Medicare

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Lumbago

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Can someone please explain the point of doctors not taking medicare? I don't see how this "head in the sand" approach helps to care for patients or improve our health care system.
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In a nutshell:

The associated costs of dealing with, and the subsequent payment may not even cover overhead. Therefore, you can not sustain a practice where you lose money.
 
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A low pay = no play scenario. I get it. Just frustrating when Medicare patients get dropped and end up seeking primary care services from specialists.
 
Lumbago said:
A low pay = no play scenario. I get it. Just frustrating when Medicare patients get dropped and end up seeking primary care services from specialists.
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Go tell it to Obama. If he wants Americans to get good care then they have to pay providers. No one wants or is able to work for free. Simple economics
 
clubdeac said:
Go tell it to Obama. If he wants Americans to get good care then they have to pay providers. No one wants or is able to work for free. Simple economics
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Ignorant statement

People have been dropping Medicare and talking about dropping medicare secondary to lower rates , before I began practicing ten years ago
 
Because families of 4 arn't paying 20K/yr for dental insurance.
 
Then lower the payments for $100,000 chemo drugs that prolong a patient's life by a month so that they can live in pain for a little longer. Or try to get Americans to take care of their bodies to stop the obesity epidemic that is overrunning our healthcare system. Or stop increasing the incentives that are allowing large inefficient and expensive hospitals to take over the healthcare system and buy out physicians practices.

That's how you lower costs with a minimal impact on the quality of healthcare. Not by lowering physicians reimbursement and decreasing their incentives to provide healthcare and their funds to pay their overhead.
 
101N said:
Because families of 4 arn't paying 20K/yr for dental insurance.
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yeah but a dentist does one thing and body part only.

I"m sure medical premiums would be cheap for each one, if you had one policy for GI and one policy for Cards, one for orthopedics, one for internal medicine, one for radiology, one for PT, one for medications, one inpatient facility etc. Each individual policy would be cheap, but the aggregate would be very pricy.
 
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bedrock said:
yeah but a dentist does one thing and body part only.

I"m sure medical premiums would be cheap for each one, if you had one policy for GI and one policy for Cards, one for orthopedics, one for internal medicine, one for radiology, one for PT, one for medications, one inpatient facility etc. Each individual policy would be cheap, but the aggregate would be very pricy.

I agree. This is a good point. Currently dentistry is a much safer profession from reimbursement poaching than medicine.
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docnyc said:
bedrock said:
yeah but a dentist does one thing and body part only.

I"m sure medical premiums would be cheap for each one, if you had one policy for GI and one policy for Cards, one for orthopedics, one for internal medicine, one for radiology, one for PT, one for medications, one inpatient facility etc. Each individual policy would be cheap, but the aggregate would be very pricy.

I agree. This is a good point. Currently dentistry is a much safer profession from reimbursement poaching than medicine.
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ADA--they are VERY politically active

ADA--all the dentists and dental specialists 'stick together'.

Would physicians ever do this. That's our Achilles heel.
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so if you disagree physicians shouldn't be denying care to medicare/medicaid patients, then what is your resolution to the issue? What do you suggest? besides taking a paycut?

insider trading is legal in congress. thought I might add that hear for sake of knowledge
 
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Lumbago said:
A low pay = no play scenario. I get it. Just frustrating when Medicare patients get dropped and end up seeking primary care services from specialists.
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We like to talk about it in those terms ("low pay = no play") but it really comes down to a business decision. Medicare patients are surrounded by a shield of threatening and slippery legalese and are "protected" from being charged fair market value. Even if you throw out the offensive nature of it it's easy to see why, if you have a choice and you are competing to succeed, you would choose other pts over Mcare pts.

It is a tragedy because these really are the most vulnerable pts. Many medical options are not available to them.
 
I understand that it's a business decision for many physicians and I respect that. I also think that there's a big difference in practice between Medicare and private insurance, in that Medicare comes with a lot more rules attached, a higher risk of auditing, and very limited coverage of meds and procedures.

