Thursday, March 22, 2012

Medicare Patients Have Trouble Finding Docs

Medicare patients are having trouble finding doctors willing to treat them. Every time the government cut's doctor reimbursements for Medicare patients, the doctor has to decide if they can afford to continue treating Medicare patients.

If you are on Medicare and need treatment you may run in to Dr. No . . .

If you just turned 65 you may be in for a surprise. Some doctors, including your family doctor, may not be taking any new Medicare patients . . . including you.

This Madison clinics decision to refuse new Medicare patients may be a trend.
Wertsch, a big guy with a droopy mustache who founded the clinic in 1977 with his wife and another graduate of the University of Wisconsin-Madison's family practice program, says he and the other 10 doctors who now manage and own the practice can no longer afford to provide that care to additional people on Medicare, who already make up a quarter of the clinic's caseload and up to 70 percent of the rosters of its older doctors, like him.

Medicare pays only a quarter to a third of every dollar the clinic charges, Wertsch says, often half of what private insurance carriers pay. When you figure that overhead for the clinic — which includes stuff like electricity, staff salaries, and a whopping $700,000 or so for the clinic's electronic records system — adds up to around 80 cents on the dollar, accepting Medicare is a losing proposition, he says. "I love taking care of Medicare patients," says Wertsch, 68. "But every time we treat them we have to dig into our wallets. What kind of business model is that?"

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We see and hear about this more often. Doctors lose money treating Medicare patients and have to make it up somewhere else.

That somewhere else is in the form of seeing fewer Medicare patients and more private insurance patients where the reimbursement for services rendered is considerably higher.

Most doctors accept Medicare asssignment but some are not taking on new Medicare patients. This can be even more challenging if you have a Medicare Advantage plan. Less than half the doctors in Georgia take ANY Medicare Assignment plan and even when you do find a doc willing to take Advantage plans they may not take yours.

Ask your doctor if they are taking new Medicare patients before making any decisions.

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