Why Can’t I Find A Doctor?
Recently, I was in my doctor’s office, when a lady came in and asked to see a doctor. When the receptionist asked her what was wrong, she explained that she had a pain in her shoulder for some time and that it had gotten to the point that she needed to have it looked at. The receptionist asked her what insurance she had, and she replied that she had Medicare and a Medicare Supplement. The receptionist informed her that she wouldn’t be able to be seen in this office, because they “weren’t accepting any new Medicare patients.”
Another time a client, who was new to the area, called me and informed me that she was having difficulty finding a new doctor, because all of them she had contacted informed her that they “weren’t accepting any new Medicare patients.”
I have also had a couple of clients contact me and tell me that their physicians had informed them that since they were going on Medicare, they would have to find a new physician. Fortunately that hasn’t happened to too many of them, but it seems to be a growing trend and is getting worse.
I received an email from SHIP recently with a list of Denver Area Doctors Accepting New Medicare Patients (you may click on the link to view the list). The list contains 69 physician offices, although I am sure there are a couple of other offices that just aren’t on it. However, there are over 2,000 doctors’ offices in Denver metro area. That means less than 4 percent of the offices will accept new Medicare patients.
How did this happen and what can be done to fix it?
In 1997, Congress passed the “Balance Budget Act of 1997”. Among many other things, the Act contained major Medicare reforms. In 1999, Congress reformed the 1997 provisions by passing the Medicare, Medicaid, and SCHIP Balanced Budget Act of 1999.
Out of these two Acts, came the Sustainable Growth Rate (SGR) formula. The SGR is the main component of the formula the Center For Medicare and Medicaid Services (CMS) uses to calculate physician payments for providing services to Medicare patients. It is based on the GDP and not on actual health care practice costs. The SGR has produced steep cuts in physician compensation for services to Medicare patients.
In June, the U.S. Senate passed a bill to push back the scheduled 21% cut for physicians who treat Medicare patients until November 30. However, absent congressional intervention, there will be a 23% cut with another 6.5% scheduled for January 1, 2011.
According to an article by the American Medical Association (AMA), without congressional intervention, Medicare physician payments will be cut by about 40 percent by 2016. Meanwhile practice costs will rise nearly 20 percent. This comes at a time when Medicare physician payment updates already lag far behind increases in the cost of caring for seniors.
In 2011, the baby-boom generation will start enrolling in Medicare, thus compounding the problem.
It should also be pointed out that other providers (Medicare Advantage Insurers, Hospitals, and Nursing Homes) continue to receive positive updates.
On October 6, 2010, Senator Blanche Lincoln introduced a bill called the Medicare Rural Physician Recruitment and Retention Act of 2010, which would base physicians pay rates more squarely on a measure of inflation in physician practice called the Medicare Economic Index (MEI), which is a move organized medicine has lobbied for, as a more accurate measurement for determining Medicare reimbursement.
This piece of legislation was initially a component of the Healthcare Reform Act passed in March of 2010, but was removed by Congressional Democrats because of the $200 billion dollar price tag.
While it is doubtful that Congress will pass such a sweeping bill before the end of the year, it is probable that there will be much discussion on a permanent fix in 2011.
We can only hope that Congress will pass another “temporary doc fix” prior to December 1, 2010, that will carry well into 2011, and give them a chance to come up with a permanent solution.
If this doesn’t happen, then you will see more and more seniors thrown into the situations that I pointed out at the beginning of this article. Perhaps even more physicians will advise their patients that they will need to seek a new health care provider when they go on Medicare.
If you would like to contact your Senators and/or Congressional Representatives, you can click on the following link to send them emails. http://www.usa.gov/Contact/Elected.shtml
