Certainly a doctor should be able to fill out an insurance form or have an assistant that can do so correctly to avoid "technical" mistakes.
ICD9 codes and billing are a bureaucratic nightmare. There are entire courses given teaching how to wade through the process. And then the rules get changed every so often. Physicians are trained in the sciences and clinical thinking; business management is another profession; one that doctors once upon a time didn't need a whole education in just to function. An assistant? Sure, let's inflate the staff so that care costs more. That, of course, is precisely the direction all the problems lie in.[/quote]
When a doctor refuses medicare patients he is saying that other customers needs are more important than those who have a different payment method. Or, one that pays at a higher premium is more important. Or, only the wealthy warrant medical care at all.
It's not the same as a mechanic who can avoid working on a car. The patron suffering from this non-service is largely mental. And, service can be deferred without much detriment. They lady with the melanoma doesn't have that luxury. Melanomas with deferred treatment result in death for the afflicted. Why? Because the doctor doesn't get enough profit from making a referral?
Okay, I'll draw a distinction here. I only really know about primary care physicians. When they refuse Medicare they aren't making a value judgement about the patient. They are saying 'if I don't get paid and in a timely fashion, I will go out of business and then no patients will get treated.' I was not exaggerating earlier. Medicare withholds payments, makes billing very difficult (and expensive if you use a billing service...driving up the cost of care which the doctor then carries not the Medicare patient), and pays very late when they pay. Paying my wife for patients she had treated more than a year earlier is unconscionable. You can be sure our creditors weren't waiting to get paid in the meantime. In poor areas like New Mexico, a family practitioner likely nets the same as their auto mechanic. So limiting the Medicare patients is a way of keeping a practice running, not just to pay the bills, but so that other patients can indeed be treated. CNNMoney reports the median expected income (gross) for a family practice physician is $156,000. It is much less in poor states like ours. When you remove taxes and all the costs of running a practice, what remains doesn't even justify the $100,000 in student loans to be paid off. (Many owe more; my wife went to a cheaper state school.) Oh, and did we mention the doctor is likely working an 80+ hour week? Half of which is just fighting the bureaucracy. And for all that there are still doctors, like my wife, who make house calls, handle hospice care, give patients their phone number (yes, her personal cell phone), and have neighbours knock on the door when they've already gone to bed. Profit? I would have liked to see it! She didn't leave private practice (though neighbours still come to the door in the middle of the night) because of poor profits. She left private practice because Medicare and other insurances created a situation where a hard-working kid in college couldn't get the help from her folks we think they deserved. (We've got three kids who are college grads, and they didn't get half the help from us that they deserved.) She left because going into the office on a Saturday night or Sunday to do billing (to keep costs down), and then get paid late still left us juggling bills and holding the bag.
Let's not forget that the first three years or so, a resident is practicing medicine, but working 100 hours a week and making less than $40,000/year. During those years, I made more as a schoolteacher than my wife did as a physician.
I don't know what AMA is to blame for, but it isn't for what I've just described. Oh, and my wife and many other physicians in the US don't belong to AMA.
I don't know which primary care practitioners you go to, but I see very little of "cold bureaucratic attitude toward patrons is beginning to impact what began as a life serving practice." I see people wracking their brains, busting their butts, and taking to heart and grieving every patient who suffers. And I see a lot of resentment that somehow the doctors are considered the bad guys when they ask little more than to keep their noses above water. Our plumber and roofing guys have more disposable income than we do, despite the 'life serving practice' provided every single day without discrimination.
Ironically, my wife had started out in a different specialty. Had she stayed there, we would have been financially secure, even a bit comfortable. She got punished by the system for moving into primary care practice, and has people now accusing her and her colleagues of cold attitude and profit chasing to boot! The reimbursement system is making good primary practice impossible, and even some of the more idealistic med students are afraid now to go into primary care.
The skewed values do not lie with the physicians. The skewed values lie with a society that says medicine and patient care should be just another business, and impose that on the medical profession. It is the same society that pays more for entertainment (sports, etc.) than education. It is the same society where a paramedic makes little more than the Domino's guy. As BobbyR pointed out, Medicare abuses the practitioners, and then leaves you thinking the docs are just cold hearted, money grubbing mercenaries.
