A less-publicized impact of Medicare financial restrictions is that residency programs are having trouble maintaining sufficient funding to meet accreditation requirements.
Recently, national accreditation requirements for residency programs added paid time for faculty research and teaching. Teaching hospitals need to find funding for these added requirements, and unless they structure their programs so that residents train at clinics owned or controlled by the teaching hospital, Medicare will not fund the training.
In rural states like Kansas, residents are deployed across a wide area to provide service across the state, and into many clinics that are not owned or controlled by the teaching hospitals. Without Medicare funds, this leaves the teaching hospital with a projected shortfall of about $12.5 million in 2009. In Kansas, this means that the state either must increase support of these residency programs or it will face a shortage of trained physicians.
As more and more baby boomers become eligible for Medicare, we are seeing that the Federal government is squeezing here and there where it can, but these are tricks to put off the day of reckoning. Here we have a case where rural states that do not fit Washington’s idea of a residency program are stuck with a cost that is federalized in urban settings. We’ve also seen new rules that cut reimbursements for doctors who don’t use e-prescribing. Expect to see more and more Federal micromanagement tied to the Medicare purse strings, but no matter how the Feds try to “improve” performance, efficiency, or whatever name you want to use to put on the latest tinkering, it will not fix the basic problem that there is an increasing demand for care by an increasing number of patients at a rate that exceeds the resources, including physicians, facilities, and funding.
More demand for more service without more funding doesn’t sound like a workable solution, so the other solutions are limiting eligibility, limiting care to those who are eligible (the Canadian solution), limiting reimbursements (but how long until physicians are asked to work for less than the cost of keeping the office open?), and cost shifting (deductibles, coinsurance).
As a physician, you are approaching a fork in the road: On the left fork, you can choose to stay inside a system that will continue to demand more of you, find more excuses to pay you less, and issue new mandates. On the right fork, you can choose to opt out of the Medicare system, practice medicine on your own terms, and charge what you decide is a fair price for your services.
Why would a Medicare patient decide to see a doctor who is outside the system?
- Availability of an appointment on short notice
- A physician that takes more time with their patients
- A more pleasant experience at your office or hospital
- More healthcare options without regard for what Medicare says is “appropriate”
The handwriting is on the wall - which road do you choose?
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