Why I stopped taking Medicare

Why I stopped taking Medicare

Why I had to quit accepting Medicare

November 8, 2013 by Dr. Gerald Roth

About four to five years ago, my practice made the decision to stop providing medical services for Medicare patients. I ran a small family clinic called Madera Medical Center where I was the only physician, and I employed two medical assistants, a receptionist and an insurance processor.

Over the last 10 to 15 years, insurance payments from Medicare and others have not kept up with the costs of running a medical clinic. Those costs, which have skyrocketed, can include processing claims, and paying for employees, property maintenance, taxes, insurance and license fees. Eventually, our overhead costs increased to such a degree that it was no longer possible to maintain our high quality standards and stay profitable. So I closed my medical practice in May, after serving the Tucson community since 1991.

Thousands of people and their families put their trust in us over the years. However, as a private practice, I couldn’t set my own prices, Medicare and private insurers did, and family doctors are at the low end of the pay scale.

Because Medicare and the insurance companies determine how much they’ll pay for my service, the only way to make up for overhead increases was to see more patients. This meant that I would have had less time to spend with them. As a result, I couldn’t afford to take care of patients who need more time, such as those who have multiple medical problems and need highly complex decision-making. In other words, Medicare patients.

Medicare has also decided that doctors are required to upgrade to electronic medical record systems, as well as “e-prescribing” systems to eliminate paper prescriptions. The software and conversion process can exceed $100,000. Doctors who choose not to implement, or cannot afford these systems face even more deductions from their Medicare reimbursements as a “penalty.” Medicare threatens doctors with audits, sanctions and fines for simple coding errors. If any private insurance plan made those demands on doctors, I doubt many would participate.

Our decision to discontinue seeing Medicare patients was made only after a great deal of deliberation. A solo family doctor simply can’t bring in enough income to offset the high cost of doing business with the Medicare system. As with any product or service that is losing money, Medicare service had to be discontinued. Unfortunately, this decision was not enough to keep my doors open.

I have since joined Northwest Allied Physicians, a large medical group associated with Northwest Medical Center in Tucson. The new practice accepts Medicare and has the backing of a national health care network that will assume the administrative tasks of running their facilities, allowing me to refocus on the medical needs of my patients. A high percentage of my former patients, including those who are seniors have followed me to the new practice, and words cannot express my gratitude to them. They made a difficult transition smoother, and it feels great to be able to focus on quality care again.


 

In September, Dr. Gerald Roth joined highly rated Northwest Allied Physicians in Tucson, Ariz., which accepts Medicare. He has resumed treating some of his former Medicare patients.

 

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