Here are some links to some of the latest news stories coming from the 21% Medicare pay cot to doctors.  Currently, there is a 10-day hold on Medicare’s payments to doctors offices. 

There are fewer and fewer primary care doctors in practice.  I remember there being a big story a few years ago form the Press Democrat talking about the crisis in Petaluma of the shrinking numbers of primary care, general physicians. 

Now, there is a lot of talk that more doctors are starting to retire prematurely because it just doesn’t make business sense to stay in practice. There is too much overhead in a doctor’s office.   Costs are rising, while income is shrinking.  Doctors in private practice wear two hats; they are business people at the same time that they are healers.  Without one, you can’t have the other.  The only choices that they have now are to retire or to go work for a hospital.  This all depends on their age and financial standing.

We are still accepting Medicare patients for chiropractic care. Even though Medicare only pays for the adjustment, and does not pay for examinations or other adjunctive procedures, we still accept it. There are some things that you have to pay out of pocket for, including the examination and extremity manipulation.  Fortunately, both of these remain affordable in my office. 

Check out the links to the articles after the break

Todd Lloyd, DC
Sonoma doctor of chiropractic

http://www.tennessean.com/article/20100301/BUSINESS01/3010332/2047/business

Uncertainty about reimbursements from payers, including Medicare and private insurers, is a lingering issue for many doctors. They face a 21 percent overall cut in Medicare reimbursements that becomes effective today. It could still be averted by a monthlong stay that the U.S. House passed on Thursday; action is pending in the Senate. Many doctors, meanwhile, are holding out hope for a "permanent fix" to how physicians are paid.

In the interim, more doctor practices are considering not accepting new Medicare patients. Many other doctors are seeking employment at hospitals. And others are focusing more on patients who pay out of pocket and ending ties with insurers that cut rates.

http://www.ama-assn.org/ama/pub/health-system-reform/physicians-sgr-medicare-cut.shtml

“The Senate had over a year to repeal the flawed formula that causes the annual payment cut and instead they abandoned America’s seniors, making them collateral damage to their procedural games,” said AMA President J. James Rohack, M.D.  “Physicians are outraged because the cut, combined with the continued instability in the system, will force them to make difficult practice changes including limiting the number of Medicare patients they can treat.”

Physicians from across the nation are in Washington, D.C. this week for the AMA’s National Advocacy Conference and will meet directly with their senators to tell them it is urgent that they permanently repeal the flawed Medicare physician payment formula and replace it with one that reflects the increased cost of caring for patients. 

“The AMA is hearing directly from physicians, and seniors should be very concerned about how the Senate’s inaction will impact their ability to see a doctor,” said Dr. Rohack. “Military families are also hurt as TRICARE ties its payment rates to Medicare.”

Messages to AMA from practicing physicians about today’s 21 percent cut include the following letters in their own words:

“As a practicing psychiatrist in D.C. for over 35 years I have always treated Medicare patients for the Medicare fee, which is already way below the standard fee for my services. I felt this was an obligation to take care of senior citizens.  At this point unless this 21 percent reduction in fee is repealed I will have to abandon seeing Medicare patients. I will have to do this with a heavy heart as I will not be able to maintain my practice at these rates.  Given the expenses of maintaining a practice where all costs escalate every year — malpractice, licensure, CME credits, rents, administrative fees, etc — it no longer becomes feasible to sustain the practice.” —Psychiatrist, Washington, D.C.

“The sad truth is that we will no longer be able to see Medicare patients who come to establish care with our group.  We won’t fire our existing patients I hope.  The alternative is to close the doors.  To say that this is discouraging is an understatement.  I went into medicine with the ideals of serving my patients with a covenant to provide the highest quality care.  I can’t do this with the cruel cynical actions of our Congress.  I am ashamed of our system.  I most likely will quit the practice of medicine.” —Primary Care, Duluth, Minn.

“We are now forced to cease seeing new Medicare patients and may have to opt out altogether. This will be a devastating turn of events for us and our community.” —Urologist, Chatanooga, Tenn.

“I plan to retire as soon as possible if the Medicare cuts go through.  Most of my patients will be unable to find another competent psychiatrist who takes Medicare.  I am the only one of my colleagues who takes Medicare now.” —Psychiatrist, New York and Pennsylvania

“These cuts are forcing me to limit the number of Medicare patients I will see. As a private practitioner, all of my expenses are going up including the rent, utilities, malpractice, employee salaries, etc. I want to continue to provide good care to my patients, but if I have to increase the number of patients I see, work longer hours, get less sleep, reduce time with my family, reduce my required medical supplies, etc., continuing to take Medicare will only make it impossible for me to do so in these tough economic times. I will not be the only physician making this tough decision. In reality these cuts will reduce the quality of care to the elderly and increase healthcare costs as the access to preventive care decreases, thus increasing the emergency room visits, intensive care visits, emergency surgical operations and poor medical outcomes. These cuts are a slap in the face to the elderly whom have worked hard and paid into the system that is now turning its back on them when they need it most." —Ob-Gyn, Baton Rouge, La.

“I am not sure which is more disruptive; the constant uncertainty each year regarding the SGR, the actual 21 percent cut, or the payment freezes that are now seemingly routine.  One thing is for sure.  My office will attempt to minimize our exposure to the now-politicized Medicare program.  Starting now, we will limit the number of new Medicare patients to 3 per week per provider (down from about 7), and limit surgeries to emergent cases on our existing Medicare patients.” —Urology, Cadillac, Mich.

“The government continues to encourage the use of EMR’s. However, these systems are extremely costly to maintain. These cuts are making it impossible to pay for expensive EMR systems, and we are considering going back to paper charts.” —Family Physician, Muncie, Ind.

The “Doc Fix” for Medicare Fees: Déjà vu All Over Again…but Worse?

As you can imagine, a 21% cut in Medicare physician fees would likely result in limited access for seniors and veterans.  Reports already highlight that doctors will be forced to drop or delay seeing their Medicare patients until they know what will happen.  Although many physicians ‘participate’ in Medicare, it is unknown how many may be limiting the number of Medicare patients they would see.  Since Medicare is the largest payer, it is likely that other insurers will follow suit and cut physician fees.  Lastly, all the money and time that goes into the short term patches have left physicians tired, uncertain of the future and with little faith in the legislative process.  We need to fix this so we can move onto other pressing issues in healthcare.

Medicare Pay Cuts to Doctors: The Latest Patch

I can’t believe it’s actually going to happen. Well I guess that it is time for us all to stop accepting medicare and charge cash for our services. We should also have a 21% cut is social security payments so that all of those medicare recipients who support the cuts can feel our pain. Then we’ll really be in this together. Let’s give it all to big pharma!!! They’re the only people who get paid for anything. Call Merk when you have chest pain.

Medicare Doctors May Limit Patients as Fee Cuts Loom

The Mayo Clinic, praised by Obama as a national model for efficient health care, said it would stop taking Medicare patients at its primary-care clinic in Glendale, Arizona, starting Jan. 1, saying the U.S. government pays too little.