The controversy over below-market government reimbursement rates has led the famed Mayo Clinic to close off access for many Medicare and Medicaid patients.
According to Mayo, Medicare was reimbursing doctors at the Mayo Clinic in Arizona for only about 50 percent of the cost of the primary care treatment they were providing, leading Mayo to make the decision to opt out of Medicare.
The clinic will continue to accept Medicare patients at the facility for primary care treatment, but only if they pay cash.
Forced into ‘Tough Decision’
Amy Ridenour, president of the National Center for Public Policy Research, said the government’s Medicaid reimbursement cuts necessitated Mayo’s decision.
“President Obama's recently adopted health care law increases the caseload borne by Medicaid, the health care system for the poor run by the states. States were struggling to meet the burden of paying for Medicaid even before the recent economic downturn.
“The Mayo Clinic has essentially been forced to make this tough decision because top-down, government-run health care does not work,” Ridenour said. “Under Medicare, government sets the rates it will pay providers for services. It often does so below market rates and, at times, below cost. When the latter happens, providers either must subsidize the care themselves or overbill other patients to make up the difference. Instead, Mayo has decided to charge the market rate.”
Alan Reynolds, a senior fellow at the Washington, DC-based Cato Institute agrees.
“Medicare reimbursement rates are far too low to cover the costs of high-quality medical services, and Medicaid reimbursement is even worse,” Reynolds said. “Very few ‘top doctors’ will accept new Medicare patients. Half of Medicaid users are forced into HMOs because half of private physicians, even more in many areas, will not treat them.”
Learning from Mayo
John Lalli, principal consultant at National Consulting and Analysis, LLC in Utah, says patients should expect more closed clinic doors in the near future.
“Mayo Center is Arizona is not going to accept Medicare in Arizona because they don’t pay enough. What we can learn from that is it’s just the tip of the iceberg. More shortages are to come,” said Lalli.
Ridenour says the situation will only worsen if President Obama’s health care law is not repealed.
“It is so difficult for Medicaid recipients to find doctors that Medicaid enrollees already have been utilizing emergency room care at twice the rate of uninsured patients,” she said. “We can expect it to be increasingly difficult for Medicaid and Medicare patients to find doctors and other providers.”
Mayo cutting experimental studies.
Thank you for all who voted Democratic. Didn't think about your mother right!
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“I don’t think there is any doubt that a significant portion of the Mayo base are very sick patients. You don’t come here for primary care. We do treat the sickest of the sick. We do experimental treatment. This is where you come for innovative treatments for life threatening illnesses,” she says.
“If healthcare, the full spectrum from primary to top speciality care, becomes commoditised, it becomes a concern for the American healthcare system,” she adds.
When the Obama administration was asked whether the new healthcare exchanges were offering adequate network options to new consumers, a spokeswoman for the Department of Health and Human Services (HHS) emphasised that the new exchanges would “vastly increase” the access to medical providers to millions of uninsured Americans.
Decisions about which private health insurance plans cover which doctors is a decision currently made by insurers and providers and will continue that way,” said an HHS spokeswoman.
The top lobby group for US health insurance plans, America’s Health Insurance Plans, said the new healthcare law brought “new costs” to the industry and that selecting hospitals and physicians that meet “quality standards” was one way of making health plans more affordable for consumers.
But Mr Priselac at Cedars-Sinai in Los Angeles says the creation of ever more narrow provider networks by insurers is being driven by price alone, and not by quality. He says the hospitals that are being excluded are leaders in innovation, which saves billions of dollars for the healthcare system in the long run.
“There is confusion between price and efficiency,” he says. “The major teaching and research hospitals are more expensive not because they are inefficient but because of what they do.”
Alta Bates Summit to lay off 358 in Berkeley, Oakland |
Berkeleyside
www.berkeleyside.com/.../alta-bates-summit-to-lay-off-358-in-berkeley-...Jan 9, 2014 - Alta Bates Summit Medical Center is planning to lay off 358 employees at its Berkeley and Oakland campuses and shutter its skilled nursing facility and infusion center.
