Why don’t more doctors take Medicare/Medicaid?
That’s the question I get frequently in my office. Most people think it’s the reimbursement doctors get from Medicare/Medicaid. That might be a part of it, but the answer really, and truly, is that it’s such a bureaucratic tar pit that doctors get frustrated that they can’t even get the medications the patient needs. Or the tests. Or even the follow up visits. Next time you visit your family physician, look on the wall of your room. You will see a sign that says many tests aren’t covered for Medicare, even if your doctor deems them necessary. So, they even admit some bean-counting bureaucrat is making the financial decisions for your health care.
Believe it or not, I don’t know a single physician who is in this business for the money. We are doing what God has called us to do. We want to serve humanity the best we can. Let’s look at some facts about the economics of becoming a physician. First, you have to be in the top 1% of your class, and from a reputable undergraduate school. That’s easily $60,000, and more likely $130,000. And then you have to get through medical school. DMU, in Des Moines, charges somewhere around $40,000 per year. So you’re talking an additional $160,000, for a grand total of $290,000. On top of that, after graduation, you get another four years (at least) of residency training, during which time the physician is accruing interest at the rate of somewhere around 8%, which means an additional $23,000 per year in interest, for a grand total of $382,000. That’s a lot of med checks. (For those of you that are going to say that the official figures are far less, the official figures are for PUBLIC medical schools. Most physicians are privately trained.)
Keep in mind that residents don’t work simple 40 hour work weeks. Often, 80 hours is the rule, and some residencies use the selling point of you are only limited to working only 80 hours. And residents only get two weeks of vacation a year. Altogether, that means the average physician has had over 19,000 hours of patient care by the time he graduated residency. If a person borrowed $400,000, and spent 19,000 hours on his business, how much more money do you think he’d have? Don’t you think his business would be booming and he’d have become a millionaire?
So money isn’t the issue. Not for the physician anyway. The issue comes down to being thwarted at EVERY turn to provide the necessary care for your patient. Of course, if the physician fibs to get the tests or medicines for his patients, then he can be guilty of fraud. All the doc is doing is trying to get his patient better. But he puts himself at risk if he does. And if he doesn’t, his patient suffers. He’s in a no-win situation.
Then the government demands and regulates what he can do when it comes to Medicare/Medicaid. He/she has to fill out reams of papers just to bill what little money he can get. And now Pres. Obama has said that he expects all facilities to have electronic medical records (EMR) for all providers by 2011. If you don’t have EMR by then, you’ll have your Medicare/Medicaid reimbursement reduced. For my office, a small one man operation, that expense is easily $32,000 when you add in the new billing software, scheduling, security, and oh, yeah, the EMR. Then you have additional expenses related to hardware upgrades and monthly service fees for the EMR. The totals I have been quoted are anywhere from $32,000 for all of that, with a monthly maintenance fee of $100, to $48,000 with $180 monthly service fee. FOR ONE DOCTOR. Those of you familiar with my practice, I also have several therapists working with me. The rates SKYROCKET for having “multiple providers”. Multiply that nationwide, and you can see why healthcare expenses are out of control. (EMR’s for the average hospital ranges from a low of $20,000,000 to $100,000,000. There are 5000 hospitals in the US.)
If Wall Street had been regulated like physicians are, there would have been no economic meltdown. But physicians aren’t capable of pushing billions into the hands of Pres. Obama, or Bush, or McCain, or Clinton(s). So you see where we rank.
But denying services is the primary way Medicare/Medicaid contain costs. So it costs the physician time he doesn’t have to fight his way through the red tape bean-counters, and the less time he has to see patients, the less money he can make, and the less money he makes because of the bureaucratic bean-counters, the more frustrated and angry he becomes, and when he’s finally had enough, he/she says goodbye to the system that has systematically raped him and his patients. The best part of this, though, is he MUST be a Medicare/Medicaid provider to be able to hospitalize patients. That’s why I don’t have a hospital practice anymore. It cost me more to drive to the hospital, than I got reimbursed. Medicare still owes me over $30,000. (That’s 2045 med checks, reimbursed at Medicare rates, which are $14.75 per med check.)
And, as if that weren’t bad enough, Iowa physicians are at the bottom of the reimbursement scale. That’s right. We’re ranked 50th as far as money we get to see a patient. So what has anyone done about it? Sen. Grassley did the most. As Chairman of the Senate Finance Committee, he introduced legislation and held meetings. Then when the Democrats took over, nothing. Nothing from Sen. Harkin, or the 3rd district Representative, Leonard Boswell. And now that their party is in COMPLETE power, guess what they are doing? Nothing.
The Wall Street Journal has a very good article on this issue, and it’s posted in my lobby. (I’ll post the link when I can find the article online again.) People skip right over it and go to Redbook, and then complain when we tell them we don’t accept Medicare, and ask us why.
My final story about this should make everyone sit up and shout, “NO FREEKING WAY WE NEED SOCIALIZED MEDICINE!!”
About two years ago, my mom was in Florida, and I was collecting her mail. She received a notice from Medicare that they were going to raise the rates for her by 10%. Of course, AARP and everyone over the age of 60 called in. About a month after that, I got a notice from Medicare at my office that they were going to cut my reimbursement 5%. (I only got $14.75 for a med check anyway) Everyone, hospitals, physicians, and outpatient centers took the 5% hit. Then, about a week after that, my mom got a notice from Medicare that said, “We have worked with our physicians, and your rates will only go up 5%“. Slick, huh? It makes it seem like physicians were the ones pushing for an increase, and then Medicare got us to back down. The truth is they didn’t consult a single non-government physician about this, but still managed to blame us anyway.
But the point no one ever makes, except me, is that an additional 10% still went to Medicare. FOR WHAT? Everyone that provides patient care got a reduction, and the seniors had to pay extra. So that’s how the Medicare bean-counting bureaucrats got themselves a raise. Slick, huh?
And that’s a single payer, (i.e., socialized) system. Imagine that spread around the country even more than it is.
And that’s why doctors don’t take Medicare/Medicaid.
