FedUpUSA

DoctoRx was puzzled by a report in Bloomberg that the Mayo Clinic in Glendale, Arizona will “stop treating” certain Medicare patients. Many readers no doubt know that Mayo is touted not just as a model for high quality of delivery of health care services, but also affordability.

Here is the gist of the story:

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….

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.

It seems the Mayo move may be a shot over the bow relative to expected Medicare reimbursement cuts:

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.

DoctoRx commented:

Despite what the article says, It’s not easy under the regs to just charge cash. So I’m not sure what Mayo is referring to. Basically a physician has to drop out of being a Medicare provider in toto in order to then charge freely. Once out, I think you’re out for a whole year (at least). And that includes seeing a patient in hospital who’s a Medicare patient (Medicare “A” covers essentially all Medicare patients). So for a whole year the doctor has to only treat outpatients and have nothing to do with Medicare. Not easy. Especially if Glendale has an elderly population.

He also had these comments about Medicare and costs:

Yes I agree that for primary care docs, it’s tough to make a decent living practicing within the regs. Not only are the rates after expenses to do a basic exam of a patient no better than a waiter’s at a nice restaurant, but because of the amount of documentation the government requires (because of all the fraud it tries to deter), the time spent is significantly greater than the patient sees. Not to mention phone calls the doctor is forbidden from charging for even though his/her lawyer/accountant properly does so.

In New York City, it is becoming difficult to find a decent primary physician (I had a good one who stopped practicing while I was overseas, and my attempts to find his replacement over the last five years sound like a bad Woody Allen movie. Needless to say, I’ve reverted to various stopgaps). My endocrinologist converted his practice to anti-aging because he does not want to deal with insurance (it’s so much more profitable to hand out human growth hormone and HRT and have your own compounding lab to boot). If our primary care system starts cracking, health care delivery will suffer, irrespective of any reform effort.

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