Medicare for All

[Averageman]

I was watching something on YouTube (Agree, not the best source for the truth.) but, it mentioned that Doctors now have less time for seeing a Patient due to the billing and payments for Medicare are less than conventional insurance billing, is this true?
If that is a fact (I do not know that it is.) how does this effect the care and decision making process?

[Hmac]

I was watching something on YouTube (Agree, not the best source for the truth.) but, it mentioned that Doctors now have less time for seeing a Patient due to the billing and payments for Medicare are less than conventional insurance billing, is this true?
If that is a fact (I do not know that it is.) how does this effect the care and decision making process?

It is a fact, but it’s actually a conflation of two different problems. Problem 1...Medicare reimburses about $.20 on the dollar. Increasingly, small practices and large systems are finding that accepting Medicare patients isn’t financially viable because they end up without sufficient doctors to care for their entire patient load. They have to decide to make room for the patients that have insurance that reimburses more. The Mayo Clinic (all locations), for example, is no longer accepting new Medicare patients for that reason. They can’t afford it. They lose money on every patient. Problem 2...the regulatory and documentation burden for doctors these days has become ridiculous. Primary care doctors spend abut two hours on the computer documenting patient care for every hour that they spend actually providing patient care. As you might imagine, that’s kind of a bummer for someone who became a doctor because they grew up watching Marcus Welby, and is the main reason for unprecedented rates of physician burnout, in turn the reason there is a critical shortage of Family Practitioners, and in turn the reason that your new doctor is probably actually a nurse. Patient care and decision-making...? It probably happens some places but I don’t see those issues affecting patient care and decision-making. The biggest problem caused by these two issues is the rapidly decreasing number of primary care doctors, and the fact that they see fewer patients in a day.

[Averageman]

Makes sense to me.

[sundance435]

It is a fact, but it’s actually a conflation of two different problems. Problem 1...Medicare reimburses about $.20 on the dollar. Increasingly, small practices and large systems are finding that accepting Medicare patients isn’t financially viable because they end up without sufficient doctors to care for their entire patient load. They have to decide to make room for the patients that have insurance that reimburses more. The Mayo Clinic (all locations), for example, is no longer accepting new Medicare patients for that reason. They can’t afford it. They lose money on every patient. Problem 2...the regulatory and documentation burden for doctors these days has become ridiculous. Primary care doctors spend abut two hours on the computer documenting patient care for every hour that they spend actually providing patient care. As you might imagine, that’s kind of a bummer for someone who became a doctor because they grew up watching Marcus Welby, and is the main reason for unprecedented rates of physician burnout, in turn the reason there is a critical shortage of Family Practitioners, and in turn the reason that your new doctor is probably actually a nurse. Patient care and decision-making...? It probably happens some places but I don’t see those issues affecting patient care and decision-making. The biggest problem caused by these two issues is the rapidly decreasing number of primary care doctors, and the fact that they see fewer patients in a day.

Serious question - I thought Medicare reimbursement was closer to 60% of established rates? Not necessarily 60% of what private insurance will pay, which is usually a negotiated rate, anyway. On the other side, hospitals/specialists/physician group facilities don't accept Medicare because they're not making any money on it, but because they're not making as much as they could through a private insurer.

I have heard that Medicare regulatory compliance is a nightmare and independent studies have shown that it adds a not-insignificant amount of cost to a healthcare operation. It's probably far simpler to deal with private insurers because the burden is ultimately on the patient, which is not how it should be. There's a lack of accountability from anyone but the patient (and Medicare), at this point.

[Averageman]

I had a very good British friend who woke up one morning and pissed blood, so he goes to the Doctor.
The Doc sent him to a Specialist, the Specialist set him up for further diagnostic evaluations and then they determined he had cancer. When his turn for an operation came up, the Surgeon didn't show because of a snow storm, so they put him back in the system for another appointment.
So, if any of all of this is beginning to sound like the DMV or the VA, perhaps it is because it's another inefficient government run system.
BTW, the poor guy got his appointment and then died on the table.

I think about him everytime someone mentions the need for our government to run our healthcare system.

[Hmac]

On the other side, hospitals/specialists/physician group facilities don't accept Medicare because they're not making any money on it, but because they're not making as much as they could through a private insurer.

I have heard that Medicare regulatory compliance is a nightmare and independent studies have shown that it adds a not-insignificant amount of cost to a healthcare operation. It's probably far simpler to deal with private insurers because the burden is ultimately on the patient, which is not how it should be. There's a lack of accountability from anyone but the patient (and Medicare), at this point.

Yes. When you have limited provider resources, you have to make a decision as to whom you are going to treat relative to how much their payor is going to reimburse. With Medicare, it's all-or-none. You can't pick and choose your Medicare patients. If you accept Medicare, you have to see them all.

