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Thu Jan 5, 2012, 09:05 PM

Doctors going broke ( and how imminent Medicare cuts are making it worse)

I just read 2 articles that deserve attention for all of us who rely on small practice doctors.

First article:
"Half of all doctors in the nation operate a private practice. So if a cash crunch forces the death of an independent practice, it robs a community of a vital health care resource.

"A lot of independent practices are starting to see serious financial issues," said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent doctor practices about their finances.

Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors' lack of business acumen is also to blame."
http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm

and what is adding to that cash crunch? Decreasing Medicare payments, set to go into effect this month.

"The payroll tax impasse in Congress has put Medicare doctors on edge over the likelihood that their pay could be slashed 27.4% in two weeks time.

Under current law, health care providers to the nation's 45 million Medicare beneficiaries -- including physicians, nurse practitioners, physical therapists and podiatrists -- face reduced government reimbursement payments on Jan. 1."

and this part:
"Federal law requires that Medicare reimbursement rates be adjusted annually based on a formula tied to the health of the economy. That law says rates should be cut every year to keep Medicare financially sound.

Although Congress has blocked those cuts from happening 13 times over the past decade, most recently on Dec. 23 with a two-month temporary "patch," this dilemma continues to haunt doctors every year."
http://money.cnn.com/2011/12/21/smallbusiness/medicare_cuts/index.htm?iid=EL

Now, look at the growing number of over 65 people who have reduced income, depend on Medicare, and depend on small dr. practices for their health services., especially those of us who live in rural/small town areas.

Not a rosy picture. Already one of the 3 dr. offices in town here is reducing staff.


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Arrow 25 replies Author Time Post
Reply Doctors going broke ( and how imminent Medicare cuts are making it worse) (Original post)
dixiegrrrrl Jan 2012 OP
RKP5637 Jan 2012 #1
Cleita Jan 2012 #5
Cleita Jan 2012 #2
RKP5637 Jan 2012 #3
Cleita Jan 2012 #4
RKP5637 Jan 2012 #6
Cleita Jan 2012 #8
xocet Jan 2012 #23
RKP5637 Jan 2012 #24
SheilaT Jan 2012 #20
Cleita Jan 2012 #21
SheilaT Jan 2012 #25
Scuba Jan 2012 #7
dflprincess Jan 2012 #9
slipslidingaway Jan 2012 #10
marmar Jan 2012 #11
dixiegrrrrl Jan 2012 #12
RKP5637 Jan 2012 #13
DeSwiss Jan 2012 #18
JDPriestly Jan 2012 #14
dixiegrrrrl Jan 2012 #15
Stuart G Jan 2012 #16
tpsbmam Jan 2012 #17
dixiegrrrrl Jan 2012 #19
MindMover Jan 2012 #22

Response to dixiegrrrrl (Original post)

Thu Jan 5, 2012, 09:17 PM

1. Here I'm running across more drs. that don't take Medicare anymore.

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Response to RKP5637 (Reply #1)

Thu Jan 5, 2012, 09:32 PM

5. My primary care still is, for her old patients, not new ones.

If I need a specialist, I doubt if I will find one.

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Response to dixiegrrrrl (Original post)

Thu Jan 5, 2012, 09:23 PM

2. It's done deliberately to crash Medicare.

Used to be that our politicos cared about seniors, even Republicans, and they would raise the fee schedules on Medicare to help doctors keep accepting it. Now they won't even do that and cut the already bare bones fees schedules even more. Then they are going to try to institute the voucher insurance program that won't cover anyone. How many old people that didn't have to die will because they can't get decent health care at a time of their lives that they need it the most? I may be one of them in the future and so will the others.

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Response to Cleita (Reply #2)

Thu Jan 5, 2012, 09:28 PM

3. IMO there is a body of individuals in this country that views the deaths of seniors, handicapped,

sick, etc. as a good thing. It's disgusting, but what else can one start to conclude. Frankly, and sadly, I see the future as a very vile wretched life for many.

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Response to RKP5637 (Reply #3)

Thu Jan 5, 2012, 09:31 PM

4. Wait until it's their turn.

Also, giving health care to seniors and handicapped is not going to extend their life. What it does is make their diseases and conditions more tolerable. It could be their parents or their children who are helped. And if there are diseases to be cured, it will help lower the costs of end of life care. It's too bad that the morons don't see that.

