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Thursday, March 18, 2010

Medicare Cuts and the Reality of Medical Care

The truth about cutting doctors reimbursement from Medicare lies not simply in cutting money from the Federal budget. Not simply in allowing Obamacare to move money from a program for Seniors, into what has become a pork-barreled promissory note to senators and congressmen in a greedy grab for their votes. It's not about cutting doctors' salaries or the money that goes into their pockets. America, you need to wake up and see the big picture far beyond what this entails.
First, most doctors are not getting rich on Medicare money. Sure, some might have huge practices that specialize in the elderly patients and, yes, some might make a good living at it. But, far and large, most doctors do not make a lot of money on Medicare. Why? Because Medicare pays a set rate for everything that a doctor does. And that rate is lower than the "usual and customary" charges for the service. So, even with the patients co-pay, the doctor doesn't make as much as they normally would.
  • Example: Doctor charges $120.00 for a "level 4 (lengthy)" office visit. Medicare allows only $65. Patient co-pay is $15. Total is $80. There is no "Balance Billing" allowed so the doctor is now out $40.

When Medicare reimbursement is cut, does anyone think that insurance reimbursement cuts will be far behind? Since many insurance companies now pay a percentage of Medicare reimbursement, such as $110% or 125%, in the above example the insurance company would either pay $71.50 or $81.25, still leaving the doctor short on payment.

  • Leaping forward, cut those rates by the proposed 21% by the current Obamacare package as a way to jump start their health care reform package, and in the first example, the doctor is now out over an additional $13.00. If you don't think the big insurance companies, who have jacked up the rates on their policyholders, while making billions by their parent companies, will not cut reimbursement rates too, you're sadly mistaken. Because that's just what will happen.

Every year, the big insurance companies make deals with hospitals and large physician groups to accept contracts, to allow them to pay less for their policyholders bills, while the rates increase. Year after year, more and more medical groups and hospitals say NO to the insurers and won't buy into their deals, reducing the policyholders choices of plans and increasing their health care costs. Do you blame the hospital for not accepting ten cents on the dollar for treating the patient? Or is it the insurance company who pockets your premium, raises it every year whether you are ill or not, and still changes your benefits so that it costs you more out of pocket if you do get sick? Not hard where to place the blame here.

Doctors have a hard choice. Many have a large clientele of Medicare patients. But cut their income so much that they can't afford to continue with that type of practice and they say they'll have to stop accepting new Medicare patients or slowly clear their book of Medicare patients altogether. That's a sad commentary on Obamacare when they're telling America how they want to make things better for Americans yet in the process they could be screwing millions at the same time. A group of greedy myopics working with blinders on and hands out in Washington, caring not about the nations' Senior Citizens, or really anyone but themselves and their political future.

Speaking of doctors, has anyone ever figured out how much it costs to actually run an office? Nurses, physician's assistants, medical assistants, receptionists, medical records clerks, an administrator, office equipment, laboratory equipment and supplies, computers, medical equipment, medical supplies, medications, disposables, special sanitation, rent, utilities, paperwork and all the rest? The cost is actually staggering. Some new physicians actually fail to make money during the first several years in practice! Ever notice how many doctors join together as a group? Mostly because they share expenses, or they couldn't survive as a single practitioner? It's expensive!

So if anyone thinks it's a good thing to cut money from the local docs Medicare reimbursement, they need to think of where they might need to go when they have to see a doc when they're on Medicare, Tricare or any other similar product. And, you needn't be old and a "geezer" to be on Medicare either. If you're disabled, you could end up on Medicare in your 20's under Social Security Disability and find you have a long road to health...or to see a doctor too.

And, don't think you're in the clear if you're not on Medicare or a similar program. Because those big insurance companies have you in their cross-hairs too. And their finger is right on the trigger...

1 comment:

chandra said...

This is a world-class write-up on medicare. I see facts like this need to be known by every american. thanks for sharing this with me..

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