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50 years of Medicare: Personal histories

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Physicians, including a former CMS administrator, talk about their experiences  dealing with Medicare and look at its future in a MedPage Today series.

Here are remarks by a couple of  the physicians:

Michael Ellis,  M.D., an ENT surgeon connected with Tulane University School of Medicine: “I think Medicare has worked well overall, providing adequate access for good reimbursement. The problem comes from the Medicare allowable charge of 80% of the doctor’s fee, with the doctor having to bill the patient or supplemental insurance for the remainder, which is a lot of paperwork. And for the dually-eligible, we get nothing for Medicaid. The good side is that Medicare is less hassle to deal with than commercial insurers, now that the program here doesn’t require pre-authorization anymore.

“Now there’s talk about paying for quality, as if we have adequate quality measures, which we don’t, and with a big push toward bundled payments, with hospitals divvying up the proceeds.”

“I think more patient knowledge of costs would help, but public information right now about real costs and not just charges is difficult to come by.”

And Peter Hollmann,  M.D.,  chief medical officer of University Medicine, in Providence: “A Medicare Level 4 visit has a fair range of complexity, and this is the area where geriatricians work. So, while the law of averages sort of works out for most physicians, if you’re working at the skewed end, like most geriatricians, there is more marked inequity in reimbursement. Also, because they’re working largely for one insurer, Medicare, geriatricians can’t cost shift among insurers like some other physicians can.

“In general, it will be difficult to address everything that should be for the more complicated patients. Quality measures may prove difficult because there’s no methodology as yet for evaluating individual physicians with any accuracy, and it’s especially difficult with geriatricians, who deal with a wide variety of cases. But it’s a good thing Medicare is looking at quality initiatives; it’s been behind some private insurers moving in this direction.”



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