I got a "nice" letter from my PCP today...

[MichaelB]

This thread prompted me to look up some statistics on Medicare coverage and I was very surprised to see that it is not nearly as high as I thought. I found an AARP report from 2012 and another website with data from 2016 that puts the percentage of the over 65 population that is covered by Medicare as something less than 20% (roughly 50 million people). I just assumed that almost everyone switched to Medicare for their primary insurance once they turned 65.

If asked, I would've said 80% of the over 65 population was on Medicare and 20% wasn't! That is certainly the impression that I have received from reading threads here and from my own personal experience. If I have my facts straight, what are the other 80% of the elderly population doing for health insurance?

The AARP pub may have meant 20% of the entire population. AFAIK, Medicare (traditional and Advantage) covers more than 95% of seniors in the US.

 

[Brat]

And it could have been referring to just Medicare Part B (medical such as physicians) or Medicare Part D (drugs).

 

[candrew]

Your doctor, and most doctors, have encountered a financial and regulatory environment that pushed them away of being their own boss, and from handing patients they way they'd like to. "Big Medical" has bought-up every group around here, and I think it's common in other places in the country too. So when you pick a doctor, you might think you're making a choice, but really, since pretty much all provider groups are owned by a handful of corporations. You're really selecting between that handful of corporations, and their doctors all live within the rules of the megacorp. If you want something different, you have to find a doctor that hasn't fallen into the web, and those are the concierge guys/gals.

I retired from a health care system mega-corp. The popular term for these corporate provider groups are "employed physicians". They are typically subject to productivity measures (assembly line medicine) that quite often determines performance ratings, and ultimately, compensation. Although our system of hospitals still had a handful of private practitioners with privileges, those seem to be an endangered species. DW's physician bolted from mega-corp's employed physician ranks and joined a small, private practice serving only Medicare or private pay patients over 65. No more productivity measures, demands from management to increase "volumes" and bean counters lording over it all.

 

[AS2019]

This thread really hits home. I’m a physician in a private practice group who contracts services to a mega Corp health system. And this is why I’m perusing early retirement websites. Several members have hit the nail on the head. Your physician likely has very little to do with sending that letter and may not even know anything about it. Most of the physicians I know just want to be doctors and care for their patients. But Medicare, insurance companies, and federal regulations make that more and more difficult every year. For many procedures, Medicare reimbursement doesn’t even cover the cost of performing it. Mega Corp hospital systems have become very aggressive in competing with one another, and cost cutting is the name of the game. Since I’m still in private practice, I still have to navigate this environment with my partners. I don’t have the luxury of just being a doctor any more and letting someone else worry about billing, personnel, etc. Now I have to worry about strategic marketing, market share, cost reduction, etc. I like to compare it to a Big box store: if you own a mom and pop hardware store in a small town and Big box store comes to town, then you have two options- fight for your survival or just close the doors and go get a job at Big box store. We are still fighting for our survival. I don’t want the fight, but the fight came to me.

It’s incredibly frustrating. This isn’t why I went to medical school, and every day I pray that I can endure one more year in this hostile healthcare environment. And I’ll say it again for emphasis: most doctors I know just want to be doctors. But that’s not really an option any more.

 

[athena53]

It’s incredibly frustrating. This isn’t why I went to medical school, and every day I pray that I can endure one more year in this hostile healthcare environment. And I’ll say it again for emphasis: most doctors I know just want to be doctors. But that’s not really an option any more.

My sister, an OB-Gyn, gave up her private practice and became a hospitallist- she has fixed shifts and she and her colleagues deliver the babies of any woman coming into the hospital. She seems to be happy, freed of the paperwork and skyrocketing Med Mal premiums- but she has lost some freedom. It also means that the patient's care is fragmented- Dr. A takes care of you throughout your pregnancy but Dr. B delivers the baby.

 

[ExFlyBoy5]

I think some people may be confusing Medicare Part B with the supplement plans. Medicare Advantage Plans are in addition to Part B, just as Medicare supplement plans are. They are cheaper because they require you to use their providers and can deny services that are not "medically necessary." People that want some choice and access to all medical services and treatments will want to avoid the Advantage Plans.

The Kaiser family had a good idea when they created plans to obtain health care for their lower income workers and their families. Somehow, managed care and the HMO have become the model for all health care. Only the most astute and determined people can get the premium quality health care they want and need.

Speaking of medical necessity...as some might already know, I am managing my 90 YO Dad's affairs...including coordinating his health care. I knew very little (and still know very little) about Medicare, but it's a helluva lot more confusing than my Tricare. Currently, he is on 19 different medicines that fall under different "tiers" and his last EOB was almost 20 pages long.

Most recently, he was prescribed a quite costly drug that is delivered via nebulizer. The prescription was rejected by his Humana Advantage plan and was told by the physician that it "had to be rejected" before it could be paid for by Medicare Part B. Huh? That tends to make no sense to me..but whatever. I will be going to the pharmacy in the next day or two to see if I can figure it all out.

All I can say is...what a pain in the arse!

