Comment on "2008 Medicare Payment Cuts and Beyond"

[Diamox]

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This is an quote from the recent AAPMR resident newsletter by Jonathan French:

"According to a recent survey by the AMA, "If Medicare payment rates are cut by nearly 40 percent by 2015, 77 percent of physician respondents said they plan to limit the number of new Medicare patients they treat." If significant changes are not made to the current SGR formula, a crisis will undoubtedly occur, resulting in a dramatic drop in healthcare accessibility."

1)Someone help the Canadian out:
Medicare - over 65
Medicaid - nursing home
Third party insurance - everyone who can afford it
No insurance - none of the above?
Patients on social assistance - ?

2) What fraction of the PMR interventional practice in the states involves Medicare patients? Does this vary depending on the setting (ie ASC, Hospital, Academic, etc)?

Cheers,

 

[Finally M3]

Medicare; generally people over 65, although people who have been medically disabled > 1 year can be on as well. Ok reimbursement, although this has been dropping. Lots of primary care physicians have closed their practice to new medicare patients. Private insurers use medicare reimbursement as a rough guideline for their own reimbursement.

Medicaid: means ($) tested, run by individual states, generally reimbursement is terrible.

Third party: generally employer-provided insurance. Also in some states, this includes auto-insurance and workers comp cases.

No insurance: young-folk who decline insurance to keep more $ in their pocket, indigent, etc.

Lots of patients who undergo interventional procedures are on medicare. Thus the wailing and gnashing of teeth in the September issue of Pain Physician. They actually do a pretty good job looking at utilization of pain procedres, as well as the impact of proposed medicare reimbursement cuts.

http://www.painphysicianjournal.com/pastissue_vw.php?jcode=37

 

[Disciple]

to answer #2

It really depends on who is referring the patients to you, i.e. geriatrics practices vs. surgical groups vs. Work Comp, auto, etc.

 

[PMR 4 MSK]

I have about 40% of my patients on Medicare, 20% Work Comp, 2% Medicaid and the rest private payors. I spend roughly 1/3 of my time in the clinic, 1/3 in fluoro and 1/3 in EMG.

That's based on billings. Collections works out more to 20% Medicare, 0.5% Medicaid, 30 % Work Comp and the rest private payors.

 

[Diamox]

thank you all for the useful information

 

[ampaphb]

thank you all for the useful information

Many private payers contract their rates as a percentage of Medicare. Some Worker's Comp carriers have begun to do the same. So Medicare rates have effects that reach far beyond just the Medicare population.

The flip side is that Medicare typically does not require prior authorization to do most procedures. Thus even though Comp may pay 150% of medicare (yes, I know it pays more in some regions -this is just an example), the time you have to invest to jump through the hoops to get your procedure approved may not be worth it. There are arguments on both sides of this discussion, and how much of your practice is dedicated to medicare is a business decision you get to make. None the less, I have friends in Florida who refer to their practices as Gos's waiting room (average age of their population, somewhere between 85 and dead) and they are doing just fine financially, so there is a viable economic model for a large percentage of your population being Medicare.