Many patients are panicked that their physician will stop seeing Medicare patients, and that is not without cause. Physicians that care for Medicare patients do so at a loss to their practice which they can only hope to make up for from other payers. As money gets tighter and tighter, physicians are forced to decide if they can continue to see any patient at a loss.
Although a number of surveys indicate that few Medicare patients (less than 18% nationally) have difficulty finding primary care physicians, much has been written criticizing the methodology of these surveys. A survey in North Carolina in August 2012 revealed that of 200 family physicians called by “mystery shoppers”, only 100 offices indicated they accept new Medicare patients.
Here are 10 reasons why physicians might consider not seeing new Medicare patients, not participating with Medicare or opting completely out of the Medicare program.
#1: Medicare does not pay enough to cover the expenses associated with the services provided.
Physicians are doing everything they can to reduce their expenses while keeping the quality of their care high. No matter what they do, it does not change the fact that the fees Medicare pays physicians – especially primary care physicians – are not enough to cover the overhead of rent, utilities, staff, benefits, malpractice, and technology.
Each year for the past 10 years, physicians have faced the possibility of a cut in their Medicare payments. Prior to the freeze on the accumulated 27% cut slated for 2013, many physicians said they would throw in the towel and opt out of Medicare. Just as physicians breathed a sigh of relief, the sequester kicked in and a 2% cut took affect.
According to a 2013 survey by Deloitte, a quarter of physicians would place new or additional limits on the acceptance of Medicare patients if there were potential payment changes to the Medicare program, such as lower payments or a switch to vouchers (Deloitte 2013 Survey of U.S. Physicians: Physician perspectives about health care reform and the future of the medical profession.)
A July 2012 survey by the Texas Medical Association found only 58% of Texas physicians would accept any new Medicare patients.
#2: Filing Medicare insurance is more complex than any other insurance.
Medicare billing codes and rules are different than the codes and rules that every other payer uses. Due to the lack of standardization physicians must employ qualified staff or purchase sophisticated technology to file Medicare claims. If incorrect codes are used, Medicare may see this as a “red flag” – in other words, an attempt to gain more payment from Medicare.
#3: Medicare does not pay for an annual physical.
Most Medicare patients want a head-to-toe annual visit, but Medicare is geared toward sick care not well care. Medicare did introduce new wellness visits in 2011, but these visits are counseling visits only, and do not include a physical exam. Physicians are stuck between a rock and a hard place as they try to give patient the care they are asking for without having the patient pay 100% out-of-pocket for it.
#4: Medicare patient care often involves taking more time to deal with the same issues.
This includes more time for patients to ambulate, more time to undress and dress, extra time for communication due to hearing issues or memory issues, extra time for blood draws or getting urine samples, and in general more time needed to discuss complex or multiple problems.
The 2013 MedPac Report noted that 20% of Medicare patients age 65 to 74 have 4-5 chronic conditions (Report to Congress: Medicare Payment Policy, March 2013.)
#5: Medicare patients are the least tech-savvy of the patients, so they may not take of advantage of the patient portal.
One of the ways physician practices can offer efficient service and communication is via the patient portal. The patient portal allows physicians to communicate securely with patients about test results and allows patients to receive automated appointment reminders, schedule appointments and request refills or records. This automation can reduce the amount of staff needed to accomplish these important tasks.
#6: Medicare patients often have more emotional needs dealing with end-of-life discussions, loss and depression.
#7: Medicare patients often have adult children in other states who want to call and speak to the physician about their parents condition.
Medicare does not reimburse for phone calls from loved ones.
#8: Regional Medicare carriers (MACs) create their own local rules for Medicare patients in specific states.
This is another level of guidelines and codes to adhere to in addition to having specific rules for Medicare nationally.
#9: Medicare requires physicians to adhere to a number of specific program requirements or lose anywhere from .05% to 2% of their payment.
These include prescribing electronically, reporting quality measures related to patient care, and using an electronic medical record system. These are all good things, but most physician practices are overwhelmed with all the requirements of participation in Medicare.
Why are physicians hanging in there with the Medicare program? Because they care deeply for their patients and find it almost impossible to decide they cannot care for them any longer.
#10: Medicare has 6 – 8 different audit programs in place at any given time looking for fraud and abuse.
Physician offices are kept busy with a constant flow of paperwork in answering audit requests, supplying medical records, and tracking medical record disclosures to adhere to HIPAA, the privacy law. Auditors include:
- Medicare Administrative Contractors (MACs)
- Recovery Auditors (RACs)
- Program Safeguard Contractors
- Zone Program Integrity Contractors (ZPICs)
- Comprehensive Error Rate Testing (CERT) Review Contractor
- Office of Inspector General (OIG) Annual Work Plan
This quote from family physician Su Zan Carpenter, MD, of Texas, who opted out of Medicare almost a year ago says it all:
“Every time you turn around someone has a new rule or a new regulation or a new audit or a new inspection or a new something,” she said. “There’s a point where enough is enough. You need to see the patient, talk to the patient, examine the patient, and actually do something with your patients for your patients. All that stuff is starting to get in the way of practicing medicine and helping people.” (Texas Medical Association website)
Disclosure: We use and believe in Box at Manage My Practice and we are Certified Box Resellers. More information here.
