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.
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.
"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.
posted by Helen at 5:04 PM
11 Comments:
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.
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.
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
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
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.
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.
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.
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.
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?'
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.
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