Still Gotta Pay the Light Bill…by Pat Conrad MD

In a slow, post-tryptophan fugue, I hadn’t found any interesting medical news, which is usually a good indication to check “Medical Economics”, and found an interesting bit.

We shouldn’t have to cover this here, or anywhere for that matter, but it reminds me of worries I had when I had a private practice.  This letter highlights the nuts-and-bolts of the mess made when state compassion runs into reality:

“Your Voice: Refusing Medicare patients a reality 

November 25, 2017

In response to your article, “Medicare payment advisory board in Congress’ crosshairs” (Sept. 10, 2017), I agree with your premise that Medicare through the Independent Payment Advisory Board (IPAB) should not cut back anymore on the fee schedule.

In your article, you worry that physicians may refuse to take Medicare patients. I can tell you that this is already happening. Medicare-only patients amount to 8% of my office visits.

In the mid 2000s, through Medicare’s Sustained Growth Rate (SGR) formula, they were paying about 34% of the physician’s usual and customary fee. Today, they pay about 29% of that fee. They cannot cut down any more.

I am in private practice as an internist in primary care. I employ 1.5 full-time equivalent employees. I see patients in my office who have private insurance, nursing home patients, disability examinations, I contract with LHI to see patients for the Army and Coast Guard and I am medical director of a local hospice.

In real dollars, I need to bring in about $130 per patient visit to stay open. I track metrics on everything. My average Medicare payment is $61.70 per patient per visit. As a result, I have eliminated Medicare-only patients. Rather, I see Medicare patients who have a supplement plan, or a Medicare replacement plan. This adds an additional $25 per visit. This is still not enough.

I have significant overhead: payroll, taxes, internet, telephone bills, electricity, medical supplies, computer technology, malpractice premiums, etc. Income has to exceed expenditures, otherwise, I close my doors and put my employees out of work.

Kevin P Rosteing, MD MSMI
Green Bay, Wisconsin”

This physician is tracking metrics, and yet…

  • He STILL loses money seeing Medicare patients, even with supplementals.
  • Much of his overhead is no doubt driven by garbage that does not improve the quality of patien care, never will, and yet is mandated.

We don’t know this doctor’s age, or financial and life circumstances, and I do not write this as criticism of a person who may be in a tough squeeze, or just fed up.

But what if he was able to dump the meaningless mandated BS, cut his overhead, and have a steady income stream as determined between him and his customers, and not by stupid metrics?  The bottom line is that he still has to keep the lights turned on.

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  3 comments for “Still Gotta Pay the Light Bill…by Pat Conrad MD

  1. Cookie
    November 29, 2017 at 10:41 pm

    So what is the solution?

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    • Pat
      November 29, 2017 at 11:27 pm

      1. Send all Medicaid back to the states.
      2. Phase out Medicare, protecting those already on it while setting hard age limits to separate younger generations from any involvement.
      3. Encourage widespread DPC w/ catastrophic policies for everyone.
      4. Use the above to devolve ALL health care except the CDC back to the states. It will NOT be perfect, but it will encourage flexibility, innovation, actual efficiency, and ultimately better health care for more people. And it might – might – give us a chance to avoid debt-driven economic collapse.

      2+
  2. Steve O'
    November 29, 2017 at 8:10 am

    A neighboring state considered making medical licensure contingent upon “not refusing Medicare and Medicaid patients.” What if your panel is full? How much is enough?

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