Friday, January 1, 2010

Doctor Shortage - Math, Mayo, and Medicare Mayhem

Will Reform Limit Beneficiary Access?

The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

December 31, Bloomberg

Will health care reforms, which may include $500 billion cuts for Medicare and unspecified billions for provider reimbursements, limit access for Medicare recipients?

Do the math. Given current shortages of 50,000 physicians, 78 million baby boomers starting to enter Medicare in 2011, and 31 million more uninsured gaining coverage circa 2014, future limited access is inevitable.

Add the news that Mayo will stop accepting Medicare patients at its Glendale primary clinic outside Phoenix, unless they pay cash, and you may be seeing the first glimpse of a grim future for access of Medicare patients. Subtract the number of doctors antionwide who are ceasing to see new Medicare patients.

A Medicare patient who chooses to stay at Mayo’s Glendale clinic will pay about $1,500 a year for an annual physical and three other doctor visits, according to an October letter from the facility. Each patient also will be assessed a $250 annual administrative fee, according to the letter. Medicare patients at the Glendale clinic won’t be allowed to switch to a primary care doctor at another Mayo facility.

Mayo’s move may soon be mimicked by physicians across the country, some 27 percent of whom have already stopped seeing new Medicare patients. In Texas, 40 percent of physicians no longer accept new Medicare patients.

According to said Lori Heim, president of the American Academy of Family Physicians, in.

“Many physicians have said, ‘I simply cannot afford to keep taking care of Medicare patients,’” said Heim, a family doctor who practices in Laurinburg, North Carolina. “If you truly know your business costs and you are losing money, it doesn’t make sense to do more of it.”

Do more math, and you will see the reason why. The Medicare payment commission says doctors on overage receive 20 percent less for treating Medicare patients than patients from private plans. Many doctors claim they cannot no longer see Medicare patients because they lose money. Medicare payment does not meet the cost of doing business.

Do more math. Medicare has 45 million recipients. Medicaid has 60 million. Medicaid pays 20 percent to 30 percent less than Medicare, and 40 percent to 50 percent of doctors do not accept Medicaid patients.

House and Senate bills call for a dramatic expansion of the Medicare population, a burden which states say they cannot afford and which will probably result in even lower Medicaid fees.

Congress seems to be getting the math message that doctors will no longer accept patients from government plans if reimbursement does not meet practice costs. Last week Congress postponed the 21.5 percent cut in Medicare fees for doctors.

Maybe it will dawn on Congress universal coverage is meaningless without physician access. Maybe it will realize access is a simple matter of math. Medicare mayhem, an unprecedented access crisis, may be at hand when new-Medicare qualified 78 million baby boomers and the 31 million newly insured, many of Medicaid, start swamping doctors’ offices – and there are no doctors there. It’s a simple matter of math.

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