It is an insult to the intelligence of our elderly to assure them that their Medicare benefits are not being cut while limiting the services these benefits can buy and decreasing reimbursements to the doctors and hospitals that provide those services.
Yet this is exactly what the president and Congress now have in mind. The cuts proposed in the current budget deal will make Medicare patients less profitable for doctors, who will run, leaving patients holding Medicare cards that don’t buy them access to health care.
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Even before Obamacare began to muddy the playing field, to say nothing of the proposed cuts, an AMA survey revealed that 17 percent of physicians were already restricting the number of Medicare patients they saw. They did this because the rates that Medicare paid for office visits were frozen, even as doctors’ office operating expenses rose by more than 20 percent over the past decade.
So, doctors can ill afford the 2 percent cuts to Medicare-service providers that, under the current deficit-reduction plan, will automatically kick in if Congress doesn’t enact at least $1.2 trillion in deficit reduction by next January.
And the 2 percent cuts are only part of the problem. There is also the so-called “doc fix,” which keeps Medicare payments from being cut dramatically and has been passed every year since 2002. This is necessary because, under the Balanced Budget Act of 1997, whenever medical costs rise beyond the “Sustainable Growth Rate” (which is based on GDP growth), Medicare payments to doctors — perversely — get cut.
Needless to say, medical costs have grown a lot in the last decade. By next January, we doctors will be facing a 29 percent cut in reimbursements unless the doc fix continues to be extended. But a doc-fix extension could count against the currently proposed deal’s deficit-reduction requirements unless a separate deal is made. Few physicians who see mainly Medicare patients will be able to afford to stay in business with almost a third less income per patient.
As more than 70 million Baby Boomers become eligible for Medicare over the next 15 years, they will have a hard time finding a doctor to take care of them or a hospital to provide the services they need.
Of course, with Medicare payments zooming out of control, something clearly needs to be done. The CBO estimates that gross Medicare spending will rise from $528 billion in 2010 to $735 billion in 2015, to over a trillion dollars by 2020.
But cuts to providers are hardly the answer. The Medicare Payment Advisory Commission recently determined that over 28 percent of patients seeking a new Medicare primary-care provider were unable to find one. This number will surely skyrocket as payments to providers are cut to the bone and the new Independent Payment Advisory Board slashes services, making it more difficult for doctors to order certain tests and treatments.
The problem with Medicare isn’t that it pays doctors too much, and it isn’t that it covers too many kinds of tests and treatments. These services are expensive, to be sure, but our elderly need them.
The problem with Medicare is that there are no disincentives for overuse, nothing to stop someone from seeing me for a common cold or a sprained ankle. Medicare can’t afford to pay for the latest technologies or to pay its physicians properly while at the same time stretching to cover every scratch or sniffle. Too many elderly patients who are not sick doctor shop, seeing specialist after specialist, receiving tests like EKGs over and over.
The only solution to this growing problem of overuse is to put brakes on the system in terms of co-pays, co-insurances, and deductibles.
Yet Obamacare does the opposite, easing access further under the mistaken notion that the more a patient sees me, the more effective I will be, no matter what condition the patient is in. An automatic trigger to cut Medicare payments to service providers by 2 percent will not solve this problem; nor will the 29 percent cut in reimbursements that is continually hanging over our heads.
As people get older and sicker, it becomes more of a challenge to take care of them. Though it is an honor to be in the position to provide this service, I also should be paid fairly for doing so.
Marc, you miss the point. The intent of these changes is less to save the govt money, but more to co-opt and corral doctors into leaving private practices for large clinics and groups, the better to be controlled and directed by the central authorities.
The problem of docs "leaving patients holding Medicare cards that don’t buy them access to health care" will be solved by making medical licenses contingent upon accepting Medicare and other central policies (as is already so in my state).
This will end with the practice of medicine being just another federal monopoly, along with student loans and GM. And 16% more of the national economy will belong to bureaucrats and other unelected dead wood.
The ultimate effect of this Sovietization of medicine will not be good for your health. Be very afraid.
Right on the head.
Decrease reimbursement, get docs to be hospital employees, publish "Evidence Based Medicine" guidelines that always seem to recommend less expense.
To those who mock doctors worrying about their salary, do you want to see someone for surgery that thinks 50K a year is great and can't find a better job? Good luck America.
