Shhhhhh. . . I went Secret Shopping for a Doc (pension, moving, drugs)
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The first post stated the hospital administrator interviewed physicians who all denied refusing Medicare patients, but the OP found exactly that.
Were the docs lying or just unaware of what the office folks were doing?
I haven't determined that yet.
Please understand . . . the hospital administrator has no "standing" with these PRIVATE PRACTICES.
If the practices were HOSPITAL OWNED, then the situation would be different.
For background: this hospital continually recruits physicians and this exercise I did is part of a larger study in re: to physician recruitment, by specialty. In this particular case, the hospital owned FAMILY PRACTIONERS have reported that they are NOT at capacity with their patient load.
At this point, I am not making assumptions about whether or not the physicians realize that new patients are being turned away. However, the typical operating procedure would be that the physicians in the practice are fully aware of what is going on.
I live in AZ and, to my knowledge, not many doctors here have dropped Medicare patients...if any. My own doc hasn't and I think he takes all kinds of insurance plans. Recently I was referred to a specialist and he still takes Medicare patients. I have friends who go to other specialists and they aren't being turned away either. I am on an Advantage plan.
That would have been an important part of the study.
Also try calling a private SNF or AL with two different scenarios and see who gets invited for an immediate interview.
It would be interesting, but it isn't what I was asked to do . . . the CEO simply wanted to know if new Medicare patients were being turned away or discouraged at the physician owned practices that had been brought to his attention by disgruntled consumers.
I think you may be right about the regional differences. I haven't heard 1 person claim to be having trouble in this area. I recently had an MRI and I asked my doc if medicare patients were a "problem". Either she was a good actress due to the subject being hush hush or she clearly believed it wasn't. I mentioned that maybe it was in certain states where there were an overwhelming # of retirees and she thought that might be the case and mentioned it was probably more prevalent in the southern states
I understand this study was done in the Midwest but the Midwest is a big area.
Yes, it is a big area and this hospital is borderline "midwest."
Also, part of the problem is that many going into medical school are going into specialized areas
because they can make much more money. This has created a shortage of internists and general practitioners.
Regarding health insurance, there may be some who cannot afford it, think they will never need it
or have minor health problems. For those of us who pay for their own health insurance we do it
because things can happen & life can throw you a curve example: a car accident due to some nut.
If paying by cash, that person would need a substantial savings account.
What's next.... a self check counter like in a supermarket?
You are entirely correct re: specialists as opposed to family practitioners/IMs.
People with cash have always had the best of healthcare in this country.
For example, I know of a gentleman who was on a heart transplant list. His insurance company refused to pay for it (I don't know what the reasons were - his age? his overall medical status? Pre-existing condition? Who knows)
Since he is a very wealthy man, he just paid out of pocket . . . we are talking hundreds of thousands here . . . and very expensive into the future, as well, as the meds are expensive.
What folks don't seem to understand is . . . we needed HEALTHCARE REFORM in this country but what we got was INSURANCE REFORM.
Healthcare, in general, should be so reasonably priced that no one has to rely on insurance (except catastrophic insurance) in order to meet their healthcare needs.
That is where the system has gone wonkers -- pricing is based on what insurance companies are willing to reimburse.
It would be interesting, but it isn't what I was asked to do . . . the CEO simply wanted to know if new Medicare patients were being turned away or discouraged at the physician owned practices that had been brought to his attention by disgruntled consumers.
I understand what you're saying, Ani, and that you were not asked to do that. I think some of us would be more interested to find out - more in context - if another call were made to the same physicians stating that the prospective patient had good insurance such as Blue Cross Blue Shield. Then one could see if there were discrepancies. Most likely the study would have shown, for new patients, yes on good mainstream insurance and no on Medicare. It is any physician's right of course to not accept certain kinds of insurance, so there really would not be illegal discrimination, at any rate.
I understand what you're saying, Ani, and that you were not asked to do that. I think some of us would be more interested to find out - more in context - if another call were made to the same physicians stating that the prospective patient had good insurance such as Blue Cross Blue Shield. Then one could see if there were discrepancies. Most likely the study would have shown, for new patients, yes on good mainstream insurance and no on Medicare. It is any physician's right of course to not accept certain kinds of insurance, so there really would not be illegal discrimination, at any rate.
For the purposes of this project I am working on, we don't need to know that. We are just juggling numbers based on what we are seeing in the hospital owned physician practices, in order to make a good decision about physician recruitment.
But yes, it would be very interesting to find out. All we need to know is that there is the possibility of a pool of Medicare patients "out there" who are not readily being serviced by some physician practices . . . leaving that group a likely marketing target for hospital owned physician practices.
4. This was the most interesting method of turning down a Medicare patient. One office sent me to the nurse supervisor and she told me that, although their patient mix was already very high with Medicare patients, if I would send all my father's medical records to her for review, she would give the information to one of the physicians and they would discuss and see if they could possibly provide him with proper care, despite their very crowded patient list. And then they would "let me know" if they could accept him as a new patient.
.
I wonder if they had received many complaints already about not accepting Medicare patients and also some media attention - which is why your call was transferred to a "higher authority". The request to send them the medical records was interesting and could have been a way to end the discussion or fish out phony calls.
I've said this before, but will repeat. Drs. refusing Medicare patients is most often reported on CD by residents of GOP governed states, primarily in the "south" - NC, TN, GA, AL, AZ, TX, etc. However, there are reports of this practice in certain areas of CA, as well ...
That might well be true. I have my problems in Arizona. Perhaps the California issues are in areas like San Diego and Orange Counties, largely run by Republicans.
That might well be true. I have my problems in Arizona. Perhaps the California issues are in areas like San Diego and Orange Counties, largely run by Republicans.
Hate to say it but the R's were not the ones responsible for "Insurance reform". Our neighbor's doctor son in law...a D after his name is thinking of quitting medicine...just too complicated.
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