retirement benefits from them, including insurance and besides, everyone get back to me if you reach s.s. age and want to retire and you refuse to accept that check or don't accept medicare.

It simply an awful, socialist system that I was forced to pay into all my working life and needs to be scuttled.

Like I see so many others say on this forum, just give me back all the money I paid in over the years (forget about interest), and many of those years I paid the max and I will consider signing off on ever getting any more ss benefits.

[I-ambush]

The generation of doctors who were practicing when Medicare started made a killing, since they were paid 100% of their usual and customary fee. However, Medicare rates are now such that practices lose money or barely break even caring for those patients.

[ElectionInspector]

...ah, you might reread your benefits book... your ER can NOT require you to be in medicare and threaten a retirement plan unless it is some unqualified exec benefit arrangement. Your pension/401k is YOURS at Retirement age and cannot be tied to a medical coverage. They can change any promised retirement medical if you don’t follow the medical rules, but that is separate and apart from a pension plan... anything else is in violation of federal law....?

ymmv

[Graybeard58]

It was laden with charges for tests & drugs she had not received.

Hospitals don't just do this with medicare. I learned a long time ago to check that bill. A hospital charged my wife for many drugs and services she did not receive. I notified my insurance company and they didn't seem to care.

I was in the hospital 2 years ago and they didn't even send me an itemized bill.

[Myrddin]

Those of us with insurance get the bill from the
doctor after one or both of our insurance
companies have paid all the “reasonable and
customary” charges. There is still a huge balance.
I’m convinced that I’m being shaken down to
cover what the Medicare payments don’t cover
for other patients. I’m also paying for the Medicare
from my payroll deductions. My middle son
has no insurance. He pays a reasonable cash rate
for his services. For as little as I use of my
insurance benefits, a cash only approach would
put me ahead financially.

[Graybeard58]

I converted my 401k when I retired 11 years ago, it was not threatened, nor did I say it was. My private pension is not under threat, I misstated that.

I could lose my health insurance from my employer if I refuse medicare. As it is now, my health insurance from my employer is my medicare supplementary insurance.

Another benefit from my employer is that they reimburse me the cost of my medicare premium, as I understand it they will send me a check every 6 months. I have no complaints about my former employer.

[The Great RJ]

The financing of care medical care under Medicare, has been a mess since the beginning. Clinics and hospitals at first became very adept at scamming the system until reimbursement changes in the mid 1980s took away the annual cost adjustment retrospective payment system and replaced it with prospective payment under a laundry list of Diagnostic Related Groups (DRG) that received fixed but regionally adjusted payment rates. The DRGs shortchanged providers in rural areas with unrealistic cost assumptions and probably overpaid in others. Again hospitals and clinics became adept at picking the DRGs that paid well and avoiding those that didn't and balanced losses from some DRGs with the larger payments for others.

The current crisis came about when to balance Medicaid budgets, government bean counters ceased making cost adjustments to account for inflation and new technology and have literally cut reimbursement in others. At present Medicare reimbursements for some DRGs are about 20% less than the cost of providing the service. Hence some providers are avoiding Medicare patients or restricting the number of Medicare patients.

[yefragetuwrabrumuy]

They’re having it cut off right now.

“The American Academy of Family Physicians said 13 percent of doctors did not participate in Medicare last year, according to the paper, up 8 percent from 2008 and 6 percent from 2004. The American Osteopathic Assn. said 15 percent of its members don’t participate in Medicare and 19 percent don’t accept new Medicare patients.

“If the 21 percent cut (to doctor’s reimbursement) becomes permanent, the AOA estimated that those numbers would double, USA Today reported. The American Medical Assn. cited a survey of 9,000 members that found that 17 percent restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31 percent.”

[zot]

Thanks for the ping.
Obamacare death panels will solve this problem.

[MSSC6644]

After meeting my deductible, the doctor still gets only $42. I almost feel guilty walking out of her office.

Why feel guilty; why not pay out of your own pocket?

[hosepipe]

The odds of Susan connecting the dots of this problem to SOCIALISM(democrat party/liberalism/progressives) are remote..