Saturday, November 21, 2009

Want To Opt Out of Medicare?

Here's how, courtesy of Mayo Clinic Family Medicine - Arrowhead (Arizona):
The discrepancy between what Medicare pays and our cost of providing care acutely impacts the sustainability of our primary care practice. Medicare reimbursements do not cover our actual costs of providing care, and therefore we have recently had to make some difficult decisions that will impact the Arrowhead Family Medicine practice. Effective January 1, 2010, the physicians at Mayo Clinic Family Medicine - Arrowhead will opt out of participating in Medicare, meaning that Medicare will no longer reimburse for the services they provide....
With the $500 billion dollars of cuts to Medicare spending in the new health care bills proposed, will we see more of this in more affluent areas?



Lockup Doc said...

If a Mayo Clinic-affiliated practice is doing this, are they the canary in the coal mine for what's about to happen on a much greater scale in the U.S.?

I don't think our gov't really understands how much private insurance subsidizes Medicare/Medicaid.

I've had a fear over the past year or two that the private insurance industry will be run out of business by a gov't plan, and then our entire health care system will implode (because a Medicare style system will not cover the actual cost of care). I'm not wedded to the insurance industry by any means, and if we were starting from scratch, then a lean, efficient single payer system may make sense, but that's not where we are today.

Anonymous said...

interesting. i presume they share the same tax numbers. i was not aware that you could take some parts out of medicare and leave some parts in (i am sure they have lawyers and businesspeople much more versed in these matters than i). i wonder if their internal medicine colleagues are still taking medicare?

Anonymous said...

FWIW - I live about 10 minutes from Mayo JAX. It too has stopped accepting Medicare primary care patients at its satellite facilities - and Medicare Advantage patients at the "mother ship" facility here:

Doesn't bother or affect me or my husband. Since we were never very impressed with the Mayo primary care "doc in a box" facilities. Nor will we go on Medicare Advantage when we go on Medicare (6 months from now for my husband - 2 1/2 years for me). Medicare Advantage is much better for lower than higher income people - something Congress refuses to acknowledge (it paints it as a boon for insurance companies - instead of a good deal for lower income people on Medicare).

That said - Mayo is basically a tertiary care facility - even here in JAX - where its claim to fame is as a transplant center (among other things). If you're on Medicare - and Medicare pays ok for what you need - you'll be able to use Mayo (Mayo tends to "cherry pick").

OTOH - there is the issue of getting a good primary care doc. My husband and I have a really good primary care internist. And have spoken to her about Medicare. She is not currently accepting new Medicare patients. But will keep us when we go on Medicare. She was quite honest when we last spoke to her. She says she likes Medicare in some ways. Because it pays for almost everything - no fights like she sometimes gets with insurance companies. It pays less though - so she likes about 30-40% or so Medicare - 60-70% private. If she drops below her Medicare patient population - she will accept new Medicare patients. But she will want ones like us. In our 60's. Relatively well-educated - affluent - and not really sick. Our visits to her are effective in terms of her cost/benefit analysis. No 80 year olds with multiple system problems and memory lapses where she has to spend an hour on a visit just to get a straight history. Robyn

P.S. to Anonymous - I suspect Mayo is sufficiently sophisticated from a legal POV that the "mother ship" is set up as a separate corporation from the "doc in a box facilities" - etc. So any separate corporate entity can do whatever it wants to do.

P.P.S. I don't understand and have never understood why Mayo gets 15% more for refusing to accept Medicare assignment. More money for less paperwork? Perhaps someone can explain this to me.

Anonymous said...

Greetings from New Zealand.
Could someone answer an awkward question I have, what do we owe Americans who come to NZ to have surgery because for some strange reason the US cannot get it's prices down even with the advantage of scale.
Now while they pay for the surgery blood in NZ is free except for a handling charge.
I have yet to hear a good reason why our single payer system should help foreign patients.
Is the USA that poor that it needs the charity of a much smaller country ?
Or are your medical services that poor for those without insurance that they are encouraged to go offshore for needed surgery ?

georgia.dv said...

It's the latter. Our medical services are abysmally poor. I'm 67, in good health. I've just had a routine physical examination, recommended by my insurance company (Medicare Plus . . . don't ask.) The bloodwork was, imo, inadequate. Something so basic as the hemoglobin was not even checked, despite my having a history of low blood iron. However there were other tests and i was billed $57, presumably for the lipid panel. The list of tests that were performed and then discounted or refused goes on and on.
My income from Social Security is only $661/month after the cost for Medicare is deducted; so after fixed monthly bills I have $350 left for food, clothing, medical expenses not covered by insurance, gas, maintenance for home and auto, and anything else.
By my reckoning everyone was short-changed by the system, the physician, the lab, and me. And I'm paying about $100 per month to participate in this farce, with no way to get out, evidently. With or without insurance, medical services in the U.S for most of us is, yes, that poor.