RX Harold and Margret Thomas, with Dr. Steven Knope, a concierge doctor in Tucson who charges a yearly retainer
IF I were warning about something that might happen if we strip half a billion dollars out of Medicare and put it into a national health care experiment, some would be justified in labeling me an alarmist; If I were, on the other hand, to point out that doctors have been abandoning the failing Medicare system for years – but that nearly 30% of the remainder threaten to quit or retire if ObamaCare passes – I would be a very accurate alarmist! Alarmists sound alarms. Alarms are to let you know there is something terribly wrong, and you need to act to prevent bad things.
In an article written in April of last year by NYT’s Julie Connelly, it’s made pretty clear that we are way, way short of Primary Care docs willing to take Medicare patients, and bound to lose even more with any addition of 30 million (47 million, if you count our illegal immigrants) new patients to our already overstressed health care system.
Here’s what she says:
Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them - often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.
When shopping for a doctor, ask if he or she is enrolled with Medicare. If the answer is no, that doctor has opted out of the system. Those who are enrolled fall into two categories, participating and nonparticipating. The latter receive a lower reimbursement from Medicare, and the patient has to pick up more of the bill.
Connelly (the ‘Alarmist’) not only warns about the missing Docs, but delves into some strategies that might be used to deal with the problem. Among these are a) A private contract with your doctor, b) Bargaining for continuing care from an “Urgent Care Center,” and c) Joining with a group that contracts with certain docs for “Concierge Care.”
Type “urgent care centers” into a search engine and thousands come up. In June, the Academy of Urgent Care Medicine plans to add a list of centers it has accredited to its Web site, www.aaucm.org.
Another, more expensive option is concierge or “boutique” care, which comes in two forms. In the most popular kind, doctors accept Medicare and other insurance, but charge patients an annual retainer of $1,600 to $1,800 to get in the door and receive services not covered by Medicare, like annual physicals. Before signing up and paying the retainer, patients should get a written agreement spelling out which services the doctor will bill Medicare for and which the retainer covers. And always check carefully for double-billing.
Since most of the cost of the health system we are so eager to fix globally is actually located in our elderly population, coupled with the expensive procedures that often occur in that age group, we need to consider what to do if Docs and hospitals are scarce, drugs hard to get, and waiting times intolerable. The younger folks not directly affected by those concerns (except to pay) can blithely vote for policies that will be disastrous for their elders – and with us for generations.
Photo by Chris Richards
