Manatee County Doctors Fear Rising Costs

Doctors are about ready to drop patients. Manatee County Doctors fear rising costs will force them out. At least for now a crisis is averted. In the final hours before the holiday recess, Congress stopped a medicare cut set for January 1st that would have reduced payments to doctors by 10%. Had the 10 percent cut gone through at least 25 local doctors were ready to limit their Medicare patients. None of those Doctors had yet mailed the mandatory 30 day notices to their patients but the letters were ready to go.

And they still are -- since a Congressional fix which includes a 0.5 percent increase for doctors lasts only until June 30. Then the 10 percent cut --mandated by the 1997 Balanced Budget Act--will come back again unless Congress again postpones the cut or permanently changes the formula that requires the cut.

UnitedHealthcare, one of the largest health-insurance providers in Florida looks at Medicare reimbursement rates as a general benchmark for provider reimbursement but these rates do not drive their reimbursement terms for service UnitedHealthcare creates its own proprietary rate schedules that are driven by local market dynamics such as availability, quality and consumer demands. Doctors who accept UnitedHealthcare contracts agree to those rates under duress because the insurance companies pit doctor against doctor when trying to force down the reimbursement costs as they build their lists of medical care providers for managed care plans.

They enter into contracts that specify a specific fee schedule which could pay as low as 80 percent of Medicare. If a doctor is unwilling to accept those fees, the insurance company threatens to move their patients to a doctor who will. So what does this mean for Manatee County patients? It means fewer doctors, and they’re getting paid less to take care of more patients, which means more doctors will likely leave the area.

Source:

Donna Wright, Doctors poised to drop patients, Bradenton Herald, January 6, 2008, page one