Has the quality of medicine been compromised by Medicare?

by Adam Teichman

The business of running an independent (non hospital-owned) healthcare practice is at times daunting. Between health insurance coding and billing, compliance with the Affordable Care Act, pre-authorizations from insurance companies, the required transition to new medical classifications (ICD-10), managing staff, HIPAA compliance, collecting co-pays and deductibles, promoting your practice, upgrading equipment, the (until very recently) maybe you’ll get your Medicare reimbursements and maybe you won’t dance from Congress every year, long wait times for reimbursements, and all of the other details that go into running a stand-alone practice, a doctor may spend more time managing the office than seeing patients. I wonder how different life was for physicians in the 50’s and 60’s, before insurance companies and government agencies drove healthcare.

I’m not complaining (well, maybe a little). I love being a Doctor of Podiatric Medicine. I love serving people and improving their quality of life. When I can save the toes, foot, or leg of a diabetic patient who was told by other physicians that the only option was amputation, I’m proud that this patient will be able to walk for many years to come. It’s what gets me out of bed every morning.

But according to the Medical Group Management Association, the cost of running a medical practice in the past decade has increased twice as fast as the consumer price index. And since 2001, Medicare reimbursements fell 18% (according to the AMA).

As a podiatrist and podiatric surgeon, my practice sees a great many Medicare and Medicaid patients. While Congress continually reduced and delayed physician payments to meet their budget (slashing payments was a quick fix, but not well thought out), seeing these patients became a break-even proposition at best. Doctors everywhere increasingly limited the amount of Medicare and Medicaid patients they saw, and happily accepted more patients with private insurance, just so their practice could make ends meet.

Unfortunately, this downward price pressure has had the opposite effect of what the Affordable Care Act set out to fix: access to healthcare for everyone. If doctors cannot afford to accept new Medicare or Medicaid patients, those patients, already suffering when they make the call, face long wait times elsewhere for appointments.

Now the new Medicare guidelines, with payments based on quality of care, will demand additional time spent keeping track of patients long after they leave our office. It’s anybody’s guess what will happen as Medicare moves away from the current pay per service model to the new plan.

It all makes a doctor wonder: should I be accepting insurance at all? There is a growing movement in the independent healthcare community of practices completely opting-out of accepting insurance. Doctors and their staffs at these practices report a much higher job satisfaction rate. More importantly, so do their patients, as physicians are able to spend more time with each of them and order the diagnostic tests and treatments they think are best. That’s good, old fashioned medicine, based on the wisdom accrued through years of medical experience, without regard to what is/isn’t covered by a patient’s policy.

But isn’t this the quality of care that insurance companies and Medicare/Medicaid seek? What irony.

Related Articles