Fewer Primary Care Doctors Take Medicare

[iatrosB]

You can't really "dump" Medicare patients unless you opt out of Medicare, but you can stop accepting new patients.

In my case, I'm basically closed to new Medicare patients off the street (with rare exceptions, usually limited to immediate family member of established patients), but as my patients "age into" Medicare (meaning they convert from commercial payors to Medicare after age 65) I will continue to see them.

Everyone's different, though. That's just the way I'm doing it.

I understand this practice, but at what point can you do this. Meaning, you have to take Medicare patients in the begining to bring patients into the practice...how "full" do you get before you say no more. You see, if you waited until you were totally booked, you couldn't even take other patients regardless of their insurance status. That is my point. Am I missing something? For this to work, you have to stop taking them BEFORE you get a full panel, right?

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[deleted87716]

I understand this practice, but at what point can you do this. Meaning, you have to take Medicare patients in the begining to bring patients into the practice...how "full" do you get before you say no more. You see, if you waited until you were totally booked, you couldn't even take other patients regardless of their insurance status. That is my point. Am I missing something? For this to work, you have to stop taking them BEFORE you get a full panel, right?

Everybody's going to have a different threshold. You're "full" when your schedule is booked every day. There's always ebb and flow ("attrition"), so it's really something of a dynamic state. When you reach that point, however, you can usually afford to be a little choosier about which payers you continue to accept, should you wish to do so.

 

[Vox Animo]

I don't believe that the way to send a message to Washington is by making the people who need my care most suffer even more. .

Sadly that is the only way to send a message to washington. In order to get anything done you can't reason, you have to turn your cause into some monumental battle of good vs. evil. And even then you have to get 51% of the population to be going for their neck, then you get stuff done. A politicians job consists of not pissing off 51% of the people, so you must act accordingly. They aren't real people like me and you with real hearts and morals.

 

[WestcoastMedicine]

Wow....Pennsylvania must really be in bad shape because our professors have told us on numerous occasions that Medicare is our LARGEST PAYER IN THE STATE. Not largest, meaning the majority of their patients are medicare, but rather that they give the largest reimbursements out of the insurance companies in the state!

 

[FamilyMD]

Wow....Pennsylvania must really be in bad shape because our professors have told us on numerous occasions that Medicare is our LARGEST PAYER IN THE STATE. Not largest, meaning the majority of their patients are medicare, but rather that they give the largest reimbursements out of the insurance companies in the state!

Simply not true, I live in PA. As I state in a previous post, I negotiate with payors based on 115%-130% of Medicare fees.

 

[WestcoastMedicine]

Thanks for the information...I'm glad to hear the anecdotes dispelled.

 

[deleted77919]

Wow....Pennsylvania must really be in bad shape because our professors have told us on numerous occasions that Medicare is our LARGEST PAYER IN THE STATE. Not largest, meaning the majority of their patients are medicare, but rather that they give the largest reimbursements out of the insurance companies in the state!

This could be reasonable if you consider that there are many insurers, but only one medicare. Medicare could be paying less per patient seen and still be the largest payer if each of 2 dozen different insurance companies covers the rest of the patients.

 

[MiesVanDerMom]

For me, I make enough, heck I make more than most specialists since I also do administrative stuff. So, sure I can see Medicare and Medicaid people, but it's the PRINCIPLE. As long as there are FP's willing to see M/M people, especially Medicaid people, CMS has NO incentive to change their ridiculous fee schedules. Sophie, why would you take $7 PMPM for all their care and liabily??? Absolute INSULT. And yet b/c of people like YOU, they keep doing it. people LIKE YOU! Allow MY field to continue to slide in terms of reimbursements. So yes, you can stand as a student and tell me how you are going to save the world and eat Ramen noodles for the rest of your life, but not me my friend, I will help the less fortunate when our Government reimburses me APPROPRIATELY. Can't wait to see your attitude after 5 years, nah make that ONE year in private practice.

It's amazing how easily you justify your immorality, all in the name of a little greed. You're making elderly, low income, and disabled people suffer. You theorize this will somehow result in higher reimbursement from the government. Where is your proof? What are you doing besides refusing these people to bring this about? Have you brought this boycott to the government's attention? Have you explained this policy to the patients you're turning away?

I'm starting med school this fall and I can tell you in all honesty I will take the medicare and medicaid patients. I highly doubt I'll wind up on ramen, but if I did: I'd rather my children eat ramen and see a mother who does the right thing than to have them live in some obnoxious house and see their mother turning away the people who need medical care the most. I guess I just lack the air of entitlement so many people on this website seem to have. And there's this whole "conscience" thing...

My kids are on medicaid right now, one because he's disabled and the other because of our income. Listening to some of these comments just makes me sick. But don't worry, I'm a cash patient myself, so I won't hurt your overhead.

 

[Faebinder]

It's amazing how easily you justify your immorality, all in the name of a little greed. You're making elderly, low income, and disabled people suffer. You theorize this will somehow result in higher reimbursement from the government. Where is your proof? What are you doing besides refusing these people to bring this about? Have you brought this boycott to the government's attention? Have you explained this policy to the patients you're turning away?

