Wednesday, January 27, 2010
Why Physicians Are Going To Stop Accepting Medicare
This post by Stanley Feld, MD, originally appeared at Better Health.
President Obama's health care reform bill will not work. It is based on decreases in physician reimbursement while forcing physicians to increase overhead with unaffordable electronic medical records. More and more physician groups and practices are starting to realize that they cannot make a living from the reimbursement from Medicare. They are quitting taking new Medicare patients and trying to get rid of the old ones by not taking assignment.
President Obama's idea is to force physicians to be more efficient producers. It is very difficult to force anyone to do anything they cannot afford.
Click on the "More" link to continue reading this post.
President Obama also believes that physicians over-test patients in order to make money. Wrong! Much of the over testing comes from the practice of defensive medicine. Many physicians have been sued for under testing. No one is sued for doing a test. Yet there is not a word about malpractice reform in either version of the healthcare reform bill to decrease testing by eliminating defensive medicine.
President Obama's solution is to prohibit physicians from testing in their office even though it is more convenient and efficient for patients. Ancillary services can help with overhead and does increase physicians' efficiency of care.
In fact, the fees for the ancillary services in a physicians' office are generally much less expensive than the fees for ancillary services in hospitals. President Obama ignores this fact. He believes physicians over test for profit. This might be true in some cases. However, this abuse can be discovered with the information technology system we have at present. He believes he can force physicians to tests less if it is outsourced to the hospital.
Physicians on average earn 20% to 30% less from Medicare than they do from private patients, and many are dropping out of the program.
The administration is beginning to feel the kick-back from the physician community. I think this kick-back will escalate in the coming months. It will worsen the delivery of medical care.
"President Obama last year praised the Mayo Clinic as a "classic example" of how a health-care provider can offer "better outcomes" at lower cost."
How were better outcomes determined? The question is unanswered.
"Mayo said last week it will no longer accept Medicare patients at one of its primary care clinics in Arizona. Mayo said the decision is part of a two-year pilot program to determine if it should also drop Medicare patients at other facilities in Arizona, Florida and Minnesota, which serve more than 500,000 seniors."
Mayo says it lost $840 million last year treating Medicare patients, the result of the program's low reimbursement rates.
In Arizona alone it lost $120 million dollars. The losses are usually made up by cost shifting to the private insurers and private patients. These losses are getting harder and harder to make up by cost shifting.
"Mayo Clinic loses a substantial amount of money every year due to the reimbursement schedule under Medicare," the institution said. "Decades of underfunding and paying for volume rather than value in Medicare have led us to this decision."
The media has reported that Mayo Clinic has only dropped accepting Medicare in a small clinic in Glendale, Ariz. It has been reported as an insignificant event by the traditional media. Mayo Clinic is being very civilized by not eliminating participation in Medicare in all the clinics at once. The Mayo Clinic is sending a message to President Obama and his future plans. It will also be a signal to physicians throughout the country.
Ninety-two percent of family physicians accept Medicare. Only about 73% of those are now accepting new patients. This reduction in participating physicians comes on top of a shortage of primary care physicians.
Patients struggle to find any specialist who will accept Medicare. This experience is greatest in the specialties of neurology, oncology and gynecology. Cardiology is next.
Last week cardiologists filed a lawsuit in U.S. District Court for the Southern District of Florida, charging that the government's planned cutbacks will deal a major blow to medical care in the USA.
"It will force thousands of cardiologists to shutter their offices, sell diagnostic equipment and work for hospitals, which charge more for the same procedures."
The lawsuit is an attempt by a group of medical specialists to stave off steep Medicare fee cuts for routine office-based procedures such as nuclear stress tests and echocardiograms.
"What they've done is basically killed the private practice of cardiology," says Jack Lewin, CEO of the American College of Cardiology (ACC), which represents 90% of the roughly 40,000 heart specialists in the USA."
The government's response was politeness. It will hide behind regulations made as a result of congressional mandates. The result is typical bureaucratic gobbledygook.
"Jonathan Blum, director of the government's Center for Medicare Management, says the agency is bound by law not to increase spending when making reimbursement decisions each year."
