"Medicare and the Mayo Clinic"..... A MUST READ

[Warph]

Get ready for ObamaCare (if passed) to destroy MediCare!  Read and weep, people of what's to come!  We need to vote everyone out of office that has anything to do with this horrible bill!!!


Medicare and the Mayo Clinic
By Jeff Jacoby
Globe Columnist / January 6, 2010

PRESIDENT OBAMA is a great admirer of the Mayo Clinic. Time and again he has extolled it as an outstanding model of health care excellence and efficiency.

"Look at what the Mayo Clinic is able to do,'' the president proclaimed at a rally in September. "It's got the best quality and the lowest cost of just about any system in the country. . . . We want to help the whole country learn from what Mayo is doing.'' On the White House website, you can find more than a dozen examples of Obama's esteem.

So perhaps the president will give some thought to the clinic's recent decision to stop accepting Medicare payments at its primary care facility in Glendale, Ariz. More than 3,000 patients will have to start paying cash if they wish to continue being seen by doctors at the clinic; those unable or unwilling to do so must look for new physicians. For now, Mayo is limiting the change in policy to its Glendale facility. But it may be just a matter of time before it drops Medicare at its other facilities in Arizona, Florida, and Minnesota as well.

Why would an institution renowned for providing health care of "the best quality and the lowest cost'' choose to sever its ties with the government's flagship single-payer insurance program? Because the relationship is one it can't afford. Last year, the Mayo Clinic lost $840 million on its Medicare patients. At the Glendale clinic, a Mayo spokesman told Bloomberg News, Medicare reimbursements covered only 50 percent of the cost of treating elderly primary-care patients. Not even the leanest, most efficient medical organization can keep doing business with a program that compels it to eat half its costs.

In breaking away from Medicare, the Mayo Clinic is hardly blazing a trail. Back in 2008, the independent Medicare Payment Advisory Commission reported that 29 percent of Medicare beneficiaries who were looking for a primary-care doctor were having difficulty finding one willing to treat them. A survey by the Texas Medical Association that year found that only 38 percent of the state's primary-care physicians were accepting new Medicare patients.

But if you think that sounds grim, wait until Congress enacts the president's health care overhaul. A central element of both the House and Senate versions of ObamaCare is that Medicare reimbursements to hospitals and doctors - already so low that many providers lose money each time they treat a Medicare patient - will be forced lower still.

The Centers for Medicare and Medicaid Services, a branch of the US Department of Health and Human Services, estimated last month that the Senate bill would squeeze $493 billion out of Medicare over the next 10 years. As a result, it cautioned, "providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and . . . might end their participation in the program (possibly jeopardizing access to care for beneficiaries).'' In short, the Democratic understanding of health care reform - more government power to set prices, combined with reduced freedom for individuals - will make medical care harder to come by: an Economics 101 lesson in the pitfalls of price controls.

Nearly six months ago, the Mayo Clinic tried to sound an alarm. Instead of making American health care better and more affordable, it warned, the legislation working its way through Congress "will do the opposite'' and "the real losers will be the citizens of the United States.''

Each year Medicare loses tens of billions of dollars to fraud and abuse. The program's long-term deficit is a staggering $38 trillion. Its expenditures have raced ahead of inflation from the day it was created: Medicare's price tag has skyrocketed from $3 billion in 1966 to $453 billion this year. Yet its reimbursement of medical providers is so meager that more and more of them cannot afford to treat Medicare patients. Whatever else Medicare might be, it is no model for rational reform.

Obama says he wants the country to "learn from what Mayo is doing.'' What Mayo is doing is trying to provide high-quality medical care in the face of Washington's compulsively misguided interference. As 3,000 Mayo patients have just learned, government interference can hurt. Ratchet up that interference with ObamaCare, and the pain will grow worse.

Jeff Jacoby can be reached at jacoby@globe.com.
http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2010/01/06/medicare_and_the_mayo_clinic/

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

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

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

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

[Warph]

January 13, 2010
The Truth about ObamaCare
By John Lilly

A senior Obama Administration official almost let the cat out of the bag about the real impact of Obama-style health care "reform." Here's the background.

