Medicare cuts—a bad thing

Look, I know no one is weeping for doctors and their complaints about payment cuts, but you should at least be concerned, and here’s why.

Some doctors are rich…very rich. Most are not. Medical education is largely financed with debt, and primary care doesn’t pay all that much. Small practices work on narrow margins, and often run “paycheck to paycheck”. For internists, a large percentage of payments come from Medicare, the national health insurance program that covers seniors. Doctors participate with Medicare voluntarily—there is no law requiring us to see Medicare patients or to bill Medicare for them.

Of course there are advantages to being a Medicare provider—in general, they pay fairly quickly; it’s easy for patients; if you are a provider, more Medicare patients are willing to see you. But there are disadvantages as well. If you accept Medicare insurance, you must follow a large set of rules, and agree to price controls. Also, you must deal with arbitrary events, such as Medicare deciding not to pay for a few weeks in order to collect interest.

Currently, a 10 percent cut in Medicare physicians fees is due to go into effect. For example, if I normally get $60.00 for seeing a patient with diabetes, hypertension, and coronary artery disease, now I will get $54.00. This ads up quickly, and makes it difficult to pay the bills.

Every time one of these cuts is supposed to go into effect, Congress reverses it. This has to due with a very long story about how reimbursement is calculated. This time, Congress is still working on it, which leaves doctors in limbo. Medicare has sent us a letter that says that they will hold off on processing payments for ten days to allow the situation to stabilize. This means an effective ten day moritorium on payments. Oddly enough, Medicare says that there will be no problem since it takes 14 days to process a claim anyway, but the idea that a ten day hold on payments won’t affect doctors is either wishful thinking or a lie.

One solution many doctors are considering is dropping Medicare. This means that they can charge what they want, make their own rules, and not be subject to the whims of CMS. Of course, they will probably lose a few patients, but they will probably survive.

But what will happen to seniors if doctors get fed up en masse and Medicare providers become few and far between?