Advertisement

Archive for Thursday, July 10, 2008

Doctors can’t afford new Medicare patients

Reimbursement rates aren’t keeping pace with rising costs, doctors say

Dr. Matthew Buxton, right, of Free State Dermatology in Lawrence, stopped taking new Medicare patients in January because his costs outpace the government's reimbursement rates.

Dr. Matthew Buxton, right, of Free State Dermatology in Lawrence, stopped taking new Medicare patients in January because his costs outpace the government's reimbursement rates.

July 10, 2008

Advertisement

Some Lawrence physicians are fed up with the lack of Medicare reimbursements and are cutting off new patients to help make ends meet.

Dr. Matthew Buxton, of Free State Dermatology in Lawrence, is one of them. Since Jan. 1, he hasn't been accepting new Medicare patients.

"It just got to the point where I couldn't continue to increase the number of patients I was seeing at that level of reimbursement," he said. "The increases that we are getting for Medicare patients aren't even meeting inflation. So as time goes on, we are getting reimbursed less and less compared with our costs."

In fact, the Senate approved legislation late Wednesday that would void a 10.6 percent pay cut for doctors treating Medicare patients.

Lawmakers were under pressure from doctors and the elderly patients they serve to void the cut, which kicked in July 1, because of a funding formula that establishes lower reimbursement rates when Medicare spending levels exceed established targets. There are 10,500 Medicare patients enrolled in Douglas County, and 400,000 statewide.

The bill, which was approved by the House in late June, now awaits President Bush's approval. The White House has threatened to veto the measure because of provisions written by Democrats that would reduce payments to private insurers who participate in an alternative program, Medicare Advantage.

Until the legislation passes, 73 doctors and 22 mid-level practitioners at Stormont-Vail HealthCare's Cotton-O'Neil clinic in Topeka won't accept new Medicare patients because of what they called a "draconian cut." They are, however, continuing to care for their current 42,000 Medicare patients and current patients who simply become eligible.

"It's just a huge hit for us. We just didn't feel like we could take that kind of a cut and still continue to take care of those tens of thousands that we are trying so hard to take care of," said Nancy Burkhardt, hospital spokeswoman.

Dr. Donald Hatton, an internist with Reed Medical Group in Lawrence, said doctors in his practice are not taking new Medicare patients because of inadequate reimbursements; some have even left for jobs in government or hospitals. With about 75 percent of their business coming from Medicare patients, it can be tough to remain sustainable, he said.

Hatton, chairman of the Board of Governors for the American College of Physicians, predicts if long-term changes aren't made in the Medicare system, there will be an access issue.

Dick Lind, 69, said he was surprised when he recently called to make an appointment at Buxton's office and was turned away because of the Medicare cut. He plans to make an appointment with his primary-care physician and hopes that the Medicare cuts don't continue to affect his health care.

"It could be really a serious handicap and very costly to people my age and older if that happens," he said.

Comments

Bob Harvey 6 years, 1 month ago

Interesting to note that of this years medical school graduates in Kansas not one new physician has chosen family practice as their speciality entering residency programs. I have long believed that the crisis in healthcare will come when there is no access to care, not because of the lack of insurance coverage but from the lack of providers willing to see you. The value of a dollar decreases significantly when there are no markets where you can spend it.

0

just_another_bozo_on_this_bus 6 years, 1 month ago

"Really? Like most things you say not fact your opinion. Which countries?? Not England or Canada."Really. Both Canada and Britain, whose systems differ from each other considerably, offer good health care for much lower cost than is available here."Most people in those countries who want to choose their providers and not wait forever have to get private insurance too."On average, waits for critical or emergency care are no longer than here, and for elective and non-emergency care, it's not that much longer than here for most procedures."Having lived in both places I would shutter to see plans like theirs come here. If you think the current healthcare system is broken, which it is, nationalized medicine in it's current form elsewhere is NOT the answer."Most people in both of those countries are generally satisfied with the care they receive. Is there 100% satisfaction? No. Is there room for improvement? Yes. Would they adopt the hodge-podge, expensive US "system" if offered the option? Likely not.

