Being Denied Coverage….

March 1, 2013

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Source: Top six myths about Medicare | Reuters.

hospitalMYTH FOUR: DOCTORS WILL NOT ACCEPT MEDICARE BECAUSE OF ALL THESE CUTS

Facts: Most Medicare patients do not have trouble finding doctors who will see them, but there is growing concern about access to primary care physicians.

This issue is monitored closely by the Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency charged with advising Congress on Medicare. The agency’s most recent annual survey of Medicare patients found that just 2 percent of beneficiaries had problems of any kind finding a new primary care doctor willing to accept Medicare – the same percentage of patients aged 50-64 with private insurance who report problems.

Likewise, just 2.1 percent report trouble of any kind finding specialists willing to accept Medicare, compared with 2.3 percent for patients with private insurance.

I recently got into a discussion with one of my frequent visitors to this blog about doctors not accepting Medicare patients so I did a little research on the topic. As seen above the difference between doctors accepting Medicare patients vs. private insurance patients is basically the same.  The statistics show that it is actually slightly easier for a Medicare patient to see a specialist than it is for someone on private insurance! How is that for knocking that myth!

We constantly hear about how government-funded healthcare will produce inferior care and denied patients but as usual these types of things are usually just fear tactics put out by political partisans. Given that the Internet is so prevalent in most of our homes (although not so much in rural areas) it is relatively easy to get information on just about anything you care to research. It took me about five minutes to find the facts above.  Granted I had to sift through dozens of political articles about death panels and such but that is the price we pay for making information so easy. Learning the trick about googling helps too.

One of my personal favorite posts on this blog is about Lazy Minds (click here to see it).  It is just too easy for people to believe  and then pass one the rhetoric from someone with a very biased agenda gives them on about something instead of taking a little time to research it on their own. Lazy minds are the primary cause for so much that haunts our world today.

So the next time someone give you a political line about Obamacare or any other topic take the time to research it on your own. The real answers are out there if you care to wade through all the garbage to know the facts. But then again finding the facts can also get you in trouble with some groups, particularly those pertaining to religion. But that is another story…

14 responses to Being Denied Coverage….

  1. 

    One of the many frauds in our congressional budgeting process is that Medicare payment cuts (of about 27%) are always scheduled to occur in “next year’s” budget. This way, the CBO can assume the cuts do occur and future deficits look better. The cuts have always “temporarily fixed” a year or two at the time. If at some point they are not, many Medicare patients will have a terrible time finding a primary care doctor. My wife is a family practice physician and the difference between what Medicare and other insurance pays is often huge. If payments from Medicare are cut by ~1/4, her group has already concluded it would have to close itself to new (not existing) Medicare patients as they are already basically “break-even” patients. But I can’t speak for the cardiac and other “specialists” who tend to charge (and earn) much, much more.

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  2. 

    I work in a single site Urgent Care clinic, so I’m always interested in this topic. There are some other factors driving the decision to accept patients or not besides what you mention. Medicare reimbursement rates vary by what kind of setting the provider works in. Primary Care and Medicare performed at a clinic owned by, or physically attached to, a hospital gets a higher repayment for service than independent practices. Before the fiscal cliff deal was reached, Medicare reimbursement rates for non-affiliated clinics were due to be reduced 37%. We were ready to begin declining Medicare patients, because we would have lost money on each one treated. We already decline to treat those with Medicaid for that reason. In our state, that doesn’t even pay for the cost of supplies.

    We will be seeing definite advantages under the Affordable Care Act, because we switched to electronic medical record keeping. There’s a perk for that, and for having providers with a variety of credentials on hand, which we do. But until the state’s health care exchange is fully implemented we won’t know if we can afford to accept patients with that kind of insurance or not.

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  3. 

