Now ... if doctors are underwhelmed by Medicare reimbursement rates ... and reduce or eliminate their acceptance of new Medicare-eligible clients ... would not a "public option" along the lines of the proposed "Medicare + 5%" exacerbate the reluctance of doctors to take on more loss leaders (Medicare patients)?

The wheels are falling off the bill in the Senate (again) as Democrats and Independent are moving away from public option, opt out, opt in, or copped out, whatever the latest names. Not to be overlooked is bluedogs in the House of Reps wanting to write in the "Hyde amendment" anti-abortion except in rape and health of Mother, having the votes Hoyer beleives it should be included.

Locally, my Doctor says Ray you need a stress test. I says I can't afford it. He's says you got Medicare. I says that's less than 80% of your bill, you gonna write off the other 20%. At least laughter is good health.



"http://jacksonville.com/business/2009-10-27/story/mayo_clinic_fees_may_be_different

Many lawmakers and health-care analysts applaud the Mayo Clinic for its innovations, namely a century-old model of care that is shown to produce better results and skimpier Medicare bills.

But recent changes at Mayo's three primary branches, including its 396-acre Jacksonville campus, have fueled criticism that Mayo's low costs are the result of cherry-picking a wealthier, less-diverse crop of patients. Studies show that low patient incomes are a predictor of high Medicare costs.

Mayo's selectivity finds itself at the center of the hurricane that is the health care reform debate. President Barack Obama and other key proponents have touted the famed clinic in recent months as an example of what health care should be: efficient, collaborative and, above all, cost-controlling.

But could it be that Mayo is too thrifty?

"If they are, in fact, restricting patients who can go there, I would say that's not a good [medical] model," said Andy Behrman, president and CEO of the Florida Association of Community Health Centers, a coalition of safety-net clinics. "The reality for us is we have no restriction on patient populations. We have to see everybody."

Mayo's headquarters in Rochester, Minn., earlier this month stopped accepting Medicaid patients from outside Minnesota and the four states it borders, according to the Washington Post. Also this month, its Arizona campus announced that Medicare patients seeking primary care would no longer be seen unless they pay an annual fee.

The moves echoed earlier revenue-enhancing changes at Mayo's Jacksonville branch.

About two years ago, Mayo Clinic Florida stopped accepting Medicare Advantage - privately run, government-subsidized Medicare plans intended to offer beneficiaries a choice of plans and a broader list of covered services. The plans cost the government about 14 percent more than traditional Medicare to operate.

To date, about one out of five Medicare-eligible beneficiaries has signed up for an Advantage plan nationwide. Mayo's decision means they can't be treated at its Florida campus.

"It definitely is an administrative expense," said Eric Palmer, head of Mayo's patient access division in Florida, referring to the Advantage program. "Our expenses were going up to get paid less, so it didn't make any sense."

In addition, the Jacksonville campus became a "nonparticipating" Medicare provider in 2003. That means Mayo can charge Medicare patients a higher rate than what the government program normally allows for physician services and outpatient care. More recently, the Jacksonville clinic has barred new Medicare patients from getting primary care. If they want to be seen, it had better be for Mayo's specialty: specialty care.

"We can't do everything for everybody," said Bill Rupp, Mayo Clinic Florida's CEO. "We have chosen that the things we do really well are these tertiary kinds of things, treating these really complex problems."

Among Mayo's many touted advantages: It pays doctors a salary instead of having them rely on insurance reimbursements, a system that proponents say discourages unnecessary patient visits and tests. The Rochester, Minn.-based nonprofit also employs what it calls the "Mayo Clinic Model of Care," a team-based approach to medicine it has been fine-tuning for more than 100 years.

Mayo certainly is not alone among providers in worrying about Medicare. The government program reimburses providers at only about 80 percent of what private insurers pay, and Medicare is sure to slip further behind as planned cuts take effect in coming years. Still, the vast majority of physicians and hospitals - including every Jacksonville-area hospital except Mayo - participate in Medicare.

That Mayo doesn't shouldn't disqualify it as a model for health care reform, Rupp said.

"We're not going to get better results because we have less ill patients. In fact, we tend to have more difficult patients," he said. "I think we are the model because we provide the value, and we, in fact, see a lot of Medicare [patients]."

About 52 percent of the hospital and clinic bills at Mayo Florida are paid by Medicare, Rupp added. He worries that some would-be Medicare patients may have heard about its billing policy and concluded they can't be seen.

That's the impression that Bob Moore got when he called Mayo's accounting department last year to see whether the clinic would take his traditional Medicare plan.