I also feel strongly that Medicare patients deserve quality care, too, and that ideally Medicare should be strengthened and payments increased so that doctors wouldn't have to make that choice. The situation is even worse with Medicaid, which is about to expand greatly due to the ACA. In my state, there are lots of poor people who currently get subsidized private insurance through the state, but this program is about to go away due to Medicaid expansion.
 
maybe medicare patients need to start receiving poor care or limited access to care to fully understand the ACA... IN my area you cannot find a PCP accepting medicare patients for routine care, forget medicare patients with secondary medicaid insurances....
 
Medicaid has no duty to cover the cost of the care that it purports to provide. So physicians are forced to do charity work or ignore the health needs of millions.
 
Dusn said:
Then lower the payments for $100,000 chemo drugs that prolong a patient's life by a month so that they can live in pain for a little longer. Or try to get Americans to take care of their bodies to stop the obesity epidemic that is overrunning our healthcare system. Or stop increasing the incentives that are allowing large inefficient and expensive hospitals to take over the healthcare system and buy out physicians practices.

That's how you lower costs with a minimal impact on the quality of healthcare. Not by lowering physicians reimbursement and decreasing their incentives to provide healthcare and their funds to pay their overhead.
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and, i might add, find some way of limiting the abuse due to health care insurance companies, that justify charging a thousands yearly for coverage yet reject the most mundane of procedures. i find it unconscionable that not for profit insurance company CEOs are making multimillions...
 
stim4u said:
maybe medicare patients need to start receiving poor care or limited access to care to fully understand the ACA... IN my area you cannot find a PCP accepting medicare patients for routine care, forget medicare patients with secondary medicaid insurances....
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Is your area underserved with respect to the number of PCPs to population? South Carolina, I think?

If it was an underserved area it would make more sense to me, because then they can pick and choose the insurances they take.
 
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I'm okay not taking Medicaid as most current medicaid patients that seek pain services just want narcotics, and primarily need psychiatric services, and are a huge pain in the ass. Some exceptions to be sure, but not enough to work for free and endure the headaches from the others.

Medicare is different. (not medicare/medicaid). Medicare patients are people who worked their whole life, paid taxes, raised kids, etc. I feel they deserve medical treatment. Most aren't narc seeking, and recognize that 80% better, is a lot better.

I know I don't make much profit on those patients, but hell we'll all be medicare patients one day, and many of us have parents on medicare.
Who else will take care of them, if we don't?
 
bedrock said:
Who else will take care of them, if we don't?
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The docs who are not enrolled in Medicare or who have "opted out", can take excellent care of them for a fair price. These docs can provide free or discounted care to some seniors in select cases (a criminal offense for those docs enrolled in Medicare).

As a citizen, I consider my contribution to Medicare is a "pay to play" fee that gets distributed among politicians, vendors, bureacrats, fraudsters, and finally, to a few honest, necessary healthcare services.

If people want to have good healthcare when they get old, they better start saving money now. The term "guaranteed benefit", coming from a politician is utterly laughable.
 
actually it is quite the opposite senario. my region has many upper class and commercial insurances plans and doctors are busy caring for better insured patients. It is impossible to find a private practice PCP to take a medicare pt at this time. MOst patients are going to ACO/hospital based practices that don't know any better. By the way, crappy medicare programs (ie, united medicare advantage with take 10% of your reinburesement of the top, look at your eob's, or wellcare, etc).

I used to subscribe to the nobility of medicare and caring for patients, until CMS sent me antagonistic comparative charts trying to compare me with non-interventional pain MD's. THis authoratarian move just pissed me off and I cut my medicare business. My income may have decreased 25%, whatever, more time for the family and less taxes to the obama welfare state.... by cumlative tax rate is 42% + 3%obamacare/medicare + 6% state or 51%, not worth my time to work.
 
its not that ACO/hospital based practices dont know any better, its that they legally have to take medicare and medicaid.
 
stim4u said:
actually it is quite the opposite senario. my region has many upper class and commercial insurances plans and doctors are busy caring for better insured patients. It is impossible to find a private practice PCP to take a medicare pt at this time. MOst patients are going to ACO/hospital based practices that don't know any better. By the way, crappy medicare programs (ie, united medicare advantage with take 10% of your reinburesement of the top, look at your eob's, or wellcare, etc).