I'm starting med school this fall and I can tell you in all honesty I will take the medicare and medicaid patients. I highly doubt I'll wind up on ramen, but if I did: I'd rather my children eat ramen and see a mother who does the right thing than to have them live in some obnoxious house and see their mother turning away the people who need medical care the most. I guess I just lack the air of entitlement so many people on this website seem to have. And there's this whole "conscience" thing...

My kids are on medicaid right now, one because he's disabled and the other because of our income. Listening to some of these comments just makes me sick. But don't worry, I'm a cash patient myself, so I won't hurt your overhead.

Oh to be young in the career and naive.... Sorry that's where my opinion turned after your above statement. Every doc here will take a disabled kid on medicaid, the issue that when you are done with residency and have that 300k loan on your head (I actually owe more..) and after you finished those years of training, payback is expected and the problem with medicaid is that the mere $10 they give you for your work doesnt even pay for the secretary outside who took your information. I just shake my head when I hear people go to vets and pay $100 for their dogs to get groomed and cats get treated.

So, if you can afford to take even one third of your patients from medicaid with that $10 reimburisement for your services.... well more power to you. Meanwhile, I got loans to pay, an overhead to pay and frankly, I'd like to be able to own a house someday and God forbid actually being able to help my kids go to college.

I honestly want to hear your opinion in 4 years... not being sarcastic here.. I just want to see how much med school will change you. Peace.

 

[deleted87716]

It's amazing how easily you justify your immorality, all in the name of a little greed.

Be careful throwing the "G" word around.

Careful attention to payor mix and general good practice management does a lot more than line the pockets of the physician(s). It also allows a practice to employ and retain quality staff, maintain a reasonable panel size, implement new technology to improve quality of care (EHRs, etc.), and more.

It's all well and good to want to save the whole world, but there's an old saying in business: "No margin, no mission." If a practice can't sustain itself financially, it can't help anyone.

 

[Miami_med]

Be careful throwing the "G" word around.

Careful attention to payor mix and general good practice management does a lot more than line the pockets of the physician(s). It also allows a practice to employ and retain quality staff, maintain a reasonable panel size, implement new technology to improve quality of care (EHRs, etc.), and more.

It's all well and good to want to save the whole world, but there's an old saying in business: "No margin, no mission." If a practice can't sustain itself financially, it can't help anyone.

Kent,

I've got to say, even though we don't always agree, I have to give you credit for having some of the most practical responses on SDN .

 

[Tn Family MD]

I'm glad there is somebody out there that wants to save the world. Cause all I really want is for my years and years of hard work and sacrifice to pay off financially so that my family will be able to live the good life and I can finally give them all the things they deserve in return for all the years they did without the things they wanted and all the time I have missed being with them while I was working my tail off in school. If that means not taking medicare, then so be it. If that means I lack compassion, I am comfortable with that as well. Nobody is ENTITLED to my time or to have access to me except my family. End of story.

And the bottom line is that entitlement is the issue we are discussing.

 

[Faebinder]

I'm glad there is somebody out there that wants to save the world. Cause all I really want is for my years and years of hard work and sacrifice to pay off financially so that my family will be able to live the good life and I can finally give them all the things they deserve in return for all the years they did without the things they wanted and all the time I have missed being with them while I was working my tail off in school. If that means not taking medicare, then so be it. If that means I lack compassion, I am comfortable with that as well. Nobody is ENTITLED to my time or to have access to me except my family. End of story.

And the bottom line is that entitlement is the issue we are discussing.

Absolutely, and it's hard for those, who have yet to spend that time/money/effort, to understand what it means. Prespectives change, people change and medical school + residency changes everyone.

 

[MacGyver]

That's cause there will always be new graduates who come to the area and of course they gotta start having patients... when you are new and dont have an established number of patients, you will take anyone. After a couple of years they start fine tuning.

This means that there is no FP or overall doctor shortage, and that all the "studies" showing this are pure crap.

So why does the AAFP, AAMC, AMA, and the rest keep crying about a doctor shortage? If there were TRULY a doctor shortage, you wouldnt have newbies coming onboard and relieving any lapse in Medicare/Medicaid access.

The bottom line is that doctors threat to "stop taking Medicare" is hollow and the government knows it. The GAO report proves it. Only a very small percentage of doctors have hte luxury of foregoing Medicare and opting out. The vast majority of docs MUST take Medicare or they would have no patient base.

So if you open up a boutique practice in Beverly Hills, then perhaps you can give Medicare the finger. But for all the newer docs coming on board, you are smoking something if you honestly believe you wont have to accept Medicare.

No medicare = no patients. This will only get worse in the future, as Medicare beneficiaries continue to balloon outwards and dominate even more of hte market.

 

[FamilyMD]

It's amazing how easily you justify your immorality, all in the name of a little greed. You're making elderly, low income, and disabled people suffer. You theorize this will somehow result in higher reimbursement from the government. Where is your proof? What are you doing besides refusing these people to bring this about? Have you brought this boycott to the government's attention? Have you explained this policy to the patients you're turning away?

