Somebody call a doctor. The Health Care System is hopelessly broken
I took my 88 year-old mother to the doctors’ group our family has used since the 1970’s, only to learn that the practice no longer participates in Medicare. What does this mean? Instead of billing Medicare for services, as has traditionally been the case, my mother was asked to pay $108 for the visit and the doctor would request that Medicare send her a check for reimbursement.
I called the doctors’ group. Would my mom be reimbursed the same amount as she paid? Nope. Only about 80 percent. How long would it take for Medicare to get her a check? Not sure but could be as little as two weeks. Were they doing the same with Blue Cross, I asked? Nope. How about Medicaid? No, the state pays Medicaid and their problem isn’t with Medicaid.
Essentially what is happening is the doctors’ group is transferring their cash flow problem to my mom and other Medicare patients. The docs get paid; the patients have to wait.
I talked with the doc, his nurse and the business office. This was a business decision, they all said. I guess I never thought of a medical practice in the same terms as being a business.
I haven’t had time to totally process this but here are some quick observations:
- As a small businessperson I understand cash flow and appreciate the time lag doctors have had to endure getting paid from the federal government. But most businesses have clients that take 60 or 90 days to pay invoices.
- The business office explained that Medicare reimbursements to docs are frequently being cut. I don’t get the connection between what they are being reimburse versus their decision to go “non participating” with Medicare. After all, they will still charge only what Medicare allows for charges and will still fill out the paperwork and file it on behalf of my mom. They are still in the same position as before, just that they get their cash up front.
- The bottom line is that from a patient's perspective they just got a fee increase from their doctor, but it is blamed on Medicare.
- If payment from Medicare only takes two weeks what’s the problem here? My 88 year old mom doesn’t deserve nor want to be the banker for doctors...or for Medicare either.
- Patients over 65 have little say-so in their health care. Their options are to accept the decisions of doctors or seek other doctors. After so many years with a doctor and at this advanced age changing doctors isn't easy or attractive.
- This move is going to force older citizens to see doctors less frequently because many of them are on fixed incomes.
- This is also going to force more patients to use convenient care providers, like minute clinics (which more appropriately should be called hour clinics) and pharmacies that provide common care services like flu vaccines.
- If this trend continues doctors will bring about the very thing they claim they oppose, total government health care like Canada and Great Britain. If they are businesses then it doesn’t matter who pays them, right?
Tell me where I’m wrong about this!
I believe every word of your post! Our health care system is broken. If you operated your small business as inefficiently as our health care system is operated, you would be out of business in short order. I am a senior citizen and so is my wife, and we both worry about exactly what has happened to your mom. I don't have a solution, but I do think the health care plan approved by Congress last year is our best hope. Doubtless, it needs modification, which will probably happen during this session of Congress. Let's hope our representatives in Congress can civilly debate this complex issue and help provide better health care for all of us.
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I hate to say it BUT welcome to the real world. Many doctors are dropping the seeing of Medicare patients ENTIRELY, not just the billing part. Interesting part is that BCBS, or any other insurance, only pays AFTER Medicare has paid. So since the doctor will bill BCBS why won't they bill Medicare, especially since how can they bill BCBS until they know how much Medicare paid. Kinda like putting the cart before the house in my opinion, for what it's worth.
Good luck if you decide to switch doctors, as stated earlier, many doctors are not accepting Medicare patients. Worst part is that many senior citizens, on fixed incomes, don't have the $108 available to pay upfront; that's why they have been paying for Medicare each month as a deduction from their Social Security check and also paying a private insurance company, such as BCBS, for the extra coverage that Medicare doesn't pay.
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i've read that if medicare is later than a few days in reimbursing doctors, interest begins accruing; also, upfront payment i believe avoids the negotiated medicare rates;
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I'm afraid we will all see such events as you have experienced.Doctors are seeing their bottomline (I'm not defending what they charge )shrink like any other business with the economy the way it as . What's the answer ? It's not Obamacare !
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Tom,
You're exactly right. The reality is doctors have learned they can transfer their Medicare reimbursement and any cash flow problems to their patients and increasingly are doing so. That way, they get their money upfront and leave the patient to deal with any delay or denial of payment. If a particular treatment or medical device is challenged as being medically necessary, the patient suffers the loss or payment delay, not the physician.
This situation has been brought about by a combination of physicians not wanting to learn what is or is not reimbursable under Medicare, their unwillingness to accept less than the lifestyle they've become accustomed to, and their ability in the current political debate to use Medicare as the scapegoat.
