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6/20/2010 9:58:00 PM
MEDICARE in crisis: The doctors
The Patients (Sunday) • The Doctors (Monday) • The Medical Suppliers (Tuesday)
Brett Soldwedel/The Daily Courier“Our problem with Medicare has always been this grappling over the fee schedule,” Dr. Joe Goldberger, a doctor at Yavapai Regional Medical Center, said. “And in the last decade, we have lost ground to inflation year after year, let alone actually getting a raise.”
Brett Soldwedel/The Daily Courier
“Our problem with Medicare has always been this grappling over the fee schedule,” Dr. Joe Goldberger, a doctor at Yavapai Regional Medical Center, said. “And in the last decade, we have lost ground to inflation year after year, let alone actually getting a raise.”
The current state of Medicare in America
Nearly 45 years have passed since President Lyndon B. Johnson signed into law the Social Security Act of 1965, which enacted Medicare - a federal-government run health insurance program designed primarily for Americans ages 65 and older.

Over the course of nearly five decades, Medicare has helped countless senior citizens stay healthy and undoubtedly saved millions of lives.

But in 2010, Medicare threatens to send this country into astronomically high deficit spending if Congress and President Obama do not consider approving serious cost-cutting measures.

The giant health care program currently serves 46 million elderly and disabled people. And as members of the massive Baby Boom generation continue to retire, doctors fear they won't be able to accept new Medicare patients if they are not compensated fairly for their services, which keeps their practices afloat financially.

This three-part series examines three of the "faces" caught in the trenches of the Medicare crisis - patients, doctors and medical suppliers - and what they are up against as President Obama and Congress attempt to solve the problem.

Doug Cook
The Daily Courier

When a doctor turns away a Medicare patient, it's not because he or she doesn't want to treat the person coming into the office. Unfortunately, it comes down to the bottom line - saving a medical practice from financial hardship.

If the federal government can't find a method for effectively reimbursing doctors for their services while accounting for inflation, increasingly more physicians will start seeing less patients who are on Medicare rather than private insurance.

Dr. William Dabney, a veteran physician at Prescott Urgent Care, 2062 Willow Creek Road, said a "change in medicine" is on the horizon.

"We're short on doctors and docs' reimbursements are getting less," he said. "We're having to see more volume and jammed schedules."

Dabney said President Obama's Affordable Care Act, which seeks to provide universal health care coverage for all Americans and give seniors greater control over their care, will exacerbate cuts in Medicare reimbursement payments for doctors. On Friday, the Senate approved legislation to spare doctors a 21 percent cut in Medicare payments, although Medicare announced it would begin processing claims it received from doctors in June at the lower rate.

"A lot of doctors are going to stop taking Medicare (because of this)," Dabney said. "Now, I don't believe in that. We have to take care of people. It's like a catch-22."


The federal government requires doctors who treat Medicare patients to follow stringent paperwork guidelines, including logging the hours spent with these patients. Doctors fear that the Obama health care plan will increase the amount of paperwork doctors have to fill out, which puts time constraints on patient visits.

"Right now with Medicare there's a lot of paperwork involved and they look over our shoulders about everything - forms to fill out and all that stuff," Dabney said.

However, Dr. Joseph Goldberger, chief medical officer at Yavapai Regional Medical Center in Prescott, said that as far as the billing side goes for physicians, Medicare is probably one of the most efficient handlers.

"Our problem with Medicare has always been this grappling over the fee schedule," Goldberger said. "And in the last decade, we have lost ground to inflation year after year, let alone actually getting a raise."

Rancor in Congress, Goldberger added, has accelerated to the point where month-by-month, reimbursements for doctors' services provided are held for two weeks. This all centers around a program called the Sustainable Growth Rate, a formula the feds have used to determine how much to pay physicians on a fee schedule.

Since the Sustainable Growth Rate is a chart plotted against inflation, the feds are attempting to control the rate of growth of the cost of the health care system.

"But they put into that facets of the Part B of Medicare that physicians have no real control over - the cost of pharmaceuticals and durable medical equipment," Goldberger said. "And when my patient needs a particular piece of equipment or medication, I prescribe it. The problem is that while we're all doing that, the inflation rate on pharmaceuticals and durable medicals has gone up significantly."


If millions more Americans go on a federal-government operated health plan and the feds continue to decrease doctors' reimbursements, more physicians say they will move toward accepting increasing numbers of privately insured patients and not treat those on Medicare.

"What's going to happen is doctors are going to say, 'I will no longer take Medicare patients because it will cost me more to see them than it's worth,'" Dabney said.

