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2008: More TX Docs Opt Out Of Medicare

A July 2008 article from the Houston Chronicle:

More Texas Doctors Opting Out of Medicare

Nearly half of physicians in Texas say they can no longer afford to take new patients

July 3, 2008

In an ominous trend for baby boomers, Texas doctors are opting out of Medicare, weary of the perennial fights over cuts in reimbursement.

Only 58 percent of doctors in the state now accept new Medicare patients, according to a recent survey by the Texas Medical Association, down from an estimated 90 percent before 1990. Among primary-care doctors, the percentage is 38 percent.

TMA leaders predict the percentage will continue to plummet if Congress doesn’t arrive at a long-term solution soon. Congress returns from a Fourth of July recess Monday needing a short-term fix just to avert a 10.6 percent reimbursement cut scheduled to go into effect July 15.

"In my 50 years in medicine, I’ve not seen the level of frustration and anger out there now," said TMA President Dr. Josie Williams. "Most doctors have got to the point that they don’t think the real problem’s ever going to be fixed and are looking at whether to continue participating. They feel they’ve carried Medicare on their back as long as they can."

Dr. Tom Garcia, president of the Harris County Medical Society, called Medicare "the new Medicaid," a reference to the even lower percentage of doctors who opt into the government insurance program for low-income people.

The struggle to find a doctor who still takes new Medicare beneficiaries has hit home for Robert Sloane, a Fort Worth senior whose longtime doctor took early retirement and left him looking for a replacement.

Sloane got the same response from receptionists of each doctor he called: They would ask his age, birthday or insurance carrier, then say they would have to get back to him. Only they never would, he said.

"They were always very nice, but the questions were a clear code that they didn’t take Medicare patients," said Sloane, a retired surgeon. "The whole experience gave me a first-hand feel for a problem I’d only heard stories about before."

Sloane finally found a doctor after one who usually didn’t take Medicare patients accepted him as a professional courtesy.

Medicare’s 10.6 percent cut was to have taken effect Tuesday. But the Centers for Medicare and Medicaid Services, or CMS, announced Monday it would process no new claims until July 15, giving Congress a reprieve to block the reduction.

‘Medicare exodus’ possible
Were the 10.6 percent cut and an additional 5 percent cut scheduled for January 2009 to go through, Texas doctors would lose $860 million treating the elderly and disabled over the next 18 months, according to TMA. On average, each Texas doctor would face an $18,000 cut over that period.

If that happened, said one Texas doctor, "you can’t imagine the Medicare exodus" that would follow.

Congress, mired in partisan bickering about how to pay for the additional funding both parties agree is necessary, already missed a June 30 deadline to prevent the 10.6 percent cut.

CMS intervened after the Senate voted last week not to take up legislation passed by the House. That would have dipped into a Medicare pool of money that currently goes to private, fee-for-service insurers and use it for the traditional Medicare program. President Bush had vowed to veto that bill.

Still, Congress is expected to reach a quick compromise next week — partly because neither party wants to alienate millions of seniors voting in November.

Texas Sens. John Cornyn and Kay Bailey Hutchison say they’re hopeful about the prospects of a bipartisan resolution, and many Washington observers see the CMS move as a strong signal Congress must act.

But the resolution is widely seen as another Band-Aid, not the fundamental reform that doctors say is needed so battles don’t keep coming up annually.

Physicians say the problem is a statutory formula that leaves less money to go around as more people use the program. Left intact, they say, the formula would reduce reimbursements by 40 percent over the next nine years.

Among those who agree with doctors is Cornyn.

Instead of reforming the system, Cornyn said Tuesday in a letter to his Senate colleagues, Congress has made "a never-ending series of patchwork fixes that were inefficient and costly and caused undue hardship on everyone involved."

Cornyn has sponsored a bill, endorsed by the TMA, that would get rid of the formula. But real consideration of the legislation is not expected to come until a new Congress takes over in January.

In the meantime, doctors are fretting. Hardest hit in Texas, say TMA leaders, are doctors in the inner city, in rural areas and along the border in the Rio Grande Valley — doctors whose patient load is often 80 percent or more Medicare beneficiaries.

Hard choices for doctors

With reimbursements cut 20 percent in inflation-adjusted dollars the last seven years, many such doctors are having a hard time making a go of it.

Houston internist Lisa Ehrlich found that the only way she could keep her current patients as they became eligible for Medicare was not to take on new Medicare patients.

"Every year, it comes up that there’s going to be a cut, then they say, no cut," she said. "But there’s no inflationary increase, and we make less and less."

The obvious losers, said former TMA President Dr. Bohn Allen, will be the baby boomers who have reached their retirement years.

"I don’t know why Congress would want to make it so Medicare beneficiaries can’t get access to care," Allen said. "They may not realize it, but we’ve reached a tipping point."

If Obama-Care is going to be simply an expansion of Medicare, how will we have the option of picking our own doctors?

Why should we think that the doctors would be willing to accept new patients with Obama mandated re-imbursements?

This article was posted by Steve on Wednesday, July 29th, 2009. Comments are currently closed.

14 Responses to “2008: More TX Docs Opt Out Of Medicare”

  1. proreason says:

    Oh, you’ll get to pick your doctor all right.

    There just won’t be any left to pick from.

    In some Canadian communities they have lotteries to get a doctor.

    But when the ex-Acorn community organizers get through med school, that problem should disappear.

    Then you will be enjoying a socially just form of medical care.

    And if your health is ruined, you will have the sweet consolation of knowing you are a patriot.

