APP - Might this be foreshadowing?

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Mayo Clinic in Arizona to Stop Treating Some Medicare Patients
By David Olmos

http://www.bloomberg.com/apps/news?pid=20601087&sid=aHoYSI84VdL0

Dec. 31 (Bloomberg) -- The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won’t affect other Mayo facilities in Arizona, Florida and Minnesota.

Obama in June cited the nonprofit Rochester, Minnesota-based Mayo Clinic and the Cleveland Clinic in Ohio for offering “the highest quality care at costs well below the national norm.” Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians, in a telephone interview yesterday.

“Many physicians have said, ‘I simply cannot afford to keep taking care of Medicare patients,’” said Heim, a family doctor who practices in Laurinburg, North Carolina. “If you truly know your business costs and you are losing money, it doesn’t make sense to do more of it.”

Medicare Loss

The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said.

Mayo’s hospital and four clinics in Arizona, including the Glendale facility, lost $120 million on Medicare patients last year, Yardley said. The program’s payments cover about 50 percent of the cost of treating elderly primary-care patients at the Glendale clinic, he said.

“We firmly believe that Medicare needs to be reformed,” Yardley said in a Dec. 23 e-mail. “It has been true for many years that Medicare payments no longer reflect the increasing cost of providing services for patients.”

Mayo will assess the financial effect of the decision in Glendale to drop Medicare patients “to see if it could have implications beyond Arizona,” he said.

Nationwide, doctors made about 20 percent less for treating Medicare patients than they did caring for privately insured patients in 2007, a payment gap that has remained stable during the last decade, according to a March report by the Medicare Payment Advisory Commission, a panel that advises Congress on Medicare issues. Congress last week postponed for two months a 21.5 percent cut in Medicare reimbursements for doctors.

National Participation

Medicare covered an estimated 45 million Americans at the end of 2008, according to the Centers for Medicare & Medicaid Services, the agency in charge of the programs. While 92 percent of U.S. family doctors participate in Medicare, only 73 percent of those are accepting new patients under the program, said Heim of the national physicians’ group, citing surveys by the Leawood, Kansas-based organization.

Greater access to primary care is a goal of the broad overhaul supported by Obama that would provide health insurance to about 31 million more Americans. More family doctors are needed to help reduce medical costs by encouraging prevention and early treatment, Obama said in a June 15 speech to the American Medical Association meeting in Chicago.

Reid Cherlin, a White House spokesman for health care, declined comment on Mayo’s decision to drop Medicare primary care patients at its Glendale clinic.

Medicare Costs

Mayo’s Medicare losses in Arizona may be worse than typical for doctors across the U.S., Heim said. Physician costs vary depending on business expenses such as office rent and payroll. “It is very common that we hear that Medicare is below costs or barely covering costs,” Heim said.

Mayo will continue to accept Medicare as payment for laboratory services and specialist care such as cardiology and neurology, Yardley said.

Robert Berenson, a fellow at the Urban Institute’s Health Policy Center in Washington, D.C., said physicians’ claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients’ primary care.

“Some primary care doctors don’t have to see Medicare patients because there is an unlimited demand for their services,” Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, “then Medicare does indeed look like a poor payer,” he said.

Annual Costs

A Medicare patient who chooses to stay at Mayo’s Glendale clinic will pay about $1,500 a year for an annual physical and three other doctor visits, according to an October letter from the facility. Each patient also will be assessed a $250 annual administrative fee, according to the letter. Medicare patients at the Glendale clinic won’t be allowed to switch to a primary care doctor at another Mayo facility.

A few hundred of the clinic’s Medicare patients have decided to pay cash to continue seeing their primary care doctors, Yardley said. Mayo is helping other patients find new physicians who will accept Medicare.

“We’ve had many patients call us and express their unhappiness,” he said. “It’s not been a pleasant experience.”