The three most important things in real estate are location, location, and location. In health care, one could argue that it's reimbursements, reimbursements, and reimbursements. One in every six workers receives a paycheck that depends on physician and hospital reimbursement for services. Except for Medicaid, Medicare reimbursement rates are the lowest of all entities that reimburse physicians and hospitals. All private insurance and Medicare Advantage reimbursements are higher than traditional Medicare ones. Medicare and Medicare Advantage plans take a $425-billion cut in the current health care reform legislation.

In 2008, a Physician Foundation survey found that 36% of physicians said Medicare reimbursement is less than their cost of providing care, and 65% of physicians said that Medicaid reimbursement is less than their cost of providing care. Raise your hand if you work for free. Then why is the administration asking one-sixth of all U.S. workers to do just that?

Larry Summers, the Obama administration's Director of the National Economic Council, spoke at The Economic Club of Washington at their April 2009 meeting.

C-SPAN was there, and at roughly minute 41, Summers said the following:

That's why health care reform is so important because a large fraction of the federal budget is health care and if health care spending is growing three to four percent a year faster than the rest of the economy then there is no way that the federal budget can be under control. And if you try to control federal spending without controlling overall health spending you know what's going to happen.  The people in the federal programs aren't going to be able to ...

Then he paused before continuing:

The health care system isn't going to want to serve the people in the federal programs. That's why the health care agenda is crucial to the long term financial sustainability agenda.

I think it is obvious that Summers was going to say that "the people in the federal programs aren't going to be able to find a doctor if you have Medicare," but he rephrased it before his original thought came out of his mouth. When he talks about overall health spending, he is including all public and private entities that reimburse physicians and hospitals. Federal spending includes just Medicare and Medicaid.

When Medicare reimbursement does not cover the cost of doing business, guess who will have a tough time finding a doctor. If there is a choice, then doctors, like any rational consumer, will prefer plans like Medicare Advantage and private insurance, which have higher reimbursement rates. The administration's idea of holding down costs is forcing all reimbursements down to Medicare levels or lower. They know that if there are alternatives, patients who are stuck with traditional Medicare won't be able to find a doctor. Recently, one of the Mayo Clinics in Arizona stopped taking Medicare because it's a money-loser. Mayo's hospital and four clinics in Arizona, including the one that stopped taking Medicare, lost $120 million on Medicare patients last year. The program's payments covered only 50% of the cost of treating elderly primary-care patients.   

If all reimbursement rates are forced down to Medicare rates or lower, then get ready for five-minute doctor visits and waiting times measured in weeks and months before appointments for major diagnostic testing like MRIs.   

Unfortunately, the Republicans do not have the answers, either. Their proposals will not control costs. Only when you introduce free-market competition and eliminate the current reimbursement system will you get lower costs. That will require a fundamental change in Medicare and all reimbursement systems.

John Lilly, MBA, D.O. is a family physician and the vice president of The YOUNG Conservatives of America (tycoa.com).

http://www.americanthinker.com/2010/01/the_truth_about_obamacare.html

[Warph]

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 "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.

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.
http://www.foxnews.com/opinion/2010/01/14/c-l-gray-medicare-doctors-deserting-obama/

[Teresa]

http://www.snopes.com/politics/soapbox/starner.asp

Dr. Starner Jones.
His short two-paragraph letter to the White House accurately puts the blame on a "Culture  Crisis" instead of a "Health Care Crisis". 
It's worth a quick read:

     
                           Dear Mr. President:

During my shift in the Emergency Room last  night,  I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone.

        While glancing over her patient chart, I happened to notice that her payer status was listed as "Medicaid"! During my examination of her, the patient informed me that she smokes more than one costly pack of cigarettes every day and somehow still has money to buy pretzels and beer.

   And, you and our Congress expect me to pay for this woman's health care?  I contend that o ur nation's "health care crisis" is  not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of  a "crisis of culture",  a culture in whichit is perfectly acceptable to spend money on  luxuries and vices while refusing to take care of one's self or, heaven forbid, purchase health insurance.  It is a culture based in the irresponsible credo that "I can do whatever I want to because someone else will always take care of me".

