Posts tagged 'doctors'
Medicare has evolved into a program rather different now than when it started. It covers over 40 million seniors and it has changed the way it is administrated. In addition, poor oversight has caused cutbacks and tight budgets which means that there are cutbacks in services, cutbacks in payments to doctors, hospitals and other medical professionals.
Yet, Medicare still moves on. They have been predicting its demise for years but it is still here. Now, don't get me wrong. It is obvious that Medicare has some serious financial issues. It is also possible that in the years between now and the time the program is supposed to run out of money, there are many things that can be done to straighten out the program by creating better oversight regarding fraud and abuse, creating better incentives for doctors in the program to stay - especially some of the great doctors that are treating Medicare patients at a fracthion of the price that they treat their private patients. This is a sacrifice financially because they care about their Medicare patients.
I have talked to doctors and other healthcare professionals who treat Medicare patients. Some of these have a patient load of 50% Medicare patients. I know of a few that treat nearly all Medicare patients because they have no place else to go. The majority of doctors say they can't afford to take on any new Medicare patients. The sad part of the situation is that with the right "tweaks" many doctors could take a few Medicare patients each. If a doctor is taking home $250,000 per year and took 10% Medicare patients, it wouldn't make him or her go broke, it would bring in extra money and it would help elderly people who need medical care. If he Medicare system could help devise a way where doctors got something out of treating Medicare patients and send out information about this to every doctor in the country, more doctors would be able to take a few Medicare patients and more elderly would be receiving continuous treatment. This would save money for the system because even if these doctors who took 10% of their caseload as Medicare patients and received a small bonus or other perk for doing so, the majority of patients would stay healthier longer and avoid costly trips to the emergency room or costly stays in the hospital or long term care. Medicare pays for these. If a doctor could help Medicare patients stay healthier and out of the hospital, perhaps he/she could receive a bonus which could come from a small percentage of what was saved for Medicare by keeping the patient healthy and at home. So the doctor gets $1,000 and Medicare saves $10,000 to $50,000. That sounds like smart finance and a win-win situation for everyone.
The elderly depend on Medicare. Some still have the means for private insurance, but even so, their Medcare benefits help defray other costs. There are ways to make sure that doctors can afford to treat Medicare patients and make enough money for it to work while at the same time actually saving Medicare money.
I am not privvy to the information being discussed in the battle over Medicare, Social Security and Healthcare by lawmakers on the hill in D.C. I just know that if I can think up something this basic, the leaders who are far more savvy than I am should be able to come up with a solution to keeping our elderly covered by Medicare and our doctors willing to take Medicare patients. There is enough time for these intelligent thinkers to come up with a plan that will work for everyone. This is not a maybe. This is a moral imperative.
In three western states – California, Hawaii and Nevada – doctors who accept Medicare as payment for patients are stuck between a huge rock and a very, very hard place. They are in a situation where Medicare’s payment backlog has created a multimillion dollar problem. They now have to make some vey difficult choices between their patients and their practice.
This is not a small thing. This is a situation where many doctors have not been paid by Medicare since February. How many of us could go through almost a full year with a large part of our salary unpaid?
It is understandable that there can be backlogs from time to time in a system as large and complex as Medicare, but no payments for almost 10 months is much more than a small backlog. It is a backlog of epic proportions.
The situation has forced some doctors to have to drop some or all of their Medicare patients. Other doctors are on the verge of declaring bankruptcy or have already done so. This has hurt the doctors in many ways – including, of course, financially – but it leaves thousands upon thousands of patients without a personal physician who can provide adequate services to keep their health conditions under control.
What does it say when the doctors who are willing to treat the most needy patients are being forced out of business or forced to drop those very patients because the system that is supposed to care for them is hurting them? How can the system be fixed so that the most vulnerable among us get the care they need from the system that they paid into for year after year?
Medicare says that the reason is that doctors who were to switch to a new identification number for claims (sort of like a social security number) did not do so. The doctors say that the numbers were never given to them until they contacted Medicare time after time over several months to finally get their identification number. In addition, Medicare moved processing to another area and there were “glitches” in the move – many of which are still not fixed.
At present, Medicare says they are fixing the problems, but for many of the doctors who were severely affected, the damage has been done, and for their patients, they are left looking for medical care.
Medicare reform is a top priority at this time. With changes that have come to pass recently, Medicare recipients and their doctors can hope that the future goes much better than the present and the past.
Just when we are talking about going back to the basics of house calls on one end of the spectrum, the other end of the spectrum is beginning a pilot program in telemedicine.
House calls will begin being expanded soon and paid for by Medicare for those with multiple serious conditions and other situations that make house calls the best form of care for them.
Now, with that out of the way, Medicare is still looking for ways to provide effective and adequate treatment to patients while containing costs. They are finally looking at telemedicine.
Telemedicine has been around for quite some time now. Some private insurers have paid for certain treatment by telemedicine. For example, I have a nephew who was born with serious heart problems and had a pacemaker installed when he was younger, nearly a decade ago. Once his initial treatment was completed, telemedicine was used to keep him in sync of his heart surgeon and keep his heart surgeon abreast of his condition.