Box, a California cloud file sharing and content management service has announced new partners and investments in the healthcare industry. Makers of software for clinical documentation, care coordination, interoperability and access to care will integrate tightly with Box’s existing platform to make sharing data from their software even easier. The platform partners announced were: EHR DrChrono, dental PM systemUmbie Dentalcare, secure messaging apps TigerText and Medigram, provider social network Doximity, telehealth platform Healthtap, image viewers iMedViewer and iPaxera, record release app Medi-Copy and finally posture analysis app Posture Screen Mobile. In addition to announcing the new platform partners, Box also announced an early-seed investment in DrChrono to help the software make medical data viewable in Box. Box also added former Google Health director Missy Krasner to help their push into healthcare. Krasner sees her work with Box as “picking up where Google Health left off“.
NOTE: CMS has just added additional presentations of the webinar below – please check the end of the article for added dates. MPW
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“Adding to Your Compliance Toolbelt: Fraud Prevention in Your EHR/Clinical Documentation”
Recent changes to the Health Information Portability and Accountability Act (HIPAA) have brought stiffer penalties for fraud prevention, with new levels of enforcement among smaller and independent medical practices. Electronic medical record users should be aware of issues that pertain to electronic documentation compliance, including patient identification and demographic accuracy; and documentation, auditing and authorship integrity. This webinar reviews these and other concepts, including: (more…)
A new report suggests that 2013 may be the year of the great electronic medical records (EMR) vendor switch given that many EMRs are falling short of providers’ expectations.
To come to that conclusion, Black Book Rankings polled roughly 17,000 active EMR adopters – and found that as many as 17 percent may switch out their first-choice EHR by the end of the year.
The reason: In light of Stage 2, provider demands are increasing, and EMR users are reporting that many EMRs arent living up to expectations. In fact, those polled cited numerous cases of software firms underperforming badly enough to lead them to lose market share.
As a result, 31 percent of survey respondents indicated they were “dissatisfied enough” with their EMR to consider switching. Of those users, the reasons cited for the potential switch were as follows: (more…)
The HIMSS13 Conference in New Orleans, one of the biggest gatherings of Health Information Technology professionals of the year, was host to speakers, panel discussions, and one pretty large announcement from some of the big names in the electronic health record industry.
Mary Pat: Your business is called “Health Security Solutions.” People often confuse privacy with security. Can you clear up the confusion for us?
Steve: The Privacy rules refer to the broad requirements to protect the confidentiality of Protected Health Information (PHI) in all its forms. So for example, a physician talking loudly on the phone in the lobby of a restaurant about a patient by name is a violation of the privacy rules. PHI on paper records is covered under the privacy rules.
The security rules are specifically concerned about protecting the confidentiality (i.e. privacy), integrity and availability of electronic PHI, or PHI that exists in a digital form. So once you are dealing with electronic health records and information systems, violations tend to fall under the security rules. (more…)
If you read my alert from August or the followup article on Audit Red Flags to Avoid, you are aware that CMS hired an accounting firm, Figliozzi & Company, to audit the compliance of eligible providers and eligible hospitals that had already received payment under the meaningful use (MU) program. According to a report from the GAO as many as 20% of eligible providers and 10% of eligible hospitals may be audited, on a post-payment basis to confirm that they actually met the requirements of the program.
I recently had the opportunity to interview a physician that is currently going through the audit process with Figliozzi & Company (an edited transcript of the interview can be found here). Although he wishes to remain anonymous, he was willing to report on his experience and provide redacted copies of the correspondence and requests that he has received from the auditors. (more…)
Too often in the rush to upgrade to the newest technology, one basic question that goes unanswered is: “Why are we doing this?”
Because of the ARRA (or “stimulus”) money available to eligible providers, a lot of offices have started or have accelerated plans to upgrade from paper medical records to an electronic medical record (EMR.)
Technology upgrades are not always an easy sell to two of your practice’s critical constituencies: your patients and your staff. I came across this infographic last month from HealthIT.gov that does a great job explaining why practices and the Federal Government are both investing in Electronic Health Record Technology. Content like this also makes a great contribution to your practice blog or email newsletter. Don’t overlook it as part of an in-office announcement of your practice’s transition to EMR. Check it out below or follow this link to healthit.gov.