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Response to Cleita (Reply #4)

Thu Jan 5, 2012, 09:34 PM

6. I've never made it through the entire movie "Idiocracy." It was just too factual.

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Response to RKP5637 (Reply #6)

Thu Jan 5, 2012, 09:38 PM

8. I know. Those movies are depressing and hard to watch. n/t

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Response to RKP5637 (Reply #6)

Fri Jan 6, 2012, 06:48 PM

23. Idiocracy (2006) accidentally nailed a few things with tremendous accuracy....

The Outburst from South Carolina

Joe Wilson (R-South Carolina) yelled the statement "You lie." at the President


This parallels the representatives from South Carolina in the "House of Representin'":

President Camacho: Shit. I know shit's bad right now, with all that starving bullshit, and the dust storms, and we are running out of french fries and burrito coverings. But I got a solution.
South Carolina Representative # 1: That's what you said last time, dipshit!
South Carolina Representative # 2: Yeah, I got a solution, you're a dick! South Carolina, what's up!




The Use of Violence and Pepper Spray

There is pepper spray for speech (a la OWS) at time index 0:29 in this video:






Speaker Boehner's Gavel

Also, Speaker Boehner chose a giant gavel similar in spirit to the one that the judge has at time index 0:47 in this video:





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Response to xocet (Reply #23)

Fri Jan 6, 2012, 07:30 PM

24. Thanks for sending these. I can't look at them right now, but will later tonight. Thanks!!!

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Response to Cleita (Reply #2)

Fri Jan 6, 2012, 02:57 PM

20. I'm not sure it's really accurate to

say that even Republicans used to care about our seniors.

I'm old enough to recall the fight to establish Medicare, and how a lot of people (especially the AMA and Republicans) said it would be the end of medical care as we know it.

I have no idea what the relative level of reimbursements has ever been for Medicare, but one doctor friend of mine was complaining a good decade ago that at least in her care (women's health) the reimbursements were totally inadequate.

There really is a closely parallel problem with all insurance reimbursements, because the insurance companies are committed to paying as little as possible. The main difference, if I understand it all correctly, is that the patient is pretty much on the hook for whatever conventional health insurance doesn't pay, but with Medicare. the doctor and hospital simply has to accept whatever Medicare pays and cannot bill additionally.

Disclosure: I'm still a couple of years away from Medicare myself, have what seems to be pretty good health insurance, but in reality I have the Republican health care plan. I don't get sick. Not, I don't seek treatment if ill or injured, but other than tripping in my driveway a couple of years ago and breaking my arm, I haven't been sick or wounded in about thirty years.

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Response to SheilaT (Reply #20)

Fri Jan 6, 2012, 03:16 PM

21. Medicare has a fee schedule that doctors must accept. Even if you have supplemental insurance, it

only pays twenty percent of the Medicare approved payment. (Medicare pays the 80%) In years past politicians realized that they had to make the fee schedule realistic to get doctors to accept Medicare patients even though it might be twenty percent less than what they could charge insurance. Even most Republicans realized this was necessary. Those trying to eliminate Medicare were on the fringe back then. But now by reducing the fee schedule below what it takes a physician to meet his bottom line, it means that most will no longer take Medicare patients. It will made the program unworkable and open to attacks from the right to eliminate it altogether.

Just because you are healthy now doesn't mean you aren't going to need medical help in the future for the problems of old age, like cataracts, BP and cholesterol management, arthritis and any number of conditions of old age that even healthy old people get.

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Response to Cleita (Reply #21)

Sat Jan 7, 2012, 01:26 AM

25. Thanks for the clarification.

My reference to my own amazing good health is intended mainly to explain why I am usually a bit vague about what is covered, be it by Medicare or any other kind of health care coverage.

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Response to dixiegrrrrl (Original post)

Thu Jan 5, 2012, 09:36 PM

7. First-rate practitioners often lack business skills ....

... and / or motivation necessary to run a practice. "I didn't go to medical school so I could research the best prices on tongue depressors".


In urban areas there are typically options for physicians to select from - straight employment, join a system, even an insurance company.

Rural docs have fewer choices.

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Response to dixiegrrrrl (Original post)

Thu Jan 5, 2012, 10:12 PM

9. It's not just the Medicare payments hurting them, it's also

because of the high deductible health plans and the number of unemployed people who couldn't keep their COBRA.

My doctor is at a clinic that's part of one of the major hospital/clinic groups in the Minneapolis area. I was amazed how quiet the waiting room was when I was in for my annual exam. It also took way less time to get an appointment for the test. The same was true when I went in for my mammogram. To begin with, it took about 8 days to get in for a screening rather than the 6 weeks it used to take & the waiting room, which use to be full, had 1 one other person in it. In all I saw maybe 4 other patients while I was there.

I asked if I had just hit a slow day and was told no, it was because so many people had lost coverage and so many people having high deductible plans that they skip screening tests because they know they can't afford the follow up.

