Friday, December 18, 2009

The Rule of Twenties

Heard from a local independent gerontologist tonight who does not accept Medicare or other insurance payments in our state:
"When it comes to geriatrics, it's the rule of twenties:
20 problems
20 medications
20-minute phone calls
20 minutes to take their clothes off
20 minutes to put their clothes back on.
With the initial physical exam, three follow-up visits, and one EKG that Medicare pays for, I would receive only $360 in total. I pay $40,000 per year in malpractice, yet have never had a judgement against me. Think how may patients I'd have to see to cover just that expense. (editor's answer: 111)

You wonder why I am not a Medicare provider? I'd never survive at that their payment rate. And Blue Cross? They're no better and often pay less.

Funny thing is, Medicare was only too happy to have me opt out, because to them, I'm no longer part of their problem."
And the reason every primary care doctor's not doing this???...



#1 Dinosaur said...

Because some of us are still misguided enough to feel a sense of responsibility to those of our patients without the financial means to pay full freight for our services without benefit of insurance coverage.

How long we can go on this way is an open question, evaluated on an ongoing basis, and subject to change at any time.

Anonymous said...

Chop, chop, Granny. Your GERONTOLOGIST'S time is worth far more than s/he gets paid for you to shilly-shally around getting your clothes on and off! Sure hope that doc never gets old and frail him/herself.

Oh, and for other patients' info: I'm guessing that the orthopedist doesn't have time for you to hobble in slowly on your crutches. Don't take precious moments with your allergist by wheezing or blowing your nose. Hey, that OB/GYN has places to go and people to see: push that kid out FASTER, dammit!

Keith said...

Fully agree with #1 dinosaur. Also, geriatrics demonstarate the falacy of increased training should translate into increased dollars in compensation. this is one specialty where you can actually take a pay cut for doing a fellowship.

To opt out of Medicare or no longer take assignment means you may no longer be able to care for people that are of lesser means, but can't afford the extra cost. The ogverment should simply relax the balance billing requirements of Medicare, allowing doctors to waive the extra payment for those who cannot afford to make up the difference.

Greg said...

Also, because not everyone can afford the additional costs of $3-5K per year just for the privilege of seeing a primary care physician.

Both my internist and my kids' pediatrician went "concierge" in 2007-08. Total out of pocket cost to continue to be seen by them: >$10K on top of the >$20K I pay out of pocket for insurance plus deductibles.

I make a very comfortable living, but I just can't justify the $10K extra scratch for what would effectively be an extra 3-5 hours of care a year.

There are a good number of people in my very wealthy part of Northern California who can/will, but I hazard to guess that it's not enough to cover all of the primary care docs' practices in NoCal.


The Happy Hospitalist said...

Medicare should pay more for the extra time it takes for granny to hobble into the room. The doctors exiting insurance are exactly the doctors who will cause change. As long as doctors pretend to survive in a failing model, the longer it will take the government to face the music. Every doctor who accepts Medicare and also complains about the low payment is part of the problem. If you aren't satisfied with what they pay don't sign the contract. If you want to practice medicine in poverty don't complain about it

my hats go off to this geriatric doc, who is the only doc in this conversation that will create necessary payment reform

Andrew_M_Garland said...

Liberal Doctrine:

Government is the ideal director of medicine. Politicians are thoughtful, caring, and altruistic. They devote their lives to helping others.

Contrast this to physicians, who spend half their lives learning diagnosis and complex, delicate procedures, with the intent of charging sick people for these services.

Anonymous said...

"...without the financial means to pay full freight for our services without benefit of insurance coverage."
Does this mean that the payroll taxes removed from our patient's never existed? Did these payroll taxes disappear into a black hole only to be conjured by the political class to their cronies? Doctors consistently sell themselves short. They are too afraid to stand up for themselves (i.e. their patients) for fear of being labeled selfish/angry.