MONTGOMERY, AL (WSFA) –
The most fragile members of the medical community are finding themselves on the outside of the healthcare loop, lacking doctors, coverage and treatment.
At the heart of the issue: the nation’s struggling Medicare system and late reimbursements that don’t cover the treatment. The failing system is pushing doctors away from the Medicare community – leaving seniors with few options. It’s become a critical issue in the River Region.
Alabama ranks among the top 8 states in the nation with the highest percentage of seniors enrolled in Medicare. That’s nearly one million people who
depend on Medicare coverage to survive. What’s keeping seniors healthy is a cancer to healthcare providers, jeopardizing their practices.
“It goes without question,” explained Dr. Greg Jones, “the government has certainly decreased reimbursements to the point you frequently lose money when you see Medicare patients.
Jones is an OBGYN with Montgomery Women’s Health Associates and describes late Medicare reimbursements as the rule, not the exception. In many cases four to five months in the rear, and less than 25 percent of what he would be paid for the same service from a private insurance carrier.
“It is complicated,” Jones admitted. “There’s a great deal of financial juggling to operating this way. At the end of the day, it’s a business. There’s no grace given to it being a doctor’s office. The power company has to be paid, overhead has to be paid.”
Many offices have been forced to hire additional workers to focus solely on the massive paperwork that would guarantee a Medicare reimbursement, despite
not knowing what the final repayment will be. Often, the time, effort, and lost wages pulls doctors away from the Medicare community or forces them to turn away the sickest seniors who desperately need a doctor.
“It really pushes doctors to screen their patients and only take the healthy folks with minor medical problems,” Jones explained.
Medicare is aware of the chronic issues and is proposing sweeping changes to give doctors more options, shifting the reimbursement schedule to a quality-based outcome model.
“Here’s the scenario,” Jones said. “If the person has complications or issues, I’m not going to pay you. Therefore, you could argue that I am rewarding you for “good” outcome, when in fact you are not going paid for bad outcomes.”
Danne Howard with the Alabama Hospital Association has been at the forefront in the fight for proper Medicare reimbursements at the federal level for decades. She describes the proposals as a risk – and an opportunity – for the medical profession.
Due to the Area Wage Index, Alabama hospitals are reimbursed less than any other state in the country for providing the same services. Insult to injury for local doctors, and a detractor for recruiting new physicians. In fact, Medicare reimbursement, coupled with the state’s underfunded Medicaid system, is putting the hospitals at risk.
“Many of them have already started putting things in place in order to not have to make that tough decision: laying off people, freezing people’s salaries,” Howard said. “It’s a very tough balance for those people whose hearts are in the right place to do the right thing.”
Hospitals bill Medicare differently for reimbursements than doctor’s offices. In fact, this is the driving force for doctors to leave their private practice
to work as a salaried employee of a hospital.
“As much as half of the physicians in the state are now employed by hospitals now, and they can’t keep up with the regulations,” Howard said.
Jones is surviving in a private practice by seeing more patients with private insurance to fill the Medicare void. He’s also spending two hours at home each
night coding and filing for Medicare reimbursements – with no plans to stop serving this community, as of now.
“Here in the office we take care of our patients, and we have always been confident that if we give patients high-quality care and take care of them,
they will take care of us,” Jones said.
In the River Region, we’ve counted less than 40 specialists serving the Medicare population in cardiology, rheumatology and urology combined.
If you would like to learn more about the proposed reimbursement changes, watch this short video:
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