Only a few more days!

Most of you will undoubtedly read the opening line and presume I am wishing happy holidays to everyone. Well, I am, however, I’m also writing in reference to the upcoming 10.1% cut in Medicare reimbursement to physicians.

You may be wondering why this is a big deal. Well for one, it will make it harder and harder for Family Physicians, such as myself to continue providing medical care to Medicare recipients. Why? Well, over the past several years, reimbursement for physician services, specifically to family physicians, has steadily declined. As the cost of running an office rises, ie heat, electricity, staff, equipment, et al, rises, the difference between income and expenses broadens and is soon reaching a point where reimbursement does not cover the cost of providing the care.

I would kindly ask everyone (if anyone is actually reading this blog) to contact Senators Snowe and Collins to stop the pending cuts.

To quote the Bartles and Jaymes commercial, thanks for your support.

Planned Medicare Cuts Weigh On Primary Care

From the Wall Street Journal (http://online.wsj.com/article/SB119732809319620055.html?mod=moj_columnis)

Planned Medicare Cuts Weigh on Primary Care
December 11, 2007
While presidential candidates are beating each other up about their plans for the uninsured, they've taken their eye off another big issue. Access to primary care for millions of people enrolled in Medicare is in peril.

As each new year approaches, doctors across the country brace for cuts in payments from Medicare. Unless there's a reprieve soon, Medicare will reduce payments to doctors by an average of 10.1% starting Jan. 1. (See the details here). Last year a planned reduction of 5% was averted by Congress at the last minute and payments stayed about flat.

Another deal remains possible. But the constant threat of decreases and the absence of increases in recent years are leading doctors to re-think their commitment to caring for Medicare patients. The question is becoming acute for primary care doctors, who are faring worse than those in other specialties.

To see why, it's worth a quick look to see how Medicare calculates how much to pay a doctor for care. There's a complex formula, but one of the keys is something called a work relative value unit that Medicare assigns to doctors' activities based on their specialties. An hour of brain surgery is valued more highly than an hour of general medical care.

Where a doctor practices also influences the payment calculation. Rural health clinics like mine operate under a special government program and will likely get a small cost of living adjustment next year.

In the end, Medicare multiplies a total relative value unit, factoring in various adjustments, by a payment benchmark to come up with fees for physician services. (For more, see this summary from the American Medical Association.)

The formula means that there are two ways for doctors to gain or lose under Medicare. The benchmark can be adjusted up or down, affecting all doctors. And the modifiers assigned to each specialty can be increased or decreased. Adjustment of the financial weight given to specialties is generally a zero-sum game and that pits one group of doctors against another in the lobbying wars.

Family medicine has been a loser, with its modifier decreasing since 2001. My medical school classmates who opted for anesthesiology are in line for a 4% increase next year. Coupling the lower payment factor for family medicine with the planned 10.1% drop in the benchmark for Medicare equals a big hit to primary care.

The Medicare crunch has been a big topic of conversation in an online discussion group on practice management run by the American Academy of Family Physicians. I'm a member and have found the chatter a little depressing.

As you might imagine, some doctors predict more grumbling and then eventual acceptance of what would amount to a salary cut for seeing Medicare patients.

Some expect to see more Medicare patients to make up for cuts with higher volume. Dr. Shane Avery, a solo practitioner in Scottsburg, Ind., will ask patients to come to the office for everything, no matter how small. Medicare doesn't pay enough to cover his overhead for the range of services he provides outside of an office visit, such as phone consultations.

Dr. Kathy Saradarian of Branchville, N.J., predicts Medicare cuts will prompt doctors to see patients more often but spend less time during each visit. But even that adjustment may not be enough. In her area of New Jersey, insurance payments are so low that Medicare is her best payer. Any cuts will come right off her bottom line. "They think we can make up the losses in other ways, but we can't," she says. "It is disheartening."

Others are considering dropping out of Medicare altogether. Dr. Marie Steinmetz, of Alexandria, Va., stopped taking Medicare six years ago because the payments didn't cover her expenses. Her practice offers traditional medical care with complementary and alternative medicine that insurance generally doesn't pay for anyway.

A family doctor in rural California named Deborah Sutcliffe stopped taking new Medicare patients two years ago. Now she's thinking about requiring her remaining Medicare patients to pay her directly rather than taking her fee via Medicare. If she goes this route, she's allowed to charge a slightly higher price. Medicare sends partial reimbursement for the office visit to the patient, and the patient pays the difference. This approach usually results in more overhead for a practice, but the total collections for the same sorts of visits can be 15% higher.

Elizabeth Pector, a family practitioner in Naperville, Ill., worries most about the effect a Medicare cut could have on other insurers. Many tie their reimbursement to Medicare. If the private sector rates drop 10%, too, her practice could be in big trouble. She worries about the health and options for our seniors, but finds herself worrying more urgently about the health of her practice.

While everyone's talking about how to expand health care for the uninsured, I think it's time to fix the Medicare system that's leading many doctors who tend to the basic health-care needs of the elderly to reconsider the proposition.

Message for the New Year

Received this via e-mail and although I can’t validate it, the message has been attributed to George Carlin. Regardless of it’s original source, the message is one that I certainly took to heart and one that I would encourage off of us to think about from time to time.


A Message by George Carlin:

The paradox of our time in history is that we have taller buildings but
shorter tempers, wider Freeways , but narrower viewpoints. We spend
more, but have less, we buy more, but enjoy less. We have bigger houses
and smaller families, more conveniences, but less time. We have more
degrees but less sense, more knowledge, but less judgment, more experts,
yet more problems, more medicine, but less wellness.

We drink too much, smoke too much, spend too recklessly, laugh too
little, drive too fast, get too angry, stay up too late, get up too
tired, read too little, watch TV too much, and pray too seldom.

We have multiplied our possessions, but reduced our values. We talk too
much, love too seldom, and hate too often.

We've learned how to make a living, but not a life. We've added years to
life not life to years. We've been all the way to the moon and back, but
have trouble crossing the street to meet a new neighbor. We conqu e red
outer space but not inner space. We've done larger things, but not
better things.

We've cleaned up the air, but polluted the soul. We've conquered the
atom, but not our prejudice. We write more, but learn less. We plan
more, but accomplish less. We've learned to rush, but not to wait. We
build more computers to hold more information, to produce more copies
than ever, but we communicate less and less.

These are the times of fast foods and slow digestion, big men and small
character, steep profits and shallow relationships. These are the days
of two incomes but more divorce, fancier houses, but broken homes. These
are days of quick trips, disposable diapers, throwaway morality, one
night stands, overweight bodies, and pills that do everything from
cheer, to quiet, to kill. It is a time when there is much in the
showroom window and nothing in the stockroom. A time when technology can
bring this letter t o you, and a time when you can choose either to
share this insight, or to just hit delete...

Remember; spend some time with your loved ones, because they are not
going to be around forever.

Remember, say a kind word to someone who looks up to you in awe, because
that little person soon will grow up and leave your side.

Remember, to give a warm hug to the one next to you, because that is the
only treasure you can give with your heart and it doesn't cost a cent.

Remember, to say, "I love you" to your partner and your loved ones, but
most of all mean it. A kiss and an embrace will mend hurt when it comes
from deep inside of you.

Remember to hold hands and cherish the moment for someday that person
will not be there again.

Give time to love, give time to speak! And give time to share the
precious thoughts in your mind.

AND ALWAYS REMEMBER:

Life is not measured by the number of breaths we take, but by the
moments that take our breath away.

If you don't send this to at least 8 people....Who cares?

George Carlin