I should have figured out that things were slow when the clinic called me with reminders that I was overdue for some tests - they have never done that before. And, now that I have a policy with an annual out of pocket of $5,950 on covered expenses (a $2,500 deductible, then a 75% payment until I hit the $5,950 plus whatever they decide isn't covered), I'll probably be joining those who skip the "free" screening tests because I can't afford the follow up. I'm just thankful that I haven't developed any chronic conditions (yet).

Meanwhile, the insurance companies are posting record profits, while those who actually provide a needed service are losing money.






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Response to dflprincess (Reply #9)

Thu Jan 5, 2012, 10:29 PM

10. Your last sentence speaks volumes ...

"Meanwhile, the insurance companies are posting record profits, while those who actually provide a needed service are losing money."





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Response to dixiegrrrrl (Original post)

Thu Jan 5, 2012, 10:56 PM

11. Can things get any more bollocksed up?




Roma in fiamme.


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Response to marmar (Reply #11)

Thu Jan 5, 2012, 11:07 PM

12. Probably.

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Response to marmar (Reply #11)

Thu Jan 5, 2012, 11:30 PM

13. I was just thinking earlier tonight, this is a really F'ed up country, and no this

is not an Obama bash.

I was just thinking about the whole picture, the ineptness of congress, the endless wars, the state of medical care, the insane politicians running for office, the bought useless congress, what's happening to the educational system, the failure of the country for the 99%, on and on ...

It's just a really really F'ed up country. Sure, other places are far worse, but most of this is being brought on by this country, by the crooks and shysters we call politicians, by the greed, the endless corruption.

I'll stop here, but I think much of the country is really F'ed for the future.

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Response to marmar (Reply #11)

Fri Jan 6, 2012, 01:13 PM

18. Yes.

As long as we retain the same system and the same idiots to run it.

- Most certainly.......

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Response to dixiegrrrrl (Original post)

Fri Jan 6, 2012, 01:54 AM

14. This "news" is way out of date.

I think that the payroll tax cut and the extension of higher rates of reimbursement to doctors from Medicare were passed before Christmas.

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Response to JDPriestly (Reply #14)

Fri Jan 6, 2012, 10:03 AM

15. Actually, your comments are off the mark.

First, this is not LBN, the post was about the IMPACT of the tax cuts which fund Medicare.

Second, the law taking effect is the REDUCED rates of reimbursement
not "the extension of higher rates of reimbursement"
to doctors from Medicare.

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Response to dixiegrrrrl (Original post)

Fri Jan 6, 2012, 11:07 AM

16. Thanks For Posting, k and r..nt

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Response to dixiegrrrrl (Original post)

Fri Jan 6, 2012, 12:43 PM

17. I immediately thought of my excellent podiatrist who performed my foot surgeries....

He was always running incredibly late and I gave him hell for it. I was also a professional and it made me incredibly late on my end. I told him at one point I was going to start billing him for MY time when it was wasted waiting for him to show up. I had a great working relationship with this guy -- he was one of the best medical professionals I'd worked with. (Among other things, when the icing mechanism they gave me after the first surgery was leaking when I started using it at home....and I was by myself.....the doc himself brought me a replacement on his way home, set it up for me, got me extra pillows to raise my foot higher than I had it, etc) Even when I was regularly scheduled in the first appointment of the day at my request, he was often STILL late because he had a number of people scheduled at that time.

He explained to be way back then (early '90s) that he was seeing twice as many people as he had the year before and making the same amount as he had the year before. I can't imagine what he's having to do now!

Those who say cutting payment to doctors isn't directly affecting care and is okay truly have their heads up their asses! I worked in the medical profession for many years and I can tell you for a fact, cutting reimbursement for doctors will cut the number of Medicare/Medicaid patients seen. When I worked in a Chicago hospital, for example, my services were billed at about $150/hour (it changed, but that was the modal cost). Medicaid reimbursed $13/hour! I saw any inpatient who came onto our unit and many inpatients on consult throughout the hospital. But we were severely limited in the number of Medicaid outpatients we saw -- I frequently continued to see patients who'd been hospitalized on our unit after discharge, among others. And I was frequently referred outpatients from other departments -- the hospital limited the number I could take who were covered by Medicaid, which, along with Medicare, formed the bulk of our patient population! I guarantee, increasing Medicare cutbacks would have the same effect.



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Response to tpsbmam (Reply #17)

Fri Jan 6, 2012, 01:17 PM

19. 45 min. in our local ER is billed at 793.00

Medicare reimbursement is 114.00.
We had to pay the difference, because ER is considered outpatient.

Medicare rates to the subscriber are going up, rates to the Drs and hospitals are going down, and less is covered.



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Response to dixiegrrrrl (Original post)

Fri Jan 6, 2012, 03:19 PM

22. Sorry, but I just cannot get all worked up about feeling sorry for someone that averages

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