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Fix Medicare

Dear President Obama,
I am in favor of Health Care Reform and I agree with you that universal coverage and eliminating the abuses that both patients and doctors have suffered at the whim of the for-profit insurance industry must be curtailed.

But I also want you to fix Medicare. Medicare is so bureaucratic that expanding it in its current form would be the death knell for primary care physicians and many community hospitals. The arcane methods of reimbursement, the ever expanding diagnosis codes, the excessive documentation rules and the poor payment to "cognitive, diagnosing, talking" physicians makes the idea of expansion untenable.

May I give you one small example, Mr. President? I moved my medical office in April. Six weeks before the move I notified Medicare of my pending change of address and filled out 22 pages of forms. Yes, Mr. Commander in Chief...22 pages for a change of address. It is now mid-August and I still do not have the "approval" for my address change.

I continue to care for my Medicare patients and they are a handful. Older folks have quite a number of medical issues, you see, and sometimes it takes 1/2 hour just to go over their medications and try to understand how their condition has changed. That is before I even begin to examine them and explain tests, treatment and coordinate their care. Despite the fact that I care for these patients, according the Medicare rules, I cannot submit a bill to Medicare because they have not approved my change of office address.

I have spent countless hours on the phone with Medicare and have sent additional documentation that they requested. I send the forms and information "overnight, registered" because a documented trail is needed to avoid having to start over at the beginning again and again. I was even required to send a signature from my "bank officer" and a utility bill from the office. Mr President, I don't have a close relationship with a bank officer so this required a bank visit and took time away from caring for patients...but I certainly did comply.

I am still waiting to hear from Medicare. At my last call they said they had not received yet another document, but when I gave them the post office tracking number, they said it was received after all. They could not tell me when or if they will accept my address change.

I have bills stacking up since April and I just found out that they will not accept them if they are over 30 days old. I have cared for patients for 5 months and will not receive any reimbursement from Medicare. The rules state I cannot bill the patient or their supplemental Medicare insurance either.

Believe me, Mr. President, I commend you for taking on such a huge task. Please also know that Medicare reform is needed along with health care reform.

A loyal American ,
Internal Medicine (aka: primary care) physician


KatieM said…
This story is actually pretty shocking for me, a patient, to read. 22 pages for a change of address? What a waste of time. Please let us know how this gets resolved, Dr. B.
chrissoup said…
I do hope you actually sent this letter to the President (not just posted it on your blog).
jobartolozzi said…
I am appalled. You, and other doctors, must have the patience of Job, or else you wake up cursing. I hope you sent the letter direct to the White House and that it gets its' just attention.
ERP said…
Oh Man, That is a horrible story. I would be pulling my hair out.
chrissoup said…
You might try calling the office of your US congressional representative. One of their functions is to help constituents to deal with federal agencies.

What an annoying situation.
Toni Brayer, MD said…
Thank you for the sympathy. I did not actually mail this letter anywhere as I am not optimistic it would even be read.
Chrissoup: I like the idea of sending it to my congressional rep and may just do that.
Toni Brayer, MD said…
This comment has been removed by the author.
el said…
I think the regular population should really learn more about these situations, because unless you are on Medicare you really know little about it. I really don't see how the government can fix this, if those are the problems they create? Maybe we should be getting them out of it then. The government is the customer in my business, and there is no way to involve government without it being a bureaucratic mess.

Just wandered across, interesting story.
I wonder what options you may have . It seems that all letter send to any of our representative are answered in form letters telling us what great job they are doing.... no kidding !!!Talking is their trade and they do , all nonsense. Medicare should put you on a "priority" to answer you, but no know , coffee breaks . Lunch time , not my job , its my day off, the supervisor is having a stomach problem , etc...It is hard to "Soar like an Eagle , when you are flying with Turkeys ".They only care about their pay, not yours .
Anonymous said…
The government runs medicare, and somehow you think a government run health care option would somehow be different.
Toni Brayer, MD said…
Anon:2:05; Nope. Medicare needs major reform as part of health care reform.
Jonathan said…
Unbelievable. Just unbelievable. I would suggest not only sending your letter to your Senators and Congresswoman, but to the President as well.
Toni Brayer, MD said…
Thank you for all the comments.
Just an addendum: I called Medicare today to check on the status. I held on voice mail recording for 47 minutes( while I did charting, made other phone calls, ate lunch) and finally gave up. This was the "provider" help line. Guess that is what they think of us "providers".

In the mean time I continue to treat complex Medicare patients that I cannot bill to anyone.

Yes, a very broken system.
Nick Dupree said…
This is awfully damning of Medicare. I hope you don't mind that I featured your Obama letter prominently in my latest blog post. I strongly agree with you: fixing Medicare and Medicaid MUST be a core part of health reform!
Emily said…
Very eye opening. I'm sorry you have had to go through that. Based on what I know about doctors, though, you will keep trying. It would be so hard to be a doctor wanting to care for people and not always being able to do so unencumbered by this kind of red tape. Do you ever read The Red Tape Chronicles? He might be interested in this. Good luck! A reporter/ congressional aide sitting by your side while you tried to call for help might be interesting.

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