Regional
(2008-02-11)
Listen Now:
BRUSH, CO
(KUNC) -
Medi-expletive-care
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by Marc Ringel, M.D.
KUNC February 11, 2008
My practice in Brush has been designated a rural health clinic, which means that Medicare reimburses us less stingily than it does the average provider, giving us a better shot at surviving financially so we can continue to address the needs of the hoards of elderly who reside in our medically underserved neighborhood. Brush Family Medicine is surviving, even thriving, thanks in part to the slack the Feds have put in the purse strings it ties to rural health clinics.
Those strings are not around our necks But they are around our ankles. The folks at the Center for Medicare Services, who are responsible for thousands of pages of regulations, don't want clinics taking business away from rural hospitals, many of which are hanging by a frayed financial string themselves. Therefore, Medicare has limited the clinic services it will pay for.
I have a patient with arthritis of the knee. I suggested a series of three weekly injections of artificial synovial fluid into the joint, which sometimes gives six months or more of pretty good pain relief. (The gooey, slippery stuff worked okay on my knee, one part of me that could qualify for Medicare early.) The medication alone costs about $600 and Medicare would only pay under $300 total for the three visits to my office.
Here's what we had to do. The woman registered as an outpatient at East Morgan County Hospital, the parent of Brush Family Medicine, to which we are physically attached. She was brought from the registration desk to the hospital outpatient clinic.
After gathering the necessary supplies, my nurse met the woman at the outpatient clinic, got her situated and prepped her skin with iodine. When my assistant called to say all was ready, I dropped what I was doing at my practice, walked through our lobby to the other clinic, did the procedure, and returned to my own office to pick up where I'd left off.
Later I found out, in an urgent communication from the office manager, that I'd dictated the procedure note on the wrong system. The record had to come from the hospital, not the clinic, or they couldn't bill Medicare. So I re-dictated.
The hospital charged Medicare for the supplies, medication, and room fee. The practice hit them up for my professional service. The total charges were way more than they had to be. And the required time and paperwork were maddeningly inflated.
I hesitated to do this commentary because I didn't want it to be used as ammunition against a single payer universal health insurance plan. That single payer would certainly have to be the government. Given the traditional American anti-government bias, many probably will hear my story about a Medicare Catch-22 and say, See how bad things get when the government does them?
Medicare administrative overhead is about 2%. Private health insurance is more like 30%. Medicare hassles tend to be in-your-face crazy, like the one I've just described. Private insurance ones are more likely to be subtle rip-offs.
Where to stick the needle into that knee would be a non-issue if we had the sort of integrated local healthcare system that does not pit the interest of the clinic against that of the hospital, focusing instead on the patient. Such integration can only be accomplished with a single fiscal intermediary.
As long as I'm dreaming, let me tell you about the one I've been having in which I run effortlessly, without knee pain, for as far as I'd like. It's even better when I'm not being chased by the Director of the Center for Medicare Services, who's trying to heel me with his lariat.
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