0

tangential_reasoners_anonymous 6 years, 1 month ago

"Be mad at the doctors if you want to, but that is short sighted and uninformed."I am not mad at Doctors, and I certainly cannot take exception to being short-sighted and uninformed... but, look at what a lovely response my flippant remark may have played a role in generating.( I know... I'm so vain... I probably think this BLOG is about me. )

0

samsnewplace 6 years, 1 month ago

Why turn away our older generation? Do they not deserve health care as well as the rest of the people? Have they not earned a right to retire? Usually after retirement, medicare/medicade is all they have for insurance and now the greedy doctors are turning them away? It boggles my mind the lack of respect this country has for our older generation who have given us so much. Doctors/dentists/chiropractors, etc.......have all been over-charging the heck out of us for years now. Most of us now only go to the doctor when there are no over the counter options left.....who can afford it? Over priced! And they get vacations paid for by us. Sad world we are in now.

0

sammyk 6 years, 1 month ago

Docs who participate with Medicare are limited to their fee schedule. No matter what they charge they are required to taken a reduction to the fee schedule. So saying that docs shouldn't charge so much makes no sense when it comes to Medicare or any other managed care that a doc has a contract with as they are bound by that contract. In my opinion if they don't like it get a new contract or shut up and take what you get.

0

tangential_reasoners_anonymous 6 years, 1 month ago

Evidently such denial of services falls well within the Hypocritic Oath.

0

repaste 6 years, 1 month ago

$150 for monor surgey would be cheap, the true cost was most likely 5-10 times that. Part of prob. is disconnect between true cost and consumer. Is medicare socialized medicine? Our countries medical care does not favor well with other countries in cost or results, lack of preventive care being big reason our system does so poorly for some. Change must come -

0

ECM 6 years, 1 month ago

My personal experience, you call it anecdotal because you disagree not that you have personal facts. Wait you never have facts just your warped, uninformed opinion. My opinion is from personal experience and that of hundreds co-workers who also had to deal with socialized medicine in both countries. That is OK though do us all a favor Bozo and move to one of those countries and tell us what you think, not that we will care.

0

Baille 6 years, 1 month ago

"The most "controllable" piece to the equation is malpractice. We need caps on malpractice awards, plain and simple."--------------------------------------------------------BS. You have caps on medical malpractice awards in Kansas. You have had them for years and unlike other states they have not increased. The fact is that the insurance industry admits that caps will not lower the cost of health care. They have admitted as such to the legislature of Texas and in publications back east.The last time I went through this in any detail, malpractice payouts represent somewhere between 1 and 2 percent of costs associated with medical care. Want to reduce even these anemic medical malpractice payouts? Then tell the impotent licensing agencies to stop allowing bad doctors to practice medicine. This debate always ticks me off because people with no understanding our legal or medical system think they have all the answers. Frankly, I have participated in this discussion multiple times on this and the other forum and it never comes to anything. No one wants to debate the facts or address real solutions (both the medical and legal system needs some major attention). Instead everyone just regurgitates the propaganda through which they have allowed themselves to be brainwashed. What a waste.

0

shirinisb 6 years, 1 month ago

If people didn't rely so much on health care and welfare didn't pay for women to have baby after baby they can't afford, and for smokers to get treatment for personal choices they make we could save a lot of money. Social medical coverage requires social responsibility which the majority of our country lacks severly. Think about how much money alone would be saved if us females shut our legs and smokers just died quickly instead of slowly and expensively.

0

Janet Lowther 6 years, 1 month ago

Mark my words, there will be cuts in compensation to physicians. Maybe just holding rises to less than the rate of real inflation (like practically every other worker has been for the last 20 years) or maybe drafting every physician into a new "National Health Service" at rates dictated by law, but there will be cuts. Big cuts.Sometimes I wonder how different the Federal Reserve's monetary policy would have been if they had been looking at the rate of inflation in services which can't easily be offshored like medical services and university tuition

0

janeyb 6 years, 1 month ago

On the rare occasion I have gone to see my family Dr., I'm the only person under 25 there, under 35 there, under 45 there, etc. How can they turn away Medicare patients and survive? The Cotton-O'Neil clinic has always been uppity and expensive. My parent's insurance won't use them. I have an uncle, an MBA, who broke into the medical field by uniting medical practices and helping them set up their own malpractice insurance in the Cayman Islands. Malpractice insurance has been off-shore since the 70's. It is not the problem.

