Sunday, April 18, 2010

Press 2 if you have Medicare

Instead of fixing the SGR, Congress pushed off the fix for a few months. SGR is a formula that is designed to decrease doctors fees for Medicare. Doctors big issue with Medicare is that the rates are about the same as they were in 1983 without an adjustment for inflation. Unfunded government mandates have increased but the reimbursement has not. Admittedly, docs were probably paid too much in 1983 but now times are different. To make the numbers look good for the healthcare plan, they used the cut numbers which include a 20% or so cut in physician reimbursement. This pretty much reimburses less than what it costs to provide the care. Anyway, our biggest primary care group of over 200 doctors has just decided enough is enough and limited its Medicare slots to less than 1 per doc per day. (45% of thier docs decided just to drop Medicare). They already do not take Medicaid. The specialists have already limited Medicare to patients that the primary care docs personally calls for an appointment.

"Thank you for calling Greater Metro Cardiothorasic Consultants' appointment line. Keeping your heart healthy is our business. If you have private insurance such as Blue Cross, United, Etna or Cigna please press 1 and one of our schedulers will be right with you to schedule a timely and convenient appointment. If you have Medicare, Medicaid or other government funded insurnance press 2 and you will be directed how to submit an appointment request in writing. Please be aware you will need your primary care doc to personally call one of our physicians. We will then get back to you in writing in 9 to 12 weeks with an answer to your request. If you are granted an appointment, it will on a space available basis."


SeaSpray said...

Throckmorton - What if you see them in the ER first? Are you obligated to do the follow up if you were the on call doc?

What a mess. I still can't get past the fact they skewed the numbers to get things past. because pure logic would dictate then that the bill was not financially feasible ..fiscally sound ..whatever.

I actually asked my orthodoc about getting a surgery I don't need yet (hope I never do), because I am concerned about the future of my HC plan. Right now my husband's employer contributes 10,000 annually and we put in 3,700. I was shocked to here senators and congressmen have the same plan. I'll bet they won't have to worry about decreasing coverage with it though and they don't have to pay for the increases. And my husband has paid into it so that I can be on it as a COBRA when he retires. Best laid plans...

I don't know if MDCR will even be in existence by the time we use it ..but if it is ..reading this is certainly worrisome. I wonder if in time ..the government will revamp all of it and your salary will come from the government and you'll have regular hours, be exempt from lawsuits, etc? I thought I read that about Canadian docs ..but I could be mistaken.

I do not believe this administration had "for the good of the people" in mind when they passed this HC debacle.

SeaSpray said...

PS - It will be interesting to see the premiums for 2011 and coverage. Our cost for premiums really did not jump up a lot.

I wonder now ..because of course this administration is looking out for all the people with private plans.

Maybe it's just like our president stated ..we will be able to keep our doctors and our insurance won't cost us any more and we can have it all ..because they made the skewed numbers work so there will be affordable quality care for EVERYONE.

Even though don't know what is in the bill ..thus unable to understand it or long term consequences... it's all good ..everything will be wonderful now.

They FIXED the health care problems.

And everyone lived happily ever after.

The End