Looking for Recommendation for ME/CFIDS Docs Who Accept Medicare

[AngelM]

Exactly. It's not greed; it's frustration. Medicare reimbursement rates have fallen considerably in recent years, so, as @Sushi says, in order to keep the practice afloat, a Medicare doctor has to keep appointment lengths to about 15 minutes. This will not serve an ME/CFS patient.

I don’t question the information in your post, but I’d like to know where those Medicare provider rules and limits can be found. I have found that privatized Medicare, as in Medicare Advantage plans, are much more restructive than regular Medicare. For example, if a Medicare patient needs more time in hospital than allowed, a number can be called, a real person answers, and an extension is usually granted. Whereas with privatized Medicare the hoops you jump through to get the “permissions” are impossible, so much so that you usually have to give up. Also Medicare is a government run program, which means they are answerable to taxpayers. If what you have reported about Medicare is true, we should all be on the phone with our Congresspeople and Senators. It would probably take a united and prolonged campaign, but at least our voices would be heard, and there is a chance these restrictive rules could be changed. Medicare Advantage plans are also answerable to the government, but not directly. Advantage plans are first and foremost owned and operated by private companies. The Medicare deducted from our Social Security goes directly to companies like United Healthcare and Humana, and patient service contracts with these companies can change monthly. I assume the same might be true for providers. With both Medicare and Advantage, doctors usually know a way to get around ridiculous time limits. You might call this “fraud.” Or you could call it a caring physician more concerned with the health of his patients, than the demands of health insurance administrators. Unfortunately, most of the physicians courageous enough to buck this lousy system are retired. And the rest have lost their copy of the Hippocratic Oath!

Because so many people diagnosed with ME/CFS in the USA are on SSDI, and therefore receive Medicare benefits. As both PWCFS and American citizens, whether Medicare is our primary source of health care, we need to work together to change these draconian limitations placed on our health providers. If you could link me to the Medicare provider site that outlines these provider regulations, I would appreciate it.

 

[AngelM]

Thank you @Sushi for providing this additional info and thus avoiding a possible wild goose chase!

You made my point. As long as Medicare does not know you visited an opt-out physician, and you can afford to pay the entire amount out-of-pocket, no problem. No penalty. However, most of us don’t have the luxury of paying out of pocket. And unless, we live within a hundred miles of a CFS specialist, we are SOL.

 

[Sushi]

Exactly. It's not greed; it's frustration. Medicare reimbursement rates have fallen considerably in recent years, so, as @Sushi says, in order to keep the practice afloat, a Medicare doctor has to keep appointment lengths to about 15 minutes. This will not serve an ME/CFS patient.

For instance I also see an electrophysiologist and I'd guess that about half of her patients have Medicare. She has her practice in a low-budget office suite, has an MA taking notes on a tablet and so is able to give me about 20 minutes undivided time--which is enough for my particular needs. But she works incredibly long hours, spends a couple of days a week in a hospital doing procedures and is working at a pace that makes me worry for her health.

Another example: I used to see an ME/CFS specialist who practiced both in Europe and in the US. In Europe, his fees are low as they are regulated by the government, and the appointment time was 15 - 20 minutes. In the US where he is in a private practice that has opted out of Medicare, his fees are in line with other ME/CFS specialists and the appointments are about an hour.

There is obviously a problem with the system.

 

[AngelM]

There is no doubt that the system is broken. I always thought that the physicians had effective lobbying power. I believe, at one point in history, they did. But they seem ineffective now. Pharmaceutical and insurance companies seem to call the shots. AARP does not work in the interest of retired people today, if in fact, they ever did. AARP should be lobbying for changes in Medicare. But instead they sell their brand to insurance companies in order to help those private sell more Advantage policies. Not sure how you effect change in America today without informing Americans of existing problems. But how do you inform Americans about important issues when political noise is blasting at us 24-7. People are too numb to listen.

 

[valentinelynx]

I always thought that the physicians had effective lobbying power

Physicians are terrible at supporting their own causes. Most are too busy to get involved. And, there are complicated anti-trust laws that prevent doctors from organizing to negotiate reimbursement. And the AMA, which is the largest lobbying voice for physicians has a long history of opposing anything that resembles socialized medicine, so they are not exactly on the side of patients. Nor have they done much to represent most doctors; AMA membership is pretty low (25%) for a variety of reasons, mostly because they are not seen as helpful.