Goldberger said Medicare gives "very good coverage" to seniors because most physicians and institutions will see them. But as the nation's health care system evolves, doctors say it will come to rely more on nurse practitioners, physicians' assistants and urgent care centers to treat patients.

One of the biggest problems confronting doctors today is the cost of medical malpractice insurance. Dabney said he pays $17,000 per year for the insurance, which dramatically increases health care costs passed on to patients.

Dabney said doctors do not impose outrageous rates on patients and that tort reform is necessary.

"If we can get a cap on non-economic damages, the lawsuits plummet and the malpractice rates go down," he said. "An OBGYN delivering babies and doing surgery pays $67,000 a year in malpractice insurance. How can a young person coming out of residency who's got $100,000 in debt for school and facing all that malpractice insurance, how can she do it?"

Dabney said "socialized medicine" will "ration " to the point where it will take too long for patients to receive the treatments they need.

"People on Medicare are going to want their MRIs right now, their hip replacements right now," he said. "If you've got a doctor group that's overburdened now, they'll say, 'Yeah, I can do you in six months.'"

Critics of Obama's plan say the federal government will have to raise taxes to pay for an estimated trillion-dollar increase in health care costs, which would shrink job creation.

But White House officials say the plan will lower prescription drug costs for America's seniors; reduce unwarranted subsidies to insurance companies; fight Medicare waste fraud and abuse; and improve seniors' quality of care, including services in nursing homes.

Dabney said patients who are not insured and need medical care must get it from a private system and not rely solely on the government.

"We have to have Medicare, but we don't have to put all these other people who don't have insurance onto the Medicare program," he said. "It's going to have to be another healthcare program that's affordable."

Party in the Pines PAYP
Related Stories:
• Editorial: Medicare 'progress' is a huge step back
• MEDICARE in crisis: The Medical Suppliers
• MEDICARE in crisis: The patients

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Reader Comments

Posted: Wednesday, June 23, 2010
Article comment by: gracie xx

My goodness, what WILL all these doctors do when they quit practicing medicine in droves? Ah, perhaps McDonald's would want to hire them. Surely they will pay more than medicare does.

Posted: Tuesday, June 22, 2010
Article comment by: stan allgood

I love the comments about doctors making too much money at 150k to 250k a year. Doctors who trained 10-15 years who then work all hours of the day, every day of the year including christmas, to be there when you get sick whether its your family doctor or an emergency doctor--to actually save a life sometimes. You say well my doctor plays golf or he takes vacation-so what. Doctors are not allowed to take some time off. You are going to see more and more physicians retire, are stop taking medicare/medicaid, then what? If you dont pay your phsycians, see what kinda of healthcare you will have.
If you think doctors make too much then why dont you go to med school then do residency, borrow the money to open a medical practice and then work for the price of average worker. I like to see how that works out for you...

Posted: Tuesday, June 22, 2010
Article comment by: RE lowe faber

Get a dictionary.... then get a clue and finally get an original train of thought. You bought into the Obama bull hook line and sinker. MAYBE YOU SHOULD LEARN TO READ AND ACTUALLY READ WHAT HIS BILLS SAY INSTEAD OF WATCHING CNN.

Posted: Monday, June 21, 2010
Article comment by: Doctors? We don't need no stinking doctors!

Just get some nurses in charge and do it that way. It would be way cheaper and we could get our ... pills and the kids could get their pink medicine same as always. Just do it!

Posted: Monday, June 21, 2010
Article comment by: A prior Prescott doctor.

I was in practice here for years back in the day, and I made about $250k (before taxes) in the big years, and about $150k before I left. I know, $150k is a fortune to you, so don't comment on that. Malpractice, payroll taxes, rent, salaries, supplies, and income taxes added up to about $350k in the good years, about $280k in the bad. I was bringing home about $9k/month at the end, so I ended it. The bad news is that a new doctor carries about $150k in debt when they start, (I carried about a tenth of that) and they look to make what I made at the end. Not good at all for someone who is starting their career at age 30 in a small town where they make about a third less than in Phoenix. No thanks. It's a nice town but it's not THAT nice. I suspect that not many new young doctors will come here like I did back in the day. You may get some older docs finishing up. I hope I'm wrong, but I bet I'm right. Just my .02.

Posted: Monday, June 21, 2010
Article comment by: WhatIs OnFirst

Rather than blaming the world’s problems on the group (left, right, socialist, communist, nudist, etc.) that doesn’t share your philosophy, why not depart from the MO of a politician? Intelligent discussion and an exchange of ideas is how things get resolved.
As far as those of you that want to blame things on Bush or Obama, both of them won because of how our system of elections works – like it or not.
So how many of you long for the way things were handled during Frontier Days? BTW, those days are long gone.

