Doctors Fleeing Medicare In Texas, Fed Up (Pun Intended)

In 2007 a handful of doctors declined to participate in Medicare.  In the last year over 150 have dropped out, 50 in the first 3 months of this year.

An article posted at the Houston Chronicle (May 17), discusses the impact of falling Medicare reimbursement rates and the corrosive effect of over a decade of uncertainty over the method by which Medicare calculates costs.  42 percentage already don't take medicare (62% among primary care docs).

I've written on this topic before.  As predicted, the number of physicians who will accept new Medicare patients, never very high, is falling.  Patients are beginning to have difficulty finding specialists who will accept them.

Further, some patients who have seen the same doctor for many years, will no longer be able to keep their doctor upon turning 65.  Add this to the list of reasons the President's promise "you can keep your doctor" is not true.

Before there are any explosive comments about "rich doctors who only care about money", it's important to know that the government purposely calculates how much it costs to "break even" delivering health care based on the type of care, or type of visit.  THEN, they decide how much to pay for it by taking a percentage off the top.

To understand this better, consider what it takes to run a medical practice.  There is office rental, supplies, employees (nurse, insurance person, and receptionist), malpractice insurance, licensing fees.  Add all that up and divide by the number of patients who get seen and you have an average cost to take care of the average person.

Say that's $80.00.  The government then takes off 10% and pays the doctor $72.00.  Medicare sees this as a way to control costs.  I'm not an economist, but what I would do under these circumstances is obtain reimbursement ABOVE cost from private insurers to break even.  That's one reason why private insurance costs more (there are a bunch of other reasons)

I would do this until the Medicare reimbursement fell below the level where I could make up the difference, then have to stop taking Medicare.  That's what's occurring.

This oversimplifies everything, and the numbers I gave are just examples, not real. (The principles are correct.)  I would try to cut staff, limit inventory of supplies, streamline paperwork (useless:  the paperwork grows faster than you can slim it down) first.

Even though I'm a doctor myself, my wife and I have been told in the last two months by three of our doctors that it's unlikely they will be able to continue to see us (we have government insurance).

Some have suggested that the states make Medicare participation a requirement of licensure as a doctor.  Massachusetts is already exploring this.  But if you want to make access even worse than it's going to be with the upcoming doctor shortage, this is a good way to do it.

When doctors get together they don't complain about wacky patients (well, a little), or money very much.  They are very reluctant to even get involved in financial issues as a rule.  What they complain about is increasing dissatisfaction with the practice of medicine:  the rising threat of litigation (hey, this is America), the increase in useless paperwork, the rising workload as the shortage of doctors grows (such that you can't spend the time you would like with each patient).

Combine the loss of that feeling of accomplishing something professionally with getting squeezed financially, and you'll see a number of doctors retire early or go into other careers.  This year the residencies in this country didn't fill for the first time in memory.  That's a harbinger of things to come.

And the "rich doctor" stuff.  I read somewhere that physicians make, on average, $184,000.00 a year.  In 30 years I never made that much, so I looked into the calculation.  It doesn't included personal professional costs, which can be as high as $50,000.00 on average.  Many specialists make much more, but guess how much the malpractice insurance premium is for an obstetrician in Chicago?  $180,000.00.  I told that to somebody and they said "that amount of coverage sounds low."  I had to say, "No, no, that's the premium."

There's another alternative for doctors who hate all the stuff that has nothing to do with taking care of people, and I've considered it:  get rid of any property that can be taken in a law suit, cancel the malpractice, let your patients know you're not covered, and take only cash. 

However, I would be insulted to be offered a chicken in payment.  A duck, now...

Doc D