This article is more than 5 years old. Information may no longer be current.
Medicare: Should we participate in 2003?
For many orthopedists, it can be an agonizing decision.
Click Here to Manage Email Alerts
We have watched steadily decreasing reimbursements from Medicare for physicians since 1991. Physicians are once again faced with the decision of changing their Medicare status for 2003.
We have several choices: We can continue our participation or we can decide not to participate during Medicare’s annual open enrollment period. We can limit the number of Medicare patients in our practice or completely drop out of the program.
One estimate is that lower reimbursements will probably encourage nearly half of all physicians to reduce the number of Medicare patients they will treat in 2003. This limitation of access will increase for Medicare patients if impending payment cuts in reimbursement continue.
Why is this decision so difficult?
We all want to offer the needed orthopedic care to patients over age 65. We feel an obligation and receive great personal fulfillment caring for the Medicare population. As orthopedic surgeons, we have been trained to bring great value — both surgical and nonsurgical — to this segment of the population.
The field of orthopedic surgery is able to improve quality of life for the elderly. Patients are living longer and need the quality of life we can often make possible. The elderly are some of the most satisfying patients, as they have come to terms with life and understand the limitations of aging and are very appreciative for the help they are given.
One group’s decision-making
Over the past several years, my partners and I have made, as a group, a joint decision about our Medicare status. This is the first year that we have been split in our decision.
Our group includes the four different decades from orthopedic residency training, with orthopedic surgeons in their 30s, 40s, 50s and 60s. We are going through the same decision-making you all will be doing. To generalize our discussions to this point in 2003:
We all want to provide access and receive great satisfaction in taking care of patients over age 65.
The younger members of our group are concerned about the immediate impact of limiting access to this population as well as the long-term effects on their practice.
If one or two members increase the number of Medicare patients they are seeing, we all will be subsidizing their decision.
The older physicians have elected to stop or to significantly restrict the numbers they are treating.
As a group, we will closely monitor the financial impact on our group’s overhead and revenue.
The hassle factor was not an important decision factor at this time, in comparison to the anticipated reimbursement cuts.
We also discussed how most of the commercial payors follow Medicare. We have contracts that reimburse 10% to 20% higher than Medicare. These contracts continue to result in decreased revenue and will require decisions also.
The breaking point?
Will 2003 be the breaking point in our profession’s approach to the Medicare patient?
Those of us in practice with overhead costs have to make a business decision. Most of us have accepted working for less but do not want to take a financial loss for the privilege of seeing patients. Donating one’s time is different than trying to support an office to give the care our elderly population deserves. It takes ancillary office workers to provide quality care to this age group and this has an expense.
In our group we have tightened and fine-tuned our office overhead, monitored closely our payor mix, seen overall downward trends in reimbursement tied to the Medicare floor as it impacts the reimbursement from other payors, given office workers smaller raises and decreased benefits, subsidized the Medicare part of our practice from the other higher payers, and started actively seeking alternatives for additional office revenue.
As small business owners, we are experiencing the sandwich effect of decreased reimbursement and increasing health premiums for employees, requests for raises from our employees, and difficulty funding our employees’ and our own retirement plans.
Reaching a crisis level
Nobody is happy: Patients are feeling more and more restrictions because they pay more and get less; hospitals are reducing beds and staff and offering fewer choices; nurses are frustrated with salary issues, staffing and paperwork; insurance companies are raising premiums to cover claims and paying less for services; employers (including physicians) are paying for rising medical costs; and our employees are paying more and getting less coverage.
How realistic is it to think that this will not reach a crisis level? Several issues must be addressed:
- Medicare cannot provide a fee schedule formula for physician and hospital reimbursement that is acceptable.
- Health care costs are now high and will become more expensive.
- We are in financially tight times.
Congress and the president are considering funding additional prescription coverage.
Major overhaul
Medicare needs a major overhaul but when and where are we headed? No one is happy, but we need to participate in the solution.
It is going to be difficult and may take years to play out the eventual changes. Before it is more acceptable, we will need to answer these questions:
What aspects of medical care are basic rights for everyone?
What aspects of medical care will be rationed?
Will we drift to a single payor with the emergence of a private sector or two-tier system?
These are big decisions. Right now, funding is the issue, but eventually just making cuts will not suffice and overhaul will be necessary. Will the politicians do it? Congress ended 2002 with no decision; the 2003 schedule has been delayed.
In this issue of Orthopedics Today, we have outlined other current options. We will bring to you in the coming months examples about what our colleagues are doing, the effect on our patients and our ability to deliver quality care.
I am struggling, just as you are, with this question: How am I going to participate?