Open Phones: Physician Access

Thursday, June 30, 2011

The Obama administration cancelled its "mystery shopper" plans in which it would send researches into the market to test access to primary health care for Medicare and Medicaid patients. We'll take calls from patients and doctors for our own unofficial survey. Are you on Medicare and Medicaid? Have you recently looked for a primary physician? Tell us your story!

Comments [19]

Claude Gerstle from New Jersey, Florida

this is a huge topic but I will touch on a few points. I'm both an ophthalmologist and a chronic care patient having been seriously injured eight years ago. I used to take Medicaid but mostly so that my Medicare + Medicaid patients could be seen by me.Medicaid reimbursements, in New York and New Jersey for many procedures cost clinician more than the Medicaid reimbursement. In other states, for example Texas, I believe they reimburse Medicaid at Medicare rates. They use Medicaid as institutional charity

Jul. 01 2011 02:05 PM

I worked for a physician who did not take Medicaid because he could not afford to. If any of his patients ended up on Medicaid, he continued to treat them pro bono, but could not accept the pittance offered by Medicaid because then he would have to accept all Medicaid patients and would go bankrupt. He was a supporter of single-payer, as am I.

Jun. 30 2011 04:50 PM
Casey from NYC

I think that BrettG made some excellent points. I am in a similar situation as I am living long-term with a chronic condition and also have Medicare/Medicaid/Part D. At one time I required the services of a nutritionist and it was her job to procure Ensure for me. All she had to do was make a call to an 800# and punch in some numbers to get a prior authorization. It took less than a minute to do this. She left the practice and later when I asked my primary care about continuing this, she couldn't be bothered so she suggested that I buy "Instant Breakfast" so she wouldn't have to make a phone call that could've been done as I sat in an office visit with her.

Also because of the general laziness of some practitioners regarding authorizations I wound up being talked into getting a full upper denture because I was told there was no way I could get a replacement for one single tooth that had to be extracted as I wouldn't have an "anchor" for a partial. I later learned that it would've been possible to do the replacement procedure, but it would've required a certain authorization and billing coding, which wouldn't have net as much revenue as did all the required office visits for adjustments of the ill-fitting denture that I was talked into getting. And it was too late, since teeth don't grow back at my age.

At the beginning of the year, I switched to a Medicare HMO because the premiums for the Part D went up and things seem to have improved despite the fact that I have to call every month and fight the $15 "facility" charge the hospital/clinic keeps trying to bill me, when I'm supposed to have a $0 co-pay.

I think that these lawmakers who are writing these policies need to be forced to live on medicare/medicaid and experience the hassles firsthand then we'd see how quickly things would change.

Jun. 30 2011 01:40 PM
Kathleen from Jackson Heights

On Christmas Eve I received letters from my pulmonologist and cardiologist that, as of Jan. 1, they would no longer participate in Medicare. After 24 years of paying premium prices for which my insurance reimbursed only a portion, I was suddenly cut off just as I became Medicare eligible. My gynecologist and dermatologist have also opted out, as has my mammogram center. I have had to locate 5 new MD's who participate and it has been difficult. In NYC it is extremely difficult to find a good doctor who accepts Medicare. This is especially true for gynecologists and dermatologists. When I finally located a gynecologist in March, I could not get an appointment until late July.
A doctor told me that they just cannot afford to charge medicare fees anymore as they are paid the same rates as doctors in Idaho, for example, and the rents, insu rance, salaries, benefits for staff, etc. are no comparison to those in Manhattan. He said they are also prohibited from discriminating by accepting Medicare for old patients and denying new ones.
It seems to me the only solution is universal, single payer insurance for all.

Jun. 30 2011 12:18 PM
chloe from bklyn

when looking for a physician, the Medicaid assigned insurance company will provide a list. i am EXTREMELY grateful for access to this service, i would be dead without Medicaid, but after contacting dozens of private doctors i have to find the one hospital affiliated health center on the list, so i can have a PCP i've never once seen. i have no problem getting help from residents, but i rarely see the same doctor more than once and it is frustrating that in several years i have not been able to connect with a doctor i can trust. again, so grateful for Medicaid, no room in my budget for the daily handful of pills that keep my heart beating, but it is a several day project just trying to find somewhere to go that isn't an ER.

Jun. 30 2011 12:05 PM
Bob from Pelham, NY

Re points made by your last two callers:

1.) As emphasized in the city and state budget negotiations, Medicaid expenditures include large grants to hospitals to subsidize doctor training. What's unreasonable about requiring docs benefiting from this training subsidy to take a reasonable share of Medicaid patients when they move into private practice?

2.) A doctor who's schedule becomes "full" to avoid Medicaid patients is no different from a cab driver who suddenly goes "off duty" when a passenger's destination is Brooklyn (or Washington Heights). Both want the advantages of a government license, but not the responsibilities that go with it -- and both are breaking the law when they do it.

Jun. 30 2011 11:58 AM

To Romanie in UES,

Have you applied to the Community Health Network clinic on 21st ST in LIC?
Check the service guide on their website.

