Medicare is scheduled for a 10.1% reimbursement reduction on July 1, 2008, unless Congress once again makes another temporary adjustment, a game Congress has been playing every year since 2002.
While a number of specialists have already opted out of the Medicare system, if the reimbursement goes into effect, the trend will spread to more primary-care physicians.
According to the Medical Society of New Jersey, caring for the 1.2 million NJ Medicare patients accounts for 30 to 40% of the average NJ physician’s income, and even with the small reimbursement overrides granted by Congress over the past few years, Medicare reimbursements have not kept up with the cost of running a medical practice.
If private insurers peg adjust their reimbursements down based on the Medicare reductions, then more physicians will leave their networks as well. The income from performing the same service as an out-of-network physician to a privately-insured patient can be three times the income provided by performing it for a Medicare patient, according to Dr. Charles Moss, a surgeon in Hackensack, NJ. See NJ Business for further details.
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I went to the link at njbiz.com and read the article. It quotes Pamela Moore of Physicians Practice as saying, “Doctors need to think of their practice as a business…offer popular procedures like botox injections…and get better at collecting patient fees.” Yes, it is a business, but please…offer botox injections? Is the pediatrician going to do this? And does she think we are not trying to collect patient fees? I appreciate all the helpful information Dr. DeJesus is trying to provide to us physicians and giving us business insight, however, I will NEVER view my patients as “customers.” People like Ms. Moore are the reason medicine is in the state it is in. Statements like hers are ridiculous and reflect the poor understanding those outside the direct practice of medicine have.
Dr. Kim:
I agree that laymen who write about the practice of medicine often stray outside the lines of what is practical, reasonable, and within the ethical boundaries that define medical practice. Furthermore, what may be a reasonable ancillary service in one type of practice is a silly idea in another specialty. When I cite an article on a non-medical site, I hope we can all see the useful points that it raises and ignore the silly ones.
I agree with you that our patients are clients who entrust us with their protection, rather than “customers” who merely purchase services from us. That is the difference between practicing a profession and being a shopkeeper.
Nevertheless, we are facing a dangerous trend where Medicare and private insurance carriers believe that they can unilaterally reduce reimbursements without consequence. At some point, it no longer makes sense to participate in those plans, and by opting out, the physician regains control over pricing. In a separate article, I’ve written about the false calculations used to compute “usual and customary” charges, and the NY Attorney General will be taking UnitedHealthcare and its subsidiaries to task, and I hope that the resulting reform will work to the benefit of physicians that choose to be out-of-network. Deciding to go out-of-network is a tough decision in markets that are controlled by an oligopoly of payers and there is tremendous pressure on those practitioners who are in a hospital-based practice to participate in all plans. However, if you are in an office-based practice and primarily handle non-emergent cases, controlling the number of patients that you accept from stingy plans will give you the opportunity to improve your quality of life.
I am finishing my residency and have already started planning ahead how to have apractice that is not run by the government or the insurance industry. There is no way I am going to spend my future career chasing dimes and nickels while risking prosecution for “fraud” in the process.
I intend to join a group of cash-based docs as soon as possible. Currently, I would rather prefer returning to my job as perosnal trainer rather than working under the current system. I’ve had enough of sleazy politicans that p[romise everything, but expect us to pay for it.
FedUPBeforestarting.
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