WHERE HAVE THE DOCTORS GONE?

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Where Have The Doctors Gone?
Medical Care, 2014
by – Sheri de Grom

I knew it would happen; I just wasn’t sure when. My internist and I were discussing some of my continuing health concerns and he admitted he would have chosen a different approach to my care if Medicare wasn’t in the picture.

Unfortunately, I was forced into Medicare when I turned sixty-five—just like the tens of thousands and perhaps millions of other American citizens who don’t want Medicare coverage. You may read my blogs, ‘Medicare, I Hate You,’ and ‘The Death Squad.’

One of my medical specialists recently retired so I asked my internist if he could suggest a doctor to replace him. Of course the unspoken questions always include: will they be practicing medicine longer than I’ll need them; do they listen to patients’ concerns and address them; and, finally—the determining question—does the doctor accept Medicare?

My internist provided me with the names of two young physicians he admired and he knew they were taking a few Medicare patients while building their private practices. I called each one today, one week after my internist had provided their names, and they are no longer accepting patients wherein they must bill Medicare first and then any secondary insurance. If I were not forced into Medicare, an additional cost for me, my individual insurance that I personally pay for and our Tricare would pay 100% of the cost billed. The federal government has taken away my freedom of choice!

I don’t blame doctors for not accepting Medicare and other government-funded insurance systems. Not only do the rules seem to change daily, but the reimbursement rates also decline yearly. Physicians can make more money as a certified Prius auto inspector than as a doctor treating a geriatric population with Medicare or those with Medicaid or Tricare. Additionally, the auto inspectors have a higher standard of living as they don’t have college and medical school loans to repay.

My internist said every physician who can is declining new patients if the patient’s primary insurance is Medicare. The same holds true for Medicaid and Tricare populations.

I wish I were allowed to opt out of Medicare the same as most physicians. I wouldn’t think twice about opting out. It doesn’t matter to me that I paid into Medicare my entire career (both twenty-year careers). I still don’t want it. As long as the Tea Party and Obama care leave me alone, I’ll be able to take care of myself and my husband as long as we live, thank you very much.

The one piece of legislation in favor of patients currently enrolled in Medicare is that if they are already a patient of the doctor, the doctor must continue treating them after they turn sixty-five and are Medicare-eligible or meet guidelines established by legislation that makes the individual Medicare eligible. Unfortunately, this isn’t true for the military and their families dependent upon Tricare.

I grew up with the moral code of being responsible for myself and those I love. I planned carefully my entire career and, yes, my husband and I have better insurance than probably 90% of the U.S. population. At the same time, the sacrifices we made to receive eligibility for this coverage were often heartbreaking, life-threatening and felt as if every limb was being pulled apart.

It’s not only that Medicare and other government-controlled programs aren’t paying doctors a living wage, there’s another insidious underbelly haunting doctors who treat the elderly. (Please note, I don’t consider myself elderly in any sense of the word but for insurance and health care law, I’m elderly).

We have an emerging trend of elder abuse adding liability risk to doctors. It’s a different

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form of elder abuse than we are used to hearing about. It has nothing to do with what comes to my mind when I think or read about elder abuse. I’ve always thought of inadequate living conditions, lack of nourishment or proper diets, not to mention, physical, emotional, or financial abuse.

This new form of abuse involves a doctor and/or his staff not following up with a patient’s continuum of care. Today we have an alarming trend of attorneys finding ways to circumvent tort reform statutes and elder abuse is not included in medical liability reform.

Cases I’ve reviewed are simple enough. Some of the greatest legal risks for physicians involve the failure to contact patients after they’ve missed an appointment. Additionally, medical record documentation rates high on the list involving cases where medical care was given, but wasn’t written down and therefore didn’t count. (In the medical arena, if something isn’t written down, it didn’t happen.)

Another example of legal actions taken include: general practitioners or internists referring patients to specialists for advanced diagnostic testing for something the general practitioner or internist suspects is occurring. Then, for any multitude of reasons, the patient never visits the specialist and subsequently dies of the very ailment the referring doctor suspected.

The above scenario is all too common and, as baby boomers age, more and more will enter the elder-care medical system and not have an advocate at their side. And this missing individual is much more than an advocate. They are the ones who keep track of appointments and ensure the patient arrives as scheduled. The advocate also makes arrangements for proper medication to be picked up and often times administered. Many of us have taken care of our parents, even from long distances, to ensure they have quality of life obtained through proper medical care. I manage all aspects of my husband’s medical care.

An example of a doctor not following continuum of care occurred immediately after my husband had an appointment with his internist Jan. 7, 2014. The internist said he would call the following day with further instructions based on the results of the overnight completion of blood tests. Although I’ve called the internist’s office three times since Jan 7, the internist has not called as promised. I’ll continue calling until I get the results I need but in the meantime, I’ll also visit the hospital where my husband’s blood work was analyzed. I’ll take with me a copy of Tom’s medical power of attorney and request copies of all laboratory reports and the results for each test my husband has had within the last six months. We are entitled to the information and I’ll blog later on the documents necessary to have in place to make the medical system work for you. You should never be held hostage.

Statisticians often remind us baby boomers that we’re not expected to live as long as our parents. I see this as reality. More of us enter the elder-care population each day and the time will come when we’ll need someone who truly cares about our quality of life and much of that quality is dependent on appropriate health care.

Due to the rising number of elder-care legal actions, physicians either can no longer get medical liability insurance to cover the growing population or they simply aren’t willing to take the many risks in treating elderly patient.

Physicians who once followed their patients upon admission to a nursing home or other care facility now elect to turn their medical care over to the facilities’ staff physician. This is a difficult adjustment for the patient and the family. This shift in medical care can be traced to the rising cost of physicians’ growing-hikes for liability insurance premiums. It’s a simple fact; doctors have to reconsider treating the elderly.

One last cautionary note: hospitalized Medicare patients are often moved into a step-down unit of a hospital

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for observation, rehabilitation or intense physical therapy. It appears to the patient and the patient’s family that Medicare is covering this care the same as the previously hospitalized days, but unfortunately, the patient is now being treated in what Medicare classifies as an outpatient environment. Medicare’s payment drops drastically in this scenario leaving the patient and the family uninformed until they receive their first statement.

What are your thoughts? Being a caregiver requires a lot of time and energy (both mental and physical). Who protects your medical interests? Does anyone know what you want?

Thank you for reading with me as we enter this world of who’s going to pay for what in 2014.

I’ll be back next week with, ‘Sharks At My Grave.’ Thank you in advance.