Saturday, November 30, 2013

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?


Unknown said...

Wake up, you Americans pay too much for your health and have a system that do not work well in term of health outcomes . Look at Europe or at Israel and you will understand that you must change .

Bob Fenton said...

Thank you Dr. Grumet. That is rather sneaking by the CMS to post this just before the holiday. They are obviously hoping it would not be noticed and they could sneak this through. This calls for letters to our members of Congress and letters to the editors of our local newspapers.

Thank you again.

Unknown said...

Thank you Dr. Grumet. Very scary.

Anonymous said...

Sadly,Medicare is broken system..
Sadly,doctor Jordan,internists DO overcode..
But mesege is true..
Thank you..

Dr John said...

I guess each pt will have a visit for their DM, another visit for their HTN, another for high cholesterol. Any new problems identified or brought to a follow up visit will have to be addressed at another visit. We can play that game, but the patients will be the ones to suffer ultimately. I would also guess that the payment will be minimally (if at all) higher than 99213. Does anyone who actually practices medicine have input in this? Or just non-physicians, old timers who don't practice anymore, and policy/university wanks with 20 letters behind their name who practice part-time at most?

Concierge medicine is calling...

Anonymous said...

In Ontario Canada our Health Care System has been in place since 1959 and is fully covered by our Government. A Family Physician receives approx.$77.00 for a full assessment and $39.00 for a follow up or re-assessment regardless if it is a 80 year old with multiple health problems or healthy 20 year old. I personally have always felt that our doctors are underpaid, yet they have accepted this type of fee schedule for over 50 years. I appreciate US doctors spend a great deal of time negotiating with insurance companies for payment whereas in Canada a receptionist may spend 4 or 5 hours a month billing the Government agency.

Unknown said...

in my humble opinion..anyone whobprefaces w/ that is far from humble..Would it be so awful to care for a person without over charging? Doctors expect to make big bucks..perhaps they should consider their role as public servants...

Anonymous said...

It's difficult to find a way that properly balances the complexity of the attention (and his dued payment) and the principles of justice in medicine (every patient should be tretaed accordingly to their individual needs).
I can understand this fear of sickly seniors being less “atractive” to their doctors in terms of revenues/effort. I work as an Internal Medicine doctor in Spain (Europe), where we are equally paid no mater if youre doing a heart surgery or visiting a complex old man (this isn't fair too), and from my experience, I can asure you that this won't happen, at least with the vast majority of the doctors.
Very few of your doctors will run away of the most needed, it doesn't matter if you are european or american, we have our call, we have devoted our lives to help others.
Again, it is difficult to stablish a balanced, fair payment for a good, high-level work in medicine. And I understand your fear, but don't frighten the patients and don't devaluate our profession, whenever they'll need us, we will respond (we can't stop doing so).
Iván Moreno.

Unknown said...

everything should be okay if dr. garland is still practicing