You say that like it's a bad thing. If keeping Medicare "as we know it" means bankrupting our country, which is in actually what it does mean, then yeah I'm all for ending Medicare. I can't speak for Andy but I'm fairly certain that he, like I, would want it replaced with something that we could actually afford, that didn't encourage overuse and was something that we could afford.
Yeah, I know I said it twice but I really meant it. We can't afford the current system. It's a numbers game we cannot win. The choice is bankrupt the country or end Medicare as we know it. Are you telling me you prefer bankrupting the country? Really??
It amazes me that any senior will vote for any politician who says he/she is fixing Medicare by reducing payments to providers.
Not only does that harm the providers, but it also harms the seniors -- big time. Seniors are finding it more and more difficult to find providers who will accept them as patients. If you are a senior looking for a provider the first question out of the receptionist's mouth is 'what is your year of birth'
It is time for the idiots in Washington to either adequately fund Medicare or eliminate the program.
It is time for the politicians to start thinking of what they are doing with Medicare -- jamming both providers and old people.
It is time for seniors to vote out every incumbent who has played this game.
We need an entirely new Congress and another president. Get rid of all of them.
Not sure how well annual deductibles would work - if you set them high enough to be effective they will often prevent the poor or seniors from seeking medical attention for potentially serious conditions, but if you set them low enough to be affordable, many will just meet the limit early in the year and then freely abuse the "free" services after that.
Co-pays, on the other hand, could work wonders. A co-worker's daughter, with kids on Medicaid, has a habt of taking her kids to a doctor - or an emergency room - for every little sneeze, sniffle, or scrape. A doctor friend tells us this is extremely common behavior. A simple co-pay of $20 or $25 would be affordable enough to not deter her from seeking help for real, legitimate needs, but would sure make her stop and think twice about running in for every minor hiccup. The same would hold true for Medicare recipients.
The system, as designed, encourages costly, wasteful behavior and over-burdens medical resources. Small co-pays would be a simple and valuable beginning to making the system work in a more rational manner.
But then I read about Obamacare covering birth control, domestic abuse counselling, "wellness" care, etc, and came back to reality. It was a nice fantasy while it lasted...
We do take what is offered, we have no negotiating ability whatsoever. Illegal in my state.
I would be very happy to charge a reasonable, collectable fee to a population of uninsured patients. In order to make a living now I have to inflate my fees terribly then get paid a percentage by most insurers. I would much rather set (and post on line) my fees, to be paid up front for a discount or over time like you do for a lawyer or accountant.
As to the malpractice wonders, one can't deny care based on the patient giving up a right. I have never been sued, not even close, but my premium for liability insurance has gone from $9k in 2000 to $58k this year. Guess whose pocket that comes from?
Boo hoo, doc. Welcome to the world the rest of the "private" sector lives in. For some reason, you believe that medical personnel should continue to be insulated from the collapse all around us. Apparently, ain't gonna happen this time. If you want special treatment, join the SEIU.
Marco, I don't want special treatment, just fair treatment, for your sake as well as mine. Happens that my costs are up 20% in three years and my revenues down slightly, despite my seeing more patients.
Do you really want to see a doc who considers his services to be of only modest value? What do you pay your accountant or lawyer?
Do yourself a favor and look at the percentage of medical costs that actually goes to MD, RN and other salaries. You will find that these are stable over 20 years, while administrative costs and prescription drugs have had the greatest increases.
Prescription costs increasing are ok with me, drugs help people get better and keep them out of surgery; but the increase in administrative costs is just a harbinger of what Mr Obama has in mind...
Poor little Doctor wants to be paid 'Fairly' Join the CLUB!, maybe we need to increase H1B Visas for Doctors, to fix the 'shortage' Oh Boy! it's FUN to be Republican!
I notice that the HORRIFIC examples I have read of payments made for services NOT rendered is not even discussed in this article.
I find the lack of accountability leaves little incentive for the employees to perform well. I could never be an employee of such an organization...but I guess this lack of accountability runs rampant in government agencies.
I have always wanted to excel and did so at every job I ever held! How could anyone process payments to a doctor for hundreds of patients living hundreds of miles from a physician's office - and NOT question the authenticity of the charges????? The lack of oversight in Medicare payments is unacceptable to this taxpayer!