0

notajayhawk 6 years, 1 month ago

Not to mention the "Botox'R'Us" factories.

0

kujayhawk 6 years, 1 month ago

Yet I do have insurance and they charge my insurance an arm and a leg for an awful job. Not these, some dermotologists up in KC. I understand their arguments, but every doctor that graduates med schools feels they are entitled to make hundreds and thousands of dollars. Good docs are worth their weight in gold (okay, maybe oil), some of the lesser docs are just glorified prescription writers.

0

onrywmn 6 years, 1 month ago

I am not on Medicare, but found it difficult to pay my bill to Dr. Buxton anyway. A few months ago I went in for my 1st visit to have him check my moles and he removed two moles, plus $50 co-pay for the office visit, $50 co-pay for the surgery, and $50 for the lab work. Next time, I will go to my PCP as it is cheaper.

0

ECM 6 years, 1 month ago

just_another_bozo_on_this_bus (Anonymous) says: "Really? Like most things you say not fact your opinion. Which countries?? Not England or Canada."Really. Both Canada and Britain, whose systems differ from each other considerably, offer good health care for much lower cost than is available here."Most people in those countries who want to choose their providers and not wait forever have to get private insurance too."On average, waits for critical or emergency care are no longer than here, and for elective and non-emergency care, it's not that much longer than here for most procedures."Having lived in both places I would shutter to see plans like theirs come here. If you think the current healthcare system is broken, which it is, nationalized medicine in it's current form elsewhere is NOT the answer."Most people in both of those countries are generally satisfied with the care they receive. Is there 100% satisfaction? No. Is there room for improvement? Yes. Would they adopt the hodge-podge, expensive US "system" if offered the option? Likely not.So Bozo you have lived in those countries and experienced on a personal level with their versions of socailized medicine??? No. Well I have. I will take my private insurance and the care I can get here over what they have to offer any day. Again your opinion based in what...nothing as usual.

0

Bob Harvey 6 years, 1 month ago

Here is an interesting article for those wanting to emulate healthcare in other countries.http://www.npr.org/templates/story/story.php?storyId=91931036It is also clearly evident that many posting have no clue how health care in the US works.

0

just_another_bozo_on_this_bus 6 years, 1 month ago

"My opinion is from personal experience" = Anecdote

0

Sigmund 6 years, 1 month ago

Another basic problem is the payers for medical service and the consumer of medical services are different. Consumers want everything because they don't have to pay for it while payers want limits because they are not the consumer. Doc's get caught in the middle and it is only going to get worse under any increase in government health services.

0

just_another_bozo_on_this_bus 6 years, 1 month ago

"The most "controllable" piece to the equation is malpractice."While malpractice insurance rates may be high, payouts for malpractice account for a very small part of overall healthcare costs-- less than $13 a year per capita according to this study done a few years ago. Still probably not much more $15 per capita by now. So malpractice rates are too high, it's because insurers are raking in obscene profits, not because payouts are high."ABSTRACT: We used data from the National Practitioner DataBank (NPDB) to study the growth of physician malpractice payments. Judgments at trial account for 4 percent of all malpractice payments; settlements account for the remaining 96 percent. The average payment grew 52 percent between 1991 and 2003 (4 percent per year) and now exceeds $12 per capita each year. These increases are consistent with increases in the cost of health care. A preoccupation with data on judgments, extreme awards, or specific specialties results in an incomplete understanding of the growth of physician malpractice payments. "http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.240v1.pdf

0

ECM 6 years, 1 month ago

just_another_bozo_on_this_bus (Anonymous) says: "But that has not been the case in any other countries who have single-payer and/or nationalized healthcare plans. They get good healthcare for much lower costs. That's just a fact."Really? Like most things you say not fact your opinion. Which countries?? Not England or Canada. Most people in those countries who want to choose their providers and not wait forever have to get private insurance too. Cost wise it is comparable or more expensive than private insurance in the US is now. Having lived in both places I would shutter to see plans like theirs come here. If you think the current healthcare system is broken, which it is, nationalized medicine in it's current form elsewhere is NOT the answer.

