Spokane7
49°
September 5, 2009 in Opinion
Had enough of Medicare
I am a primary care physician, board-certified in family practice. I am a self-employed solo practitioner with a physician’s assistant. I have been practicing medicine in Spokane for 30 years. For the first time I will not renew my contract with Medicare when it expires on Oct. 1. In this time of discussion about health care reform, I feel the public should know how this government system impacts physicians.
The primary problem with Medicare is simply this: Medicare doesn’t pay. Reimbursement for care is 35 to 50 cents on the dollar of charges submitted. This doesn’t cover overhead. It costs more to provide care for a Medicare patient than the reimbursement schedule pays.
Medicare constitutes 20 percent of my schedule, but since Medicare patients are, generally speaking, more complex, it often requires 30 percent of my time.
Medicare payments represent 5 percent of my income, so that means 25 percent of my day I am working for free. This busyness does not mean business is good. My practice population is aging and matriculating into Medicare coverage, threatening the viability of my practice.
I have worked with Medicare for 30 years, feeling I was doing my part. If ever there was such an obligation, it was paid back years ago.
In not renewing my Medicare contract, I am rejecting a faulty insurance system, not the patient. My patients are invited to stay on with the understanding that they will be responsible for their bill, and many have elected to do so. I do understand that many on Medicare do not have an alternative.
Each year I have to decide which insurance companies with whom to participate. Unfortunately, Medicare is no longer a responsible choice.
I have a responsibility to remain viable as a business. I have a responsibility to my family and myself, my staff and their families, my other patients, the owner of the building from whom I rent, the bank from whom I borrow to keep my practice up to date, other health care providers to whom I refer, to laboratories and imaging businesses which I use, and the list goes on. If I fail, many will feel the ripple effect.
There are other problems with Medicare besides their reimbursement schedule.
Medicare is out of touch: Clerks operating from models established by committees who have not seen the patient decide what is covered, how much is covered and for whom it is covered. The physician, who actually sees the patient, is trained to diagnose and prescribe, may be and often is overruled by a clerk.
Medicare is irresponsible and not held accountable: About two years ago Medicare prematurely launched a new computer program that was not ready to handle its own billing requirements. The consequence to my practice was that over $60,000 in charges was not paid for over six months.
Medicare is restrictive: Medicare will not allow patients to submit a bill from a non-contracted physician. This would allow patients to stay with a non-contracted physician and give them a greater choice of physicians.
Medicare is unprofitable: Contracted physicians must accept what Medicare pays as payment in full and cannot bill the patient or a secondary insurance for additional charges that would make it profitable to care for Medicare patients.
Medicare interferes with the doctor-patient relationship: Medicare instructs patients to report physicians they feel may be overbilling. This is an unfair burden on the patient.
Medicare is unfriendly: Medicare threatens fines of $25,000 per incident for any billing infraction as defined by Medicare clerks.
Medicare is arbitrary: Office visits are routinely downgraded to pay less.
Medicare is bureaucratic: I am now required to sign an “opt-out” contract stating that I am not going to sign a contract. I need to repeat this every two years.
I know of no other industry that is as mistreated as the health care industry. Government and military contract winners expect a profit, sometimes even large profits. Only the health care industry, charged with the health of the nation, is expected to subsidize the government.
Most of the physicians I know are generous and serving; that is why they are in health care. The Medicare system has taken advantage of the generosity of the physician for far too long. The current administration claims that physicians are paid too much and proposes to pay even less. This does not inspire confidence that the current administration understands the business of health care. As the business goes so goes the health care. In Spokane, for instance, more physicians are leaving the area than are coming in.
It is time to stop enabling a fundamentally flawed model by participating in it. Like giving alcohol to an alcoholic, it is time to say no – enough is enough.
Dr. Donald F. Condon is a physician in Spokane.
Editorial: Workers’ beer routine undermines public trust 
greyhound2 on September 05 at 8:00 a.m.
A lot of the health care mess is a result of the overcharges, overbilling, inflated medical bills for years by greedy stakeholders who think they should get rich off of sick people. Medicare pays what is customary in an area and doctors are only allowed to overbill by 15%, which they all do. Doctors are famous for not telling you how much something will probably run and then bushwacking you in your mailbox when the final bill arrives and you are stuck.
dkerns on September 05 at 8:07 a.m.