I used to subscribe to the nobility of medicare and caring for patients, until CMS sent me antagonistic comparative charts trying to compare me with non-interventional pain MD's. THis authoratarian move just pissed me off and I cut my medicare business. My income may have decreased 25%, whatever, more time for the family and less taxes to the obama welfare state.... by cumlative tax rate is 42% + 3%obamacare/medicare + 6% state or 51%, not worth my time to work.
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Do you see any Mcare pts now? If you have a very low/no volume, you might as well un-enroll and then offer your services to seniors for a price you feel is worthwhile. Dropping Medicare will allow you to legally provide healthcare to seniors the way you want and the way they want, sans the outrageous, communist, quality-chopping, adversarial ball and chain that is Medicare. Of course easy for me to say this and no facts to back it up, but I'm sure there are many seniors on Medicare who want better care and are willing to pay for it.
 
hyperalgesia said:
Do you see any Mcare pts now? If you have a very low/no volume, you might as well un-enroll and then offer your services to seniors for a price you feel is worthwhile. Dropping Medicare will allow you to legally provide healthcare to seniors the way you want and the way they want, sans the outrageous, communist, quality-chopping, adversarial ball and chain that is Medicare. Of course easy for me to say this and no facts to back it up, but I'm sure there are many seniors on Medicare who want better care and are willing to pay for it.
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What do you feel is worthwhile? In my area most commercial insurance pays about 130% of medicare. How about yours?

Would you just charge them the 130% or whatever you get from commercial insurance where you are, or would you charge more say 200% of medicare, which are the supposed "charges" of most docs I know ?

So you're basically telling the older patients they need to pay an extra 30 cents (on the dollar that would have been paid anyway), plus the original medicare rate, in order for them to be seen by you.....
 
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hyperalgesia said:
Do you see any Mcare pts now? If you have a very low/no volume, you might as well un-enroll and then offer your services to seniors for a price you feel is worthwhile. Dropping Medicare will allow you to legally provide healthcare to seniors the way you want and the way they want, sans the outrageous, communist, quality-chopping, adversarial ball and chain that is Medicare. Of course easy for me to say this and no facts to back it up, but I'm sure there are many seniors on Medicare who want better care and are willing to pay for it.
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Not everybody thinks like you. In fact, most don't. Tell seniors they gave to pay hundreds for an epidural, and you think they will be ok with that?
 
I'm gonna put my practice where my mouth is and let you know how it goes... I was hoping someone else would try out my model for me while I ate popcorn, but guess not...

I do think people are willing to spend money on elective pain procedures. Also I think they are wiling to pay in advance, like they pay for something on Amazon. Of course it doesn't help when there's a Habitat for Medicare Blockshop on every street corner. But I'll try it and see what happens...
 
Most people I see as patients on Medicare made no more than $100,000 a year and are on a somewhat fixed income. Asking them to pay $100 to see them, then $300 for an epidural, would guarantee a no-show.

These are the same people that complain that the $25 copay for 8 sessions of PT is too much.

I guess your Medicare/ retired patients are all living the life of luxury - some of mine are still working at macdonalds to make ends meet.

I should move...
 
I still see medicare, and my best guess it constitutes 30-40 of my population, but used to be >50%. I have eliminated the wellcares, united's, and other crappy medicare advantage programs that are milking a 10% off the reinbursement.
Ultimately, I feel bad for medicare patients but one cannot fill a practice with ongoing reinbursement disasters. focus on wc, pi, cash, commercial insurances, etc....
If medicare cuts tfesi's/RFA anther 20%, I am out of medicare for sure.
 
Well just got notice from BCBS that they plan to pay 65% of 2010 Medicare rates effective in July. They are also jacking up everyone's premiums. United pays 80% of Medicare. So Medicare is like gold up my way. Going to have to aim for WC and MVA to get paid anything at all!
 
that is nuts. go out of network man....
nobody should work for less than medicare fees.
 