0

gypsygirl 6 years, 1 month ago

newsreader - the answer to your question is No.

0

just_another_bozo_on_this_bus 6 years, 1 month ago

"it is only going to get worse under any increase in government health services."Certainly it would be possible for it to be screwed up under government control, especially if put under the control of ideologues like BushCo who intentionally try to sabotage any government programs that aren't primarily designed to be cash cows for their cronies. But that has not been the case in any other countries who have single-payer and/or nationalized healthcare plans. They get good healthcare for much lower costs. That's just a fact.

0

gypsygirl 6 years, 1 month ago

The reality is that physicians who are managing their own offices, would probably have to close if they continued to take Medicare at its current rate. It would be less expensive to give each Medicare patient a $10 bill when they came through the door rather than treat them based on Medicare reimbursements. At a reimbursement of $40 for an office visit, that physician has to pay a front desk person, at least one nurse, an individual to file the Medicare claim, a person to draw the blood, a person to process the paperwork etc. etc. Be mad at the doctors if you want to, but that is short sighted and uninformed. Most physicians have completed at least a dozen years of education to have the priviledge of getting paid a rate determined by some guy in a basement in another state. If you want that guy making your health decisions, just keep slamming the person who most likely spends a good deal of each day listening and caring for individual concerns. When you all decide that the guy who fixes your car should fix the elderly's car for free or that the elderly should get a discount on groceries - then we'll talk about who is greedy.

0

kufanattic 6 years, 1 month ago

I dont see the problem being cuts with medicare, I see the problem being that we are and have been over paying for medical care for sometime now. if medical care would come down to where it should be, then the Docs might not feel the hit so hard.

0

newsreader 6 years, 1 month ago

Not to get off topic but...I'm subject to random drug tests at my job... do people have to pass a drug test to get on Welfare or Medicaid??

0

MrMister 6 years, 1 month ago

Want to reduce the cost of health care? Simple solution. No more advertising by drug companies. All that money spent on prime time advertising should be put into research for actual cures rather than creating false chronic conditions that require lifetime treatment to relieve symptoms without fixing the cause. Those symptom relieving meds just cause other issues that require more symtom relieving meds. it is a vicious cycle that does more harm than good. I can't believe the number of meds in my mother's house. Most of them are there to treat ailments caused by the others. Some times I think she would be better off if she just stopped taking them all, but it is her choice.

0

Sigmund 6 years, 1 month ago

twosides (Anonymous) says: "Difficult to feel sorry for a Dr. when your daughter goes to him, $50 for the visit and an additonal $50.00 charged to insurance for the "surgery" required to pop a pimple with a little hand tool."Pop your own damn pimples and save yourself money and quit wasting the Doctors time.

0

amart84 6 years, 1 month ago

Unless doctors start making millions of dollars, their pay is completely in line with the amount of work they do and the education that they receive. It now costs the average doctor around $500,000 to go to school in undergraduate and medical school after including accumulating interest. Therefore doctors take a huge financial risk getting to where they are not to mention the 11-15 years of training it takes to become a doctor (undergrad included). In terms of difficulty medical school is unlike nearly any other type of education any person in this country will receive and then comes yoru residency training where you are working 80+ hours a week for 40k (well under 10 dollars an hour). It is obvious doctors make a huge sacrifice and there is nothing wrong with making a decent salary to offset the ridiculous amount of hard work that they must endure. That being said, I think the biggest issue here is lack of knowledge by the public. The costs of health care have not and are still not due to doctors salary. Doctors salaries make up a very tiny portion of the health care costs in this country. The main factor screwing up the health care in this country is the health insurance companies, high paying administrative positions. Managed care has led to a plateauing of doctors salaries in the last 20 years and will continue to plaque the profession. Blame the health insurance companies and overpaid Administrative positions at hospitals if you want to place blame somewhere, not the doctors.

0

just_another_bozo_on_this_bus 6 years, 1 month ago

No, I haven't had to use their healthcare systems, but you aren't the only one who has, and your anecdotal evidence contradicts the experience of most others who have, along with the empirical data.

0

gypsygirl 6 years, 1 month ago

amart84 - amen sister (or brother). I agree - it's ignorance on the part of the general population. You hate what you don't understand.