"Lewin and other heart specialists met with Sebelius on Dec. 8 and explained their concerns. "I thought she was very empathic," he says, but Sebelius has yet to take action."
Kathryn Sebelius will not take action. Neither she nor President Obama really understands the problem, much less the solutions. One cardiologist said it is an efficient way of getting rid of cardiologists and ration access to care.
"It's so absurd, it's kind of funny," he says. "I know ACC doesn't think it's funny, but I do."
It isn't funny. It is an unintended consequence of government control of healthcare. Healthcare should be consumer driven not government controlled. Government should make appropriate rules to level the playing field for all stakeholders and then get out of the way.
A cardiologist in Silver City, N.M., not far from the Mexican border, said,
"The closest cardiologist to me is 150 miles away. With all these cuts coming, it will make it impossible for me to break even seeing 40 patients a day."
Does anyone want the government and its 118 new bureaucracies to take over medical care?
What is the problem?
1. The government is broke.
2. They have to reduce expenditures.
3. Physicians are the weakest link, politically, in the healthcare system because they are ineffectively represented.
4. The government will not fight the healthcare insurance industry's lobbying.
5. The government will not fight the Plaintiff attorney's lobbying.
6. The government will continue to waste taxpayers dollars on stakeholders who add little value to the treatment of sick patients.
It is about time groups of physicians started to make some noise.
Congratulations goes to the Mayo Clinic and the American College of Cardiology.
This post originally appeared on Better Health , a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
Labels: cardiology, health care reform, health information technology, Medicaid, physician shortage
posted by the Better Health network at
3:00 PM
3 Comments
Thursday, December 17, 2009
QD: News Every Day--mistletoe and miscellanea
ACP Internist's daily digest of news and events continues with delays in the Senate, progress for hospital medicine and mistletoe's evidence-based medical uses.
Health care reform
Senators may find lumps of coal in their stockings if they miss their self-imposed Christmas deadline to pass a reform measure. With the 60-vote coalition so fragile, any diva can hold up the works to wring the most out of the process. Following grandstanding by Senators Joseph Lieberman and Bernard Saunders, it's now Sen. Ben Nelson's turn to wring some provisions out of the Senate. He wants tougher abortion language. Sen. Max Baucus has said his party would work on Christmas day to reach the deadline.(Washington Post, Los Angeles Times, The Hill)
Health reform is needed. A Centers for Disease Control and Prevention survey showed that 45.4 million (15.1%) were uninsured at the time of survey, 58.4 million (19.4%) had been uninsured for at least part of the year prior to interview, and 31.9 million (10.6%) had been uninsured for more than a year.
Physician reimbursement
A Senate amendment By Sen. Arlen Specter would postpone for one year an increase in payments for primary care physicians. The American Academy of Family Physicians is moving to raise opposition. 
In case you missed it ...
Mistletoe has an evidence-based background. It's not as poisonous as feared, and it's being examined for uses in cancer treatment. The good folks at ChiroACCESS digested the peer review literature on this decorative holiday staple.
Hospital medicine
In Wilmar, Minn., hospitalist Fred Hund, ACP Member, is featured at part of Rice Memorial Hospital's plan increase the number of primary and specialty care doctors. They'll work with local practices to increase primary care, specialty and hospital positions in the community. (West Central Tribune)
ACP members in Amarillo, Texas, are rolling out a hospitalist model to their community to ease the physician shortage there. Hospitalist Sheryl Williams, FACP, and Alan Keister, ACP Member, of Amarillo Medical Specialists, say doctors spend too much shuttling between facilities, and not having hospitalists has hindered recruitment that would ease the shortage. They've e-mailed patients to explain the changes. (NewsWest9.com)
Labels: evidence-based medicine, health care reform, hospital medicine, physician shortage, QD
posted by Ryan DuBosar at
11:16 AM
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Friday, October 16, 2009
QD: News Every Day--One stolen laptop threatens all doctors' personal data
ACP Internist's daily digest of news and events continues with a stolen laptop's threat to physician's personal info, plus the Senate voting and voting and voting on physician payments, and the reasons why the public is so divided on the way they view public health issues.
