Fw: WHY DOCTORS ARE ABANDONING MEDICARE

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A good case for tort reform?

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Why Doctors Are Abandoning Medicare

By C.L. Gray

- FOXNews.com

Physicians will not be bullied into bankruptcy. Our system needs reform,

but what's being hammered out in Washington is not the answer.

Two weeks ago the Mayo Clinic shocked the nation when it closed the

doors of one of its Arizona clinics to patients on Medicare. Just this past June

President Obama himself praised Mayo as a model of medical efficiency noting

that Mayo gives " the highest quality care at costs well below the national

norm. " If Mayo feels compelled to walk away from this government-run program,

others will surely follow. The nation must understand why.

Doctors are leaving Medicare for two reasons: one obvious, the other

more concealed.

The first is simple―the math:

1) For the past decade Medicare consistently paid physicians 20% less

than traditional insurance companies for identical service.

2) On January 1, 2010 Washington made hidden cuts to Medicare by

altering its billing codes.

3) Medicare will cut physician reimbursement by another 21% on March 1.

The CBO said this cut must take place if the Senate healthcare bill was to

" reduce the deficit. "

4) Even more, Congress pledged to cut Medicare by yet another $500

billion. Again, the CBO said this additional cut must take place if the Senate

healthcare bill was to " reduce the deficit. "

Many physicians were operating at a loss even before this series of

massive cuts. In 2008, Mayo Clinic posted an $840 million loss in caring for

Medicare patients. No businesses can survive when patient care expenses exceed

revenue.

The second is more ominous― Washington ’s increasingly abusive

posture toward physicians.

President Obama reflected this attitude last summer. On national

television, he stated as fact a surgeon is paid between $30,000 and $50,000 for

amputating a patient’s foot.

In reality, a surgeon is paid between $740 and $1,140 to perform this

unfortunate, but often life-saving procedure. This reimbursement must cover a

pre-operative evaluation the day of surgery, the surgery, and follow-up for 90

days after surgery―not to mention malpractice insurance, salaries for clinic

nurses, and clinic overhead. It is frightening to think our president is so

wildly misinformed even as he stands on the cusp of overhauling American health

care. But it gets worse.

Given massive federal deficits, Washington now faces increasing pressure

to cut Medicare spending. One way to do this is to intimidate physicians into

under-billing. To do this Washington intends to spend tax payer dollars to ramp

up physician audits using Recovery Audit Contractors (RAC audits) to randomly

investigate private physician’s Medicare billing.

A physician group at my hospital recently experienced an AdvanceMed

audit, an earlier version of the RAC. For a year Medicare auditors made their

practice a living hell, making them question if it was worth caring for Medicare

patients at all.

An independent reviewer (who was paid a percentage of the audit)

reviewed 86 patient records and " found " the physicians had " fraudulently billed "

Medicare for $351,820. After spending a year fighting the allegations,

eventually, eventually all charges were dropped. The physician group was

vindicated but only after spending almost $100,000 defending themselves. The

independent reviewers were clearly after money, not justice.

For example, one patient the auditor alleged the group had

" fraudulently " billed for was a man undergoing a chemical stress test.

The allegation was the patient should have undergone a cheaper

traditional treadmill stress test. The difficulty with this accusation

was this man was a double amputee―he had no legs. This made a traditional

treadmill test impossible. The auditors clearly were not trained health care

professionals―they were bounty hunters. (It is worth noting the investigators

are given legal immunity from a countersuit for

conducting a " fraudulent investigation. " )

This story is not unique. To reduce Medicare’s budget shortfall

physicians are being subjected to these abusive investigations

nationwide. If medicine increasingly falls under government control, why

should the best and the brightest of our youth give up 15 years of their life to

go into medicine?

The relationship between the Centers for Medicare & Medicaid Services

and the average working physician has become abusive. Mayo is but the first to

make the leap to less government control by closing its doors to some patients

on Medicare.

Washington, slow down and listen; reconsider what you are about to do.

Physicians cannot be bullied into bankruptcy. Our system needs reform,

but this is not it. If you continue on your present course, sadly, it will be

our seniors that pay the price.

C. L. Gray, M.D. is president of Physicians for Reform.

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