Heads up about Medicare changes

This post if for any of my readers who are Medicare age or about to be Medicare age.

I think it’s important to understand what changes are in the pipeline that will affect your doctors and their ability to be able to treat you.

Some doctors already refuse to see Medicare patients because of government red tape and poor reimbursement.

But starting in 2017 it’s going to get worse, and many physicians are wondering if they should follow their colleagues and drop out of the Medicare game altogether.

I recently read two posts by physicians on the health care blog KevinMD, each expressing their sorrow that they wouldn’t be able to continue to see Medicare patients and explaining the myriad of reasons why.

Dr. Rebekah Bernard talks about the “regulatory burden” she and other docs have been forced to bear:

During and after every visit, I type away at my keyboard, clicking boxes to demonstrate to Medicare that I did my job.  My notes, which used to be informative and succinct, now include pages of irrelevant information, disclaimers and computer-generated statements to “document” that I am playing by the rules.

And next year the whole ballgame changes for physicians as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) goes into full effect, with a complete paradigm shift in Medicare payment from “fee-for-service” (I send a bill for your medical care, Medicare pays me), to “value-based payment” (I submit a bill, and I get paid if Medicare thinks that I’ve done a good enough job).

Basically, in 2017, all doctors that care for Medicare patients will have to make a choice.  The first option is to join an accountable care organization (ACO), which is a large group that acts kind of like an HMO to control costs and accept financial risk.  Having just left a large hospital system with daily productivity reports and a glut of middle managers, this option does not appeal to me.

The second option, for those who choose to stay in solo or small practices, is for the physician to enter into a Merit-Based Incentive Payment System (MIPS), in which payment will be determined by where the doctor ranks on a physician scorecard.  The kicker is that the pot of money remains constant – so even if every doctor makes an ‘A’ grade, half of them will be paid less money, just by nature of this “budget-neutral” payment system.

I understand that whoever pays the bills makes the rules.  The only recourse a player has is to choose whether or not to play the game, especially when the deck is stacked against them.

Related story from MedScape: Physicians Decry Broken Promise of Medicare Raise in 2016

Dr. Pamela Wible has not accepted Medicare patients since 2006: I love old people, but I’m not taking Medicare

Why? Because, among other things:

Medicare demonstrates no transparency in the flow of tax payer money through their program.

Medicare may reimburse physicians so little that we lose money with each appointment forcing doctors to go bankrupt (or run Medicare mills with ramped up volume and quickie visits to make ends meet).

Medicare regulatory codes by which physicians must abide is 130,000 pages long! (US Tax code is only 75,000).

Medicare requires compliance with more unfunded mandates and administrative trivia than any other insurer.

Medicare penalizes physicians financially if we don’t use a Medicare-approved computer system and electronic health record.

Medicare abuses and bullies doctors.

Dr. Wible has already shifted to a cash-only practice, and Dr. Bernard might soon, too. As will lots of other primary-care doctors.

Cash only, or Direct Patient Care (DPC), practices don’t accept insurance, Medicare or otherwise. DPC business models differ, but typically you pay an age-based monthly fee, and your physician can treat you as he or she sees fit, without jumping through all the bureaucratic hoops the insurance companies employ.

Related post: No shortage of bureaucrats

AARP hailed Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as “an improved payment system” that “moves Medicare in the right direction.” 

How can that be, if physicians respond by dropping Medicare patients? And considering how they are treated, who can blame them if they do?

Sláinte,

Frugal Nurse

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