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 stop accepting new Medicare patients, limit the number of Medicare patients they see or simply stop seeing Medicare patients to stay afloat. Some 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.
Ten years ago, I was the second physician (the first was an Internist in Fairbanks ) in the State of Alaska to OPT-OUT of Medicare. Due to large percentage of my practice being Medicare, I was in a situation of either closing down my practice and moving or making changes to my current practice and survive. I sent an open letter to survey all my Medicare patients (approximately 60% of my practice)and those who were close to enrolling and asked for their opinion about the Medicare program and their opinion of what they thought about my decision to OPT-OUT of Medicare. To my surprise 95% of those responding supported my decision to "opt-out" and promised to continue as patients.
Then came the difficult decision of finding that "first" patient who was willing to sign the "first contract" before I could legally opt out. The Feds. have purposefully made it a difficult process for physicians to opt-out. It required certain legalities that were not published and had time constraints and most importantly required that first Medicare Patient to sign a "Private Contract" before I could even submit my application and affidavit to opt-out. I sent a letter to 10 randomly selected 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 was delighted to sign that first contract and was happy to see her physician "liberated" from the woes of Medicare program and it's bureaucracy.
After several thousand dollars in legal fees and much needed 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 care my elderly patients deserved and without the fear of 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 and has made them better patients and consumers who use the system judiously.
Not to say that all were happy, I admit some of my "newer" Medicare patients have left my practice to see another doctor but that percentage is small. Some have left to check out the "greener pastures" in the new Providence Senior Clinic run by Family Practice physician and a Public Health physician 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).
In Dr. Rhyneers Medicare Clinic care is provided by one family practice doctor supported by an ancillary staff of 3 receptionists, 3 nurses, 2 medical assistants, a manager and three billing staff, with a one time financial grant provided by the State and support from a few non-profit foundations. The formula of "success" proposed by this clinic is based on a "one problem -one appointment" scheme that is supposed to generate revenue by over utilization of Medicare.
This revenue generating scheme forces a patient with multiple medical problems to make multiple appointments to get medical care that should have been provided in one visit with one charge. Patients are required to make an appointment for each medication refill and are required to make an appointment if they have a question or a concern. The clinic's "concept" does not allow phone calls to be made to the providers. The end result is generating revenue by over utilization of the burdened , financially run down Medicare Program.
So how is this cost effective for the patient and the entire Medicare Program?
Would this not be considered fraud by over-utilization?
Is there a solution to this Mediare 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 the social programs needed for the increasing number of baby boomers turning 65 and being FORCED into the Medicare Program. The health insurance industry with it's massive lobbying efforts has always taken advantage of the loop holes in Medicare program that is flawed by concept and design. The Medicare program is managed by these insurance companies under the guise of so called third party adminstrators. These TPA's profit by "pushing paper" for the Medicare program and 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" loop hole in Medicare that forces the providers to write off 65% of the billed charges. The secondary insurance does not honor the balance of the bill and pays only (20%) a miniscule amount left after Medicare pays 80% of the "allowable" charge.
The ill informed public is made to believe that the doctors collect the entire balance from their secondary insurance, but the reality hits home when I explain to the few who have asked, and they are surprised or rather shocked to learn how little the actual reimbursement is.
Senator Murkowski has been the first Senator to actually listen to our "woes" and introduce the bill. 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.
It's time for seniors to step up and demand that their employers and their insurance companies honor their contracts of "life long" health care benefits. This bill needs a lot of public support and we all need to do our share. Beleive me, It's not about money, but truth is that the primary care doctors will soon become extinct and then care will be provided by mid levels. Thus over-utilization and unnecessary and expensive referrals to specialists by the mid-levels cause the costs to go up.
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 health 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.
Harbir Makin, MD
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