(Time pressures today require that I be brief today.)
Medicare is often held out as the model for a government run health care system in America. It is true that Medicare allows all of the elderly to receive medical care that they can afford. It is also true that the Medicare system will probably either be bankrupt or will bankrupt our country (with the assistance of our other entitlement programs) and that in one way or another future benefits will have to be cut. Yet there is another problem with Medicare that is likely to cause serious, and increasing disruptions, over time. Although it is always tricky to generalize from small sample sizes, my experience as a Physician who has accepted Medicare since I finished my Residency in 1981 may be instructive.
For many years, I was comfortable with Medicare, willing to accept a 10-20% reduction in my fees in order to serve a population that often lacked the financial wherewithal to afford private Psychiatric treatment. For much of that time, the paperwork was minimal and the hassles of accosting the coverage were tolerable.
That all began to change several years ago. Over time Medicare fees stagnated while private practice fees increased. By the early part of this century, the Medicare reduction represented 40-50%. I continued to be a provider because I had a number of older patients and was committed to their treatment. Several years ago, I stopped taking on new Medicare patients. The problems worsened. Over the course of the last 3-4 years, the Medicare reduction has gone from 50% to almost 70%! Worse, last year I had to engage a billing service because I had been driven to distraction by Medicare's increasing problems actually paying their bills. The billing service costs me an additional 8% of my fee. Since I only have a few patients on Medicare at this point, this is more an inconvenience (and I have never had a problem offering to reduce my fees when a patient cannot pay a full fee) than a practice destroyer (though Doctors who rely on Medicare for a larger percentage of their practice are in genuine financial trouble.)
I had already decided to drop out of the system altogether at the end of this year when the most recent Medicare insult occurred. For those fortunate enough to be unaware of the minutiae of Medical treatment and insurance, some information: last year the Government and Insurance companies introduced the NPI (National Provide Identifier) number meant to replace Medicare provider numbers and all other provider numbers. I dutifully acquired one and began to include it on my Medicare forms for reimbursement, as directed. Apparently, sometime in May, the Medicare administrators in their great wisdom decided, without bothering to inform anyone, that forms that included the NPI and the old Medicare Provider Number would no longer be accepted. All of my Medicare billing from January through April has been returned unpaid because the system will not even look at a form that has any information on it that is not in accord with whatever regulations they have promulgated that day.
As of the end of December, 2008, there will be one less Doctor participating in Medicare. I doubt I am alone in my disgust and annoyance. Keep this in mind when you hear politicians talk about the wonders of a government run health care system.
Also keep in mind that if we want our brightest young people to continue to put the effort and time into their medical studies required to become a Doctor and continue to expect them to graduate with loans nearing $200,000, we had better think carefully before we set up a Medical system that is partially designed to minimize their compensation.
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