The 79-year-old Ponte Vedra Beach man wasn't sick at the time. But with his diabetes and deteriorating sense of balance, he wanted to establish a relationship with the clinic's doctors before an emergency. He never got an appointment, though.

"I was left with the idea they didn't want to accept [Medicare]," said Moore, a former chief financial officer for St. Vincent's Medical Center.

Put simply, traditional Medicare patients are charged more for physician services at Mayo. Mayo, though, must accept Medicare-approved rates for hospital-related fees, according to the law.

The dichotomy between physician and facility charges can lead to confusing billing scenarios.

For example: A patient with a broken arm will be charged at a Medicare-approved rate for an X-ray in the emergency department but will pay a premium for a physician to analyze it. Further, Medicare will pay the hospital directly for the X-ray, but for the physician, Medicare will pay the patient, and the patient is in charge of reimbursing the hospital.

"It becomes a very, very frustrating, confusing, time-consuming situation for patients and their families when they're managing their bills," said Harvey Matoren, who, as head of a Jacksonville patient advocacy company, handles scores of Medicare cases for Mayo patients every year. He added: "I'm in business because of providers like the Mayo Clinic."

By law, Mayo can charge as much as a 15 percent premium on its doctor bills, adding thousands of dollars in out-of-pocket expenses to some of the heftiest bills, Matoren said. Those with supplemental insurance don't have to pay the extra charges themselves, but Matoren cautions that some plans don't cover such expenses.

"Theoretically," Matoren said of the Mayo model, "it should be more cost-effective to provide that service. But the flip side of that is what kind of financial impact that has on the patients. While they're in that ideal medical model, I know they're frustrated with their billing and financial situation."

Rupp doesn't disagree.

"It's such a hassle to our patients. It does put a bigger burden on Medicare patients. They have to process their own checks and turn them over to us," he said.

Administrators at the Jacksonville clinic recently began evaluating whether the billing policy should be changed and are expected to reach a decision in about six months. He didn't offer any details about how the policy may be altered

quote:

Originally posted by I_M_Qwerty:
Now ... if doctors are underwhelmed by Medicare reimbursement rates ... and reduce or eliminate their acceptance of new Medicare-eligible clients ... would not a "public option" along the lines of the proposed "Medicare + 5%" exacerbate the reluctance of doctors to take on more loss leaders (Medicare patients)?

First off, don't count on the cuts, mandated by legislation passed in 1997 and postponed every single year since, actually taking place. I also wouldn't count too heavily on those screams of anguish being entirely accurate, either. Regardless of what private plans pay, Medicare accounts for an overwhelming majority of geriatric care payments, and I think what will eventually happen is that some or all practices may have to scale down their expenses ... but will hardly stop treating the patients that they have been ruthlessly trained to treat, rather than going in for forestry or art history instead.

quote:

Originally posted by oldmole:

quote:

Originally posted by I_M_Qwerty:
Now ... if doctors are underwhelmed by Medicare reimbursement rates ... and reduce or eliminate their acceptance of new Medicare-eligible clients ... would not a "public option" along the lines of the proposed "Medicare + 5%" exacerbate the reluctance of doctors to take on more loss leaders (Medicare patients)?

First off, don't count on the cuts, mandated by legislation passed in 1997 and postponed every single year since, actually taking place. I also wouldn't count too heavily on those screams of anguish being entirely accurate, either. Regardless of what private plans pay, Medicare accounts for an overwhelming majority of geriatric care payments, and I think what will eventually happen is that some or all practices may have to scale down their expenses ... but will hardly stop treating the patients that they have been ruthlessly trained to treat, rather than going in for forestry or art history instead.

Local news stated last week Medicare cuts to Doctors voted down 47 to 53 last week.

quote:

Local news stated last week Medicare cuts to Doctors voted down 47 to 53 last week.

What was defeated was a bill that would have permanently prevented Medicare payment cuts to doctors. The 21% cut still stands ... though Harry Reid has inicated that he plans to introduce another short term ( one year ) fix ... much like the annual fix to the AMT.

As one who has been there, this will become a problem if the cuts take place. For years, my wife and I had difficulties getting MDs to take us in as patients because we had Tricare. Occasionally we would find a Doc and they would shed us due to slow pay and low reimburesments. Once we were eligible for Medicare with TFL as a second payer, we no longer had a problem. Short story, they will dump us if these cuts take place. The "Public Option" may be our only choice, if we can not use the normal insurance for those over 65.