If the reduction in Medicare spending had taken place, MDs would have suffered a 10% decrease in their fees received from treating Medicare patients.
littlek wrote:Go Teddy! ... Now he needs to go rest.
That's not where he needs to go...
Phoenix32890 wrote:Well, that's two points for old Teddy. One of the worst things that happened to Medicare was having private insurers in on it. It just upped the ante for everyone, and caused situations where clerks were making medical decisions about what was to be paid or not.
That last paragraph may sound strange from someone who believes in the smaller the government the better, but Medicare had become a hybrid fiasco.
People over 65 pay for Medicare. When the privately run "Medicare Advantage" plans came into being, (read H.M.O.") many people jumped on the bandwagon because they thought that they were getting away with murder because on the surface it cost less. Ultimately, it cost MORE for everyone on Medicare.
But what about all the holes in the original medicare plan, that private insurers pay for? Consider for example, that medicare pays for only ONE mammogram and additionally, medicare does not pay for refractions when having eye exams.
If you don't have a refraction, there's no way you can buy glasses from an optometrist.
There are many, many other holes in the original medicare program, so the private plans do serve a a fuction in filling the so-called medigaps.
Miller wrote:Phoenix32890 wrote:Well, that's two points for old Teddy. One of the worst things that happened to Medicare was having private insurers in on it. It just upped the ante for everyone, and caused situations where clerks were making medical decisions about what was to be paid or not.
That last paragraph may sound strange from someone who believes in the smaller the government the better, but Medicare had become a hybrid fiasco.
People over 65 pay for Medicare. When the privately run "Medicare Advantage" plans came into being, (read H.M.O.") many people jumped on the bandwagon because they thought that they were getting away with murder because on the surface it cost less. Ultimately, it cost MORE for everyone on Medicare.
But what about all the holes in the original medicare plan, that private insurers pay for? Consider for example, that medicare pays for only ONE mammogram and additionally, medicare does not pay for refractions when having eye exams.
If you don't have a refraction, there's no way you can buy glasses from an optometrist.
There are many, many other holes in the original medicare program, so the private plans do serve a a fuction in filling the so-called medigaps.
... while at the same time making obscene profits. No longer, tho.
Cycloptichorn
7.13.2008
Doctors Dropping Medicare - The Domino Effect
When the docs in my area began dropping Medicare, their patients had no where to go but to the docs like me who still participate in the plan.
And so, over the past year or so, I began seeing more and more new older patients in my practice. The shift in my practice demographic was almost palpable as these new Medicare patients began filling my appointment book months in advance for routine annual visits. Add in a few retiring docs, and the influx of older women became too much to ignore.
On the day I saw seven new Medicare patients, all coming from the practices that had stopped taking Medicare, I knew that I had to do something.
The Practice Impact
Now I already see more Medicare than most of my colleagues in 0b-gyn. I'm known for managing menopause, and that tends to draw an older crowd to start with, who move into Medicare as they age. Plus, I like the older patients, and almost went into geriatrics at one point.
But this was getting to be too much. The Medicare patients were taking all my new patient appointments.
You see, unlike younger patients, Medicare patients usually call far in advance for their appointments, and fill up my new patient slots for weeks to months at a time. That leaves no room for the 25 year old who just moved to Manhattan and needs her pills refilled within the month, the 35 year old who thinks she is pregnant, the 45 year old with hot flashes who can't wait till March, the Italian tourist with the UTI or the 16 year old whose mom just found out she was having sex. If I don't have the slots to see these patients soon, they'll find someone else who does.
These younger patients provide the variety that drew me to this field in the first place - the opportunity to care for women at all stages in their reproductive lives, with medical problems that change with each decade. My research arena is contraception and std's, and that means younger patients. I especially love the teens, and ran the adolescent gyn and teen pregnancy clinics at my former jobs. I really missed seeing these patients in my practice as the older patients began taking all the new patient appointments.
What are the financial impacts? Well, if the visit is medically complicated, Medicare pays reasonably well for my time, although it's still less than half of what I get from managed care for the same services. At current volume levels, it's not that much of a problem. But if Medicare were to increase much beyond that, it could impact the bottom line significantly.
And finally, I have to be honest and admit that my temperament is not suited to seeing a large volume of elderly patients in one day. I can't stand having patients waiting in my waiting room because I am behind. Older patients just take more time per visit, no matter what the reason. I can handle a few Medicare patients a day, no problem. But more than, and I am guaranteed to get behind on schedule. And that stresses me to no end.
My Response
In response to this rapid change in my practice demographic I advised my staff that if a non-Medicare patient called, for whatever reason, she got offered an appointment immediately, even if it meant adding her onto the beginning or end of an already full day.
I thought that would solve the problem.
But after a few months, it became clear that this was not working. New patient slots continued to be filled months in advance by the Medicare patients.
So I put a moratorium on new Medicare patients except those referred by colleagues for a problem. I am continuing to see my current Medicare patients, as well as my own patients who transition into Medicare.
I feel terribly guilty about all this, but it's working. I'm seeing more and more new younger patients. The Medicare new visits are still coming, but on a more limited basis, and overall Medicare now comprises about 20% of my visits. Which is fine for now. This solution is working for me and for my current patients, as well as for my referring docs.
Of course, it's not working for those women out there still looking for a new gynecologist.
Posted by TBTAM at 7/13/2008
Source: The Blog That Ate Manhatten
Miller wrote:If the reduction in Medicare spending had taken place, MDs would have suffered a 10% decrease in their fees received from treating Medicare patients.
Don't forget the 10% decrease for treating active duty military families. They pay on the same scale as Medicare.
"It is largely funded by cutting about $13 billion in reimbursements to insurers such as UnitedHealth Group Inc and Aetna Inc that contract with the Medicare program.
The Bush administration opposes any effort to trim payments to private health plans. The president has said the move would limit plan choices for seniors. But doctors and the seniors' group AARP waged an aggressive lobbying effort to prevent the doctors' pay cut. "
So when will the premiums be increased? Do you really expect the insurance companies to take the hit? Just another tax increase coming our way.
