Are people here aware that in some parts of the country, doctors are turning

[pnwmom]

down Medicare patients -- not just Medicaid patients -- because the payment rates are too low?

I like the idea of a public option tied to Medicare rates, but I can see why legislators in areas where doctors are already turning down Medicare might think this isn't a good solution.

[EFerrari]

1. I don't know about the rest of the country but it's always been like that here.

And since Medicare took the biggest risk out of the insurance pool, nobody really did anything about it because only a small group of people were affected.

[The_Casual_Observer]

2. The population is aging. Eventually they'll have no choice but to take

what medicare pays or they can close up shop.

[pnwmom]

15. I think they'd rather just charge younger patients more. n/t

[mrcheerful]

3. Been like that every since I started on SSDI in 1984, I went without medical unless it was

the hospital emergency room for years. In fact I finally found a regular doctor to see me on a regular basis, after my August heart attack. The doctor at the hospital emergency room found me a family doctor that would take medicare. I'm now walking around with a stint in my heart with nitro pills in my pocket.

[Oregone]

4. How low exactly are rates?

I mean, are they still enough to make a living? A good living after everything is paid off?

Just curious. Im on Canadian Medicare...as a short anecdote, my doctor remarked he made 10 X as much on a certain surgery I need while practicing in Seattle. So I did the math, and he could clear about $250+ dollars an hour doing the operation in Canada, and around $3000 in the US paid through private insurance (he of course chose to move back north, for one reason or another).

But even $250 an hour is a damn good living. I wasn't sure what justifies over 10 X the rate.

Anyway....what Im getting at...is Medicare rates in the US lower than that? Are Medicare rates too low really, or are the private rates simply too high and ridiculous?

I have no idea what the US Medicare rate table is.

[Indenturedebtor]

6. Hmmm did your math include costs?

http://wiki.answers.com/Q/How_much_do_doctors_get_paid

Compared with bankers, lawyers, real estate agents, ceo's, project managers, etc... it's really not that ridiculous. How many lives have you saved today?

And no I'm not a doc, I don't make much money, and my job is stressful as hell. Still, doctor pay is not the problem.

[Oregone]

7. I understand the costs, but...

I'm talking from an anecdotal experience with a guy who has experience with private practice in 2 different contexts (one where he was paid less than 1/10th the other), and he was clearly still able to make ends meet in the lower paying context. This was an elective procedure though that is not necessary, so maybe he makes better rates on cancer, and that sorta stuff. For this elective procedure, he gets handed $98 bucks a pop and it takes 10 to 15 minutes to do, though US private insurance paid over a grand a procedure (it seems excessive, but I don't have the overhead numbers).

My question is really if US Medicare rates allow doctors to pay costs and make a good living. I'm not criticizing doctor pay, because honestly, I don't have enough information to do that.

OTOH, I do know that many doctors can still have a good living working on salary, which vastly controls health care costs. How do you balance personal incentive with national health care expenditures? No ideological mantra provides a simple answer to that question

[Indenturedebtor]

8. You don't have to consider Dr. Pay... 1/3 of costs is insurance companies

Drop insurance companies and you've automatically dropped costs by 1/3. Going after the docs is a divisive tactic advanced by insurance companies.

[Oregone]

9. This conversation is actually more about doctor's pay

Doctors are refusing Medicare because they say it doesn't pay them enough.

My question is merely about how low Medicare rates really are and why doctors can't make a "good" living accepting this.

I'm all for raising Medicare rates to enhance doctor pay if necessary. I ask, how necessary is that though?

Btw...who's "Going after the docs"? :) Its a rational discussion

[Indenturedebtor]

10. I wasn't trying to be combative but I would rather tax people who make 1 mil plus

to fly around in jets and discuss strategies on how to more efficiently externalize their costs and squeeze more work for less pay out of their workers, in order to pay for healthcare than worry about cutting pay for people who have some of the hardest and most stressful jobs in the world. If we're going to talk cutting pay, I say cut all of the pay for insurance companies.

[Oregone]

11. Well, lowering the insurance pay/profits would still lead to this general question...

How much does a doctor need to get paid to make a "good" living (considering costs)?

I'm all for eliminating insurance companies actually, but even in a single-payer system, you have to answer that question to keep the doctors in business, incentivized, and happy.