As to remibursement, it varies widely from region to region. Around here, it's 20% when you take denials into account. With Medicare, there's no pre-authorization possible. You do an operation, for example, then have to hope that Medicare won't deny it after the fact. Which is not uncommon.

And yes, Medicare comes with a HUGE regulatory burden, as you would expect from a government with a history of truly profound bureacracy.

[chuckman]

I have not had to deal with it from the provider standpoint as hmac has, but I have dealt with it from a leadership in the hospital perspective. It is a pain in the ass, no doubt. It all has a trickle-down effect as well with funding being controlled or pooled based on patient outcomes. So it's not just about the funding upfront, there is control throughout process.

Every veteran has dealt with socialized medicine with the VA or with military medicine. It's all about rationing resource and cost mitigation. We have seen what that does.

[FromMyColdDeadHand]

I had a very good British friend who woke up one morning and pissed blood, so he goes to the Doctor.
The Doc sent him to a Specialist, the Specialist set him up for further diagnostic evaluations and then they determined he had cancer. When his turn for an operation came up, the Surgeon didn't show because of a snow storm, so they put him back in the system for another appointment.
So, if any of all of this is beginning to sound like the DMV or the VA, perhaps it is because it's another inefficient government run system.
BTW, the poor guy got his appointment and then died on the table.

I think about him everytime someone mentions the need for our government to run our healthcare system.

I have two workmates that had parents in Britian, had. Both died from flu/colds that got out of hand, with delay of care being a primary cause they didn't make it. Old people die of a lot of routine stuff, but routinely, they die of routine stuff in socialized care.

Serious question - I thought Medicare reimbursement was closer to 60% of established rates? Not necessarily 60% of what private insurance will pay, which is usually a negotiated rate, anyway. On the other side, hospitals/specialists/physician group facilities don't accept Medicare because they're not making any money on it, but because they're not making as much as they could through a private insurer.

I have heard that Medicare regulatory compliance is a nightmare and independent studies have shown that it adds a not-insignificant amount of cost to a healthcare operation. It's probably far simpler to deal with private insurers because the burden is ultimately on the patient, which is not how it should be. There's a lack of accountability from anyone but the patient (and Medicare), at this point.

I had three bills for short hospitalizations/ED triggered events from my MIL's sister. All three were within a few percent of 20% reimbursement rate.

So the issue is that if your provider doesn't have a 'deal' with the hospital system that you visit for something- they get charged the full boat rate. That is why they want you at an in system facility where even if it isn't 'theirs', they might pay 50% rather than the suckers 100%.

[Hmac]

So the issue is that if your provider doesn't have a 'deal' with the hospital system that you visit for something- they get charged the full boat rate. That is why they want you at an in system facility where even if it isn't 'theirs', they might pay 50% rather than the suckers 100%.

I don't follow this at all. Hospitals can't make "deals" with providers. It's a blatant violation of Stark Laws.

[26 Inf]

I don't follow this at all. Hospitals can't make "deals" with providers. It's a blatant violation of Stark Laws.

Okay, I said I was bowing out, but I've been following. I submit the following as an example:

I was at the dentist being scheduled for a root canal and cap - apparently a 30 year-old root canal can go bad if the cap isn't sealed or something, I trust my dentist and I was having problems, so there you go. The last stop was the part when they make sure you know what you are going to pay. I saw the chart and the following discussion ensued:

Me: Wow, so this would cost almost 2,000 bucks if I didn't have insurance?

Nice, about to be confused, office lady: Yes it would, but when you consider the write off we give the insurance company, and what they cover, your cost will be $400.00

Me: So, you charge more for a root canal and cap if folks don't have insurance.

Nice office lady: No, everyone pays the same, we just give the insurance company a write off.

Me: Let me make sure I understand, at the end of the day with the 1200.000 the insurance is paying, and my 400.00 co-pay you are getting a total of 1600.00 for doing my root canal.

Nice office lady, who doesn't like where this is going: Yes, but that's with the write off.

Me: But if I didn't have insurance, I'd be paying you a total of 2000.00, correct.

Nice office lady, trying to salvage it, but failing: Well. yes, but most of our patients have insurance.

Me: I know you aren't the one who sets prices, or decides how things are run, so I don't mean to upset you, I just think there are a lot of unfair practices in medical billing. (or something like that - I apologized for any discomfort - the total write off was a couple hundred for the root canal and almost one fifty for the cap IIRC, nimbers in example are approximate, this was a couple years ago)

I think that's what FromMyColdDeadHand meant by the 'deal' and the 'suckers.'

Now, I'm going back in my hole.