Tuesday, December 18, 2007

Medicare 10% cut averted - For now...


Hot off the press from the Associated Press is a story stating that Congress is about to pass legislation which avoids the proposed 10% cut in Medicare payment scheduled to take place 14 days from now.
The legislation crafted by Democratic and Republican leaders of the Senate Finance Committee would give doctors a 0.5 percent raise when they treat the elderly and disabled. The Senate was expected to approve the bill Tuesday or Wednesday. The legislation would then move to the House, which hopes to wrap up work this week.
Like practically everything else in government, there's a catch. What's the catch? Well, this HUGE zero-point-five percent raise in Medicare payment will expire on June 30, 2008. Which means, that docs will have to go through this stress and anguish and Congressional advocacy efforts all over again in six months.

I know what you're saying, what's the big deal? Docs have all kinds of money anyway. They don't need a pay raise like everyone else does. I don't want to get started on a rant. But, I will say that patients are feeling the effects of status quo or less payment by the federal government and private insurance companies for physician services. Here is how one patient sees it:
Docs, especially GP's (or PA's, my GP was on vacation and also works with a PA who handles some things, you can make an appointment with either but the PA is available much sooner usually) are so pressed-for time, something needs to CHANGE to make it so they can spend a little more time with each patient, geez! Yet not lose money because they might be seeing fewer by a couple, each day . . . . . and then there's all the paperwork, etc. I'm sure Doctor Anonymous, aka Dr. A, can chime in with some comments to this post, from his point of view (he's a GP).
Presuming this legislation passes, I would like to thank Congress for the HUGE raise for taking care of Medicare patients. Of course, the private insurance companies will follow suit, or even continue their tradition of sometimes paying 80-90% of what Medicare pays. For all the Senators and Congress representatives out there reading this - Merry Christmas (er, for the politically correct, Happy Winter Solstice) and we'll see you in June when we have to do this dance all over again.

3 comments:

MY OWN WOMAN... said...

Yep, doctors make so much money they put it in their fireplaces and burn it for heat.

Let me give you a little 411 people. My daughter went to undergraduate school for free. She got scholorships and my total cost was a little less then $1,000.

Then she arrived in medical school. Sorry, you don't get scholorships for medical school, you just get a lot of sleep deprevation and a bill for greater....and I mean greater.... than $160,000.00.

Now you are probably saying...the doctor can make that in a year. Well, wake up America! The doctor has to pay for his office, his supplies and his help; not to mention paying for certifications, CME's and admitting privledges.

Yes, they are rich. My daughter is rolling in the dough already. In fact, she's so rich, she drives a Toyota Corolla. How's that for status!

The Happy Hospitalist said...

If I'm only getting a 0.5% raise, does that mean my health insurance premiums will only be fixed at a 0.5% raise?

and when the "reprive" expires in 6 months, does that mean that my health insurance premiums will then drop 10%?

I think that's fair.

The reprive is a joke. A 0.5% raise is a cut that only adds insult to injury over the last 15 years.

Chris Morton said...

While doctors usually do make a great deal of money (some much more than others - it is invidious to generalize, and it is probably not the really high income doctors who will be adversely affected by this isuue), the issue of the 10% cut in Medicare reimbursements to doctors now and 5% again in 2009, affect their practices so badly that patients are the ones who will suffer.

My wife and I have just come home from a visit to our Rheumatologist - a doctor who really cares and whose practice consists of at least 50% of Medicare patients, including my wife and I. If these fiscal losses to doctors are applied, thousands of doctors will have to seek relief - and there are some choices, but vacuums are unnatural and they will be filled.

My wife and I are disabled - before I became disabled I was content to work into my twilight years. Our total income now, is fixed, and consists of my small pension, and our social security payments (my wife's is $450.00 per month and mine is not much more). Because of our disabilities
we have to see a number of doctors on a regular basis and we take a number of meds (my wife takes 11 different meds every day, and I take 9 - as a cost example, my wife has just been put on a drug called cyclosporine and it will cost us $470.00 a month if she buys it - she probably will not be able to pay for it). I am not asking for sympathy. I am simply giving you information about medical costs that affect us and our deep need for Medicare support and our doctors' care.

