Medicare Pay Cuts for Physicians 26%

[CuteOldGuy]

For those of you like Medicare, get over it. More and more doctors are refusing Medicare patients, and here is why:

The medicare pay cut for 2013 is expected to be 26%.

CMS has issued its final rule on the Medicare physician fee schedule (pdf) for 2013, saying Medicare reimbursement rates for physicians will be slashed by 26.5 percent on Jan. 1, 2013, unless Congress bypasses the sustainable growth rate.

The medicare pay cut for 2012 was 27%, via AMA-ASSN:

The across-the-board Medicare physician pay reduction scheduled for 2012 shrank slightly from projections made earlier this year, but doctor organizations said the cut still would be catastrophically large.

A 27.4% reduction to doctor pay starting Jan. 1 would have devastating consequences on all physicians and the millions of patients who rely on the insurance program for coverage, patient advocacy associations and organized medicine groups have warned. Beneficiaries would suffer from not being able to see the doctors of their choice, and physicians would weigh leaving the program and perhaps closing their doors.

Read more at http://www.reagancoalition.com/artic...twgetHZdJG0.99

[Sidewinder]

According to the general medicine clinic I use, Medicare reimbursement for services does not cover the actual costs of providing the services.

That was as of a few years ago.

I got the same answer from a small neighborhood practice in Austin TX, a few years ago.

A 26% cut on top of a 27% cut is a net 46% cut. Not good...

[LexusLover]

Originally Posted by Sidewinder

A 26% cut on top of a 27% cut is a net 46% cut. Not good...

The actual pay schedule is available on line for a comparison, but keep in mind the 26% and 27% cuts are "average" for services and some services are not even reimbursed. In addition the "problem" is that historically the physician "creates" an in-office rate for charges of "coded" services over a period of time to get an "increase" for those services that can be passed to private insurance carriers ... and uninsured/self-insured patients. To compensate for the loss from medicare/medicaid patients the rates on the others will have to be increased .... because their overhead costs WERE NOT reduced by 26% and 27% during the past two years. And will be increasing.

FYI the medicare supplemental insurance does not pay the "gap" ... it reduces the copay....as opposed to increasing or even maintaining what the physician, pharmacist, or clinic/hospital gets.

When "the Department" completes the round of regulations under the Affordable Care Act the required minimum will further eliminate physicians, because they will get no co-pays on some services and employers will start reducing or eliminating coverage for their employees.... by either paying out of pocket "fines" or reducing hours of employees to avoid the requirement to provide coverage.

[gnadfly]

Originally Posted by LexusLover

FYI the medicare supplemental insurance does not pay the "gap" ... it reduces the copay....as opposed to increasing or even maintaining what the physician, pharmacist, or clinic/hospital gets.

Are you sure about this? I handle my mother's bills and her supplemental insurance says "addl amount covered". BTW, the amount of paperwork they send a month is staggering.

[Guest123018-4]

My ophthalmologist decided to retire instead of having to succumb to Obamacare.
He will now only perform surgery for charity at no cost via a foundation.

[i'va biggen]

If you have no insurance at all they will charge you a lot less than they do the clients with insurance.

[Iaintliein]

I once heard a lawyer say he advised all his healthcare provider clients to decline seeing Medicare patients. His contention was that even a small, unintentional error in paperwork results in horrific fines, if these errors were made systematically over a couple of years the practice would be bankrupt.

Healthcare costs followed general inflation until Medicare drove it higher, then the advent of HMO/PPO by the government corrupticrats resulted in an even steeper incline, just the threat of Hillarycare drove the vast majority of hospitals to join joint purchasing coops. The result? Probably 90% of disposable medical devices used in the US are now made in Mexico by tens of thousands of employees.

If I believed in god I'd say only it knows what this mess will end up costing us.

[LexusLover]

Originally Posted by gnadfly

Are you sure about this? I handle my mother's bills and her supplemental insurance says "addl amount covered". BTW, the amount of paperwork they send a month is staggering.

"covered" doesn't mean "paid" ....

If you are monitoring the paper work, keep it on a spreadsheet with every charge and get the billing vs. bills paid totals from the quaterly/annual reports to compare. My perspective has been to address attempts by providers to bill insureds for the amount "not covered" by the carrier/medicare/medicaid when it is obvious that the provider has "contracted" with the carrier/mediare/medicaid to ACCEPT the amount paid by them with the contracted limitation of the insured for the "copay."

The days of the providers getting rich off medicare/medicaid billing systems are over.There will be continued a lot of fraud, but they get so cut back it is difficult to squeeze much out of the rock by fraud. Some still get a squeeze, but it won't cover the shortfall on overhead. 30 years ago some physicians were knocking down $1 million + a year in medicare billings/receipts

[CJ7]

cut = gouging

the docs cant overcharge taxpayers ... woe is them.

as many new, hungry Doctors as we have rolling out of med school I dont imagine there will be too much slack

[Yssup Rider]

Get your facts straight COLiar.

Get what, boys, this isn't the result of Obamacare. Medicare reimbursement cuts have been prescribed since long before Obama was a US Senator. In fact, every couple of years, the health care system has faced a somewhat less publicized "fiscal cliff." Lawmakers have been putting bandaids on the estimated 40% cut for years.

Not coincidentally, any cut in Medicare reimbursement generally triggers an equal cut in reimbursement to physicians by insurance companies. That's right, the greedy insurance companies seize every opportunity to squeeze the providers while sticking it to the insured.

The "trend" for new physicians is to go to work as employees of a health system or hospital. The new docs don't care.

The biggest issues are with the radiologists, anesthesiologists and other specialists who don't deal with patients, yet are whining the loudest because their annual take is gonna drop from $900K to $750K.

[CuteOldGuy]

I have a family member who is a "new doc". Trust me, they DO care!

[CJ7]

Originally Posted by CuteOldGuy

I have a family member who is a "new doc". Trust me, they DO care!

trust you? ... thats rich

[Yssup Rider]

Yeah? Did this youngun go into medicine for the money?

If so, then one of you are lying.

I have yet to meet a med student who mentions money as the motivator. Even the ones in residencies for high paying specialties, like dermatology.

It's always about the patients. Of course then the student loans come due and their outlook changes a tad...

[LexusLover]

Originally Posted by Yssup Rider

Of course then the student loans come due and their outlook changes a tad...

.. and the car payments, country club dues, trips to Europe, the "doctor's home" mortgage, the "doctor's yacht," and finally the lodge for the winter vacation....... and those famous medical association junkets to brush up on the latest tax loopholes.

If they set up their own practice it is overhead, personnel intensive, and they have to maintain that level of staffing to keep the flow of patients and their paper work moving. But when someone sees a doctor for 5 minutes and a bill goes out for $100 the hourly rate of charging is pretty good....and then the extras for tests gets added with an upcharge on the costs.

[LexusLover]

Originally Posted by i'va biggen

If you have no insurance at all they will charge you a lot less than they do the clients with insurance.

It's still more than they will get for the same service through the government.