White Coat Underground

Medicare is the government health care program for the elderly. For internists such as me, Medicare patients make up around half our practice. Because of historical budget tools, every year Congress goes through the motion of watching our reimbursement cut, and quickly fixing it. It’s a terrible system. As a small business, my costs are pretty much fixed: rent, employee pay, health insurance, supplies, etc. Every year, a Medicare pay cut goes into effect, and then our checks are held while Congress puts together a temporary fix.

This year, the pay cut is 21%. That means that I will have to try to pay my rent, my employees and my suppliers and myself on somewhere around 10-12% less pay. We work on very narrow margins to begin with, so this means that we may not be able to pay our bills. This week, the Senate managed to pass a fix that would have stopped the pay cut. They did this by stripping away other legislation it was attached to. When it went to the House, Speaker Pelosi added back a bunch of unrelated legislation, which essentially insures that the fix won’t pass, or if it does, it won’t be for a long time. We’ve been informed that our checks, which were being held by Medicare until the fix, are now being mailed out with the 21% pay cut.

This may seem boring, this may seem like whining from someone in a higher income bracket, but providing medical care to our seniors is expensive. When these checks hit our accounts, we’re going to have to make big cuts just to pay the rent. These cuts may mean we have to try to run the office with fewer employees, we may need to cut our health insurance for our employees, and we will definitely need to stop taking Medicare patients.

This is not something that can wait. There are fewer and fewer primary care doctors taking Medicare patients every day. With more Americans reaching Medicare age, it will rapidly become nearly impossible for them to find doctors.

This cannot wait. Please call or write your representative now. Currently the House is the body holding up the “doc fix”. Doctors and their elderly patients need your help immediately.

Here’s how you can find your Representative’s contact info.

I’ve also started a twitter hastag #FixMedicare to help brainstorm ideas and connect people who care about this issue.

Comments

#1 James Sweet
June 24, 2010

this may seem like whining from someone in a higher income bracket

As someone in a “higher income bracket” who has nonetheless managed to get himself in a bit of financial trouble, believe me, it does not sound like whining. I’m working hard to pull myself out from underneath some past mistakes, but a sudden 10% hit in income would put me under in a matter of weeks. I can’t even imagine it…
#2 Mike
June 24, 2010

When you live by the sword, you die by the sword. It is a great irony that doctors were so supportive of greater government intervention in health care and now it is so horrible that government is limiting how much money they can make on government funded patients. you have no sympathy from me.
#3 Marcus Kurtz
June 24, 2010

To be fair, wasn’t some of the unrelated stuff things like unemployment compensation and aid to states to keep Medicaid functioning? Since the former helps out people who’ve lost 100% of their income and the latter makes possible *any* real medical care for poor people, aren’t they arguably as critical as the reimbursement rates for doctors. I’m not against the last being reasonable,indeed, it’s entirely to the good to fix this problem. But what’s the case that Medicare reimbursement rates are higher priority than the unemployed and the poor? In this instance the problem isn’t Pelosi – it’s Republican obstruction.
#4 PalMD
June 24, 2010

I don’t buy it. This is a unique problem created by the SGR formula. There is no need to tie other legislation to it. Getting unemployment and medicaid taken care of is important too, but those are much bigger problems, and not related directly to the SGR problem, a problem which threatens to close doctors offices soon.
#5 Sarah
June 24, 2010

Wow, Mike. “You supported health care overhaul; therefore, you obviously deserve it if you don’t get paid for your services! And the elderly patients who won’t have access to doctors, because those doctors can’t afford to not get paid? Fuck ’em!” That’s just….wow.
#6 PalMD
June 24, 2010

Marcus, part of the Obama health care bill is normalizing Medicare and Medicaid reimbursement so that the poor can actually get care. Few docs will take medicaid due to the poor reimbursement and many who do are just mills.

Obviously a real solution would be comprehensive, but meanwhile, they need to slap another band-aid on this before doctors close their doors to medicare patients, and perhaps close up altogether.
#7 "Shecky Riemann"
June 24, 2010

We don’t do major fixes in this country anymore unless things reach crisis levels… changes needed in Medicare and health reform, energy policy, corporate and financial practices, aren’t there yet from the cloistered perspective of powers-that-be, so baby steps continue… and we all sound like whiners cuz’ we all have pressing issues that are barely being addressed (though they could’ve been addressed 20-30 yrs. ago).
#8 Donna B.
June 24, 2010

My husband is on Medicare and after reading his EOB’s, I’m grateful that his doctors continue to see him.
#9 OleanderTea
June 25, 2010

I worked for Medicare for fifteen years, and was disgusted how cavailierly the program treats healthcare providers. For every multi-millionare making money from fraudulent claims, there are hundreds of docs who are operating on very thin margins.