Almost all U.S. physicians, 800,000 total, have been warned that a stolen laptop had their names, addresses social security numbers and provider identification numbers on it. An employee of the trade group representing Blue Cross insurance plans moved information to a personal laptop that was then stolen, which leave as many as 20% of all doctors vulnerable to identity theft.
H1N1 influenza
The World Health Organization urged prompt antiviral treatments in people with suspected H1N1 flu because it can lead to pneumonia so quickly in young, otherwise healthy people.
Physician payments
A bill that would increase Medicare payments to physicians will require three votes by the Senate--needing 60 votes each time--before the Senate can take a fourth vote. Greatest legislative body in the world, indeed. Oh, and the Congressional Budget Office estimated the $240 billion bill will actually cost $247 billion over 10 years.
Primary care shortage
A blog post explaining the reasons why there is a primary care shortage doesn't offer any new insight so much as it puts all the reasons in one easy-to-read place. These aren't esoteric issues; they play out in real life all across the country, as this profile explains what's happening in Omaha.
In case you missed it ...
Much of the disconnect on health care reform can be explained by political beliefs, researchers reported in the American Journal of Public Health. They tested a news article describing how a lack of sidewalks and presence of fast food were linked to type 2 diabetes. Republicans were less likely to believe junk food led to a diabetes epidemic than Democrats. Researchers told ABC News that the same message has to be framed differently to the two audiences to garner support.
Labels: H1N1, medicare, physician shortage, QD
posted by Ryan DuBosar at
12:27 PM
0 Comments
Wednesday, July 15, 2009
Pay attention! Primary care faces a shortage
NBC devoted prime time news coverage to the shortage of primary care physicians, and interviewed residents on why they're not pursuing primary care. (Apologies for the short commercial NBC posts before its online outtakes.)
Near-daily coverage of the provider shortage crosses our desks at ACP Internist, shown here, here and here to post just a few from recent days. And to post a few more, here, here and here.
It may be cold comfort, but the issue doesn't lack for attention, just a solution.
Labels: health care reform, physician shortage, primary care shortage
posted by Ryan DuBosar at
2:04 PM
0 Comments
Tuesday, May 26, 2009
Who's referring who?
There's an interesting column in the New York Times today about the business of physician referrals. The physician author worries about the financial incentives generated by the dynamic in which specialists rely on primary care physicians to keep their schedules full.
Here in Philadelphia, at least, that concern seems almost laughable. Studies have established (and we have discussed) the long wait times to see a doctor here. And in the time it has taken me to write this post, I've been sitting on hold with a dermatologist's office--the same office that I've been calling for two months to try to schedule an appointment. At least with some specialties, the dynamic has so reversed itself that patients look to their internists to help them jump the queue to get in to see a specialist.
There's a lot of talk about the shortage of primary care, but what's with the shortage of specialist appointments?
Labels: physician shortage
posted by Stacey Butterfield at
2:36 PM
0 Comments
Wednesday, May 6, 2009
Need to see a doc? Take a number.
It's almost Medical News of the Obvious to those of us who have lived in big cities.
Merritt Hawkins released a survey today on the cities with the longest wait times to get a new patient appointment. Number one on the list of 15 metro areas? Boston, where it takes, on average, 70 days to see an Ob/Gyn, 63 days to see a family doctor, 54 days to see a dermatologist, 40 days to see an orthopedic surgeon, and 21 days to see a cardiologist.
Next on the list is Philadelphia (no surprise to yours truly), followed by L.A., Houston, Washington, D.C., San Diego, Minneapolis, Dallas, Miami, New York, Denver, Portland, Seattle, Detroit and Atlanta.
It's always been a little perplexing to me that it's so difficult to get appointments in Philadelphia, when there is such a large supply of medical schools and facilities. Boston is also chock-a-block with doctors, although, as the Merritt Hawkins release points out, there's been a surge in demand there since the state mandated coverage for all residents in 2006.
The survey also looked at Medicaid acceptance rates among medical offices, and found the overal rate for all 15 metro areas was 55%. It was highest in Minneapolis at 82%, and lowest in Dallas at 39%.
Labels: appointments, Medicaid, physician shortage
posted by Jessica Berthold at
12:20 PM
0 Comments
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
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