The support staff is CHN, but the MDs, attending & fellows/residents are from NYP-Weill-Cornell.

Jun. 30 2011 11:54 AM


Food stamps give no additional benefits for diabetic patients to assure the pt can eat every 4 hours as requires.

Parts A/B, D of Medicare no longer cover first aid, & other miscellaneous needs that diabetics may have - e.g. band-aids/other bandage to help stop bleeding, etc.

Medicare no longer covers vitamin/mineral supplements to offset the bad medical effects of chronic medication.

Jun. 30 2011 11:54 AM
E Gudwin

I find it particularly vexing that I never hear comments about the fact that those who are writing the Medicare/Medicaid laws do not and never will experience either of these plans. After very few years of service, they are provided with private Medical Ins. for life, how nice.

Jun. 30 2011 11:52 AM
RJ from prospect hts.

In response to the last caller on Medicare/Medicaid: one of the reasons that overhead is so high is the *for-profit* poor-health insurance industry, whose paperwork is so onerous that practitioners have had to hire numerous people to manage the paperwork: preauthorizations, referrals, Rxs, insurance forms, etc ... and all the back and forth for every piece of paper, all the followup, the lost paper, the appeals, etc. etc. etc. This is one of the *key* problems with for-profit insurance.

Jun. 30 2011 11:48 AM

Brian, as a 62yo dependent on SSDI/food stamps/Medicare (not medicaid) is more complicated.

1) Dental & vision care is NOT covered "primary care" by Medicare in NYS. This is even though dental care is necessary to prevent infections & vision care is necessary to prevent medication labeling problems - dosage/frequency/sidd effects, etc.
2) Food stamp reductions make it difficult/impossible to insure adequate nourishment which also may have negative effects on Rx drugs.
3) Increased Part D premiums & copays, despite frozen SocSec benefits, have risen in the past 3 years that benefits have been frozen. Also, the COLA increase next year will not cover the cost increases of the past 3 years, only the minimal inflation of 2010.
I'm lucky as I live near a NYPresbyterian Clinic which accepts medicare w/or w/o additional insurance.

Jun. 30 2011 11:47 AM
Romanie Baines from Manhattan

I found it extremely difficult to find a Primary Care physician here in Manhattan when I retired and reached Medicare age a couple of years ago.

I live in the East 60's and had hoped to find someone who had rights at New York Hospital Presbyterian at East 68th St. It was not possible! I asked the hospital for a referral, they had nearly 200 PC physicians affiliated with them but only 2 of them still accepted medicare. I gave up on finding someone affiliated with that nearby hospital.

It took me over a year of searching around to eventually find someone who would agree to be my primary care physician.

I might add that fortunately for me, I'm very healthy, don't take any prescription medicines, and only visit a doctor for occasional routine preventive care, so hardly put a burden on a physician's time!

Jun. 30 2011 11:47 AM
David in Fredericksburg, VA from Fredericksburg, VA

In response to the general surgeon callin in. Medicare reimbursement in NOT resonable. They pay a pittance for surgery and no matter what happens, the patients get 3 months of post op care for free - whether they are being treated for a completely different problem or not.

Jun. 30 2011 11:44 AM

It's a wonderful Kountry®!

Jun. 30 2011 11:38 AM

This isn't just an issue with respect to Medicaid or Medicare. Many doctors refuse to accept some insurance plans for a variety of reasons. The reason that I have most often heard is that the insurer rejects everything, makes the paperwork impossible to complete, etc.

Jun. 30 2011 11:37 AM
niki from park slope, brooklyn

I Have a primary care doc on medicaid, but finding specialists is hard and becoming nearly impossible. My medicaid is provided through HIP. I log into thier website - WITH my I.D., which should make results specific to me - and I'D say four of five docs who appear there as accepting my plan say they do not when i call.

HIPS blames it on the doctors, who they say haven not informed them of their choice to discontinue the plan. The docs blame it on HIP and medicaid, saying they pay too little, too late, with too much hassle, and they don't keep their information up to date. Grrrrr!

Jun. 30 2011 11:08 AM

Robert, we've added a link above and clarified the Obama program, which was intended to research the availability of doctors for Medicare and Medicaid patients.

Jun. 30 2011 10:16 AM
David in Fredericksburg, VA from Fredericksburg, VA

I work for an orthopedist in Virginia. While we didn't generally take medicaid, we would see some patients in the past - especially children in need of fracture treatment. The Medicaid program canceled all provider IDs at the time NPI (National Provider Identification) was implemented. If doctors want to be able to treat those on medicaid, they have to fill out a new application - including signing an agreement to take any and all patients requesting service. There are no orthopedists in Fredericksburg with medicaid - patients must go to northern Virginia or Richmond.

Jun. 30 2011 10:13 AM
Robert from NYC

Can you explain before this segment what you mean by "mystery shopper" I have never heard that before and don't know what you're referring to regarding that phrase.

Jun. 30 2011 10:03 AM

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