[Indenturedebtor]

13. I would say that they need to be paid more on average than in any other country

That way we can continue to soak up a lot of the best doctors from around the world.

[Oregone]

14. Soak em up, eh?

Yeah, it sucks that one factor negatively influencing the doctor to patient ratio where I live is attrition to the US. A lot of the high rates (that the private market is paying) is soaking up doctors from single-payer countries with saner policies for their people.

Honestly, to get a real handle on costs, it almost seems like it would be more effective to invest in training and producing more doctors domestically with public funds, then relying on exorbitant pay to steal/attract/soak/whatever them from other countries (which may of subsidized their educations). In one scenario, the expense is made a single time (and provides domestic jobs), and in the other its a perpetual bleeding to produce the soaking effect.

BTW, the issue of providing enough compensation for a "good" life is separate than purposely providing so much to stimulate immigration.

[Indenturedebtor]

28. I would generally agree with your post

I also think that Docs should be among the best paid workers. Anyone who works at saving lives should be very well paid. That would include nurses, etc as well.

It burns my ass to think of all of the people who are in the business of taking lives like Ins Co CEO's who make multiples of what most docs and nurses make.

[Johonny]

26. I think it's more about opperational costs

The malpractice insurance is a real escalating cost for them. There aren't many options to increasing revenue as fast as this cost is increasing. You can either see more patients, cut support staff, or charge more. But most doctors are already in fee negotiated systems for those in insurance networks. The only thing they can do then is try to see less patients in systems with lower payouts. To me it's a made up problem. Malpractice costs are as fake as health insurance costs. Instead of "tort" reform they should reform malpractice insurance rates the way the are/were/should reform health insurance rates. Insurance the bane of the whole health care industry, yet it must not die!

[Oregone]

27. I thought Obama said, more or less, malpractice costs were a red herring

And "tort reform" would cause a minimal reduction in the price of health care (and thus, Id assume the doctor's expense). He cited some minuscule percentile I thought.

Hey, how about single-payer malpractice insurance? :)

Im not a huge fan of privatized insurance in general--it doesn't bring anything new, innovated or more efficient to the table.

[pnwmom]

16. One problem is they're always behind, because they're based on a portion

of average charges from the year before.

They also vary between regions, so some areas are worse off than others.

[Oregone]

17. That explains a lot

Just if there is a hassle, especially when bills are due. There is no excuse for not improving this.

[GreenPartyVoter]

5. Sometimes it's not rates but slow payment that is the problem.

[Hekate]

12. In Salt Lake City a few years ago there were only a handful of rheumatologists,NONE of whom would...

... take Medicare patients. Since my mom lived in SLC and got bad rheumatoid arthritis two years before she died, this was not a pretty state of affairs. She was basically told that to be seen by one of these specialists all she had to do was bring Visa or MasterCard and pay the full uninsured rate, which at her age was something she could not wrap her head around. Her gerontologist had no access to sample drugs for RA, nor did he have a relationship with any of the rheumatologists, so all he could prescribe was prednisone, which amped her up.

In my own area of California the reimbursement rates are too low for the cost of living that all of us -- including doctors -- have to live with here. My Congresswoman said she authored an amendment to the House health care plan that would take regional cost-of-living into account and would hopefully make it easier for patients to gain access to willing doctors.

Anyway, it's a problem that needs addressing.

Hekate

[Undercurrent]

18. I live in Washington State, and

and am on SSDI. Our Medicare reimbursement ranks 42nd in the country. I live in a very rural area, and most local doctors refuse Medicare patients. It's hard finding a regular family doctor, or a specialist without driving 50 miles or more. I've had a regualr doctors in the past who have moved away.

I need regualr medical care, and lab work but often go without.



From Senator Patty Murray's website:

Medicare reimbursements per beneficiary.


Average "per beneficiary" payment:

New York $6,924
National Average $5,490
Washington State $3,921

(Source: CMS, FY 2000)

As a Result, Patients Can't Get the Access They Need

Many doctors are no longer accepting new Medicare patients.

* Nationwide: 17 percent of family doctors refused to take new Medicare patients in 2000. (American Academy of Family Physicians)
* Washington State: 57 percent of physicians responding to a survey are either limiting their Medicare patients or dropping Medicare patients from their practice. (source: Washington State Medical Association)

Other doctors are retiring early or leaving our state.