I'm 2/3 Medicare. Comp pays okay but the never approve anything and they're a royal pain in the arse. Take everything but Medicaid. Take self pay, but not considered candidates for opiates.
 
good for you. know your options, diversify your practice. reach out to large companies, give lectures, contact attorneys, chiro's etc.
Read this article from the daily beast. This liberal journalism is actually very good.

I have opted out of all obama exchange plans via commercial insurances. I recommend you do the same. that way the networks are limited (ie. 36% physician access in California via Blue Shield).
Doctors need to be proactive, and intelligent, not lame ducks...

http://www.thedailybeast.com/articl...ighest-rates-on-the-california-exchanges.html
 
stim4u said:
good for you. know your options, diversify your practice. reach out to large companies, give lectures, contact attorneys, chiro's etc.
Read this article from the daily beast. This liberal journalism is actually very good.

I have opted out of all obama exchange plans via commercial insurances. I recommend you do the same. that way the networks are limited (ie. 36% physician access in California via Blue Shield).
Doctors need to be proactive, and intelligent, not lame ducks...

http://www.thedailybeast.com/articl...ighest-rates-on-the-california-exchanges.html
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what i take out of this article is: dont be a doctor in california.
 
or any other state considering implementing obama care exchanges, as mentioned in the conclusion...again the take home point is the flooding of medicaid and low tier commercial plans with patients and limited physician practices in network.
 
Doctor can help ensure the failure of obamacare by one simple means-----

not accepting any of the upcoming low paying exchange programs that are medicaid by another name.

My life has improved so much since I stopped taking medicaid. I will make sure our practice doesn't accept any of the exchange programs coming out next year, unless they at least pay medicare rates at a bare minimum.
 
bedrock said:
Doctor can help ensure the failure of obamacare by one simple means-----

not accepting any of the upcoming low paying exchange programs that are medicaid by another name.

My life has improved so much since I stopped taking medicaid. I will make sure our practice doesn't accept any of the exchange programs coming out next year, unless they at least pay medicare rates at a bare minimum.
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This will definitely be interesting. Very state-dependent. States with big influxes of medicaid patients will likely have poor access and plans that don't pay crap. States like Massachusetts may not see much change.
 
You can stay on the plans to have a "wait and see" approach....maybe in 2-3 years they will increase reimbursment.....just don't have any openings for those patients or suddenly cancel when their appt comes up.

What's more likely to happen is that nurses will see these patients and act as their PCP'S
 
Doctodd said:
You can stay on the plans to have a "wait and see" approach....maybe in 2-3 years they will increase reimbursment.....just don't have any openings for those patients or suddenly cancel when their appt comes up.
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I've never seen any type of insurance plan increase reimbursement for something. Pay only seems to decrease over the years. .......
 
bedrock said:
I've never seen any type of insurance plan increase reimbursement for something. Pay only seems to decrease over the years. .......
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Sure you have.....Medicare has increased reimbursement for some codes. PCP's are getting a raise to see Medicaid patients. It might happen.....not likely, but possible.
 
i will say that it will happen, but not for specialty care such as ours.

or more likely, CMS will continue to dock reimbursements to docs who do not show that they are doing more preventative care, and call it pay bonuses.
 
Ducttape said:
i will say that it will happen, but not for specialty care such as ours.

or more likely, CMS will continue to dock reimbursements to docs who do not show that they are doing more preventative care, and call it pay bonuses.
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For the codes we share with PCP's it will happen. But for all our procedure codes it won't. Not sure if it's legal but have patients pay out of pocket for certain procedures and bill Medicare for the visits.
 
Doctodd said:
For the codes we share with PCP's it will happen. But for all our procedure codes it won't. Not sure if it's legal but have patients pay out of pocket for certain procedures and bill Medicare for the visits.
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You mean E&M codes? It'd be great if everyone got a percentage bump on these. I envision a system where the PCPs get a bump, but the specialists don't somehow
 
I can't imagine a significant, sustainable bump in reimbursements for these codes. Where will the money come from? I think it's much more likely we'll see the stick instead of the carrot (another mandate of some kind).
 
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