Friday, December 16, 2005

It's not Worth the Hassle

The American Medical Association is concerned about a proposed pay cut in Medicare reimbursements but some doctors say it's not about the money.

"Surveys conducted by AAPS show many physicians ALREADY refuse new Medicare patients. In fact, about 33 percent. But even more alarming is that 40 percent already restrict services the services they'll perform to current Medicare patients. (See Disheartened Doctors, Patient Problems: AAPS Biannual Survey of Physicians on Medicare and Patients' Access to Care, Journal of American Physicians & Surgeons, Winter 2004.)

"But here's what you need to know: the reason they do so is NOT because of money. When asked, it's the government 'hassle factor.' The two leading reasons given were 'billing and regulatory requirements, and hassles and/or threats from Medicare carriers/government.' Payment rates were down the list.

"So it's really about FREEDOM, not the money.


Having dealt with Medicare and Medicaid frequently in my practice, I can vouch for how these doctors feel. The red tape is great and there is always a nagging threat that you will be accused unfairly of doing something wrong after an audit or investigation with a government bureaucracy. It is easier not to deal with the hassle of Medicare or Medicaid which means I either work pro bono at times or take on very few clients with these means of payment.

Update: The Medical Blog Network has more thoughts on Autonomy for Doctors and Patients.

26 Comments:

Anonymous Bruce Small said...

I don't blame the doctors. I have a successful business, and I won't accept any contract involving the government because of the inane hassles involved. I'd much rather deal with private enterprise, where we can negotiate and promtly solve any problems. And get paid promptly.

You can't do that with government contracts, where there is a long list of rules and common sense is never allowed to intrude.

7:07 PM, December 16, 2005  
Blogger Helen said...

bruce,

I agree. People seem to think that doctors aren't entitled to a free enterprise and that they are somehow a public commodity. Yes, some doctors make a lot of money but it seems to me to come at a price--long hours, high stress at times etc. and the freedom is less and less.

As a psychologist, it seems even worse at times, people think you are there to "do good in the world" and forget that you have to make a living. I am now down to working part time--partly because there was too much regulation and it was too hard to fight to get paid.

7:19 PM, December 16, 2005  
Anonymous Hippocrates said...

It is refreshing to see AAPS take a more intelligent position than AMA. Of course, something still has to be done about Medicare, but the priority should be cutting the red tape: Let the Freedom Ring: Doctors and Patients Deserve More Autonomy

7:41 PM, December 16, 2005  
Anonymous Anonymous said...

My father-in-law is a dermatologist in a private practice in a mid-sized town. Several years ago he stopped taking Medicare/Medicaid patients. He said it was because he didn't have time to do the paperwork and deal with the hassles. The paperwork for regular insurance eats up enough of his time, and he only has enough revenue to pay for one employee. I've never heard him mention the money factor even tangentially. Although if you think about it, the time he would waste on Medicare paperwork would be time he couldn't see patients; so he would essentially lose money.
BTW, great blog!
Beckster

9:20 PM, December 16, 2005  
Blogger dadvocate said...

Medicare and Medicaid regulations drive up the cost of medical care. I worked a short stint as social service director at a nursing home. The rate Medicaid and Medicare would pay was based on some sort of formula using regional income, costs, etc. which the government computed.

The regulations required that no one, even those not paying thru Medicaid or Medicare, be charges less that what M/M paid. The nursing home would have accepted private pay patients for less because of less paperwork, fewer hassles, etc. but couldn't.

I would be willing to bet there are similiar situations in many areas of health care.

11:01 PM, December 16, 2005  
Blogger Assistant Village Idiot said...

You aint seen nuthin' yet. Wait until you see what Medicare D is like. I've been following it for weeks and still can't understand it.

12:25 AM, December 17, 2005  
Blogger Nancy said...

On the patient side, my parents cared for both sets of grandparents through their old age until death. Dad hassled through all their Medicare paperwork and was delighted to have HMO NY Life in his sixties, but during the nineties, some law got passed as to require HMO's to drop their rates for subscribers. NY Life and indeed all HMO's could no longer afford the Houston area and pulled up stakes.

Mom and Dad are hassling through their seventies with Medicare.

9:58 AM, December 17, 2005  
Blogger Assistant Village Idiot said...

The well-intentioned laws surrounding insurers, mandating that they cover conditions in certain ways, has amounted to a declaration by the government that everyone buying a car must buy a Mercedes.

12:16 PM, December 17, 2005  
Blogger a psychiatrist who learned from veterans said...

Medicaid makes some inane contradoctor decisions ocasionally, mostly contrapatients and public, which it is easier, as a doc, to take philosophically. Society is giving people play money here. I am sure Milton Friedman has something brilliant to say about it other than 'Shut up and spend China's money.' Probably taking a more statistical approach to their pricing requiremnets to meet the problem highlighted by dadvocate above would help unbind the market. The nice thing with Medicare is you don't have to play a game of 'who's hiding the authorization?'

8:11 AM, December 18, 2005  
Blogger sass said...