* Since 1998, the number of Washington State Medical Association members leaving Washington State has increased by 31% (WSMA, 2002)
* Each time a physician leaves, about 2000 patients must find a new caregiver.

As a result, Washington seniors on Medicare are having a hard time even finding a doctor who will see them.


More:
http://murray.senate.gov/medicare/medicare-stats.cfm

[pnwmom]

19. Undercurrent, these numbers are eye-opening. Thanks. n/t

[TexasObserver]

20. Yes. They just don't like dealing with it and figure they'll say NO.

They should not be eligible for any federal funds or loans of any kind if they fail to honor Medicare.

[OneGrassRoot]

21. What is the answer here?

Everything has suddenly become like white noise as I try to absorb the pros and cons of various approaches, the fact that everything is different from state to state, etc.

If the ultimate goal is Medicare for All, what about the OP's question? How is this problem rectified? Is it a matter of removing the waste and "cleaning" up the system -- will that somehow improve reimbursement rates with Medicare? Private insurance doesn't figure in this equation, right?

Sorry....I'm suddenly so very, very confused.

All I know is that everything in this country feels like one big clusterf*ck right now. We absolutely MUST do better...somehow.

:(


Edit for typos

[rucky]

22. Well, I guess the private insurance companies could compete, after all.

I'm okay with this.

[NNN0LHI]

23. So if everyone was on Medicare what are they going to do?

Turn down all their patients and go to the park and sit on a bench and sulk?

What do you think?

I seen Judd Gregg on TV twist himself into a pretzel with this question yesterday.

Don

[SpartanDem]

24. Very true

What good does do people to tie the program to medicare rates and then have no one willing to see them

[Blue_In_AK]

25. In Anchorage, there are very, very few doctors

who take new Medicare patients. As in basically none. My mother-in-law was only able to get health care at our neighborhood health clinic which was originally set up for low-income patients, despite the fact that she has supplemental insurance. My husband and I, who are 62 and 63, just recently established relationships with family practice physicians...we're hoping they won't drop us when we reach 65.

It's a very serious problem here.

Here's an article from March detailing the problem: http://www.adn.com/news/alaska/anchorage/story/736149.html

Only 13 of 75 primary care doctors surveyed in Anchorage are willing to accept new Medicare patients, according to a study by the Institute of Social and Economic Research at the University of Alaska Anchorage.

And only five primary care doctors here who accept new Medicare patients are in private practice. The rest work in publicly supported health care centers or limited service urgent-care clinics.

"There's a major problem in Anchorage," wrote study co-authors Mark Foster and Rosyland Frazier -- who interviewed 229 primary care physicians or their staff members statewide.

"As more Alaskans turn 65, the access problem will get worse, unless something changes."

Stories are increasingly told of Anchorage doctors refusing to accept new patients on Medicare, which pays them about two-thirds as much as private insurance companies pay them. But those reports have mostly been anecdotal. Now the ISER study says they're mostly true.

The same problem prevails to a lesser extent in Fairbanks and the Matanuska-Susitna Borough, the study found. In Mat-Su 11 of 26 doctors surveyed won't accept new Medicare patients. In Fairbanks, seven out of 23 do not.

However, almost all doctors surveyed in smaller cities and rural Alaska -- 84 out of 87 doctors -- accept new Medicare patients.

"Rural places have few doctors, so (they) probably feel more of an obligation to see all patients," the authors wrote.

Most of the 62 primary care physicians in Anchorage who refuse to accept new Medicare patients -- 42 of them -- bend their own rules for longtime patients who "age in" to Medicare, the survey found.

But 20 of the 75 doctors surveyed here have officially opted out of the Medicare system altogether. Patients on Medicare who choose to see them must pay the entire bill themselves.

The exodus appears to be placing a greater strain on the Anchorage Neighborhood Health Center, whose five doctors accept all walk-in Medicare patients. Since 2001, the number of Medicare patients there has more than doubled.

<snip>

Anchorage is a city of approximately 275,000 people. I think it's pathetic that there are only five private primary care doctors here who will take Medicare patients, especially considering another statistic I recently read, which is that Alaska has one of the fastest-growing senior populations in the country. (All of us who were "young" when we moved up here.)

As Rep. Grayson says, my plan is not to get sick.