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If you are over 65 and looking for a doctor in Oregon, you may have a tough time. That's because of a federal calculation that reimburses Oregon doctors at a lower rate than most other states for Medicare patients. According to 2008 data, a typical visit was reimbursed at $74.81 in San Francisco, for example, but just $60.26 in Portland (and even lower at $57.11 in the rest of Oregon). The relatively low reimbursement means some doctors choose not to accept Medicare patients. Others decide not to practice in Oregon at all.
But in the move to reshape healthcare in this country, all that may change.
A number of Democratic lawmakers — including Oregonians David Wu, Earl Blumenauer, Peter DeFazio and Kurt Schrader — just reached a deal with the House leadership that would balance out the reimbursement rates across the country. The new formula would value quality of care, not just quantity of tests and procedures.
Congressman Earl Blumenauer said:
I have been working for years to get the federal government to stop rewarding health care inefficiencies. These perverse incentives burden people in more efficient, low-cost regions such as Oregon, where we have had to subsidize expensive and unnecessary treatments in high cost regions. At a time when we are working to recover our economy and spur job growth, subsidizing other regions that overspend on care simply isn't an option. This agreement and the recommendations that will be made by the Institute of Medicine are a significant step in improving care across the nation and reining in costs.
This new pricing mechanism is now planned to be part of the healthcare plan put forward by the House. In the Senate, a measure that would have prevented Medicare payments from going down as of January 1st, was recently voted down.
Are you a Medicare patient? Have you had difficulty getting care? If you are a doctor, what do you think of the current rates for Medicare reimbursement? Do you, or do you not, accept Medicare patients? What would it take for that to change? How should Medicare fit into a new healthcare plan for the country?
GUESTS:
- Dr. Lynn Bentson, Internist with Albany Internal Medicine Group
- Peter Bernardo, President of the Oregon Medical Association and a practicing surgeon in Salem
- Congressmen Earl Blumenauer (D-Ore.), represents Oregon's 3rd Congressional District
- John Ayanian, Professor of Medicine and Healthcare Policy at Harvard Medical School and a practicing physician with Brigham And Women's Hospital
Tagged as: health · medicare · rx
Photo credit: martellobrasile / Creative Commons
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I am a faith community nurse in the Salem area and when I checked for one of our parishoners for a Salem doctor willing to take new Medicare patients, there were none. If the person is already part of the practice and they become a Medicare beneficiary, the practice will generally accept. However, if a new person moves to our community with Medicare, I do not know where to send them for their primary care other than Corvallis area or possibly Portland. Thanks, Barbara
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My husband and I moved an elderly aunt to Salem from Florida three years ago. She arrived on a Wednesday evening, and on Thursday morning as we were going into a Starbucks for a cup of coffee, she fell and broke her hip.
Salem Hospital provided an orthopedic surgeon to handle the surgery and follow-up, but I could not find a primary physician. The social worker at the hospital made calls on her behalf, the employees at the rehab center where she went after the fall called trying to find a doctor, and then I made about 40 phone calls on my own. No physician was willing to take her.
My aunt had been a federal employee for 30 years. She had a great supplemental plan, but that didn't matter, because her primary insurance was Medicare. I could have gotten her in if we would have cancelled her government supplemental plan and purchased an Advantage Plan. But if we'd done that, she would have never been able to go back to her government sponsored supplemental plan.
I was railing about this at a dinner party, and it turns out one of the guests was a physician, and she agreed to take my aunt. I am so grateful to her. My only other option would have been to take my aunt to the emergency room if she got ill. There would have been no way to get preventative health care for her.
She lives in an active retirement community. Many people move here from out of state to be close to their children. These seniors are all experiencing the same problem. It just isn't right.
I've heard that there are a few doctors in Silverton and Woodburn who may accept new Medicare patients. It would be great to have their names and contact information for people in the Valley who need medical attention and have no where to go. I am so hopeful that health care reform will change this situation. It isn't right to abandon people just because they are old, and at the same time, it isn't fair to expect doctors to offer services at a loss.
