Local doctors opt out of Medicare

MARBLE FALLS, Texas (KXAN) - Diminishing reimbursements and payment delays have area doctors opting out of Medicare .

Dr. Juliette Madrigal-Dersch , an internist in Marble Falls, is among 300 doctors across Texas who have opted to leave the system.

"It was continual frustration, lots and lots of paper work, lots of coding," explained Dersch.  "The patients get reduced down to numbers.  If you make a mistake, even accidental, it can be a felony."

Dersch's decision to sever all ties with the program is rare, but growing more commonplace as Medicare pay cuts loom now that Congress failed to delay the 21 percent Medicare cut which took effect June 1.

Congressional inaction has national health care advocates outraged.

"The Senate has turned it's back on seniors," said Dr. James Rohack, president of the American Medical Association , in a statement issued Friday. "Senators are more interested in heading home for the holiday than in preventing a Medicare meltdown for seniors...Already, about one in four Medicare patients looking for a new primary care physician have trouble finding one, and Congressional inaction will make it much worse."

Dersch admitted her decision to opt out didn't come easy.

"I was worried," Dersch said.

Unlike other doctors, Dersch is not turning away medicare patients.

Instead, she is seeing them only on a private-contracting basis, meaning she nor her patients can make any Medicare payment claims.

Dersch's system also allows her to charge what her services actually cost, not what the government says they are worth.

"We just try to charge what is fair and it is less than it costs me to get my haircut," Dersch added.

She also is choosing not to charge patients 90 and older for her services and she even makes house calls.

"We probably see at least one free person a day.  We see a lot of people for free," Dersch said.

Minor sacrifices that save her from dealing with what critics call "an imploding" government funded program.

The Senate is due back in session June 7. Doctors who still accept Medicare and health care advocates are holding out hope that freezing payment cuts until December 2011 will be voted into law.

If passed, this will not be the first time payment cuts are delayed. There have been nine delays over the past eight years.

Meanwhile, Medicare claims are now on hold for 10 days to allow passage of the bill.

 

MEDICARE MILESTONES

1945- Harry Truman asks Congress to develop legislation establishing a national health insurance plan.

1965- President Lyndon B. Johnson signs Medicare and Medicaid into law.  President Truman is the first to enroll and Medicare Part B premium is $3.

1972- Payments to HMOs are authorized.

1983-Most federal civilian employees become covered.

1984-All federal employees, including the president, become covered.

1988- Medicare benefits are overhauled. Coverage for catastrophic illness, routine mammograms and prescription drugs now included in benefits.

1989- Catastrophic illness and routine mammography no longer included in benefits. Coverage, however, for pap smears is added.

1992-Physician services payments are based on fee schedule.

1997-Medicare+Choice is enacted under the Balanced Budget Act.  Some provisions prove to be so financially restrictive Congress is forced to revisit the issue in 1999.

1999-Congress reviews and relaxes funding restriction under the Balanced Budget Act.

2000 -Medicare Part B premium is $45.40 per month.

2007-Medicare Payment Advisory Commission (MedPAC), established in 2007 to advise Congress on the program.

January 1, 2010-21 percent Medicare payment cut scheduled to take place.  Congress later votes to push back the date.

June 1, 2010-Congress fails to meet Medicare deadline, imposing the 21 percent cut in Medicare payments.