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Why I'll Keep Accepting Medicare Patients
In spite of the uncertainty and the inadequate pay, I have decided to continue accepting Medicare patients in my solo practice. Why? It's more a matter of philosophy than of economics. It's about my purpose and my aim in being in family medicine and this practice.
In addition, Medicare is a positive thing for my older patients, including Part D, which is so helpful regarding their medications. Before Medicare, people who didn't have cash or insurance were often too embarrassed to ask for care. Or they got the care and paid what they could, if anything. Doctors weren't going to turn away families they'd seen for 20 years, so they wrote off an astronomical amount of bad debt.
Sometimes the only reward the doctor received was the patient's goodwill -- the fellowship and handshakes at church. Those doctors gave their service and hoped for some payment to keep going. Now, with Medicare, we may be underpaid compared to what our expenses are, but at least we are guaranteed that we're going to get something. It's much better than it was 50 years ago.
Although I'll continue to accept Medicare patients, I don't take Medicaid, and I'm not in the Women, Infants and Children Program. Both are simply not cost-effective, and the billing is extremely complicated. But other physicians in my community do participate in those programs, so people have access without my participation.
That's not necessarily the case with Medicare. If I were to stop accepting Medicare patients, some of the people I would turn away might not be able to access care somewhere else. How could I deny those people the care they need?
One change I might consider is to stretch out the interval between health maintenance visits for Medicare patients with chronic diseases, such as diabetes, because the cost of each office visit is greater than the payment Medicare provides. I'll do it only if I can find research showing that patients can be kept on track with less frequent visits than my patients get now, but I won't do it if it could cause harm. Of course, any patient who gets sick will be seen as soon as possible.
What the Future May Bring
But when I feel anxious about such questions, my worries quiet as I consider what my true objective in medicine really is. And it's not all about the money.
Linda Stewart, M.D., is a practicing family physician in Baton Rouge, La.
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