  2. Petronius says:

    Working definition of Obama-Care: Obama-Care means waiting in line to see your death counselor.

    • Liberals Demise says:

      “Obama -Care means waiting in line until you die.” (counselor denied)
      There Petronius………now we can concentrate on our “Over Our Heads” straw business.


  3. neocon mom says:

    “If Obama-Care is going to be simply an expansion of Medicare, how will we have the option of picking our own doctors?”

    I don’t know Steve, but if they found a way to force banks to give home loans to unqualified people, surely this is something the government, in its infinite wisdom, will figure a way to do sooner or later.

  4. canary says:

    This can lead to doctor’s not accepting insurance coverage too.
    Doctors already have to give discounts to patients on Medicare. They already give discounts to insurance company providers too. This idea that Obama wants things done at the snap of his fingers, when he’s not busy
    in make-up dept getting ready for the cameras and teleprompt.

    Obama’s wife is an example to go by. Hospital paying her for work she did not do. Holding on to charity money, sending patients away. Laying off workers at one company.

  5. If I am not mistaken.. Texas is a Free Republic with embassies in several countries. Just a tidbit.

  6. retire05 says:

    I live in a central Texas county that has a population over 50K. We have a lot of retired due to the fact that it is a) basically rural and b) real estate prices have remained steady over the last 5 years.

    We have two doctors, TWO, that will accept M/M patients that don’t have secondary insurance. Many retired people who have moved here in the last few years have to drive 40 miles to a major city for routine medical care. Some of the doctors are refusing to take insurance assignments while simply means; you pay up front, you get a receipt and the doctor’s office fills out insurance paperwork for you and you send it in and the insurance company sends you what they cover.

    And Jason, no the State of Texas doesn’t have embassies. We did when we were an independent nation, but they were closed when we became a state.

  7. BillK says:

    And Jason, no the State of Texas doesn’t have embassies.

    Hey, Texas did on the television show Jericho! :-)

    (Texas also came off looking really, really good at the end of that show…)

  8. canary says:

    retire05, I believe doctor’s in the U.S. can all insist you pay upfront and file your insurance yourself. It used to be common. The new fad is doctor’s charging large new patient fee’s, in otherwise you pay a fee for them to take you on as a patient. Now my regular office is doing it, and am glad I am already a patient. I’ve been running into these charges more and more. I think it’s a way of doctor’s to take on more wealthy patients. It does not mean better health care. One place a spin off clinic from a hospital, did not even tell me of a 400 dollar for being new patient, even though they allready had all my information in their computer from the head facility, and charged high just as their regular ER. And messed up my injury, messed up the billing. It’s just the way it is these days. We need more doctors and nurses, and threatening them with lower pay, isn’t going to help.

  9. Dug says:

    “If Obama-Care is going to be simply an expansion of Medicare, how will we have the option of picking our own doctors?
    Why should we think that the doctors would be willing to accept new patients with Obama mandated re-imbursements?”

    My take on this is (for seniors) as follows:
    1) If you have a doctor now and are on medicare or nearing medicare and the doctor continues to accept medicare, you will probably be able to keep the doctor.
    2) If the doctor does not accept medicare or decides to no longer have you as a patient on medicare, you will be competing with many other seniors for the few doctors that do accept medicare and will probably be put on a waiting list or your appointment will be 6 or more months out for an office visit… or a doctor will be assigned to you.
    3) Eventually, as more and more doctors retire because they no longer want to deal with this and fewer students pursue medical degrees, the situation in item 2 will get worse.
    4) Then, eventually, the government will be forced to bring in “doctors” from other countries (see Britain).

    It’s called rationing. Eventually, for seniors, it means death/life termination counseling.

  10. retire05 says:

    Texas increased its doctor count a few years ago by enacting tort reform in the state. Small town that have done without a doctor for years now have one. But still, they refused to take M/M because it takes them as long as six months to get paid here is the really crappy thing: it’s called Reasonable and Customary. That is how M/M get out of paying the doctors what they charge. Example: doctor’s standard office visit $75.00; M/M has a fee plan that make the R & C set at $50.00 and then M/M pays 80% of that. So the doctor charges $75.00 but only gets $40.00.

    Most doctors I know, when they have a patient that is on only M/M, and the doctor knows that patient is trying to survive on Social Security, will just eat the other $35.00 of their charge.

    Also, there is a new thing M/M is doing; making doctors get preapproval for a test. My stepmother’s doctor recommended her to a cardiologist due to her age (86). The cardiologist suggested she have a test that would detect any risk of having a stroke due to her age. M/M denied it. Two weeks later, she had a stroke. And wound up in the hosptial for a week. All of that could have been avoided by the test, and medication like Plavix and Norvasc to prevent the TIA she had.

    Instead of a simple test, that she would have had to pay around $100 for (her share) she now owes the hospital $1,200.00, the part that M/M didn’t cover.

    This, my friends, is Obamacare.

  11. joeblough says:

    Yes. Something that nobody ever seems to mention in the public discourse about “health care” … doctors.

    Hmmmmm…. How about that?

    Curious don’t you think? Here is the entire rest of the damn country debating what doctors should be allowed to do or not do, what they should get or not get paid for their work, what medical methods they should or should not be allowed to use, and for whom.

    As if it were our place or our business to have an opinion about such things!

    Someone, somewhere, sometime has got to bring up in public the fact that at the core of this “debate” about “health care” is really a discussion about the enslavement of doctors.

  12. MinnesotaRush says:

    “Ya ain’t seen nothin’ yet .. ba ba ba baby .. ya ain’t seen nothin’ yet.”

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