Elaine S.
Salem
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This is a little confusing.
If the private system can pay the market rate while making a profit and paying executives huge amounts of money. An extremely wasteful and stupid thing to spend profit on, but there is still profit.
Then why does so much more efficient government system without the requirement to make a profit or to pay executives huge amounts of money; not pay the same market price? -
Desolation,
The answer is in your question it is the word government it is not ever efficient. One example is the use of the Tobacco settlement money. The physician complained that no one is available to give anti smoking advice and that this could be handled by non MDs.
The state of Oregon received some 5 billion dollars in total settlement to be used for anti smoking education and treatment of smoking related illness. Did they invest the money to make a perpetual money screen? Nooo they squandered it on their pet programs an efficient money manager would have had the state rolling in money. Even worse in California they borrowed against future Tobacco Settlement payments assuming the revenue would stay the same but people smoke less, guess what? They received less money. The problem is stupid people interested in their own interests and being reelected. The over 400 attorneys in congress and nearly 100 in the senate will never decide anything to your or my benefit unless we run a huge interest group.
Who told you that Medicare is efficient?
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We seemed to be ignoring the elephant in the room. How much do these physicians think they should be making per year? Are they having a hard time making a living?
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David,
I'm not sure it's an elephant, in that Lynn Bentson did address the issue (if briefly) at the top of the show.
But you might be interested to hear this whole hour about compensation and doctors:
http://www.opb.org/thinkoutloud/shows/rx-doctors-salaries/
Dave
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I am a 42yo disabled by a chronic, life-threatening genetic illness, and when I moved to a little town east of salem, I could NOT find a doctor to accept me, medicare and OHP, until a friend of a friend persuaded her personal doctor to charitable acceptance. Humiliation. Besides the fact that I had to accept a doctor whose practice consists of delivering babies, and has no idea whatever what to do for me. I am very grateful for the help, and appreciate it; but I wonder if another doctor might be able to help me get better.
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An experience from a patient/client/consumer's point of view: My primary care physician has referred me to a vascular surgeon and I will need some kind of surgical procedure to correct an acute condition. It is VERY challenging to find out what my Medicare Advantage insurance policy covers before I make the appointment. It is very complicated to figure out: I am told that the physician I'm referred to is on the plan but not in network so my co-pay is twice as high. I have made many phone calls in an attempt to find out what my coverage is, for which institutions, and I have yet to get clear answers. Very frustrating to try to be responsible and know in advance what the costs will be, at which institution, so I can make an informed decision.
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One has to wonder if we actually get the public option we all deserve, will a similar stumbling block occur, that we are seeing with Medicare, that few doctors will take the public plan?
Hopefully the Medicare issue can be remedied. Because we certainly do not need another impediment to equitable health-care for all.
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primary care is not aways the best way to care for patients with chronic illness. There is too much information for doctors to keep up on all the current recommendations for certain problems. At Kaiser Permanente, nephrologists provide all care for people with chronic kidney disease, heart failure patients are followed by cardiologists and nurse practitioners and pts with diabetics are followed by diabetic nurse specialists.
Trying to get Primary care doctors to know all areas well can detract from care. We often see people with heart failure, for example, being treated with inhalers by PCPs who are not used to chronic heart failure care and patients.
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In the late 70's I worked on a news feature article about Oregon's medical school and the conclusion was that we were providing a subsidized medical school for Oregon residents, who then tended to go into specialty care, not basic care, often out of state. Part of the reason we have problems with medicare people finding doctors is that we don't have enough basic care physicians. the job is tougher and probably doesn't pay as well in general. Meanwhile, specialists tend to congregate in the urban areas (meaning Portland, Salem and Eugene). This is a trend throughout the country. Also, I can't believe that the cost of living in Florida is greater than here in Oregon.
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What can you say to a journalist who doesn't understand that Florida is more expensive than Oregon? You did not address the huge number of foreign students in medical schools. OHSU has foreign students taking the place of Oregon residents who want to go to medical school but have to go out of state. My dental school has 38 percent foreigners and mostly Egyptians, who is treating the Egyptians. Where are the docs coming from who will treat the 40 million new patients, have you seen any mention of measures to increase the supply of health care workers?
