AZ Mayo Clinics: We don't accept Medicare anymore

[AZRedhawk44]

http://www.bloomberg.com/apps/news?pid=20601087&sid=aHoYSI84VdL0

Background: The AMA has a ritual with Congress every January/February.  They withhold campaign contribution funds because Congress decides to freeze Medicare Fee Schedule reimbursement rates.  One or the other will budge in late January, and a new Medicare Fee Schedule will be published to supercede the previous one that is typically released in November of the previous year, and Congress gets its annual campaign bribes from the AMA.

This could be a prelude to that action... "We don't accept Medicare" is a hightened form of this war, because it gets the AARP and others riled up against the clinic and the Congresscritters.  Granted, Mayo isn't the whole of AMA by any stretch... but they are well respected.

I do know doctors that have gone this route and never looked back, and are quite happy in their practice from doing so.  They'll still SEE medicare patients... they just treat them for cash.

Dec. 31 (Bloomberg) -- The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won’t affect other Mayo facilities in Arizona, Florida and Minnesota.

Obama in June cited the nonprofit Rochester, Minnesota-based Mayo Clinic and the Cleveland Clinic in Ohio for offering “the highest quality care at costs well below the national norm.” Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians, in a telephone interview yesterday.

“Many physicians have said, ‘I simply cannot afford to keep taking care of Medicare patients,’” said Heim, a family doctor who practices in Laurinburg, North Carolina. “If you truly know your business costs and you are losing money, it doesn’t make sense to do more of it.”

Medicare Loss

The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said.

Mayo’s hospital and four clinics in Arizona, including the Glendale facility, lost $120 million on Medicare patients last year, Yardley said. The program’s payments cover about 50 percent of the cost of treating elderly primary-care patients at the Glendale clinic, he said.

“We firmly believe that Medicare needs to be reformed,” Yardley said in a Dec. 23 e-mail. “It has been true for many years that Medicare payments no longer reflect the increasing cost of providing services for patients.”

Mayo will assess the financial effect of the decision in Glendale to drop Medicare patients “to see if it could have implications beyond Arizona,” he said.

Nationwide, doctors made about 20 percent less for treating Medicare patients than they did caring for privately insured patients in 2007, a payment gap that has remained stable during the last decade, according to a March report by the Medicare Payment Advisory Commission, a panel that advises Congress on Medicare issues. Congress last week postponed for two months a 21.5 percent cut in Medicare reimbursements for doctors.

National Participation

Medicare covered an estimated 45 million Americans at the end of 2008, according to the Centers for Medicare & Medicaid Services, the agency in charge of the programs. While 92 percent of U.S. family doctors participate in Medicare, only 73 percent of those are accepting new patients under the program, said Heim of the national physicians’ group, citing surveys by the Leawood, Kansas-based organization.

Greater access to primary care is a goal of the broad overhaul supported by Obama that would provide health insurance to about 31 million more Americans. More family doctors are needed to help reduce medical costs by encouraging prevention and early treatment, Obama said in a June 15 speech to the American Medical Association meeting in Chicago.

Reid Cherlin, a White House spokesman for health care, declined comment on Mayo’s decision to drop Medicare primary care patients at its Glendale clinic.

Medicare Costs

Mayo’s Medicare losses in Arizona may be worse than typical for doctors across the U.S., Heim said. Physician costs vary depending on business expenses such as office rent and payroll. “It is very common that we hear that Medicare is below costs or barely covering costs,” Heim said.

Mayo will continue to accept Medicare as payment for laboratory services and specialist care such as cardiology and neurology, Yardley said.

Robert Berenson, a fellow at the Urban Institute’s Health Policy Center in Washington, D.C., said physicians’ claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients’ primary care.

“Some primary care doctors don’t have to see Medicare patients because there is an unlimited demand for their services,” Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, “then Medicare does indeed look like a poor payer,” he said.

Annual Costs

A Medicare patient who chooses to stay at Mayo’s Glendale clinic will pay about $1,500 a year for an annual physical and three other doctor visits, according to an October letter from the facility. Each patient also will be assessed a $250 annual administrative fee, according to the letter. Medicare patients at the Glendale clinic won’t be allowed to switch to a primary care doctor at another Mayo facility.

A few hundred of the clinic’s Medicare patients have decided to pay cash to continue seeing their primary care doctors, Yardley said. Mayo is helping other patients find new physicians who will accept Medicare.

“We’ve had many patients call us and express their unhappiness,” he said. “It’s not been a pleasant experience.”

Mayo’s decision may herald similar moves by other Phoenix- area doctors who cite inadequate Medicare fees as a reason to curtail treatment of the elderly, said John Rivers, chief executive of the Phoenix-based Arizona Hospital and Healthcare Association.

“We’ve got doctors who are saying we are not going to deal with Medicare patients in the hospital” because they consider the fees too low, Rivers said. “Or they are saying we are not going to take new ones in our practice.”

This is the trickling of sand that begins an avalanche, if not nipped quickly by a responsive Congress.

[Monkeyleg]

It's simple. Obama orders doctors to accept Medicare patients and pay Medicare fees. If he could extort the bond holders for GM and Chrysler, why not doctors?

