Bob Doherty lays out the problem – Has Medicare access reached a tipping point?
Maggie Mahar, blogging in Health Beat, also casts doubt more on the notion that a large number of doctors are boycotting Medicare. Citing the MedPAC surveys and other data, she notes that there is palpable “anxiety” among physicians, “The take-away message is that while the 21% cuts doctors are now facing are an administrative nightmare, they will be fleeting. And reports of a mass exodus by doctors from Medicare are overblown.”
She may be right that there isn’t a “mass” exodus from Medicare – yet.
But something tells me that this time, things may be different. The latest cut and the chaos it creates may have reached a tipping point. An ACP member from Georgia told me that it wasn’t until yesterday that her practice received the first check from Medicare (with the 21% cut included) since the first of the month, and that as a result, her practice is living off credit and having trouble making ends meet. She predicted that she, and many others, will soon have no choice but to close their primary care practices if Medicare can’t be counted on to pay its bills.
But it more than money, I think, that is behind more and more physicians giving thought to what in the past was unthinkable: finding a way to make a living that doesn’t involve Medicare. It is a matter of the government breaking the bond of trust between doctors and the program. Trust that they government will pay them fairly, and on time, for their services, in exchange for physicians honoring their commitment to provide seniors with the best care possible. And as any cuckolded spouse can tell you, once a bond of trust is broken, it is almost impossible to restore.
An internist in our town, who has a predominantly Medicare practice, just sent a letter to all his patients. He has decided to eschew Medicare payments for outpatient practice. He is converting his practice to a retainer model – $100/month – and no Medicare billing. Given the shortage of outpatient internists in this area, he will have no problem having enough patients. His patients will still have Medicare coverage for hospitalizations, if they decide to pay $100/month.
While I relate an “isolated” incident, sometimes examples foretell the future. Internists and family physicians run their small businesses on a tight margin. When payments decrease, overhead remains high. This physician has decreased his overhead because he will no longer bill Medicare nor have to meet their documentation requirements. He will likely spend more time with each patient and provide a higher quality of care.
I do believe we have reached a tipping point. Congress has failed. The government and both political parties have played political games with health care. Whenever I hear a political speech about health care delivery, I remember how disingenuous they all are.
Can they regain our trust? I assure you it will be very difficult. It will no longer come from patches. Trust will only come from a major retooling of CMS. Perhaps Berwick can do that, but bureaucracies turn about as quickly as the Titanic did.
