Once Again, The Pound Of fat Comes From The Primary Care Physician

My dear medicare patients.  The government has just screwed you.  Did you know it?  Probably not, probably you have no idea about what the government is proposing to do.  But it is going to have profound effects on the quality of the care you are about to receive.  You are confused? You are surprised?  Let me explain.

The government is proposing to change the way it pays doctors for outpatients visits. According to modern healthcare, medicare intends to pay physicians a flat rate for each visit.  That's right, a healthy sixty five year old with a cold will lead to physician charges that are the same for a ninety five year old with congestive heart failure, emphysema, and out of control diabetes.

Accordingly, the complexity of the visit will no longer figure into the amount of reimbursement for the physicians.  What does this mean?  Physicians, fatigued and overwhelmed with patient care, will be much more likely to avoid sickly seniors.  It pays the same, why not select for the most healthy of the medicare population?

If you are old, sick, or have a complex medical problem, expect physicians to avoid you like the plague. You're care will cost us more, and lead to lower reimbursements.  For those of us in private practice, I expect that this will be the death knell.  You might as well sign up to a hospital based large medical group now, no one else will be able to afford to take care of you.

The reason why this is happening?  Apparently medicare believes that physicians are over coding.  The pound of fat for healthcare reform is going to be born by those who healthcare needs the most, primary care physicians.  It is the primary who handles the broadest, most complex, most multi system problems.  These problems take time, deep thought, and advanced planning.  These were things that medicare used to pay for.  Apparently no more.

This is a sentinel moment, a tipping point,

By the time I reach medicare age, will there be any physicians left?