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60 Minutes had a segment on Medicare fraud last night. It was eye-opening and showed how we could save billions each year if the Medicare system had some extra money to do more oversight. The good news is that this administration is apparently the first to even look at the issue seriously. The Attorney General is giving it attention and, of course, it is something that Obama mentions frequently as a part of the funding source for healthcare reform [including raising rates for physicians].
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Dear Think Out Loud
Why don't you do a story on what happened to the Tobacco Settlement money Oregon received and still receives I believe?
This was supposed to go to anti smoking campaigns and programs to treat smoking related illness. A huge scandal will be found.
Have you seen any programs financed by this money except a few lame commercials?
Truth is the state squandered this money instead of investing it, even in the money markets it would never run out by judicious investment. It went for anything but tobacco problems.
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I have Medicare and Medicare Advantage. It is a horror. The amount of paper I am sent yearly is hilarious. You would have to be a lawyer to make sense of it.
Our medical system is BROKEN. For every doctor there are a five other pill-counting, paper-pushers, who are making a living off what that doctor does. Health insurers add NOTHING to health care or health care delivery, and just bring a blizzard of paper work for every illness, every doctor visit. We must cut them out of the health care pie completely.
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Our guest, Lynn Bentson, wrote to me after the show and wanted to share these comments:
"I did not intend to mislead the public, $57 is the Medicare reimbursement for a "standard" 15 minute visit , my take home is $21-22 before taxes. A longer visit ( twenty-five minute )is paid $88 or $84 or something and my take home would be $30-$32 before taxes. I did not want to get into the whole issue of how we bill, since it is arcane and basically irrelevant, I thought."
Thank you, Lynn, for the clarification.
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In my 20's I experienced a psychotic break, and for a short period of time was catatonic. I have been "a mental patient" for all of my adult life. I will be 67 shortly. Several years ago, I started working with a very fine Jungian lay analyst. She did not accept Medicare. I paid her fee myself. And my secondary insurer would not pay because she was not first reimbursed by Medicare. Finally, I could no longer afford to see her every two weeks for about $100 a visit.
I asked my primary care physicican to help me find a counselor earlier this year. I was referred to six or seven women. After initial contacts, only one called me back to let me know she was not accepting patients. No one else even returned my call. My primary physician prescribes a maintenance dose of a neuroleptic. And views me as "depressed." I check in with my dietitian of some 20 years once a month. At this time I am very isolated, close to immobile, and dealing with a mild case of hoarding with a monthly day of work with a Native American woman. I listen to OPB, watch TV and dream.
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I hope the US government should do all the means to provide a very affordable health care need.As a consumer what is cheaper is always an advantage to us may it be product or healthcare services we are always on the pursuit of saving money. If you’re one of the 47 million Americans without health insurance, finding a place for insurance in your budget may seem like an insurmountable task. Options do exist, however, and the expenses of the options must be weighted against the cost of an unpredictable medical emergency - a $ 50,000 surgery is harder to cope with than a couple hundred bucks a month. One option for lowering your costs is to consider a high-deductible health plan, which will give you a smaller monthly payment in exchange for a lower level of coverage. It’s not ideal – you’ll have to pay out of pocket for any doctor’s appointments or tests until you reach your deductible – but it will prevent major medical expenses from causing you to go bankrupt.
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Comments are now closed.
The current system is in keeping with many standard practices, let me give you some examples:
The US Military pays BAH (Basic Allowance for Housing) at different rates based on ZIP code, because rent is higher in SF than Portland.
General Schedule (GS) federal employees are paid different "Locality Adjustment" Guess what Portland is lower than New York or Philly...
The bottom line is costs are higher for everyone (even DR's) in places like New York, San Francisco, a real measurment would be a percentage of DR's in various Cities and States WHO REFUSE medicare and look for a pattern.