0

OldEnuf2BYurDad 6 years, 1 month ago

"I dont see the problem being cuts with medicare, I see the problem being that we are and have been over paying for medical care for sometime now. if medical care would come down to where it should be, then the Docs might not feel the hit so hard."This is not a very helpful statement. The statement implies that doctors are outside of the medical care system. Every part of medical expenses has increased, so simplistic "why don't they just charge less?" statements like this really do nothing to address the issues.It used to be that the richest guy in town was the doctor. That is no longer the case. The most "controllable" piece to the equation is malpractice. We need caps on malpractice awards, plain and simple. The cost of researching medications, the cost of energy, the cost of medical schools... none of these things can just be "reduced". When a professional person spends half their income on insurance, something has gone awry.

0

ECM 6 years, 1 month ago

empirical adjective 1. derived from or guided by experience or experiment. 2. depending upon experience or observation alone, without using scientific method or theory, esp. as in medicine. 3. provable or verifiable by experience or experiment. Bozo since you do not meet the definition you have no basis for opinion as usual.

0

Eurekahwk 6 years, 1 month ago

I'm not going to feel sorry for doctors or insurance companies. I am 27 and I have Cystic Fibrosis. Am I insured? No, because insurance companies turn down people with pre-existing conditions. Do I get help from the government? No, because the Kansas Health Policing Authority has told me that I can just find less stressful work. Needless to say, I don't get any kind of treatment.

0

sourpuss 6 years, 1 month ago

I'm currently undergoing cancer treatments in Canada. I got a CT the same day my tumor was found. I saw my surgeon the next day, I saw a fertility specialist the day after that and started emergency fertility treatments (as the cancer treatment was going to destroy my fertility and I have not had children). I got MRIs, no problem. Two days after the fertility cycle was done, I had my first operation. A week later, I started chemo/radiation. I will have my next operation next week, perfectly on schedule. I have no co-pays, I have 80% prescription reimbursement (and with $1300 chemo med, I am glad for that!), the $12,000 fertility treatment was cut down to $5000 because I am a cancer patient. My hospital stays are great, they check and double-check everything, do C. difficile testing regularly... and I pay $500 a YEAR for medical coverage.When people talk about waiting for medical care in Canada, they are talking about getting a likely unnecessary MRI for their tennis elbow, or needing to wait an extra month to reverse an ileostomy or something. The fact is, patients whose lives are in the balance get the procedures and the imaging, and those who are not going to die need to wait a little bit. I guess in the US, you get to jump to the front of the line if you have money, but up here, it is who NEEDS the care most goes first.That is not to say there are not problems, of course there are. No system of ANYTHING is perfect. Still, if I had to choose between the problems of the Canadian system and the problems of the US system, I would choose Canada any day of the week.I am VERY glad not to be in the US with cancer. Very glad indeed. I thank my stars for that every day.

0

simplykristib 6 years, 1 month ago

shirinisb,You would probably feel differently if a smoker in your family quit smoking and then got lung cancer years later. I am dealing with that very situation right now. Both my parents are former smokers (Mom quit in August 1990 and Dad quit in Feb. 1993) and they both have lung cancer. It doesn't matter to me how they got cancer. The fact is they both have cancer. My parents' oncologist is seeing more and more younger people who are non-smokers with lung cancer. Why don't you try to show some compassion?

0

VTHawk 6 years, 1 month ago

As my username suggests, I just left Vermont to return to greener pastures here in Kansas. Vermont hospitals are literally filled to capacity with Canadiens seeking healthcare in the US because of the long waits in Canada. There are several large clinics set up directly across the US border for the same reason. Without a doubt, healthcare in the US (and Canada) is flawed, but this is due largely to overconsumption and inefficient consumption of healthcare in the US. Obesity, along with other lifestyle factors, greatly contribute to high prices in the US. Also, those with insurance tend to overconsume expensive drugs and visit the doctor too frequently for minor problems.

