Saturday, June 05, 2010

Obamacare Begins

Texas doctors are fleeing the Medicare system. More than 300 Texas Physicians have dropped Medicare in the past two years (including 50 this year alone). The greatest proportion of these docs are in the primary care arena.

Even without the looming 21% cut in physician payments which the Democrats used to falsify the cost of Obamacare, our colleagues just don't want to hassle with it. Medicare pays poorly and is 1.7 times more likely to deny claims than private insurance. (Medicare claims denial rate is 6.85% compared to private insurers like: United at 2.7%, Humana at 2.9% and CIGNA at 3.4%).

According to Dr. Guy Culpepper (Dallas Area FP Doc): “You do Medicare for God and country because you lose money on it, the only way to provide cost-effective care is outside the Medicare system, a system without constant paperwork and headaches and inadequate reimbursement.”

Many of us have predicted all along that Obamacare will result in FEWER physicians available to see patients, and evidence of this is already mounting.


  1. that's it... i'm moving to canada.

  2. For all you PCP Docs, here's something to consider. By choice I moved and lost my company provided health insurance. As such I have been paying cash for appointments. In trying to leverage my upfront cash payment to negotiate a discount (sorry, I just don't believe $260/hr for your 15 min is acceptable) I have hit nothing but brick walls. The office folks don't know, don't care or haven't been given any direction in this matter.

  3. dear phgx,

    i do not do primary care so i don't know... but you are right... docs should be welcoming you with open arms. i wonder if they are disallowed from providing discounts for cash payers?

    i tried to open a cash only clinic and was told that the first time someone tried to file an insurance claim on a visit to me that i would be sued by the insurance companies for treating their patients without contracting with them.

    it made no sense to me, but was one of the reasons i decided against doing this.


  4. $260 as an hourly rate seems very reasonable for primary care. That rate includes your payment to the doctor and all of the office expenses and salaries and health insurance for all of the office staff.
    It is a low rate if you look at lawyers as a comparison. Most lawyers I know have an hourly rate of >$400/hr and all bill by the tenth of an hour. Again, these are educated professionals paying themselves and covering high overhead expenses.
    Your lack of traction in negotiating a lower rate may simply be a reflection of the actual costs of running a primary care practice...
    Dr. J

  5. Any of y'all got back pain?
    I mean REAL back pain, the kind the Chiropracter won't even treat cause he's sick of stealing your money, I mean seeing you.
    I know a guy, does Epidural Steroids anywhere.
    Well, just in the back, but he'll give em to ya anywhere, back alley, front alley, airport restroom, price is negotiable, like anything worthwhile. He'll take lottery tickets, cash, trading stamps, your first born, second born, that Pioneer 58 inch Plasma that just happens to not have a remote or owners manual.
    Drop me, I mean Him, an e-mail..what was the address again?? Oh yeah, its on my blog.


  6. phgx: I'm sure you are aware that the doc doesn't get $260 for 15 mins, or even $260/hr for that matter. If I took home 25% of what the patient was charged, I'd be a happy camper!

    Thanks to trial lawyers and Governmental bureaucracy, costs are grossly inflated and overhead is a b&%$#.

    I agree that as a cash paying customer, you should get a discount AND be charged a fair rate (in most settings, the "cash" patient is lumped with the "no insurance" patient and is charged the highest rate since there is no pre-negotiated price reduction).

    I know a couple of docs who divested everything, dropped their malpractice, and went to "cash only" practices (both are Gyneccologists). Their practices are small.

    This practice model makes sense to me, but it never has seemed to catch on. I suspect that you'll see more docs adopt it in the near future.

    Which begs the next question.....

    When people have trouble getting primary care, will we be told that there is another "crisis" of healthcare that the Government needs to "fix"? (rhetorical question...of course we will).

    Politicians will never realize that Government is the problem, not the solution.

  7. ERdoc85, since I pay cash and my 15 min costs $65, he earns albeit a fraction thereof $260/hr by seeing me. Since he books 3 pt every 15 min I have no doubt his actual earnings are considerably higher.

    However, here is where I believe few see the value of the cash customer. Basically, there is no "no insurance" liability like the ER is subjected to, you don;t pay, you don;t get service. Period. But they are subjected to the delay in reimbursement at levels below what a cash customer pays.
    (ex. My co-pay was $15 and the insurance, Aetna, paid an additional $25 for a normal care visit totaling $40)
    Now the only difference is that instead of waiting 45+ days for the reimbursement, my doc gets the cash on the day service is provided. My argument is that I should should get to pay the $40/visit. This is especially true in that nothing about my health condition has changed except I no longer am covered by insurance.

    Unfortunately for all of us (me being a paramedic) will be subjected to Obamacare which is neither a solution or an incentive to what ails the system.

    I should have become a Veterinarian.

  8. As 911 indicated, your doc may be prevented from giving you a discount by the nature of his insurance contracts. If he has agreed to accept a discounted percentage of his usual & customary fees in exchange for the volume of patients from an insurer, he can't charge less. In your case, if he charged you the same as a member of that insurance plan, the insurer would argue that they were paying 100% of his usual fee rather than 60%. (I'm not advocating this "logic", only relaying what has been explained to me when I have tried to "discount" my charges to certain patients.

    Though I agree with the premise, there is another side to be argued.

    First, your doc isn't scheduling 3 pts every 15 mins.

    Second, if he were bringing in $260/hr to run a medical office, that works out to less than $500k/yr to pay rent, salaries, benefits, malpractice, utilities, & buy supplies. The $ doesn't go directly into his pocket.

    Third, if you are so obsessed with your doc's $/minute, then you obviously don't feel that he is doing a good job of taking care of your needs and are convinced that you are on a time clock. I suggest a new doctor that makes you feel you have gotten your money's worth.

    Finally, your first post suggested that a doc visit was $260. But really, you're arguing over the $25 difference between what you want to pay & what he charges. Given the cost of health insurance, if you're not paying the monthly premium anymore, you're WAY ahead.

  9. OK, I agree, somewhat, however here's what I know for fact. I just moved from AZ where it was all but impossible to negotiate for cash payment. Here in CO most PCP docs and nearly all specialists I have looked at, primarily podiatry, offer cash payment discounts.

    Perhaps it's an AZ rule but so far the best I can tell CO has progressed further down the same path as TX and the docs are open to other marketing avenues to increase office revenues.

    And yes, I am absolutely interested in ways to control my personal healthcare costs. That's what the market needs.