Gastroenterology: Still a Great Way to Make a Living
Some physicians are so apprehensive about reduced payments from third-party payers that they have decided to stop dealing with them. The 2013 survey revealed how gastroenterologists plan to deal with Medicare and Medicaid (Figure 5).
Figure 5. Gastroenterologists' intentions for Medicare/Medicaid patients.
Many physicians are ready to let go of other insurers judged to be too low-paying. Among gastroenterologists, 29% plan to abandon insurance plans with inadequate reimbursement, although 22% say that they need to maintain all third-party payers, and 20% believe that it is improper to stop accepting selected insurance plans.
Although Kosinski understands the temptation to cut off certain third-party payers, he is not sure that all of those who are thinking about it will actually sever those ties. "There are 75 million of us baby boomers," he said. "We are adding 10,000 new Medicare beneficiaries each day, and we are going to continue doing that for the next 10 years. If you are running a business taking care of human beings, and 75 million will soon enter Medicare, how will you run your business without accepting it? I don't think you will. Yes, Medicare can cut your fees, but you know how you are going to get paid, why you are going to get paid, and when you are going to get paid, and I can run a business on that even if it's going to be different."
If you are absolutely determined to send patients on their way, there is an ethical way of accomplishing the separation, according to Zetterman. "If I have patients who I am having enormous disagreements with, I can tell them that I never want to take care of them again. Ethically, that's okay, as long as I give them at least 30 days of care until they find another physician, and I ensure that I will give them emergency services in that 30 days. Let's say that I decide that I'm not going to take Medicare patients. As long as I ensure that those patients have a period of time to find another physician, and I live in a community in which there are plenty of physicians available, I think everybody would agree that ethically, I can decide which patients I will or will not take care of. But what if I'm a family physician in a little town, and it's 50 miles to the next physician? Now you have an ethical dilemma."
Just Say No to Third-Party Payers?
Some physicians are so apprehensive about reduced payments from third-party payers that they have decided to stop dealing with them. The 2013 survey revealed how gastroenterologists plan to deal with Medicare and Medicaid (Figure 5).
Figure 5. Gastroenterologists' intentions for Medicare/Medicaid patients.
Many physicians are ready to let go of other insurers judged to be too low-paying. Among gastroenterologists, 29% plan to abandon insurance plans with inadequate reimbursement, although 22% say that they need to maintain all third-party payers, and 20% believe that it is improper to stop accepting selected insurance plans.
Although Kosinski understands the temptation to cut off certain third-party payers, he is not sure that all of those who are thinking about it will actually sever those ties. "There are 75 million of us baby boomers," he said. "We are adding 10,000 new Medicare beneficiaries each day, and we are going to continue doing that for the next 10 years. If you are running a business taking care of human beings, and 75 million will soon enter Medicare, how will you run your business without accepting it? I don't think you will. Yes, Medicare can cut your fees, but you know how you are going to get paid, why you are going to get paid, and when you are going to get paid, and I can run a business on that even if it's going to be different."
If you are absolutely determined to send patients on their way, there is an ethical way of accomplishing the separation, according to Zetterman. "If I have patients who I am having enormous disagreements with, I can tell them that I never want to take care of them again. Ethically, that's okay, as long as I give them at least 30 days of care until they find another physician, and I ensure that I will give them emergency services in that 30 days. Let's say that I decide that I'm not going to take Medicare patients. As long as I ensure that those patients have a period of time to find another physician, and I live in a community in which there are plenty of physicians available, I think everybody would agree that ethically, I can decide which patients I will or will not take care of. But what if I'm a family physician in a little town, and it's 50 miles to the next physician? Now you have an ethical dilemma."
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