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 "reduced 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 "reduced 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.

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?

Labels: Medicare

E-mail Paul Hsieh, MD / PermaLink / Comments