I'm starting med school this fall and I can tell you in all honesty I will take the medicare and medicaid patients. I highly doubt I'll wind up on ramen, but if I did: I'd rather my children eat ramen and see a mother who does the right thing than to have them live in some obnoxious house and see their mother turning away the people who need medical care the most. I guess I just lack the air of entitlement so many people on this website seem to have. And there's this whole "conscience" thing...

My kids are on medicaid right now, one because he's disabled and the other because of our income. Listening to some of these comments just makes me sick. But don't worry, I'm a cash patient myself, so I won't hurt your overhead.

At first I wasn't even going to reply to your obvious naive student drivel, but I'm not sure if it's your blatant stupidity that intrigues me more or your holier than thou attitude. Whether the gov't gets my message or not is irrelevant, I GET the message that I AM WORTH more than the pennies medicaid wants to pay me. capeesh??? If you and your low self esteem have convinced yourself you are worth pennies on the dollar, knock yourself out but me and 99.9% of private docs know the truth. I won't be too harsh as you are but some silly student trying to act all mature and mighty here but before you rant on those of us "in the trenches" ask yourself this...who knows more about this subject, me a student, or doctors dealing with real life economics day in and day out...and then feel free to STFU.

 

[Faebinder]

This means that there is no FP or overall doctor shortage, and that all the "studies" showing this are pure crap.
So why does the AAFP, AAMC, AMA, and the rest keep crying about a doctor shortage? If there were TRULY a doctor shortage, you wouldnt have newbies coming onboard and relieving any lapse in Medicare/Medicaid access.

The bottom line is that doctors threat to "stop taking Medicare" is hollow and the government knows it. The GAO report proves it. Only a very small percentage of doctors have hte luxury of foregoing Medicare and opting out. The vast majority of docs MUST take Medicare or they would have no patient base.

So if you open up a boutique practice in Beverly Hills, then perhaps you can give Medicare the finger. But for all the newer docs coming on board, you are smoking something if you honestly believe you wont have to accept Medicare.

No medicare = no patients. This will only get worse in the future, as Medicare beneficiaries continue to balloon outwards and dominate even more of hte market.

There is no doctor shortage.... unless you are looking for doctors who will do primary care for 110k a year.. then ya you will be short on those.

Also, you are wrong about not being able to take medicare. We should do a poll and see how much is the percentage of people who take medicare here. Last time we did this poll everyone claimed around 30%. That's a small percentage considering the vast amount of medicare patients.

 

[sophiejane]

At first I wasn't even going to reply to your obvious naive student drivel, but I'm not sure if it's your blatant stupidity that intrigues me more or your holier than thou attitude. Whether the gov't gets my message or not is irrelevant, I GET the message that I AM WORTH more than the pennies medicaid wants to pay me. capeesh??? If you and your low self esteem have convinced yourself you are worth pennies on the dollar, knock yourself out but me and 99.9% of private docs know the truth. I won't be too harsh as you are but some silly student trying to act all mature and mighty here but before you rant on those of us "in the trenches" ask yourself this...who knows more about this subject, me a student, or doctors dealing with real life economics day in and day out...and then feel free to STFU.

From your friendly neighborhood advisor, a reminder to play nice. The reply above is not made in the spirit of collegial discussion.

Consider yourself warned.

By the way, this is the STUDENT Doctor Network, and while we very much value input from professionals, please keep in mind that this is primarily a meeting place for students and residents. If you can't express yourself in a civil way and offer advice and constructive criticism in a mature way, please find another site to express your views.

 

[FamilyMD]

From your friendly neighborhood advisor, a reminder to play nice. The reply above is not made in the spirit of collegial discussion.

Consider yourself warned.

By the way, this is the STUDENT Doctor Network, and while we very much value input from professionals, please keep in mind that this is primarily a meeting place for students and residents. If you can't express yourself in a civil way and offer advice and constructive criticism in a mature way, please find another site to express your views.

I see...but where were you when I was being called immoral, greedy, one who made the elderly and handicap "suffer", among other unkind things. Funny how you were strangely very silent then huh???
Whatever, I'll just have to console myself as I decide whether to drive my lexus GX, Porsche Boxster, or Benz CLK Cabrio to work tomorrow.

 

[Faebinder]

I see...but where were you when I was being called immoral, greedy, one who made the elderly and handicap "suffer", among other unkind things. Funny how you were strangely very silent then huh???
Whatever, I'll just have to console myself as I decide whether to drive my lexus GX, Porsche Boxster, or Benz CLK Cabrio to work tomorrow.

FamilyMD, I think most of us agreed with your points but I am unsure why you feel the need to tell people to "STFU" etc etc if they have their own opinion (as naive as it is). I agree with Sophie that you are jumping too far.

 

[deleted87716]

I see...but where were you when I was being called immoral, greedy, one who made the elderly and handicap "suffer", among other unkind things. Funny how you were strangely very silent then huh???

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