Left in the Medicare lurch

Got Medicare? If you do, there’s an increasing likelihood in some parts of the United States that you might have to look long and hard to find a doctor who will see you.

Anecdotal evidence has been mounting over the past several months that growing numbers of physicians are opting out of Medicare. One of the latest, and more high-profile, cases: the Mayo Clinic, which stopped accepting Medicare patients at its Glendale, Ariz., clinic as of Jan. 1. Patients who want to continue seeing their doctor can do so, but they’ll have to pay cash, plus they’ll be assessed an annual $250 administrative fee.

Bloomberg News explains the reason for Mayo’s decision:

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, [Mayo spokesman Michael] Yardley said.

There’s some concern this might be only the beginning:

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.”

Just to be clear, I’ve heard no hints or suggestions that medical providers here in west central Minnesota plan to follow suit. And the trend might not be particularly widespread; research by the Center for Studying Health System Change found that 74 percent of the physicians who were surveyed were still accepting most or all new Medicare patients in 2008.

Still, it’s troubling. These survey numbers are a year old, and the rumblings of dissatisfaction by physicians are getting louder. On many levels it’s hard to blame them. Medicare has tended to respond to escalating costs by simply paying less to the doctors and hospitals who provide the care (a practice, it should be noted, that isn’t necessarily confined to Medicare or Medicaid). This kind of math can’t and won’t work, not in the long term. It’s especially onerous for smaller medical practices – and indeed, larger practices and practices with a higher patient volume appear to be the most likely to continue accepting Medicare, an analysis by the U.S. Census Bureau found last fall.

What does it mean for patients? Dr. Marc Siegel, a New York internist, writes about what he has been experiencing:

More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I’ve had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider – who they liked – abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.

Would it be so bad if more and more physicians decided to stop accepting Medicare? Physician/blogger Val Jones speculates it wouldn’t be the worst thing in the world – and that it perhaps might even save money. She writes that her own physician runs a cash-only practice and that most of his patients spend around $300 a year on their care – less than a low-deductible health plan.

I think that people need to begin to accept that health care costs money. Primary care should be budgeted for (the way we budget for our utilities) and that “health insurance” should be “sickness insurance” with a high deductible for emergency coverage. The majority of Americans can afford $300/year in primary care fees, and the service they’ll receive is far superior to what they have now. Government-run initiatives should focus on the very poor and inpatient services. Everyone else should enjoy the wonderful experience of having a personal physician available without long waiting lines or administrative and insurance hassles – all for the cost of less than we pay for TV.

Well, maybe. But even Dr. Jones notes this kind of arrangement seems to be best suited to people who are willing to pay cash for their care and who don’t require hospitalization. I’m not sure how many Medicare-aged patients would fit this description.

Should Medicare patients just have to pay out of pocket to see a doctor who no longer accepts Medicare? Will these patients migrate to other doctors and possibly overburden the practices that still participate in Medicare? I’m not sure of the answers, and an overhaul of the Medicare program doesn’t seem likely to happen any time soon. In the meantime, we can expect to hear about more seniors around the U.S. being left in the Medicare lurch.