Medicare Cuts

Few Americans would support major cuts to Medicare Program to reduce the federal deficit, but many would like to see the increasingly unpopular health care program to improve the accessibility to quality medical care.

The Medicare program with it's extreme dictatorship style bureaucracy, steadily declining reimbursement and flawed reimbursement formula has become a major issue for physicians, particularly the primary care physicians across the Nation to keep their doors open. This has forced a large number of primary care physicians to either stop accepting new Medicare patients, limit the number of Medicare patients they will see or simply stop seeing Medicare patients to stay afloat.

The fearless few have boldly "OPTED-OUT" of the Medicare Program with the risk of losing a good percentage of their patients to mid-level practitioner's such as the nurse practitioners or the physician assistants who are not trained to make complex diagnosis and provide comprehensive care to this group of patients who by virtue of their age suffer from multi-organ disease.

I was the second physician (the first was an Internist in Fairbanks ) in the State of Alaska to OPT-OUT of Medicare about 10 years ago. Due to large percentage of my practice being Medicare, I was in a situation of either closing down my practice and moving or make changes to my current practice to survive. I sent an open letter to survey all my current Medicare patients (approximately 60% of my practice and those who were close to retirement asking for their opinion about the Medicare program and asked their opinion if they would honor my decision to OPT-OUT.  I was worried about retaliation from the community, the Medicare Program and my colleagues. To my surprise 95% of those responding solemnly supported my decision to "opt-out" and promised to continue as patients. 

Then came the tough decision of  finding that first patient who was willing to sign the first contract before I could opt out.   The Feds. have purposefully made it a difficult process for physicians to opt-out.  It required legalities that were not published and had time constraints and most importantly required one Medicare Patient to sign a "Private Contract" before I could submit my affidavit with Medicare to opt-out.  I sent a random letter to 10 patients asking for a volunteer and to my surprise eight showed up the following week to sign up.  A kind lady, who has since passed away was delighted to sign the first contract and was so happy to see her physician "liberated" from the woes of Medicare and it's bureaucracy. 

After several thousand dollars in legal fees and moral support of my wife, friends, patients, employees and an attorney friend I launched into the era of  "OPT-OUT" medicine to provide the best of care my elderly patients deserved without the fear Medicare bureaucracy and dictatorship. I have always been an advocate for my patients and that is what won my battle against Medicare Bureaucracy.   There has been no turning back, my patients no longer feel like "second class citizens" the Medicare Program made them feel.  On the other hand it has made them better patients and consumers.

I admit some of my "newer" Medicare patients have sporadically left my practice to see another doctor and that percentage is minute. Some have left to check the "greener pasture" in the new Providence Senior Clinic run by one Family Doctor, a Public Health Doctor and a band of mid level practitioners and a handful have migrated to Dr. George Rhyneer's Medicare Clinic run by the Alaska Physicians and Surgeons (APS) where care is provided by one family practice doctor supported by a large ancillary staff of 3 receptionists, 3 nurses, 2 medical assistants, a manager and three billing staff, with financial support from the State and a few foundations.  

The formula to "success" proposed by this clinic is based on  "one problem - one appointment" concept that is supposed to generate revenue by over utilization.   This concept leads to a patient with multiple medical problems to make multiple appointments for medical care that should have been and could have been provided in one visit and one charge.  Patients are required to make an appointment to get medication refills and are required to make an appointment if they have a concern as the clinic "concept" does not allow phone calls or advise over the phone.  The end result is generating revenue by over utilization.  So how is this cost effective for the patient and the entire Medicare Program?  This is just another way of circumventing the flawed reimbursement formula and the whole Medicare Program.

Is there a solution to this problem?

While policing the entire world and spending trillions of dollars fighting global wars, the Federal Government will never have enough money to provide for the health care and social programs for the increasing number of baby boomers who are turning 65 and being FORCED into the Medicare Program.

The health insurance industry with its massive lobbying efforts has always taken advantage of the way Medicare program was designed. The Medicare program is managed by the so called third party adminstrators who profit by "pushing paper" for the Medicare program. 35 % of health care dollars are spent on adminstrative "paper pushing". 

Congratulations to Alaska Senator Lisa Murkowski, for taking the bold step of being the first Senator to introduce the bill for "balance billing". The insurance companies have for decades taken advantage of the "no balance billing" provision in Medicare. The doctors are forced to write off 65% of the billed charges. The secondary insurance does not honor the balance of the bill and pays only (20%) a minute amount left after Medicare has paid 80% of the "allowable" charge. Most think that doctors collect the entire balance from their secondary insurance, but when I explain to the few who have asked, they are surprised or rather shocked to hear how low the actual reimbursement is. Senator Murkowski has been the first Senator to actually listen to our "woes". If her bill goes through (it's a uphill battle against a big insurance industry lobby) the balance of the bill will have to be paid by the secondary insurance that majority of seniors do have from having paid into their employers health palns their entire lives, or the pateints would be empowered to negotiate that with the physician.

 It's time for seniors to step up and tell their employers to honor their contracts of "life long" health benefits that they were promised.  This bill needs a lot of public support and we all need to do our share. Beleive me, It's not all about money, but truth is that the primary care doctors will soon be forced to take the shingle down and care will be provided by mid levels.

Finally comes the million dollar (or a trillion dollar !) question:   Is the American public willing to accept Medicare Cuts proposed by the Obama White House?

The latest tracking survey on healthcarerovide comprehensive care issues by the Kaiser Family Foundation found that the public is more willing to accept Medicare spending cuts if done to shore up the elderly healthcare program rather than for deficit reduction or avoiding tax increases. Congressional Republicans want cuts to Medicare and other health and welfare programs as part of a deficit-reduction package they say is needed to secure their support for an increase in the $14.3 trillion debt limit. Democrats balk at including Medicare cuts as long as Republicans refuse to accept revenue increases. Both parties balk as the 2012 elections fast approach. Does the Tea party have a clue?  

The Kaiser survey found that the public's willingness to accept Medicare spending cuts varied with how the savings would be used. Thirty-two percent of those polled said they would back major cuts if the money was used to prevent Medicare from going bankrupt, 42% said they would accept minor changes to keep the program solvent, while 21% said they would support no program reductions for that purpose.

When asked about Medicare cuts to reduce the federal deficit, 18% said they would back major cuts, while 45% said they would be okay with minor cuts. Thirty-three percent said they oppose any Medicare spending cuts for deficit reduction, the survey said.

A similar number, 32%, said they don't support cutting Medicare to avoid tax increases. Forty-three percent said they would be okay with minor cuts, while 20% said they backed major Medicare cuts to avoid tax increases.

When it came to avoiding tax increases for the wealthy, 40% said they would not back Medicare cuts. Thirty-three percent said they would support minor Medicare spending reductions, while 21% said they were okay with major Medicare spending cuts to avoid raising taxes on the wealthy.

Overall, the survey found that the public prefers spending cuts over tax increases as the main approach to deficit reduction.

Kaiser said the survey of 1,203 adults was conducted June 9 through June 14 and has a sampling error of plus or minus 3 percentage points.