Medical Tuesday Blog
Why We Had To Eliminate Medicare, Medicaid From Our Practice
Approximately in July of 2014 there were a number of new Medicare regulations that came down the pike which we had to learn second hand. We wrote the same prescriptions we’ve written for decades and our patient and pharmacists called or faxed back that those Rx were no longer covered. Medicare had changed to a different generic than the one we’ve been prescribing. The pharmacists simply asked us write a new prescription, which doubles the time for prescription writing. Or we could contest the change and go through the Prior Authorization process. We only did this once to understand the cost. Medicare intermediaries wanted to know what different drugs we had tried before they considered it. Since, the patient had been on the current ones for a number of years and the trial period was prior to that, we no longer knew which ones were used. The patients revolted when we tried to use a new generic. They frequently had already had experience that that generic and refused to fill it. So the 30 second Rx became 60 seconds (100 % increase in professional time and overhead) and then 5 minutes, 15 minutes—the prescription process could tie up my front desk for days—occasionally for weeks.
But this harassment was not confined to medicine prescriptions. As a pulmonologist, we have been in the business of treating respiratory failure patients (low oxygen levels) for more than 40 years. Ordering oxygen for a patient was simply writing a “Durable Medical Equipment” (DME) requisition, fax it to the DME Company and the oxygen would be at the patient’s home, sometimes before the patient got there from the office.
In July of 2014, this request was not honored. My front desk spent considerable time with the DME Company which stated there were a number of new Medicare rules. They needed the request completed on a new Medicare Form, a detailed medical reason (usually termed: chart notes), a printout of the oxygen determination, and appropriate time to process the request.
After we had completed the request in detail, provided a copy of the complete office visit (we don’t have written chart notes – as a consultant we have complete EMR typed up professional visits we could send to the personal physician in response to the consultation request. This included a typed up Oxygen saturation report documenting the low oxygen of respiratory failure, justifying the life-saving oxygen need. We knew they would not be able to find the oxygen portion in a two page report so we underlined the required lab evaluation with bright ink.
My front desk spent another 10 or 15 minutes with the Medicare intermediary before they interrupted me while I’m with the next patient. She stated that they didn’t need a complete report they couldn’t understand. They just needed the answers to their questions—nothing more. Plus they needed the actually printout of the oxygen level. I pointed out we didn’t have such a fancy machine with a printer like the hospitals have. We just have the standard “pulse-ox” monitor which most physicians use in their offices. We’ve used this same type of instrument in our office for 40 years documenting respiratory failure. The Medicare lady replied, “How will we know if you’re telling us the truth? You could put down any level you wish.” I told her that I was sorry she didn’t trust our honesty. I also informed her we would not be purchasing a $1500 instrument that measures all vital signs, in addition to the oxygen level required for our type of practice, and handed the phone back to my medical assistant and proceeded seeing the patient that Medicare interrupted.
This lady who was in such severe lung failure, her arterial oxygen saturation was 78%, about the level of blue venous blood so that we had to help her to her car. She declined to go the hospital emergency room. She spent the next two months in her lounger gasping for breath before the oxygen was finally delivered. She called Medicaid, which referred her to another oxygen company that was willing to bypass Medicare’s directives to save a human life. Of note, is that the following month, she had to begin using the Medicare required oxygen company.
At this time in January 2015, after six months of this type of harassment, my front office stated that they were spending between 15 minutes to more than two hours, justifying the low cost care our patient were accustomed to receiving and doing well on it. With the front desk medical assistant being paid $30 an hour, this exceeded many of Medicaid reimbursement payments as low as $28. And with office overhead now exceeding 50%, with Medicare reimbursement of $69 for a $150 office evaluation, the cost of our practice now exceeded the joy of a professional practice for the benefit of our patients, we notified our patients on Jan 1, 2015, that we would close our practice on June 30, 2015. This would give them six months to find a new physician and we would be happy to transfer their Medical File to whatever physician they would choose.
We regretted this intrusion and reduction in quality of care by the government into their private healthcare. We no longer were able to work for them. We were working for Medicare which is a corruption of our professional oath and journey for the last 45 years.
Government is not the solution to our problems, government is the problem.
– Ronald Reagan