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“.
I have been on the management side of the healthcare industry for more than twenty-five years, so I know how heath insurance works and how it is sold. Many times in my career I have been the administrator entrusted with evaluating health insurance for the entire practice. So when my husband and I recently found ourselves in the market for coverage I was confident about navigating the market, even though this would be the first time we had ever funded our own premiums 100%. The process was pretty eye-opening.
To get our readers ready for National Nurses Week, we wanted to share a great new video from the Robert Wood Johnson Foundation that asks the question “What is a Nurse?”
The traditional view of the nurse as direct caregiver and bedside attendant to patients is really a limited view of the expansive and critical role nurses play in our healthcare system. As more and more change arrives in our system, nurses have taken on a myriad of other roles in the care process: research, community outreach, education, counseling – all of these represent departures from a “stereotypical” view of the role of nursing, and the video highlights the growth in these and other areas.
At Manage My Practice, we would like to thank all of our readers in nursing for delivering quality patient care in so many of our healthcare settings. Happy National Nurses day on May 6th, 2013!
NOTE: CMS has just added additional presentations of the webinar below – please check the end of the article for added dates. MPW
What is PQRS?
Staying with the theme of practice models for independent physicians, here’s an interview with Samir Qamar, MD of MedLion.
Mary Pat: You are the Founder and Chief Executive Officer of MedLion, as well as a practicing Family Physician. Tell us your story.
Dr. Qamar: I grew up around the world the son of a UN diplomat, with a lot of time spent in Europe (including medical school). Growing up, I always wondered why most Europeans never needed insurance for basic medical care. I also learned a lot about the pros and cons of government-run health systems.
At Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, doctors are saving time and sharing ideas using Box, a file-sharing and collaboration software that lets providers browse available medical documents and communicate with each other about treatment options. We are big believers in Box at Manage My Practice – we use it, and most of our clients end up using it too. Box is the only HIPAA-compliant file storage and collaboration service, and just like the doctors at Wake Forest, it makes our lives easier countless times a day. Wake Forest uses Box to store all of their medical journals and articles, as well as commenting on each file so that physicians can discussproceduresand treatment options. The doctors can access the repository from their tablets and smartphones, so that accessing detailed disease or treatment information is always as close as their mobile device.
Box is a simple and secure solution for sharing content with your coworkers, customers and audience. If you have moved your organizations’s practice management, electronic health record or email service to “the cloud” then it only makes sense to move your paperwork and content out of boxes and storage and into the cloud as well. If you have are using email attachments, a network drive, FTP server, or a non-compliant solution like Dropbox, then switching to Box can help your practice reduce your liability, stay HIPAA compliant, and store all of your digital content in a secure and accessible manner.
Box also makes mobilizing your workforce across locations easy. Box means your content is always available in a web browser, a phone or tablet, or synced on your desktop. Many of our consulting clients also use it to coordinate work and file across locations. If you have outsourced your billing or human resources, a shared folder in Box allows both locations to have the latest information and stay in touch.
Manage My Practice is a Certified Box Reseller, and would love to help you leverage Box to improve your practice’s workflow.
This is no April Fool’s Joke for medical practices and providers: starting Monday, April 1st, we will face a 2% cut in reimbursement for services due to the “sequester.” The sequester is the other half of the “fiscal cliff” that we reported on back in January. Although not too long ago, all the conventional wisdom was dead set against the government “going over the cliff,” and here we are with both automatic tax hikes and spending cuts now a reality.
Managers might find themselves giving the same explanations about gridlock to the doctors that you gave your employees when their first paycheck of 2013 was lower than usual.
Although the cut is only 2%, it comes entirely from the 80% of the allowable that the government reimburses, as opposed to the 20% patient responsibility. The cut does not affect the Medicare patient’s co-insurance, not does it affect the 2013 Medicare Part B deductible.
To give medical practice managers an idea of what that cut will look like, here are some sample numbers.
Most readers know that I have a special interest in helping physician practices survive and thrive, and have been writing recently about different models of care that physicians are adopting to make private practice financially viable. Here’s an interview with Scott Borden of Direct Care Consulting, who helps practices convert to a Direct Pay Model. ~ Mary Pat Whaley
Mary Pat: What is your background, Scott?
Scott: I am a passionate Health Savings Account (HSA) expert. My background has been in health insurance marketing and management for 23 years. I have been heavily involved with Consumer Driven Healthcare for the past 15 years. I have been both a talk radio show host and guest on hundreds of shows over the past 8 years. I have also been featured on several television broadcasts and been a guest speaker for dozens of organizations.
Mary Pat: Your company is calledDirect Pay Consulting and you help primary care practices transition to a Direct Payment Care (DPC) model – will you explain what that model is? (more…)