Saturday, February 27, 2010

San Francisco Medicare Patients Need to Brace for Worsening Customer Service at Doctor Appointments

Medicare Cuts of 21.2% can only spell longer waits and less time with the doctor.

On 2/26/2010 is was reported that nothing short of a political miracle in Congress can prevent a scheduled 21.2% pay cut to doctors across the San Francisco Bay Area and the rest of of the U.S. The fact is that the extraordinary cost of living, rent and office space in the San Francisco area can only have one reasonable effect... poor customer service in doctor's offices.

For the past several months, Democrats in Congress have attempted to get legislation to pass and avoid the massive pay cut, which was written into law by the old "sustainable growth rate" formula Medicare uses to determine how much physicians get paid for treating patients. However, this week Sen. Jim Bunning (R-KY) effectively blocked the bill that would have extended the deadline by 30 days.

The big problem with this situation is that many doctors cannot make a living by seeing Medicare patients for less money. Others find a way to survev, but are forced to ration care and perform "assembly line medicine." If physicians are true to their warnings and quit seeing these people, Medicare beneficiaries might experience difficulty making an appointment with any doctor or podiatrist who takes Medicare. One poll among neurosurgeons showed that about 40% would cut back on seeing new Medicare patients if reimbursement continues to decline, while 18% would quit accepting new Medicare patients into their medical practices altogether. Another 27% said they would treat fewer Medicare patients who were already in their practices.

The fact is that all doctors in San Francisco went to medical school so they could spend their careers helping people. But when it comes to continual decreases in pay with continual escalating costs of seeing patients, something has to give.

There are really only a couple of ways doctors can deal with the 21% cuts in Medicare reimbursement that will take effect Monday morning. One option is for doctors to stop taking Medicare. That means they just don't schedule your appointment. Or you have to pay for the visit yourself. Very few doctors have had the courage to do this. However those that do, find they can provide more time, attention, and personalized care with each patient.

The other option is to just see more patients. Its just math. A doctor that was seeing 50 patients a day, will now need to seen something like 70 per day. With all of the rules and regulations about what has to be documented in the medical record for each visit, that can only translate to very short visits.

Don't be surprised if you go to the doctor on Monday and are told "we'll have to tall about that problem at your netx visit, we just don't have time for more than two problems during your visit today." But don't take it personally of you can't get in to the San Francisco podiatry office to treat that diabetic foot infection or remove that ingrown toenail... it's just math.

Dr. Christopher Segler is a San Francisco Podiatrist and Foot Doctor who stopped accepting Medicare so he could practice Direct Medicine. He provides housecalls and is a podiatrist who will go to your home so you don't have to wait in some dingy waiting room all day. He practices podaitry in the San Francisco Bay Area and treats urgent foot problems 24/7 in the Bay Area. You can use the “foot pain finder” to learn more about foot problems at and

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