Blog | 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.