[RocketMan]

It's simple. Obama orders doctors to accept Medicare patients and pay Medicare fees. If he could extort the bond holders for GM and Chrysler, why not doctors?

I don't see this as being out of the realm of possibility.  Once the takeover reform of health care is in place, there is likely to be some significant push-back from various entities.  If the doctors and clinics decide to push back enough, and if that pisses off the Obama camp enough, he could decide to do it.

[MillCreek]

Having worked in healthcare administration for many a year, this is nothing new.  An ever-increasing number of physicians, especially primary-care, no longer accept Medicare, Medicaid or state welfare.  They can only get away with this if there are large numbers of patients in the area who have private insurance that pays better than the state or Feds.  In many cases, you lose money per visit on the Medicare, Medicaid or welfare patients, and there comes a point where you can no longer do it and still keep the doors open.

[RevDisk]

Having worked in healthcare administration for many a year, this is nothing new.  An ever-increasing number of physicians, especially primary-care, no longer accept Medicare, Medicaid or state welfare.  They can only get away with this if there are large numbers of patients in the area who have private insurance that pays better than the state or Feds.  In many cases, you lose money per visit on the Medicare, Medicaid or welfare patients, and there comes a point where you can no longer do it and still keep the doors open.

If you lose money per visit on the Medicare/Medicaid/welfare, why would you take them whatsoever?

[Northwoods]

If you lose money per visit on the Medicare/Medicaid/welfare, why would you take them whatsoever?

They make up for it with volume.

[Stand_watie]

If you lose money per visit on the Medicare/Medicaid/welfare, why would you take them whatsoever?

'Pro Bono' is the legal terminology. M.D.'s taking on welfare patients is an act of charity. Many M.D.'s believe that there is an afterlife, in which they will have to answer to God. They offer 'Pro Bono' services in the same spirit that you and I drop a couple of bucks in the can at the salvation army santa at walmart.

[MillCreek]

If you lose money per visit on the Medicare/Medicaid/welfare, why would you take them whatsoever?

The insurance companies pay more for specialists, diagnostic and therapeutic procedures.  So if you can order a radiology study, a lab test or perform surgery, that is where you can make your money.  Strictly cognitive services, such as an office visit that has no labs or diagnostic testing, are the money-losers.  

There is some good data from various medical practice groups, that if a practice has more than about 30% of their patients in Medicare, Medicaid or welfare, then the long-term financial viability of the practice is doubtful. 

[Headless Thompson Gunner]

This is the painfully obvious and perfectly predictable result of price controls.  There is less supply available at lower prices than at higher prices.  Artificially low prices lead to artificially low supply, lead to shortages of the good/service in question.

Government has guaranteed that there will be shortages of healthcare for those using medicare.  Sucks to be them.

These same problems are destined to happen to anyone using a private health insurance plan in the coming years, now that Barry has promised to reduce everyone medical costs through his wunderbar forced health insurance laws.  Prices will be artificially reduced, supply will decrease, and we'll all enjoy shortages of medical care.

Sucks to be us.

[MillCreek]

In some areas of the country, the shortage of primary-care providers is ever more acute.  You can have gold-plated insurance or pay cash, but you cannot find a family practitioner, internist, pediatrician or ob/gyn to see you because their practices are full.  You can only take care of so many patients and do a decent job and still have a life away from the office. 

If you live in a large urban or suburban area, you can still find largely find care, since this is where primary-care physicians like to practice.  In smaller urban, suburban or especially rural areas, the shortage is getting worse.  If some sort of national mandate regarding healthcare insurance is passed into law, that is all well and good, but it will not increase the supply of providers.  Massachusetts is an excellent example of this.  Now everyone in Massachusetts has state-mandated health insurance, but the reimbursement rates from the state insurance are low, and there are just not enough physicians to see everyone.  Waiting times of several weeks or months for non-urgent care are common. 

[Standing Wolf]

It's simple. Obama orders doctors to accept Medicare patients and pay Medicare fees. If he could extort the bond holders for GM and Chrysler, why not doctors?

Yep. The current occupant of the White House, like all Marxists, is waging jihad against what he perceives as "the rich" and capitalism in general.

In less encompassing terms, he's doing the same thing Lyndon Johnson did during the 1960s: creating a large, growing sub-class of lifelong government dependents who can be counted on to vote for representatives of the Democratic [sic] party. That party's only interest is its own expansion. It couldn't possibly care less about America.

[GigaBuist]

If you lose money per visit on the Medicare/Medicaid/welfare, why would you take them whatsoever?

Not a doctor, but I am familiar with taking on work where you "lose" money or just don't make a profit sometimes.

The doc still has to pay the receptionist, the lights are still on, and he's still at the office between actual paying customers.  So, you take some cut-rate work to fill in the gaps so you lose less money than you otherwise would.  When you're billing out 100% of your time you start to cut loose the customers that pay less.

[Jamisjockey]

The politics board is shut down.  Save this for when it reopens.

Yep. The current occupant of the White House, like all Marxists, is waging jihad against what he perceives as "the rich" and capitalism in general.