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Medicare As a Business Partner

May 16, 2012 | Comments: 0 | Views: 166

If you were in business, and you had a contract with a major company that was responsible for 9-12% of your business, and that business sent you a letter saying they would be decreasing the amount of money they currently paid to you by about 30%, what would you say to this company? Imagine for a moment that you and this company had been in business together since 1965. Imagine, also, that over the years, the company had slowly and methodically begun decreasing their payment for your goods and services over the last decade; 2-3% one year, 5% another. Throughout the past generation you had already absorbed a 10% decrease in how much this company would pay for your services. At first, you were hesitant to let the company go, as they accounted for about one third of your business. You pondered the past, recalling the years of doing business together. Yet, you were quickly reminded how this company had changed drastically since its doors opened in 1965. You remembered the ease with which you initially had conducted business with this company, but how this had become more and more difficult with each passing year. The company's level of bureaucracy had grown exponentially. The mounds of paperwork they now required just to submit your bill for fair and reasonable payment for your services had grown tiresome. Over the past ten years you found more and more of you and your staffs time wasted contacting the company and explaining and re-explaining what services you had just performed. You found the tenor of the companies employees had shifted from that of cordial customer service to a more confrontational and accusatory method. You realized you had shifted your own processes from cooperative to defensive, as a means of survival. You found the only way to deal with this company was to defend; your services, your documentation, your bill.

After much deliberation and thought, you finally came to the only reasonable conclusion; it was now time to sever your business relationship with this company. Even though you had a forty-seven year history with doing business with this company, and it bothered you greatly to remove them from your ledger, you realized that it was no longer cost effective, prudent or even feasible to continue this professional relationship. However, attempting to remain as objective as possible, you contacted one of your respected competitors who had also provided this company with goods and services, to see if they had experienced any of these same problems, and what you discovered shocked you.

You contacted the administrator at the Famous Clinic and asked them if they were still providing goods and services for this company, and the Chief Executive Officer laughed and said, we quit working with them almost two years ago. After you regained your composure, you asked a couple follow-up questions. Has it hurt your bottom line? No, it's actually helped us, as we're not wasting staff hours filling out all their forms and jumping through all of their hoops and still never getting paid. Have you ever regretted your decision? Not for a second; in fact, we have found that other businesses like you have contacted us weekly to see how we are doing after our decision to sever our ties with them. What we have learned since our decision two years ago, is that we all should have done this years ago. But, we were afraid to, because they had always been so big and powerful. One more question, would you ever go back? Not unless the entire companies methods of doing business are scrapped and a whole new way of functioning is implemented. Why should any business have to put up with the unbelievable inefficiencies and ineptitude that we have experienced with the company? And, they aren't even nice or fair about it. In fact, they had become accusatory and hateful even in our daily business interactions. No, I would never allow Famous Clinic to return to working with this company.

Alright, I'm sure by now you have figured out what company or entity I'm referring to, CMS, Medicare. In my hypothetical example, you may have even deduced that the Famous Clinic is synonymous with the Mayo Clinic. Doctors are facing this difficult decision daily. Many of us are even tortured at the thought of not participating in Medicare. We think about our geriatric patients who expect us to always be there for them. We remind ourselves we have always taken Medicare patients. To discontinue this relationship isn't a decision made lightly.

As physicians, we realize better than most, that Medicare has been managed so poorly, and so ineffectively, that to continue to participate in Medicare would be professional suicide. With the focus now placed on a punitive model, in which the it's assumed (wrongfully for the majority of physicians) that doctors willfully and egregiously engage in Medicare fraud, all for the almighty dollar, it is foolish to remain a provider in such a penalistic environment, professionally speaking. No other profession would accept or even consider remaining a participant in any like program. They would never allow their professionalism to be excoriated, as has been done to doctors. Nor would they accept the repeated unilateral pay cuts forced upon all Medicare providers over the last ten years. Diagnostic radiology has seen a decrease in their Medicare fees by over 35%. What profession would continue to provide their services for less and less money every year. And Americans have been duped into thinking that doctor's fees are responsible for the cost of Medicare, yet doctors fees only make up 9-12% of total Medicare expenditures. Where's the other 88-91% going? If the bureaucracy wasn't so bloated with high paid employees and administrators, the doctors could be getting standard cost of living allowance increases each year, instead of having pay cuts forced down their throats.

Yet, the doctors are the ones who have to look their 65 year old and above patients in the eyes and say, I can no longer see you as a patient as I do not participate in Medicare. And, to have this discussion often times leads to hurt feelings and misunderstanding, as the patient has always trusted that the hared earned money they contributed to the Medicare system would insure them of accessible, affordable, high level medical care. And now, they are quickly realizing that the entire Medicare program has been mismanaged and in essence, bankrupted. Imagine, working your entire life, placing a portion of every dollar you earned into a health insurance fund, and another portion of every dollar earned into a pension plan, and then to turn sixty-five, and proceed to drawing upon your health benefits and your retirement pension, only to find out that the coffers of both programs are empty. Imagine the shear panic, and anger you would feel. Well, that's nearly where we are with both Medicare and with Social Security.

So, when a doctor electively chooses to opt out of being a Medicare provider, instead of scrutinizing or criticizing him or her, let me inform you that these doctors are not alone, the respected and revered Mayo Clinic quit taking Medicare almost two years ago. And, if it's good enough for Mayo, then it's good enough for the rest of least that's my opinion.

Source: EzineArticles
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