Friday, August 14, 2009
Mr. President, please fix Medicare
Dear President Obama,
I am in favor of health care reform and I agree with you that universal coverage and eliminating the abuses that both patients and doctors have suffered at the whim of the for-profit insurance industry must be curtailed.
But I also want you to fix Medicare. Medicare is so bureaucratic that expanding it in its current form would be the death knell for primary care physicians and many community hospitals. The arcane methods of reimbursement, the ever-expanding diagnosis codes, the excessive documentation rules and the poor payment to "cognitive, diagnosing, talking" physicians make the idea of expansion untenable.
May I give you one small example? I moved my medical office in April. Six weeks before the move I notified Medicare of my pending change of address and filled out 22 pages of forms. Yes, 22 pages for a change of address. It is now mid-August and I still do not have the "approval" for my address change.
I continue to care for my Medicare patients and they are a handful. Older folks have quite a number of medical issues, you see, and sometimes it takes half an hour just to go over their medications and try to understand how their condition has changed. That is before I even begin to examine them and explain tests and treatments and coordinate their care. Despite the fact that I care for these patients, according the Medicare rules I cannot submit a bill to Medicare because they have not 
approved my change of office address.
I have spent countless hours on the phone with Medicare and have sent additional documentation that they requested. I sent the forms and information "overnight, registered" because a documented trail is needed to avoid having to start over at the beginning again and again. I was even required to send a signature from my "bank officer" and a utility bill from the office. Mr President, I don't have a close relationship with a bank officer so this required a bank visit and took time away from caring for patients...but I certainly did comply.
I am still waiting to hear from Medicare. At my last call they said they had not received yet another document, but when I gave them the post office tracking number, they said it was received after all. They could not tell me when or if they will accept my address change.
I have bills stacking up since April and I just found out that they will not accept them if they are over 30 days old. I have cared for patients for five months and will not receive any reimbursement from Medicare. The rules state I cannot bill the patients or their supplemental Medicare insurance either.
Believe me, Mr. President, I commend you for taking on such a huge task. Please also know that Medicare reform is needed along with health care reform.
Sincerely,
An internal medicine (read: primary care) physician
Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
Labels: medicare
posted by Toni Brayer, MD at
1:27 AM
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3 Comments:
I had a similar experience. I left a group practice I'd been in for 17 years, and went solo 1/1/08. We submitted the littany of confusing forms to MCR (after receiving conflicting and ultimately incorrect advice from MCR about which ones to send in) 1 month prior to the change in practice. We monitored the situation closely and put pressure on MCR to make the proper changes and reimburse us for care provided.
On April 28th they send us a communication which had a typo in the name of our business - MCR staff's fault - and said we'd be delayed another month while they fixed their own mistake. We had to seek "inside" influence on MCR through our local medical society, and finally received our first check from MCR on May 8th for 4 months of work. 50% of my volume is MCR, as a general internist.
We lived off of some savings and bank lines of credit in the meantime. I know of several colleagues in our state for whom the same process took 7-9 months and nearly ruined them financially. It shouldn't be this hard.
We can bitch about things like this all we want, but these aren't even the big issues on the table for reform. A public plan might be necessary to bridge the gap for many of the 47 million uninsured, although it doesn't seem to have much support from anyone - too much like socialized medicine, right?
I wonder how long it'll take to get credentialled and ultimately paid for our work if the public plan becomes a reality?
If health care reform isn't accomplished in the near term, we will eventually get a closer look at the "socialized medicine piece". When our medical system undergoes fiscal disintegration in a few years in the absence of significant reform, the government will be faced with how to resurrect it. How to do it? Hmm, let's see, how about MCR for everybody. The single payor advocates, now in the minority, may have their wish come true.
I hope you sent this letter to the White House, besides the blog. It needs to be read. Terrible!
Outstanding letter!!!
I am absolutely SICK of hearing that Medicaid and Medicare are the "success stories" of how the Government handles healthcare administration. (OUR own ACP sometimes is part of this "spin" also!!!)
Medicare is bureaucratic, underfunded, and poorly administered. It is a source of $$ Billions in fraud.
People criticise the "private" payors and say their overheads are too high, but when was the last time you read that Blue Cross "accidently" overpaid $270 million for "scooters" for elderly patients that were actually not eligible??
The only thing "reformed" in Obama/Pelosi/Reid care is going to be that private payors come under more control of the government, and MORE patients have Medicare and Medicaid (Medicare, by the way, will have 500 Billion cut out over the next 10 years).
Doctors will simply have to stop seeing Medicare patients because they can't take the losses these patients incur. The "losers" will be the patients themselves and the doctors and hospitals.
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