    THanks for the additional input Steve and Mikey. Of course there is constant game playing with Medicare and other budgets. This is kind of like the arguments against raising the minimum wage. Many claim it will cause millions of people of lose their jobs but the data never proves that out. I’m sure there is a tipping point for Medicare reimbursement but by the data it looks like we have not reached it yet. As Mikey says there are some incentives in the ACA to raise rates; such as electronic medical records. Being a retired IT engineer who developed these types of databases it amazes me that there are still those who do it with paper. Just the duplication of services for many patients because of the lack of sharing data is estimated to cost several billion dollars year.

    But it was surprising to me to see that denying patient services is actually higher under private insurance than it is Medicare. I don’t think that is because of the lack of private insurance to cover some procedures. That is probably a different topic.

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  4. 

    I have checked with all of our current healthcare providers and all will accept Medicare. Other than pediatricians, the 65 and over crowd are the ones filling the waiting rooms.

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    • 

      Hi Denise, I can say as a senior citizen I have had more health issues in the last six years than the previous sixty so I am not surprised that seniors fill waiting rooms. That is just the aging process and facing some bad decisions from earlier life.

      But I was really surprised that only one in fifty are turned away from a particular provider. Even on this blog I hear all the stories about not finding doctors who take Medicare. Are they fabrications for political purposes or is this just the two percent that do happen. I was also surprised that those with private insurance are rejected actually a little more than those on Medicare. It just goes against all the rhetoric that is going around today.

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  5. 

    I guess you have the drop on PBS. Their topic this weekend: ” Why fewer doctors are accepting Medicare.” Maybe you should contact them on your research findings.

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    • 

      Yeah maybe I should. Maybe they didn’t see the official monitoring agency report. Thanks for letting me know….

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    • 

      Janette, I went through all the PBS listings for the weekend and didn’t find any show that you cited. Can you give me more details. I would like to see what they say?

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  6. 

    It was a lead on the nightly report as what they are working on for the weekend.

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    • 

      Thanks Janette, but I looked through three different PBS channels didn’t see anything remotely about Medicare for the weekend on PBS. I will look again.

      I don’t deny that some doctors are rejecting Medicare and Medicaid patients. As the statistic show 1 out of every 50 patients are being turned away in both the Medicare and private insurance plans. That is not an insignificant number but it is not catastrophic as many want us to believe.

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  7. 

    It isn’t significant if YOU are not denied.
    ThePBS section was shown tonight ( Monday ).

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  8. 

    Hi Janette. you are right it is significant then but that also means that you have a 98% of the second doctor accepting you. I would take those odds without a lot of stress.

    I looked at the three PBS channels I receive and none have it. Since this is “beg” month on PBS local channels run thing that others don’t. If you get a chance give me the title of the show and where it came from (like Frontline, or such)

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  9. 

    I live in Walnut Creek Ca. About two years ago when I wanted to get a new primary care doctor I called all the ones in the phone book near me, about 18, and only two would take a new medicare patient. One of the two had recently had her licence almost revoked for ignoring the problems of an elderly man who turned out to have cancer, but she was allowed to continue with certain limitations to her licence: so I chose the other doctor. I am not sure the doctor I chose still takes medicare as the gov. site has her down with a question mark. (meaning what I am not sure-she doesn’t take or she adds a bit more to the bill. )
    To be fair when I first moved here 15 years ago , most of the doctors said they would not take my HMO (heathnet insurance) and the neighbor lady said she had trouble getting a doctor with her private insurance. Perhaps the doctors in Walnut Creek only take group insurance.

    But in any case it can’t be that 3 percent crap. I have read in California about half the doctors don’t take medicare, but that may be very old data. Keep in mind most states don”t collect any data on the subject.

    Joy ( grew up in a Friends Meeting- no preacher type of Friend)

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    • 

      Thanks for the input Joy. The data above is from a federal commission so overall I would think it is accurate. But as you indicate it may not reflect every State so maybe California makes up a bigger portion of the 2.1%. I don’t know. A lot of things about California are not normal ;)

      It was somewhat surprising to see that as many of trouble with doctors when they have private insurance.

      I don’t officially belong to a Friends meeting but I have found that their philosophy is very close to my personal views.

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