0

Sigmund 6 years, 1 month ago

just_another_bozo_on_this_bus (Anonymous) says: "Certainly it would be possible for it to be screwed up under government control, especially if put under the control of ideologues like BushCo who intentionally try to sabotage any government programs that aren't primarily designed to be cash cows for their cronies."Right now the government is paying insane rental prices for medical equipment prices far higher than it would cost to purchase the equipment outright in the free market. The Democratic Congress (not BushCo, hasn't been since the last election) has an opportunity to end just one example of a billion dollar Medicare fraud and abuse. If Congress fails to uphold even this modest effort at entitlement reform, there is little reason to believe its members will muster the political courage for the unspeakably harder choices that await them under a government run Health Services."An oxygen concentrator, for example, is a device that delivers oxygen through a tube to patients, and it costs about $600 on the open market....As with most items and services in Medicare Part B, beneficiaries pay 20% of the costs, and Medicare pays the remaining 80%. The government, therefore, pays $5,714 almost 10 times the free-market price of purchasing a concentrator outright. The patient pays $1,428 more than twice the free-market price of purchase."http://online.wsj.com/article/SB121556116413437535.html?mod=opinion_main_commentariesPlace your bets ladies and gentleman. As I don't know of one thing that the government does that COSTS less to provide than what the free market provides, my money is on continued fraud and abuse.

0

ECM 6 years, 1 month ago

sourpuss I am happy that you are receiving good care and I hope you are well soon.Unfortunately a family member who died of cancer in January did not recieve the level of treatment you are. Her tumor was discovered and she had to wait for treament or even to be seen by the oncologist. When they did see her weeks later they misdiagnosed the type of cancer and had to start then stop treatment, did surgery that was blotched and then told her husband they couldn't do anything for her. They were uncaring and incompetent.I work with a woman who can never have children because of a botched surgery in Canada. Another co-worker broke his leg while working in Canada. The doctor did such a bad job this doctor here had to rebreak it so he could walk without pain.Again I am glad you feel you are getting good treatment in Canada but not everyone does.

0

notajayhawk 6 years, 1 month ago

just_another_bozo_on_this_bus (Anonymous) says: "While malpractice insurance rates may be high, payouts for malpractice account for a very small part of overall healthcare costs- less than $13 a year per capita according to this study done a few years ago. Still probably not much more $15 per capita by now."Gee, that's great - you mean it's only about four and a half billion dollars. Plus all the associated costs in addition to the actual judgment or settlement. Pocket change."But that has not been the case in any other countries who have single-payer and/or nationalized healthcare plans. They get good healthcare for much lower costs. That's just a fact."Hardly a 'fact,' this is just more of boohoozo's usual baseless ideological rants. There is no objective measure of whether people get better or worse healthcare between different systems, and when boohoozo says they get 'good' healthcare his only basis for that claim is that the government pays for it (with someone else's tax dollars). You only have to look at the disaster that's the Canadian system to see what people get for 'less' money.And you aren't going to find the numbers anywhere that would be a true measure of whether it's even cheaper - like for instance healthcare as measured by a percentage of disposable income (it may sound great if someone's annual healthcare costs were only $75 - but not if their annual income was only $100)."On average, waits for critical or emergency care are no longer than here, and for elective and non-emergency care, it's not that much longer than here for most procedures."I notice boohoozo doesn't give numbers. Or a verifiable source. How unusual."Most people in both of those countries are generally satisfied with the care they receive. Is there 100% satisfaction? No. Is there room for improvement? Yes. Would they adopt the hodge-podge, expensive US "system" if offered the option? Likely not."And again, wrong. Most people in Canada, according to surveys, would prefer to have more options than what's given to them by the nationalized system. And the Canadian courts are agreeing with them - recent rulings have been in favor of ending the restrictions on what non-medicaid providers can offer, since the waiting times for those government-monopolized services were literally killing people.

0

larams 6 years, 1 month ago

How often do you see a poor doctor? The same doctor who turns away sick people because they have medicare gets in his/her $90,000 luxury sedan and drives home to his million dollar mansion at the end of every day. Bottom line is that way to many people think health care is about making money 1st and helping people 2nd. So of course health care is expensive when doctors are millionaires and Nurses are getting paid $50-$100 an hour! These are the people who you would think care the most but they don't anymore. They care about living like kings and queens and if you can't afford the outrageous costthen like someone else said you can go out in the parking lot and die. Health care people have lost there conscienceand will justify your death in some way and never bat an eyelash over it.

0

Commenting has been disabled for this item.