At the time, what would happen was that we would call a particular phone number and use our phone and another instrument to measure my nephew’s heart rate, heart rhythm, blood pressure and other vitals, as well as whether the pacemaker was working. The doctor would get the reports and then we would have a conference by phone. If there were problems or complications we would go to the local emergency room where my nephew’s doctor would communicate with the emergency room doctor by phone and computer. If things got too serious, we would get my nephew up to the Children’s Hospital where his doctor was on staff.
Today’s telemedicine is more advanced than it was a decade ago. There are cameras and TV screens that allow doctors and patients to see one another. Patients have some of the instruments such as stethoscopes, so that they can be instructed by the doctor when and how to use them so he can help them remotely. There are also touch screens patients can use to answer doctor’s questions to aid in a diagnosis.
Now that insurance companies – and Medicare – have realized what doctors and patients have been saying for years, they are finally trying telemedicine out. Doctors and patients have been telling insurers that it is better for everyone that telemedicine evaluations, where appropriate, cost under $1,500 on average as opposed to a hospital admission or other tests that often add up to somewhere between $2,500 to $15,000.
It is good news that Medicare is now looking at ways to see if telemedicine will work well for certain patients. If it only keeps a few patients out of each hospital, Medicare can save potentially over $100,000 per hospital while patients receive quality care. This is an issue to keep an eye on.
With all the financial issues surrounding Medicare it has become harder to find doctors who readily accept Medicare, or even accept it at all.
Before the increase of fraud, red tape, financial woes, budget constraints and the like, doctors who accepted Medicare were not hard to find. Many doctors used to set aside a percentage of their time to devote to Medicare patients. They certainly weren’t making money on these patients, in fact, many times, they did not even break even by covering expenses, but the income from their overall practice absorbed the losses. Though Medicare was not a perfect system, it worked out for the doctors and their patients.
More recently, with all the Medicare woes, including very slow reimbursement at an extremely reduced rate, the majority of doctors say that it is too expensive to treat Medicare patients. They want to treat these patients and try to treat as many as possible, but are unable to take on new Medicare patients for financial reasons. Their regular practices cannot absorb the losses any longer.
This is not just frustrating to the doctors who would like to help these patients, but it is frightening and frustrating to patients who have spent a lifetime paying into a system that promised healthcare coverage but is now in such shambles that the doctors and specialists these patients need the most will not accept it for payment. This critical situation nationwide is leaving too many of our most vulnerable citizens without adequate care and actually making them more vulnerable because of it.
Lawmakers continue to say they are trying to fix the ailing system but are caught up in partisan arguing rather than bipartisan efforts, while the situation continues to worsen. The question arises as to whether they would rather pay out hundreds for office visits that prevent major health issues or thousands to pay for the health conditions that are not treated because of being penny wise and dollar foolish, as well as short sighted. Surely if there is enough money to fund billions for war, there should be enough to send Medicare recipients to the doctor.
As fewer doctors accept Medicare, there is the real possibility of a far worse health crisis than we see today. If you have Medicare benefits, check with your doctor and call others to make sure they will accept it. You can also call your local health department or hospital for further information about doctors in your area.
There are doctors who continue to accept Medicare, but it is becoming more difficult to find them and Medicare recipients who should be automatically taken care of are having to search for services. The system needs fixing NOW.
There was a time not too long ago when many doctors made house calls, especially for the elderly or disabled. It was more of a comfortable, less stressful and easier situation for the individual who needed medical care.
With the increase in “big medicine” people have gotten used to going to the doctor’s office. There are many reasons for this. Doctors are able to treat more patients if they can stay in one place and have the patients come to them. They also have all of their equipment set up in their office, as well as usually having a laboratory, x-rays and other services located in their medical building or close by, making it much easier for them to diagnose and treat their patients. And, of course, if they are at the office and the patients come to them, they can schedule up to 30-35 patients per 8 hour day in 15 minute increments.
Though this is convenient and cost-effective for the doctor, it has its down side for both the doctor and patients. If a doctor takes longer than the 15 minute time slot with a patient, it has a domino effect and backs all the other patients’ appointments up, making them have to wait longer. We have all sat for what seemed like forever just to be rushed through a doctors appointment and we have left wondering if the doctor actually heard anything that we said in the rushed 5 minutes that we were able to the doctor face to face.
Though most of us can sit through the wait and get through the appointment, it is often much harder for a person who is elderly, frail or disabled. Medicare knows this and so do doctors. There are still some doctors that will schedule house calls and Medicare will pay for these visits, though most patients don’t know it.
There is a quiet but powerful move by a number of doctors across the country to try to see ore patients in their homes. With an elderly or disabled patient, an appointment at home saves the often difficult trip to the office. A home visit also allows the doctor more time to examine and talk with the patient to take a closer look at any changes in health or any difficulties the patient might be having. If a problem is discovered that cannot be dealt with at home, the patient can then be seen at the doctor’s office, but most often, with regular care, most treatment and observation can be carried out at home.
If you receive Medicare benefits and find it too difficult to go to your doctor’s office, ask if your doctor makes house calls or if the doctor knows of a doctor, nurse or nurse practitioner who does. You can also ask for information from the home health care agencies and hospice in your area. There is not an overabundance of doctors who make home visits, but there are some and the numbers are slowly growing making it easier for individuals covered by Medicare to receive the care they need.