Anyone who thinks that they’re gonna get rich off sick people is in for a major disappointment.
Geyhound2, you are off base; there is no charge allowed over the assignment. The provider must accept what Medicare pays and no more. You won’t be bushwacked in your mailbox.
If your comment reflects your experience with your own physician, you need to find a new one.
Ninch on September 05 at 8:48 a.m.
Great editorial. It is a good parable for how Obamacare will look. BTW: Obama has yet to explain in detail (rather than “promises”) how cutting Medicare by half a trillion $ will work to improve or even maintain Medicare services, especially when so many baby boomers are entering the system.
Note: Medicare reimbursements for the Spokane region are unrealistically low, especially compared to the Florida region.
gmorton on September 05 at 12:38 p.m.
Dr. Condon’s column should be syndicated and printed in every newspaper in the country. It should also be forwarded to every congresscritter.
Not that it would change any of their minds. Most of them have a sizable claque of constituents who believe they have a “right” to health care, and that providers like Dr. Condon are the slaves who must provide it. The congresscritters know that they must deliver that free lunch if they are to retain their offices and thus their power.
Welcome to the post-Constitutional Era and Tocqueville’s nightmare, Doctor.
twogeezers on September 05 at 12:47 p.m.
As a recently registered Medicare patient, I agree, in part, with Dr. Condon’s assessment of Medicare. I especially concur that Medicare committees, clerks, or the like have no business dictating what tests are necessary for a specific diagnosis, or interfering in the medical decisions between doctor and patient.
Dr. Condon neglected to point out, however, that as a retired 65-year-old, regardless of what other private insurance I might have, that I am penalized with a higher Medicare monthly premium (10%) for each year I do not subscribe to Medicare Part B from the time I am eligible. For the reasons outlined by Dr. Condon, I did not want to sign up for Medicare, but the decision was taken out of my hands because of the penalty imposed if I didn’t sign up.
It is too bad Dr. Condon places such an emphasis on the almight dollar when I’m sure he is not living from paycheck to paycheck or on a fixed income as most retirees.
As a personal side note, my husband was a patient of Dr. Condon until now. Dr. Condon complains that Medicare patients take up too much of his time with complex issues. Not so in our case. The most he spent with my husband during office visits for the last 20 years was five minutes on the average and never gave my husband a true physical. We have been amazed at the difference in care and attention now that my husband has a new internist.
I don’t know what the answer is to the healthcare crisis, but I wanted to voice an opinion from a patient’s point of view. It’s not easy for us either.
Hank Greer on September 06 at 7:38 p.m.
Dr Condron said: “The primary problem with Medicare is simply this: Medicare doesn’t pay.”
But the majority of his piece does not address that. Consequently, the tenor of his letter leans towards a rant.
Rather than making use of the available space to present a cogent argument about the “primary problem”, the good doctor goes off on petty tangents to denigrate Medicare. This does nothing more than appeal to people who already agree with him. It diverts attention from—and adds nothing to—the argument he’s trying to make.
And this statement is particularly telling.
“I have worked with Medicare for 30 years, feeling I was doing my part. If ever there was such an obligation, it was paid back years ago.”
It conveys a disturbing sense of entitlement.
According to the claim summaries for my recent emergency room visit to stitch up my box cutter wound, the hospital billed $1188 and TriCare allowed $415. $30 of that is my co-payment. That is a reimbursement rate of 35 percent.
Paying less than the billed amount is not unique to TriCare or Medicare. I have yet to see insurance coverage that pays the billed amount. This is not a recent problem nor is it unique to government run coverage. Five years ago Sacred Heart Hospital threatened to stop accepting Premera Blue Cross because they didn’t pay enough. See http://community.seattletimes.nwsource.com/archive/?date=20040330&slug=premera30m. And this was an issue again just a year ago. See http://www.spokesmanreview.com/breaking/story.asp?ID=16733 and scroll down where it’s mentioned.
Dr Condron is right to be concerned with maintaining a profitable business. But Medicare is not the singular cause of it losing money. And his rant only make me want to hand him a tissue for him to wipe the tears away.