Doctors Are Opting Out of Medicare -NYT
- From: jim@xxxxxxxxxx
- Date: Sun, 14 Jun 2009 21:39:54 GMT
Doctors Are Opting Out of Medicare
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By JULIE CONNELLY
Published: April 1, 2009
http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html?_r=1&em
EARLY this year, Barbara Plumb, a freelance editor and writer in New
York who is on Medicare, received a disturbing letter. Her
gynecologist informed her that she was opting out of Medicare. When
Ms. Plumb asked her primary-care doctor to recommend another
gynecologist who took Medicare, the doctor responded that she didn?t
know any ? and that if Ms. Plumb found one she liked, could she call
and tell her the name?
Many people, just as they become eligible for Medicare, discover that
the insurance rug has been pulled out from under them. Some doctors ?
often internists but also gastroenterologists, gynecologists,
psychiatrists and other specialists ? are no longer accepting
Medicare, either because they have opted out of the insurance system
or they are not accepting new patients with Medicare coverage. The
doctors? reasons: reimbursement rates are too low and paperwork too
much of a hassle.
When shopping for a doctor, ask if he or she is enrolled with
Medicare. If the answer is no, that doctor has opted out of the
system. Those who are enrolled fall into two categories, participating
and nonparticipating. The latter receive a lower reimbursement from
Medicare, and the patient has to pick up more of the bill.
Doctors who have opted out of Medicare can charge whatever they want,
but they cannot bill Medicare for reimbursement, nor may their
patients. Medigap, or supplemental insurance, policies usually do not
provide coverage when Medicare doesn?t, so the entire bill is the
patient?s responsibility.
The solution to this problem is to find doctors who accept Medicare
insurance ? and to do it well before reaching age 65. But that is not
always easy, especially if you are looking for an internist, a primary
care doctor who deals with adults. Of the 93 internists affiliated
with New York-Presbyterian Hospital, for example, only 37 accept
Medicare, according to the hospital?s Web site.
Two trends are converging: there is a shortage of internists
nationally ? the American College of Physicians, the organization for
internists, estimates that by 2025 there will be 35,000 to 45,000
fewer than the population needs ? and internists are increasingly
unwilling to accept new Medicare patients.
In a June 2008 report, the Medicare Payment Advisory Commission, an
independent federal panel that advises Congress on Medicare, said that
29 percent of the Medicare beneficiaries it surveyed who were looking
for a primary care doctor had a problem finding one to treat them, up
from 24 percent the year before. And a 2008 survey by the Texas
Medical Association found that while 58 percent of the state?s doctors
took new Medicare patients, only 38 percent of primary care doctors
did.
Currently, about 40 million Americans have Medicare insurance,
according to medicare.gov. Coverage is provided to those 65 or older,
some younger disabled people and people of all ages with end-stage
renal disease.
Those approaching Medicare eligibility should talk to their doctors.
Even doctors who won?t take new Medicare patients may be willing to
allow their existing ones to remain in their care. If they are not,
it?s advisable to start looking around. But the search will be easier
for people who start early.
?If you have just moved into town and are 64,? said Dr. Jeffrey P.
Harris, an internist and the president of the American College of
Physicians, ?it is easier for you to see a doctor than if you had just
moved into town and are 65.?
Before giving up on a doctor who will not accept Medicare, a patient
should ask about signing a private contract that stipulates the
patient will be responsible for paying the doctor?s fees and lists
exactly what those fees are and what they cover. Some doctors may be
willing to negotiate and tailor prices to what patients can afford.
For example, a doctor who charges younger patients with employer
health coverage $250 for an office visit might be willing to accept
$175 from an older patient who pays cash and requires no insurance
claims.
?I have a lady of 93 who pays me $5 a visit, and for her that?s real
money,? said Dr. Steven D. Knope, an internist and private contract
doctor in Tucson. ?I charge her because then she listens to what I
say.?
How do you find a doctor who accepts Medicare? The Web site
www.medicare.gov provides a list of enrolled doctors. Other sources
are state medical societies and local hospitals, most of which have
online directories of doctors. But that?s no guarantee they will see
new patients.
Other options are also available. Roughly 18,000 walk-in, stand-alone
urgent care centers in the United States are staffed with doctors who
set simple fractures, take X-rays, do minor surgery, diagnose ailments
and write prescriptions. By far the majority of these centers take
Medicare.
Although they were never intended to provide continuing care, ?our
primary care practice is growing more than anything else,? said Dr.
Franz Ritucci, who is medical director of the American Academy of
Urgent Care Medicine and practices at America?s Urgent Care in
Orlando, Fla., a chain of walk-in centers that also has clinics in
Columbus, Ohio.
The centers are open 12 to 18 hours a day and patients do not need an
appointment, though they may have to wait. Some centers allow
appointments to see a specific doctor for follow-up.
?If you can hook up with a primary care provider in an urgent care
center who is willing? to provide continuing care, said Dr. J. James
Rohack, a cardiologist who is president-elect of the American Medical
Association, ?then yes, it?s an option.?
Type ?urgent care centers? into a search engine and thousands come up.
In June, the Academy of Urgent Care Medicine plans to add a list of
centers it has accredited to its Web site, www.aaucm.org.
Another, more expensive option is concierge or ?boutique? care, which
comes in two forms. In the most popular kind, doctors accept Medicare
and other insurance, but charge patients an annual retainer of $1,600
to $1,800 to get in the door and receive services not covered by
Medicare, like annual physicals. Before signing up and paying the
retainer, patients should get a written agreement spelling out which
services the doctor will bill Medicare for and which the retainer
covers. And always check carefully for double-billing.
The other form of concierge medicine ? doctors who have opted out of
Medicare ? is more expensive still. Fees range as high as $15,000 a
year and cover office visits, access to the doctor when care is
needed, referrals to specialists and thorough annual physicals.
Dr. Knope, the author of ?Concierge Medicine: A New System to Get the
Best Healthcare,? has this kind of practice in Tucson. His patients
sign a contract agreeing to pay $6,000 a year for individuals and
$10,000 a year for couples. The fee covers office visits, physical
exams and phone consultations, and Dr. Knope will meet patients in the
emergency room, see them in the hospital and occasionally make house
calls.
A list of about 500 concierge doctors throughout the country is
available on Dr. Knope?s Web site, www.conciergemedicinemd.com.
Is the care worth the money? Harold and Margret Thomas, who are in
their mid-70s and live in Cincinnati, spend the winter in Tucson.
After many phone calls, the couple were unable to find an internist in
Tucson who took new Medicare patients, so they signed with Dr. Knope
in 1996. Five years ago, when Mrs. Thomas developed a blinding
headache, her husband called the doctor at 8 o?clock one night, and
he, suspecting an aneurysm, insisted they get to the emergency room
immediately.
The doctor met them and ordered an M.R.I. and a CT scan. The tests
revealed an aneurysm, and Dr. Knope found a surgeon who quickly
operated. Medicare paid for the emergency room, the surgery and the
hospital stay.
?If there were a concierge practice in Cincinnati, I?d be part of it
there, too,? Harold Thomas said.
.
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