        Once you fix this  "culture crisis" that rewards irresponsibility and dependency, you'll be amazed at how quickly our nation's health care difficulties will disappear.

        Respectfully,

        STARNER JONES,  MD

[larryJ]

This reminded me of my teen years.  I had a friend whose dad was the janitor/maintenance/handyman for the local courthouse.  One of his jobs, one day a week, was to carry grocery staples such as rice and beans, canned goods and cleaning supplies to the back door of the courthouse.  My friend and I would go over to the courthouse to help his dad dole out these "goodies" to those on the county's welfare roll.  I loaded boxes of food and sacks of dry goods into cadillacs and fancy buicks and other luxury vehicles.  I don't remember any of those people helping to load these things into their cars.  Even today, when I go to the grocery store, I see women using government assistance coupons for food and then going out and putting in their Mercedes or their BMW.  This article is right on, in that, fix the culture and that will fix the problem.

Larryj

[Teresa]

I see it here even.. Not the Mercedes etc.. but I have seen women using Wic and food stamps who I KNOW have more money than my family does.. They use the welfare subsidies.. but they sure can afford beer and cigarettes.
I was at Newkirk at the casino and darned if I didn't see one of those "recipients" who owe bills in town.. who get gov't help cause they say they can't work ..and have to wait to buy anything until their 'check come in the mail on the 1st".. ..gambling at the slots.. and it was the $1 slots too...
I wanted to bad to go up and use my expertise forked tongue on them.. but I didn't..

[Diane Amberg]

To my knowledge, nobody has ever had to take Medicare assignment as payment in full.  Some of our Docs did because of contract obligations, and some would bill for the difference between what medicare pays and their regular bill.That's why people have supplemental policies.  Even then there might be a bit extra to pay. Why would anyone expect it to be free? 
    As far as people taking advantage of food stamps and "commodities". That's one drawback to freedom. People are free to be mean, stupid people who think they are entitled to take food from the mouths of those who really need it. As far as people not using their money wisely...again,one drawback to unregulated freedom .We don't legislate against what each one of us thinks is someone else's stupidity.

[srkruzich]

To my knowledge, nobody has ever had to take Medicare assignment as payment in full.  Some of our Docs did because of contract obligations, and some would bill for the difference between what medicare pays and their regular bill.That's why people have supplemental policies.  Even then there might be a bit extra to pay. Why would anyone expect it to be free?  

One thing about doctors billing the difference is that it is illegal for them to do so.  You get what the doctor submits and then medicare gives a figure that it will pay less 20% for copays. THe doctor cannot bill the difference between what he submitted and what medicare pays.  The only amount that the doctor can bill for is the 20% copay, and in some cases if you fill out a hardship waiver, your not even required to pay the copay.

 

As far as people taking advantage of food stamps and "commodities". That's one drawback to freedom. People are free to be mean, stupid people who think they are entitled to take food from the mouths of those who really need it.

Uhmm Excuse me. But this is a crime.  If these people are taking food from people that need it and they are driving mercedes and bmw's then those are assets that are not supposed to be allowed.   That constitutes fraud.  I too have seen the welfare brood mares rolling through the grocery store with a load of kids they are collecting off of, and they ride up in a fairly new lincoln navigator, wearing a 300 dollar watch, 1200 dollars worth of gold on their body, and designer clothes from macys.  Sorry but thats fraud and a crime.  On those forms they fill out, they ask if htey have any other source of cash. IF each of those kids daddies provide some of their crack money for her to buy those clothes, lincoln ect, then thats a source of cash they did not report!

As far as people not using their money wisely...again,one drawback to unregulated freedom .We don't legislate against what each one of us thinks is someone else's stupidity.

I don't have too much of a problem how people use their money, other than i cringe when i see it wasted.  But when you have people drawing public assistance and they are living large then i do have a problem!  

I have no problem telling people like that they ought to get down on their knees and thank every working taxpayer for providing her steak and lobster dinners that she's buying.

[greatguns]

Is it only the females that we have a problem with?

[srkruzich]

Is it only the females that we have a problem with?

Only the mouthy ones