Now, let's look at the choices that are open to our doctors if the 10% and 5% cuts are applied and the effects of this action on other sections of our society:

First, (and this is what is happening), just the threat of the 10% cut is making doctors stop accepting new Medicare patients - what must they do?

Second, many doctors (in spite of the pithy humor about doctors burning money) will have to stop accepting medicare payments altogether - their current Medicare patients will suddenly have to end their visits to their doctors (because a high percentage of their patients are Medicare patients - in some parts of the country like South Florida this percentage is very high). This means that thousands of elderly and sick patients with fixed incomes like ours will have to seek relief elsewhere - most will have to go to places like Emergency Rooms in hospitals.

Third, doctors who have cut their medicare patients will have to seek fiscal relief elsewhere (anyone who suddenly gets a 15% cut in their income has real problems). The choices they have, are: increasing their fees for paying and insured patients; shutting down their practices and moving to parts of the country where the percentage of Medicare patients is small, moving overseas, leaving private practice and working for hospitals, clinics, medical insurance companies, or doing some basic retraining to go into high income, low risk, low effort medical practices like dermatology, plastic surgery, ophthalmology, and podiatry.

Fourth, because doctors will work to fill the fiscal vacuum left by the loss of Medicare patients, their relocation and other choices will cause serious deficits in particular types of doctors who once helped Medicare patients in parts of the country with high elderly and sick populations.

Fifth, hospitals, clinics and ERs will be flooded with these elderly and sick patients. The ERs, hospitals etc. will be further unable to serve patients with any form of medical acumen or compassion as the cattle truck syndrome (also called the sausage machine syndrome) becomes a reality. A quickly increasing and overwhelming number of patients unable to pay full fees in these institutions will cause fiscal crises and they will begin to choose bankruptcy and close down.

Sixth; because doctor's fees will rise and their remaining patients will be either self-insured or business insured, medical insurance fees will rise. Many businesses (especially small businesses) will no longer be able to pay employee medical insurance, and the privately insured will face a similar need to cut costs and be overwhelmed by the increasing medical costs. Many more will stop paying for medical insurance. Our country's medically uninsured will increase dramatically, medical costs will increase, and the costs to local, state and national support systems for the uninsured will increase alarmingly. Increased taxation must follow.

Seventh; as anyone with an iota of sense can see, the reaction to the 10% AND 5% decrease in doctor's Medicare reimbursement, and the resulting chain reaction, would be disastrous - and together with the country's threatening recession, which includes high job losses, home foreclosures and continuing war, we would be in much deeper trouble than we are now.

Eighth, fiscal disaster after fiscal disaster will result and if China, India and the Arab countries like Bahrain and Saudi Arabia choose to call in their loans, the U.S. will collapse like a pack of cards.

Ninth, the only group to benefit from all of this will be the death industry (no joke). Because of the disasters that will follow these cuts, the weak, and the poor will be hit first and the aged, children, the sick and the fiscally unstable will die like flies from the lack of regular and caring medical support and their drop in fiscal stability.

Here are nine scenarios because the federal government is continuing to fiddle with Medicare and pander to the medical insurance industry (yes, it is, once again, big business that is pushing this process - as shown, if the Doctor's reimbursement decreases, insurance costs will increase). But, whatever happens, it is not the doctors or the insurance industry that will suffer in the end - it is the patients, particularly the weak, the elderly, and the poor.

The American people must continue to oppose this bill (the current status of the bill is that it has been suspended until June 30, 2009 when the fight will begin again). If U.S. citizens remain apathetic about this issue and the bill goes through, they may be a part of one of the biggest disasters in the history of their country.

You are urged to contact your Senators and urge them to vote against the Bill in the future. This applies, particularly, to Republican Senators. It is the Republicans who are pushing the 10% and 5% reimbursement cuts for the benefit of the Insurance industry - the Democrats are trying to stop them. But don't ignore the Democratic Senators either; they need public support and they need to know that we don't want these cuts to go through. Some of them teeter on the brink of Republicanism and need, in a situation like this, to be helped make the right decision.

NOTE: My wife and I are not members of any doctor's groups opposing this bill. We are both ex-educators and elderly, sick American citizens with low incomes and high medical needs who see this bill as a threat to our lives.

Chris & Cheri Morton
chris.morton@comcast.net