Mayo’s decision may herald similar moves by other Phoenix- area doctors who cite inadequate Medicare fees as a reason to curtail treatment of the elderly, said John Rivers, chief executive of the Phoenix-based Arizona Hospital and Healthcare Association.

“We’ve got doctors who are saying we are not going to deal with Medicare patients in the hospital” because they consider the fees too low, Rivers said. “Or they are saying we are not going to take new ones in our practice.”

To contact the reporter on this story: David Olmos in San Francisco at dolmos@bloomberg.net
 
Nationwide, doctors made about 20 percent less for treating Medicare patients than they did caring for privately insured patients in 2007, a payment gap that has remained stable during the last decade,

Well, here’s a tip. Old people cost more money to care for than everyone else in the insurance pool. WAY more. That’s a primary reason we have government health insurance for old people. Private insurance won’t touch them. They cost too much. We are always going to have to subsidize healthcare for old people. They’re always sick, and they need like ten billion drugs just to keep them alive, and they have way more physical problems than everyone else. Here’s another quick tip: No one is ever going to make money insuring old people. It ain’t gonna happen. Humana Health Insurance Corporation doesn’t want to lose money, hand over fist, on those old farts. Whatever system we have, we will always be subsidizing old fogies. They cost a fortune just to keep alive. Presumably, we are going to have to tweak medicare reimbursement rates, and reform our healthcare system so it performs more cost effectively for everyone, like the European systems.


While 92 percent of U.S. family doctors participate in Medicare, only 73 percent of those are accepting new patients under the program, said Heim of the national physicians’ group,

93 percent and 73 percent!!! Well, holy crap. Those old farts have it pretty good with their medicare. I doubt that more than 1% of the doctors in the country would accept my insurance, because I have to stay in network, and I’m geographically limited in choices. God damn, I guess Medicare provides way more choices to old fogies than the piece of crap insurance I have.

Mayo’s Medicare losses in Arizona may be worse than typical for doctors across the U.S., Heim said. Physician costs vary depending on business expenses such as office rent and payroll. “It is very common that we hear that Medicare is below costs or barely covering costs,” Heim said.

Hmmm, they buried the money quote way down in the article. Sounds like we have some problems with Medicare, just like we have massive problems with our health insurance system at large. Everybody is getting fucked with this system, not just Medicare patients. I really think its pretty alarmist to suggest that doctors are simply going to bail on medicare. Whatever its faults are, I don’t think reforms to strenghthen Medicare require rocket science. And Medicare still, even by the metrics quoted in this article, is a better deal for old people than jettisoning them to the vagaries of the magic free market of private insurance.
 
I know, let's just force doctors to treat them or lose their license to practice. Why is this even a problem? If liberals can come up with penalties for the people who can't afford insurance, why is it hard to squeeze the people with big bucks?
 
I know, let's just force doctors to treat them or lose their license to practice. Why is this even a problem? If liberals can come up with penalties for the people who can't afford insurance, why is it hard to squeeze the people with big bucks?
THIS
 
this does not bode well and in fact reinforces the view that medicare, if expanded could not cope with the costs or a public option would never be deficit neutral....we need to accept that if we are going to insure people, it is not going to be deficit neutral, it something that if we undertake, we understand it will cost money....iraq and afghanistan are not deficit neutral, but dems and repubs support afghanistan....i don't see a problem insuring the older folks or those who can't afford insurance, so long as the system is efficient, not like medicare now
 
this does not bode well and in fact reinforces the view that medicare, if expanded could not cope with the costs or a public option would never be deficit neutral....we need to accept that if we are going to insure people, it is not going to be deficit neutral, it something that if we undertake, we understand it will cost money....iraq and afghanistan are not deficit neutral, but dems and repubs support afghanistan....i don't see a problem insuring the older folks or those who can't afford insurance, so long as the system is efficient, not like medicare now

First to tumble in the domino maze.

Something tells me it's not going to be quite as fascinating as those set ups we see on gym room floors...
 
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