Shhhhhh. . . I went Secret Shopping for a Doc (move, retired, diabetes)
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A lot of my work I can't discuss b/c of confidentiality agreements, but this project was so generic . . . I thought you all might find it interesting . . . so I am sharing.
We have talked about Docs dumping Medicare patients, or refusing new patients, or leaving the practice of medicine, due to changes in reimbursement.
One of my clients is a 235 bed tertiary hospital in the midwest. Administration had received letters and calls regarding Medicare patients being turned away from a total of 11 physician practices. The CEO was puzzled, as over the course of the last six months or so, he had talked directly with the practice managers and some of the physicians at each practice and all denied turning away Medicare patients, either established patients or new patients.
Caveat: These are physician-owned practices. They are not hospital-owned practices, but all of the docs have privileges at this particular hospital.
As part of a bigger assessment, I was given the task to do some "secret shopping" to find out what response I got if I should call and ask to make an appointment with each of these practices.
I created a scenario, stating that my hubby and I were retiring to <Said Midwest City> and would be arriving on August 12th, and my father would be making the move with us. We wanted to get him set up ASAP in a relationship with a physician, as he is 83 and has some medical issues, including diabetes and some cardiac issues that need monitoring.
I called the 11 practices. Here are my findings:
One physician is no longer in practice. He and his fellow physicians have closed their practice, evidently in June. Although I will be doing further research, I have no idea what the circumstances were, i.e., retired, moved to another location, sold to another physician practice, etc.
The remaining 10 practices:
There were basically three methods of discouraging new Medicare patients, and one office had a rather unique approach, lol.
1. Our practice is full; we have no more slots for Medicare patients. (3 handled it this way)
2. We have closed our practice to ALL new patients, including Medicare patients (4)
3. We are a very busy practice. The soonest we can make your Dad an appointment would be the end of October. One office said it would be late October or early November. (2)
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.
So there you have it, in a nutshell.
Oh, I should add . . . all of these were primary care (Internal Medicine) practices. And the population estimates are such that it would appear very unlikely that these practices are actually "full," especially considering that the hospital-owned practices are not solidly booked.
I don't find #3 particularly out of the ordinary, at all. I've experienced long waits all my life - not that I doctor much.
Even with my regular providers, as far back as 50 years ago, I recall having to wait months to get an appointment with my regular internist. And, my ob-gyn was a nightmare. The only patients he saw quickly were pregnant women. Otherwise for a physical, etc. appts were scheduled as far as six months out.
I don't find #3 particularly out of the ordinary, at all. I've experienced long waits all my life - not that I doctor much.
Even with my regular providers, as far back as 50 years ago, I recall having to wait months to get an appointment with my regular internist. And, my ob-gyn was a nightmare. The only patients he saw quickly were pregnant women. Otherwise for a physical, etc. appts were scheduled as far as six months out.
For a well check for a new patient, and with my saying that we needed to do this ASAP, nearly 3 months wait seems unreasonable.
However, it was not my assignment to analyze the findings - just submit them (as part of a larger demographic study).
My feeling was that they were discouraging me and hoping I would find another provider, but again, that is just my opinion (and suspicion). YMMV.
Dear OP, this doesn't surprise me at all. Not only do some doctors avoid Medicare patients there is also a new trend
of concierge medicine. I had a great physician for many years who changed his practice to concierge and an annual
fee of $3,500 included a check-up and lab work. He reduced his patient load by 2/3rd's and would be on call for them
24/7 and all other visits would go through insurance or paid by cash.
My husband who never needs to see a doctor and who is not on Medicare had a swollen wrist and tried to see
my current doctor but was told to wait 3 months or go to the emergency room. He eventually saw a nurse
practioner who expertise was limited to what was wrong and just prescribed some medication. The charge was
exactly the same as if he saw the doctor. He is still waiting to see the doctor and that was 4 months ago.
Dear OP, this doesn't surprise me at all. Not only do some doctors avoid Medicare patients there is also a new trend
of concierge medicine. I had a great physician for many years who changed his practice to concierge and an annual
fee of $3,500 included a check-up and lab work. He reduced his patient load by 2/3rd's and would be on call for them
24/7 and all other visits would go through insurance or paid by cash.
My husband who never needs to see a doctor and who is not on Medicare had a swollen wrist and tried to see
my current doctor but was told to wait 3 months or go to the emergency room. He eventually saw a nurse
practioner who expertise was limited to what was wrong and just prescribed some medication. The charge was
exactly the same as if he saw the doctor. He is still waiting to see the doctor and that was 4 months ago.
Yes, concierge medicine has been around a while, and becoming more popular, especially in larger metropolitan areas.
I am sorry your hubby hasn't been able to get in to see a physician in a timely manner. A lot of folks resort to Urgent Care Centers, but the charges are often what I consider very high.
Interesting! I always wonder if doctors refusing to see Medicare patients is a myth. It is certainly a popular notion.
My plan is to continue paying cash, and, if I decide to enroll in Medicare, to let Medicare reimburse me. I hope this is still possible.
You should be able to fill out and submit your own paperwork for Medicare if you decide to enroll. It is a hassle from what I have seen . . . and some docs will be telling patients that they have to submit their own forms -- as a cost saving (staffing) measure. We are starting to see this already in some areas of the country. Too soon to call it a "trend."
My plan is to continue paying cash, and, if I decide to enroll in Medicare, to let Medicare reimburse me. I hope this is still possible.
Your current physician takes cash? Stick with him/her. Finding a practice that that takes new uninsured patients might be even harder than finding one that accepts Medicare.
edit to clarify: I once asked a Nurse Practitioner friend what the problem was with accepting non-insured patients. She said that if the patient ends up in a hospital or emergency room and names the practice physician as their doc, then it quickly turns into an ethical dilemma for the doc because the doc has no way of knowing if the patient can afford and will pay in-hospital treatment expenses.
Last edited by biscuitmom; 08-01-2013 at 08:40 PM..
Did you call and also try to make an appt. saying you had X brand insurance (that they accept) and see if they took you on or got you in sooner?
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