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Monday, October 14, 2019  Spokane, Washington  Est. May 19, 1883
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Opinion

Had enough of Medicare

By Dr. Donald F. Condon Special to The Spokesman-Review

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.
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