When you manage your own practice or lead a large physician group of any kind, there are a plethora of daily decisions that need to be made. Beyond patient care standards and treatment protocols, business decisions are paramount.
Which makes this one pretty easy: if you can afford to cut out Medicare patients from your practice, you do it. It simply isn’t worth the time, paperwork, and long-term legal risk.
Speaking to a doctor on background about this particular issue it became crystal clear why some physicians won’t go near Medicare patients. Listen to his explanation:
“There are different reasons for different offices and specialties. They mainly come down to low reimbursement combined with excessive paperwork and red tape of the worst kind.”
“When I started in private practice, I received after about 6 months a nasty letter from Medicare signed by a nurse that I spend more time with my patients than whatever average they were comparing me to. Looking at online ratings and patient feedback, actual patients cited that as a huge plus but that Medicare nurse didn’t care about that and wanted to tell me how I should practice and how much time I should spend with my Medicare patients.”
“The second incident (which made me leave Medicare) was when I accidentally read that every office that accepts Medicare has to have a written policy regarding identity theft. Now you would figure out that in a complex legal society like the USA we would have plenty of Federal and State laws and regulations about identity theft in place but that was not enough for the Medicare bureaucrats. I was wondering how many other onerous and ridiculous Medicare regulations I was not following and figuring out that any Medicare audit would cost me much more (in treble damages and interest) than I could ever get from Medicare by taking care of their members. So, in my case, it wasn’t even low reimbursement but the absurd regulations that the bureaucrats were pumping out on a daily basis. Just to keep up with their deluge of daily changing regulations I would have to hire a full-time person. To let Medicare know that I am closing my office we had to fill out not one but TWO 40+ page reams of forms. You would figure out that it could be done on one sheet of paper, but that’s not the way Medicare works.”
“In conclusion: if there is a tiny carrot and a huge stick wrapped in thousands of pages of regulations coupled with harsh penalties (monetary and prison!), many physicians just don’t waste their time on Medicare.”
No physician, if they can avoid it, should be asked to receive significantly fewer dollars for their services, while also taking on exponentially more risk. That is an easy and simple decision.
But what strikes us as a bit of a moral conundrum, is what to make of doctors in somewhat impoverished communities, where Medicare plays a much bigger role. Physicians are then forced to take on the risk and simply accept reimbursement levels a good deal less than their peers. We’d guess this is why pay packages in those areas seem to promise more than what they deliver, ultimately.
You know, the whole ‘carrot and stick’ thing.