When Doctors Opt Out: We already know what government-run health care looks like.
Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.
More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I’ve had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider — who they liked — abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.
I hope that health care reform considers carefully paying appropriately for primary care. Such payment will probably take some money away from non-primary care physicians. I hope that we can find a balance that encourages primary care, but does not discourage other specialties. Our current system is out of balance.
{ 5 comments… read them below or add one }
“I hope that health care reform considers carefully paying appropriately for primary care.”
This is politics. Hope ain’t going to be enough. You physicians better wake up and get organized and bring your considerable financial resources to bear.
One of our problems is that it’s illegal for us to organize on some of these things. We can’t decide as a group not to see United healthcare or Medicare, but they can easily decide to change our rates with no negotiation. We also get stuck because the patient gets caught in the middle. To Medicare or UHC, a patient is just a number. To me, they’re my patients who I’ve been through a lot with. I don’t want them to suffer for payer decisions. Docs who care get stuck between a rock & a hard place.
What is far more likely is that reimbursement will stay low to push more primary care by non-physicians.
Likely with univervsal health care the total pie will be the same. Currently the pie divided unequally among primary and specialty care. My primary care 12 hour days are worth less and my knowledge is less valuable compared to the same 12 hours spent each specialist. Medicare has the same total funding, but larger pieces of the pie go to procedures and specialty testing. It does not seem to matter that the specialists send their patients back to the primary care physician to manage dozens of medications and treatment plans.
The private plans seem to base their fees on Medicare or less, and it is a take it or leave it attitude with poor out of network coverage.
A note about the $300 procedure above, Medicare has a limiting charge, even for out of network physicians, which is why the fee schedule has a limiting charge. An exception is for a procedure that is not medically necessary or that Medicare is unlikely to cover, which means an advanced beneficiary notice needs to be signed.
With coverage in the New York Times and Wall Street Journal recently, the Texas Medical Association’s survey of primary care physicians’ reluctance to take new Medicare patients is getting lots of play. Certainly the economic and administrative hassle factors are there and make a big impact on physicians trying to keep open their practice.
What has been omitted, though, is the other major finding from our survey: Texas physicians will not refuse their current Medicare patients. Nearly 70 percent say that is something they will not do. Fewer than five percent say that is something they have done or will do.
As a family medicine specialist from Dallas said in response to our survey: “I will continue to provide care to my existing Medicare patients as a courtesy to them, but I will soon be closing my panel to new Medicare patients, because not doing so will jeopardize my ability to provide care to everyone else.”
http://tinyurl.com/6de3pl
Steve Levine
VP, Communication
Texas Medical Association