As patients covered by Medicare who do NOT run to the doctor for every little ache and pain, my husband and I send a monetary gift to our doctor because we DO see the obscene payment schedule set by people with NO concept of what the individual doctors in America are dealing with. Staff, malpractice insurance, higher billing costs due to the ridiculous demands of Medicare, and simply higher operating expenses of maintaining an office...and the government wants to CUT their reimbursement??!!??
Doctors do NOT deserve to be treated as second-class citizens!
@Doctor Robert, Thoughtful post. I always felt your profession was ill served by EVERYONE having Insurance, in essence a 'middle man' that does NOTHING to lower costs or improve care, it also increases Bureaucratic overhead. If there was no 'Insurance' you would bill at what the Public could pay, or go out of business. One think I disagree with you is a Doctor is NOT a Lawyer or Accountant. I can choose to see an accountant or lawyer, but I NEED a Doctor, as EVERYONE will sooner or later.I also need some reasonable protection from possible incompetence.(Malpractice Insurance)
Right now, Medicare pays about .65 on the dollar. Physicians already take a cut to care for these patients. A lean clinic has overhead costs of at least 40% or .40/$1 leaving about 25% for profit. Most of this does not go to the doctor but reinvested in the clinic. Regardless, if the SGR goes into effect that brings reimbursement down to about .35/$1.
My overhead doesn't go down ( still have electricity, payroll, etc), so for every patient with Medicare I see at these levels, I lose money. I'm better off sitting at home with the other 99 week-ers not doing anything and watching Jerry Springer. This already has happened with Medicaid and i no longer see it.
As to Dr Robert's statement "The problem of docs "leaving patients holding Medicare cards that don’t buy them access to health care" will be solved by making medical licenses contingent upon accepting Medicare and other central policies (as is already so in my state).", the solution is simple. I will either open spot for one Medicare patient a month to satisfy the requirements or just go into another line of work. Like anyone else, I'm not going to work for free.
" I will either open spot for one Medicare patient a month to satisfy the requirements or just go into another line of work. Like anyone else, I'm not going to work for free."
Well DrGuido, Barry is already on to your first idea. That's what the doctor shopping program was about, calling doctors to see if they "discriminated" on appt. availability based on payment type. Big Sis Sebelius suspended it for now, but it'll be back.
For myself, I plan to go insurance/medicare free in the future, but I do sports and family medicine and can offer patients reasonable cash prices.
Surgeons and other invasive specilaties have less flexibility because their services are more costly and are reasonable uses for "health insurance." If it becomes illegal for me to practice outside of government regulated payment schemes (like in Canada) I will probably move to another country.
I am not buying this 40 cent on the dollar overhead costs. That is a 'Strange' way to figure costs. The way it SHOULD be done is divide Month costs into a daily business figure. Anything OVER that is Profit. If Rent/Insurance/equipment/Utilities/Low wage Salaries of your 'staff' add up to say $1000 a day, than you need to bill OVER a $1,000 a day to be profitable. Most Doctors bill on a Cost+ basics anyway, so an injection would be office visit+ cost of shot(With markup).You can make TONS of money off all patients,even MEDICAID, but you can't run your office like a 'country club' you have to have 'tight scheduling of at least 3-4 patients an hour and if need be a 'group' of doctors to share expenses, and keep the patient flow at top speed.
Overhead for a typical insurance-based practice is 50%. That's why concierge/insurance free practices are popular with patients and family doctors. I can see fewer patients per day and make more money, and have a nicer office, just by cutting out insurance or medicare.
I can see a patient for a simple problem easily for $35 bucks. That's probably $10-15 more than the co-pay--and that's the entire cost. No insurance. Of course Medicaid patients pay $0 co-pay, and most Americans want healthcare to be free, much less have to pay a $20 co-pay. Such is the mentality of entitlement.
What you bill is irrelevant. Insurers and medicare pay on fee schedules. It is a crime to bill the patient for the difference. Our expenses are increasing while our schedules are decreasing. My partners and I just voted ourselves a 25% pay cut to keep the corp profitable.
The states are broke so Medicaid pays NOTHING so you simply have no idea what you are talking about.
Medicare pays $1300 for a knee replacement. That includes the surgery and 3 months of follow up no matter how often the patient demands to be seen.
Medicare patients exhaust 50 times more than they ever paid in yet are the most indulged and demanding patients on earth.
The age must be raised, copays must increase, and physicians should be able to negotiate a fee beyond medicare. This will introduce competition and force patients to shop for quality before spending their own dollars rather than the next generations.