A good deal of the “cut reimbursement!” rhetoric is indeed class and education envy. I’m shocked that no one seems to understand that the ongoing cuts are going to harm a segment of population that needs medical services so much.

To add insult to injury, Medicare is overseen by the government, but it’s administered by private insurance companies, so some of your tax dollars are helping pay for things like private jets and private club membership for insurance executives. All while they talk about cutting payment to doctors.

It’s disgusting, and I support fixing the reimbursement travesty.
#10 Rugosa
June 26, 2010

This riles my inner socialist. The elderly and poor depend on Medicare and Medicaid because the free market does not make it possible for them to receive care through their own resources. Thus, doctors depend on a fickle Congress for their compensation, and are jerked around by the funding cycle. I suppose doctors should accept a lowered payment for patients on government programs* but it must be within reason. Less than the cost of doing business hurts everyone, from doctors making the difficult decision to cut off some of their patients, to the patients who have trouble finding care, to the taxpayers who are being sold a bill of goods. Our taxes aren’t providing the safety net we are paying for, if compensation is so low that providers drop out of the system. We should all be asking ourselves where will Medicare be when we need it, if it is not reliably funded.

*sort of like the old days, when if the doctor knew you only had a few chickens, he’d accept one instead of two for delivering a baby 😉
#11 medrecgal
June 26, 2010

Yes, I see directly the horrendous reimbursement rate primary care docs get for Medicare/Medicaid patients, so I can understand why so many are not accepting new patients with these forms of insurance. It’s a sad commentary on our obviously screwed up health care system when so many of our citizens, often those who need the most care, can’t access it. But aside from shelving the whole setup and starting over, which has the potential to be disastrous, what’s the solution? Some have suggested a “socialized” system (like Canada’s or the NHS), but I highly doubt most Americans would accept a system where it takes weeks to months to get in to see a provider or have an elective procedure done. (Don’t know enough about the reimbursement rates to comment from the provider’s side.) We need a middle of the road between completely socialist medicine and care that’s better only for those who can afford to pay for it, because of the unique setup of our population. A good start would be to remove most if not all of those “middle men” in the insurance business that are taking money from those who actually provide the care. Maybe a direct payment system would help some patients, though I don’t think there’s a one size fits all solution to the insanity.

Part of our problem might be solved by making preventive care more lucrative and fancy procedures less so; even out what the providers get, and we might get a more equitable distribution of physicians that would go a long way towards helping cut the expenses in our system. (Not necessarily the same payments, but make it so they’re at least in the same ballpark.)
#12 Dr. Steve
June 28, 2010

Marcus, part of the Obama health care bill is normalizing Medicare and Medicaid reimbursement so that the poor can actually get care. Few docs will take medicaid due to the poor reimbursement and many who do are just mills.

Obviously a real solution would be comprehensive, but meanwhile, they need to slap another band-aid on this before doctors close their doors to medicare patients, and perhaps close up altogether.
========
Uh, excuse me but as a doctor who took any Medicaid patient who called for the 8 years I practiced and did not run a “mill”, and who knew and knows many other such doctors, I think you overstate your case on this point.
#13 PalMD
June 28, 2010

As someone who does quite a bit of Medcaid work, I would agree that there are many out there doing good work, but the incentives are otherwise, and I can’t imagine you don’t know exactly what I’m talking about.

You are notable for being a (presumably) good medicaid doc.
#14 Vicki
June 28, 2010

Medrecgal–

What America do you live in where nobody has to wait weeks to months for an elective procedure? Where I am, that can be the ordinary wait for things like mammograms. (That’s for people with health insurance, in a city with multiple medical schools and teaching hospitals.)

I continue to be amazed at how people can say “Americans will not accept” something that a sixth of us are living with right now.

OleanderTea–

I suspect, alas, that people do know that these cuts are going to affect those who can least handle it, and they don’t care, because they think of the people getting those benefits as “other.” In California, they’re talking seriously about cutting the benefits that let disabled people live independently in the community. There are two possible outcomes if they do that. One is that people wind up in hospitals or nursing homes, and the state pays a lot more money for them to be less happy. The other is that those Californians simply die. Either way, the able-bodied legislator won’t have to see them.
#15 Bill in NC
June 29, 2010

I’m afraid this is the future of medicine.

We’ve been spoiled by Medicare’s fee-for-service structure, but to survive it will have to move to a fixed cost structure, with strict cost-benefit analysis.

Medicare will become more like Medicaid, not vice-versa.

Hopefully they’ll kick out private insurers to save money.