When my son became eighteen years old, his father dropped his health insurance. He'd lost his job and even though he is a RN, he refuses to honor our divorce agreement and insure our son until he reaches 21. Brian needs medical interventions every week, and since I am on Medicare disability I am unable to help him with group coverage. He received Medicaid, and I thank God for it. He is very fortunate that we live in NYC and can attend first rate Dermatology clinics.
I hate how the government makes these unreasonable paper work demands on doctors, causing them to leave the system, when they might have stayed and helped my son combat his Lithium induced acne in one hour, instead his having to wait for upwards 4-5 hours per clinic day. In one year he will have Medicare and then perhaps I can help him find a dermatologist....I hope.

11:23 PM, August 05, 2006  
Blogger Graham Strouse said...

Isn't it nice to have an issue where we can excoriate the democrats AND the republicans?

Let's see...

Who goes first against the wall? Hillary? Newt? Coin flip, anyone?

I've had a miserable experience with medicaid. And the hell of it is I don't have much choice but to ride it out until I can find a smart angle for getting out.

It's basically a RICO deal. Racketeering. I suffer from severe chronic fatigue & anhedonic depression, a consequence of many things, not the least of which was working too many hours at combinations of mind-numbing and nerve-wracking jobs (sometimes both at once, for flavor), too much shift work, too much isolation, too much trust in psychatrists back in the early '90s. And then I had testicular cancer surgery the day after a woman I loved very much killed herself. Lost another friend to cancer within six weeks, watched his wife, who I'd been close to since college, go crazy. And my 18-year-old cat died. I omit other bits because it would put a strain on relations with family members upon whom I am still unfortunately dependent.

The Country Song From Hell.

So I've got maybe $650 worth of drugs and I need to get checked regular for tumor remission. I can't afford to go off medicaid.

And medicaid won't let me work. That is to say that every over-the-table dollar I make is subtracted from the 215 bucks a month the state "loans" me against future disability payments. When this hits zero, I lose coverage.

And trust me, 33-year-old out of work journalists with too much education & spotty resumes don't have a lot of opportunities.

And the people who determine where I live (presently my family) have left me in an area with nada in the way of work opportunity.

It's prison with the disadvantage of less career networking (with other criminals) & the advantage of being able to take a shower or go to the laundry without a shiv handy.

True, in PA, there is a program that one can use to skim around some of this, but in the SE PA suburbs, in a sector where the economy is collapsing, where the only work available is either occuppied by kids and old people and second-income women who pull down incomes and reduce the likelihood of benefits, this is small comfort.

I'm even effectively restricted from going back to school. I'm even limited in the amount of student loans I can take out. Tuition is okay. But books, room & board--you're on your own.

Philly has tons of universities and colleges. Driving into Philly is expensive. Taking the train into Philly is expensive.

It's basically a scam designed to force sick people into the welfare trap.

Do I look sick? Not really. I work hard at keeping myself stapled together. But I tire quickly and unexpectedly and some days I just have to stay in bed. I have bad ankles and worse knees from my more athletic days. I'm very strong, but clumsy, and at 33 with chronic fatigue, shift work and manual labor aren't realistic options unless I want to dope myself to the gills with pain pills and prescription speed.

So I sit, rot, try to find a smart angle, try to keep myseld stapled together & wait.

Because if I don't, I've suddenly got $20k or so worth of doctor and medication bills to deal with each year in an area where, working full-time, third shift, at a convenience store, I might make $15k.

And that's what's available.

It's a bad system for everybody. The welfare bureacracy is necessary, but we don't need so bloody much of it. It should be a lateral, not a hierarchal system. Social service agents need more authority and more responsibility. In my experience, the brightest and most dedicated social servants work at the bottom. They've been conditioned against initiative by stupid superiors with stupid books of rules.

Pay them a little more money, fire their superiors & let them do their bloody jobs.

People will actually get help & the taxbase won't be hit as hard.

Same with doctors. Most young doctors go into the profession for the right reasons. It's hard. They expect that.

What they shouldn't have to deal with are situations where residents are routinely humiliated & bullied by their overseers in front of prospective patients who, every so often, just might--it does happen--call the department chair to lay down compaints against the attending physician...not just because the attending physician was an evil, pompous, moral-free ass, but because he humiliated his own resident in front of a patient who he then refused to deal with for undisclosed reasons.

University of Pennsylvania Medical School folks.

And they've done worse. Believe me.

Everyone despises Big Pharma, except the morally leprous MDs they've purchased. Everyone despises the insurance companies, the HMOs, who collectively drive up costs for doctors and patients and steal time, money & lives that they might make some more easy dollars and create more layers of dubious bureacracy, thus further cluttering a system which has managed to take on all the worst aspects of American capitalism and Soviet communism. We've created a huge bureacracy, privatized it & essentially rolled ourselves back into a medieval economy where nobles rule, make the rules, and chew up serfs.

And some of these serfs make SIX FIGURES!!!!

And yes, I do sympathize with them.

I really do.

I have strong negative feelings about bureacrats which I suspect could be allevatiated with a very large catapult, or perhaps a magnetic rail gun & hollow projectiles designed to accomodate one or more of the aforementioned bureacratic scoundrels.

That would be therapeutic.

Not practical, maybe, but it would make me feel better.

How about y'all?

Load the vache!

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