 

[JoeWras]

This thread really hits home. I’m a physician in a private practice group who contracts services to a mega Corp health system. And this is why I’m perusing early retirement websites. Several members have hit the nail on the head. Your physician likely has very little to do with sending that letter and may not even know anything about it. Most of the physicians I know just want to be doctors and care for their patients. But Medicare, insurance companies, and federal regulations make that more and more difficult every year. For many procedures, Medicare reimbursement doesn’t even cover the cost of performing it. Mega Corp hospital systems have become very aggressive in competing with one another, and cost cutting is the name of the game. Since I’m still in private practice, I still have to navigate this environment with my partners. I don’t have the luxury of just being a doctor any more and letting someone else worry about billing, personnel, etc. Now I have to worry about strategic marketing, market share, cost reduction, etc. I like to compare it to a Big box store: if you own a mom and pop hardware store in a small town and Big box store comes to town, then you have two options- fight for your survival or just close the doors and go get a job at Big box store. We are still fighting for our survival. I don’t want the fight, but the fight came to me.

It’s incredibly frustrating. This isn’t why I went to medical school, and every day I pray that I can endure one more year in this hostile healthcare environment. And I’ll say it again for emphasis: most doctors I know just want to be doctors. But that’s not really an option any more.

Wow, thanks for the perspective, RL!

I recently had a discussion about this with my PCP. He is still independent, and is banding together with other PCP independents in the area. But he said it may be a losing cause. AFAIK, he isn't contracting with anyone yet. He was adamant about his independence. This discussion came from a short talk about job stress. Yeah, he's feeling it too.

He's 70 and wants to leave a legacy in the area. It may be a losing cause.

I've been seeing him for 30 years. In that time, I saw his office personell grow from 1 to 5 people. His practice grew from him, to him + a PA and NP (3). The office workers are outgrowing the caregivers.

 

[AS2019]

The office workers are outgrowing the caregivers.

Without a doubt.

 

[CardsFan]

I'm glad I still have an independent PCP. While he has a preferred hospital across the street, he is at least attuned to the cost structure. Last year, when I was having hip pain, he wanted an x-ray. His first question was "have you met your deductable for the year?". When the answer was "no", he sent me to an imaging center, not the hospital. x-ray was $45.

Of course, the subsequent hip replacement was a little more pricey.

 

[Silver]

I think that sometimes Americans may lose sight of the fact that the American health care system is part of our capitalist culture, and can be expected to behave as such.

Health care providers typically care very much about clients and their welfare. The health care system they work for cares only about the money. It's a very stressful, "schizophrenic" (used as a descriptive term) environment to work in as a provider, and it's tough on clients as well because there isn't a good understanding of how the system works.

 

[Scrapr]

Speaking of medical necessity...as some might already know, I am managing my 90 YO Dad's affairs...including coordinating his health care. I knew very little (and still know very little) about Medicare, but it's a helluva lot more confusing than my Tricare. Currently, he is on 19 different medicines that fall under different "tiers" and his last EOB was almost 20 pages long.

Mrs Scrapr is near the end of (sucessfull) cancer treatment which was 2 hospitalizations over 5 months. We don't even look at the EOB. We went into the Member services and asked for a print out of each years costs and procedures. We were part 2017 and part 2018. Member services says Why don't you add up your EOB? LOL. We were getting 5/day. Essentially they could not provide it.

We just figured we hit the full out of pocket and paid it off. The young girl taking our payment asked how much we wanted to pay. We said all of it? She was shocked. This is the biggest amount I have collected she said. She got a couple spiffs for collections over a certain amount. Cookies I think

The Docs & nurses are great. Extraordinary even. Healthcare is a mess.

And this is Kaiser where everything is integrated. I don't think we could navigate independents

 

[Scuba]

This thread really hits home. I’m a physician in a private practice group who contracts services to a mega Corp health system. And this is why I’m perusing early retirement websites. Several members have hit the nail on the head. Your physician likely has very little to do with sending that letter and may not even know anything about it. Most of the physicians I know just want to be doctors and care for their patients. But Medicare, insurance companies, and federal regulations make that more and more difficult every year. For many procedures, Medicare reimbursement doesn’t even cover the cost of performing it. Mega Corp hospital systems have become very aggressive in competing with one another, and cost cutting is the name of the game. Since I’m still in private practice, I still have to navigate this environment with my partners. I don’t have the luxury of just being a doctor any more and letting someone else worry about billing, personnel, etc. Now I have to worry about strategic marketing, market share, cost reduction, etc. I like to compare it to a Big box store: if you own a mom and pop hardware store in a small town and Big box store comes to town, then you have two options- fight for your survival or just close the doors and go get a job at Big box store. We are still fighting for our survival. I don’t want the fight, but the fight came to me.

It’s incredibly frustrating. This isn’t why I went to medical school, and every day I pray that I can endure one more year in this hostile healthcare environment. And I’ll say it again for emphasis: most doctors I know just want to be doctors. But that’s not really an option any more.

I think our doc shares these frustrations. He is an independent GP, really a great doctor who still spends time listening to his patients and thinking about what’s going on in their lives that could be affecting their health. DH & I have both been seeing him as our PCP for over 20 years. We really hope he will keep working independently.

 

[NoMoreJob]

Just like "Sick Call" in the Army.



G.I.G.O.

Seriously, none of my PCs have ever known anything about me anyway. Kept writing prescrips for drugs that would kill me. And they were the ones who had prescribed them in the first place that lead to the bad reactions. They did, however, manage to keep track of whether or not I was on statins and always tried to pimp some notion of phantom "risk" because I wasn't on them.

The No-Name / No-Face doctor just might be better. Or at least easier.

I like to think that my doctor knows me but I seriously doubt that he does. It seems that most PCPs have to carry such a heavy patient load today that having a personal relationship with all patients is next to impossible. I'm all for the database knowing me and hope that the doctor will consult it. Some AI coupled with the database may be of help as well.