Texas Doctors Opting Out of Medicare

[guido911]

Apparently another broken government program.

http://www.chron.com/disp/story.mpl/metropolitan/7009807.html

[nathanm]

Apparently another broken government program.

http://www.chron.com/disp/story.mpl/metropolitan/7009807.html

I take it they're also not taking private insurance, since they're complaining about excessive paperwork and low reimbursement rates? Oh, they are? How disingenuous.

[guido911]

Are you suggesting these doctors motives is political?  Well that cannot be:



Oh wait, now I remember. Was that a disingenuous photo op?



Thanks for the softball Nate. 

[nathanm]

I guess that's some sort of sarcasm? Do you really not think that given that private insurance reimbursement rates are similar to Medicare's, yet require more paperwork that it's odd that a doctor would complain about Medicare while still taking private insurance?

[sgrizzle]

My wife works in a doctor's office that takes Soonercare/medicaid, but has no medicare patients. Reimbursement rates were slashed earlier this year and many basic tests are non-reimbursable under medicaid as they consider it should just be "part of the office visit" despite the fact it incurs actual lab costs. Whereas my medical insurance recently paid out MORE than the billed rate for one lab test (which kinda ticked me off, but that's another story)

There are plenty of sound financial reasons to drop medicare/medicaid.

[guido911]

I guess that's some sort of sarcasm? Do you really not think that given that private insurance reimbursement rates are similar to Medicare's, yet require more paperwork that it's odd that a doctor would complain about Medicare while still taking private insurance?

So you are sticking with the political motive, got it (even though they have been leaving Medicare for the past TWO years, um, that includes Bush).

[nathanm]

So you are sticking with the political motive, got it (even though they have been leaving Medicare for the past TWO years, um, that includes Bush).

I have made zero statements about what I think their motive is, because it's completely unfathomable to me.

My former insurer reimbursed at well under 50% of the "rack rate." Big name company, too.

[we vs us]

Apparently another broken government program.

http://www.chron.com/disp/story.mpl/metropolitan/7009807.html

Interestingly enough, the government program is broken because of out of control cost increases:

"The problem dates back to 1997, when Congress passed a balanced budget law that included a Medicare payment formula aimed at reining in spending. The formula, which assumed low growth rates, called for payment cuts if spending exceeded goals, a scenario that occurred year after year as health care costs grew. The scheduled cuts, expected to be modest, turned out to be large.

Congress would overturn the cuts, but their short-term fixes didn't keep up with inflation. The Texas Medical Association says the cumulative effect since 2001 already amounts to an inflation-adjusted cut of 20.9 percent. In 2001, doctors receiving a $1,000 Medicare payment made roughly $410, after taking out operating expenses. In 2010, they'll net $290. If the scheduled 21.2 percent cut goes through, they'd net $72, effectively an 83 percent cut since 2001."

In the end, the problem remains the same:  healthcare costs have been skyrocketing, while reimbursement rates have increased modestly, or not at all.   That's more about the lopsided healthcare market than about Medicare. Unless you feel like having Medicare reimbursements track the cost of services rather than the inflation rate, which would suggest you're ALSO into paying more tax to the gov.

But something tells me you posted this because you're more of a mind to abolish the entire thing and let the chips (and our elders) fall where they may.  How close am I?  Do I win a prize?

[guido911]

But something tells me you posted this because you're more of a mind to abolish the entire thing and let the chips (and our elders) fall where they may. 

Nope, I just think this is just a sign of things to come. 

[Gaspar]

I guess that's some sort of sarcasm? Do you really not think that given that private insurance reimbursement rates are similar to Medicare's, yet require more paperwork that it's odd that a doctor would complain about Medicare while still taking private insurance?

My goodness Nate, have you never seen a Medicare coding book?  It’s almost as big as the Obamacare bill.  Most docs purchase expensive software or hire people trained in Medicare coding just to bill the proper code.  With hundreds of thousands of codes, it’s an industry in itself. 

My dad sold his practice back in the late 90’s to Warren Clinics because the overhead of employing a nurse, and keeping an employee certified in Medicare coding was too much.  The big clinics offered that service for free, and were able to gobble up most private practices. 

A single mistake in coding results in NO PAY for the visit.  It’s even a nightmare for hospitals.  For instance, if a blood bank codes an 86930 (frozen blood prep) as a 86931 (frozen blood thaw), a common mistake because they can mean the same thing depending on how they are charted, the patient account can go unpaid for years until an audit.

It’s a nightmare.  The audit process is also quite disgusting too.  It's designed to discourage hospitals and doctors from pursuing payment for services.