Medicare’s reimbursement rates are still too low, and its regulations are too burdensome.
Ever since the Balance the Budget Act of 1997 passed, almost every physician I know has been chaffing against the bit of the Sustained Growth Rate formula, under which our Medicare reimbursement rates are tied directly to the inflation in health-care spending. Every time this horrendously punitive plan comes up, Congress kicks the can down the road and we receive a temporary reprieve from the penalty. This year we were facing an across-the-board 21 percent cut in our Medicare reimbursement that would have practically finished us.
So now that Congress has finally passed a permanent fix to the problem (the so-called Doctor Fix) and the president has just signed the new bill into law, do you think we are happy and out celebrating? The answer is an emphatic no — because our lives under Medicare have eroded over the years to such an excruciating degree that even a permanent 21 percent reprieve doesn’t change this stark reality.
For starters, modern medicine has advanced to the point where people can stay alive longer with more complex medical problems. While this is a great advance, it makes it much harder to practice medicine. Most of my elderly patients come to see me with long lists of problems and medications, yet Medicare pays me about $50 for a 15- to 20-minute follow-up visit, and over this period of time I am also expected to enter a complex series of information, test ordering, and decision making into the patient’s electronic health records. For Medicare, I must now document data including the patient’s allergies, height, weight, blood pressure, and smoking history, or endure a 1 percent penalty on my total income from Medicare.
The new bill just passed by Congress includes built-in incentives for doctors to bill Medicare for overall care delivered rather than individual office visits, but it is office visits that chew up our time, and office visits where most care is delivered and decisions made. No solo practitioner is confident in his or her ability to convince Medicare about the amount or quality of care delivered. This is a job for a business manager of a large practice or hospital.
And yet, though we grumble, most of us continue to work with Medicare. What choice do we have? Our patients get older, and they still need us. Close to 700,000 physicians in the U.S. continue to work with Medicare, and the drop-out rate is still less than 2 percent.
We stay because many of us realize that it is an honor and a privilege to take care of the elderly, and more gratifying the more our tools to do so improve. But the federal government is taking advantage of our goodwill by paying us less and less to do more and more.
Signs of discontent can be found in the fact that some of us have had to limit the number of new Medicare patients we will see. Recent federal statistics reveal that 12 percent of office-based physicians don’t see new Medicare patients, and close to 30 percent of practicing primary-care doctors limit the number of new Medicare patients they see.
Most of us keep going. We don’t have time to fight for reform. Our patients need us, and we need to take care of them. We are definitely not celebrating this week; we are too busy struggling to practice medicine.
— Marc Siegel is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a member of the Fox News Medical A-Team.