Medicare patients have been singled out because physicians historically have been reimbursed on a fee-for-service where more tests, more referrals, and more time spent on a patient resulted in more revenue. Medicare doesn't operate that way, but instead provides a fixed reimbursement for a given diagnosis. This has created an incentive for physicians to dedicate their time and resources to those whose insurance plans still pay on a fee-for-service basis and to leave any leftover time to see Medicare recipients.
This rationing leaves Medicare recipients holding the short end of the stick. An intended benefit has become a problem for recipients at a time in their lives when they are least able to afford it financially and/or deal with it emotionally or psychologically.
As bad as the current situation is, imagine our country without Medicare. Physicians would be left to deal directly with insurance companies and the extend of coverage they wish to offer would be determined by them (remember pre-existing illness?). What power would the elderly have in that situation? What about the uninsured? The answer is very little and insurance profit margins--already high--without competition or other incentive would increase dramatically. (By the way, this is the plan Republicans currently endorse.)
I believe the best compromise for both patients and physicians is a public health system where best practices, costs, and reimbursements are monitored and scrutinized, patients are treated fairly and equitably, and physicians reimbursed accordingly. There would be no loopholes, no rationing of care, and no surprises regarding what is or isn't covered. That's because everyone, patient or physician, would know what to expect upfront--full and equitable health care coverage for all Americans regardless of age or financial status modeled after the successful plans of Canada, Great Britain, France, and others. If the U.S. would invest some of the wasted resources being devoted to Afghanistan and Iraq, such a plan can be afforded and accomplished.
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How can you fault a medical provider for a business decision that benefits their business. I'm sure you don't give your advertisers the 60-90 days to pay their bill from you.
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Tom, some of your comments almost have an undercurrent that suggests Medicare patients are entitled to have physicians participate with Medicare. But how does that square with a society that espouses economic freedom? Physicians should not feel compelled to participate with any type of insurance.
In fact, physicians have ample reason to question the wisdom of participating with Medicare:
1. There is a compulsory fee schedule established by the government. Few professions are expected to adhere to a compulsory fee schedule for a significant part of their business-- law, accounting, dentistry, architecture, engineering, etc.
2. Physicians can be subject to criminal prosecution under Medicare if they make certain types of administrative errors. Going to jail is not an acceptable risk to some physicians.
3. Elderly patients are often complex, with multiple medical problems and medications. It can be very difficult to manage so many problems in the context of a 10-15 minute office visit. It can almost be like a hamster wheel. In addition, the reimbursement provided by Medicare does not adequately pay for these types of patients, or allow patients to spend sufficient time with them. Many physicians regard this component of their practice as a humanitarian, charitable endeavor even though there is some reimbursement attached. But physicians who have to see many Medicare patients-- general internal medicine, geriatrics, etc.-- have a major business problem on their hands. And there is nearly an annual threat that reimbursement will be cut dramatically-- until Congress typically relents.
Medicare was a massive public policy error. It is very bad for the federal government to have so much control over the health care of its citizens. The debt crisis we will be facing in a few years because of the Medicare program is one indicator of how poorly conceived the program was.
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I agree with you that our health care system is broken. Let us look at where the break is, shall we? My dad was a dentist here in Raleigh for 35 years. When he sold his practice and retired in 1992, he had just begun paying out more in malpractice premium than he paid himself. I can only imagine what it must be like today? As a small business owner I am sure you can empathize about how he paid those premiums. He passed them on to the patient. The same rings true about any business. When costs go up, businesses pass them on to the consumer in order to maintain their margins. It is good economics, and just common sense. Most people can now have a meager understanding why it costs $5 dollars for one Tylenol tablet at the hospital. As a snowball effect resulted over time, the insurance industry was born.
I do not blame Doctors for their decision to drop Medicare. The government is trying to cut expenses wherever they can. So, they started paying out less for services. It is the same ideology we face today that Doctors make too much money, and can afford the pay cut. Bull… Why should they sacrifice everything they have worked so hard for, only to have a bureaucrat tell them how much they are allowed to earn? It will be over my dead body that I allow the government to impose their will over my small business, and property rights in that manner. Now, those same lawyers who drove the cost sky high are in all levels of government attempting to impose their ideology upon us for a single payer system. I say: no way, Jose’. This destructive ideology cannot be tolerated any longer. It must be defeated at the ballot box, period.
The bottom line is this; common sense reforms through the free market, and get government out of the equation entirely.
• Only allow lawsuits where the medical board deems negligence occurred, and possibly have a patient sign a release of liability for certain procedures.
• Simplify the insurance industry for the consumer’s benefit because people fear what they don’t understand.
• Allow portability across state lines.
• Allow transfers between groups policies when an individual changes employers.
• Wait for it…Privatize Social Security, Medicaid, and Medicare because government has shown how inefficiently it operates!
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