Posted: Monday, June 21, 2010
Article comment by: James B.

Before you start filling the tip jar at your Doctor's office, go to this web site. Then make up your own mind.

Posted: Monday, June 21, 2010
Article comment by: Typical Socialist Atitudes

Reading these comments makes me sick to my stomach. For those of you who vilify doctors for wanting to earn a living, please consider the following: in high school, the future doctor took AP classes, studied more than most students, and earned straight A's. What did the typical Obama socialist do? Skated by, earned C's and an occasional D or B. In college, the future doctor took out student loans, studied harder than most college students, and again earned straight A’s in order to get into medical school. The Obama socialist tried to get a job, complained that none were available, found a low-paying job, got fired, and received unemployment benefits. In medical school, the future doctor took out more student loans, studied 60 hours a week, and interned another 40 hours a week. The Obama socialist did more complaining. After graduating, the Doctor has $100K in student loans, $60K per YEAR in malpractice insurance, and gets to listen to Obama socialists complain that Doctors should give free medical care. Health care IS NOT FREE and it is NOT a God-given right! If you think it is, then become a doctor and work for free.

Posted: Monday, June 21, 2010
Article comment by: Little Lucy

Excellent article - as was yesterday's. It's extremely interesting that some who have posted here see it as un-American for doctors to actually make a profit. They work hard and deserve our respect. Personally, my doctor will convert to a cash-only basis as of August 15th. That means a significant financial increase for me when I go to see him but I support his decision - even though it will strain my budget. It amazes me how many people think the service they receive is really only worth the $5, $10 or $15 they pay. This administration has elevated class envy/hatred to a new level. Keep demonizing doctors, supporting policies that deny them the right to make a living and more will retire from the profession. Gee I wonder who will be screaming the loudest then when the current doctor shortage will look like the glory days. Wake up - it's only going to get worse unless we block implementation of Obamacare. Remember in November!

Posted: Monday, June 21, 2010
Article comment by: Pseud nyms

'lowe faber' used the name 'jenna kirsy' in the Patients article's comments. Can't wait to see what he/she uses in the next one. Gee, I must be bored.

Posted: Monday, June 21, 2010
Article comment by: The Real Write Wing Conservative

After 40 years in the health industry and after years of watching the health activities in Prescott, every citizen should know a few (general) facts. Most MDs and Dentist for that matter charge normal & customary rates, usually based on the big cities of AZ and California. On the same token, very few work more than three or four days a week, take liberal expensive vacations, pay their staff typical Prescott rates (no benefits & much less than the big cities), many have never updated their equipment or office space (lower overhead) since beginning the practice and status is everything. Basically, most do not want to work harder or longer, so they cherry pick the best insurance type clients and don't (won't) take those with lower reimbursement. Prescott has and has had a major problem for years due to the retirement age citizenry. As long as Medicare requires longer hours & paperwork, the MDs in Prescott rather be golfing. Forget about the nobility of medicine, it's about the all mighty dollar.

Posted: Monday, June 21, 2010
Article comment by: Don't you people have a sense of humor?

Lowe Faber was obviously playing you people and you fell for it. I thought it was pretty funny.

Posted: Monday, June 21, 2010
Article comment by: Grundle Cat

The previous post is strangely reminiscent of one from the previous Medicare article. You're not doing the argument any good by being too lazy to a) type a new comment and b) actually spell out the words you wish to use. The righties are all over us like white on rice - please quit proving their point for them about the lazy, illiterate, entitled Libs. Thank you.

Posted: Monday, June 21, 2010
Article comment by: One can only shake theri head

lowe faber, a typical Obama supporter. Nuff said!

Posted: Monday, June 21, 2010
Article comment by: To Lowe Faber


Posted: Monday, June 21, 2010
Article comment by: To Lowe Faber


Posted: Monday, June 21, 2010
Article comment by: R J

The reason there are so many guidelines is because of fraud. It is unfortunate that all doctors must pay for the trangressions of a few unethical physicians. If doctors were harder on themselves, i.e. stricter policing, it might not have to be the responsibility of the federal government to create the absurd documentation guidelines.

Posted: Monday, June 21, 2010
Article comment by: Chino Rez

All I can say is Wow. Thanks to ACORN, people with the mental intellect of Lowe is the number one reason Obama was elected in the first place. Are you better off today than 6 years ago? I'm not. How's that change working for us now?

Posted: Monday, June 21, 2010
Article comment by: birther t. bagur

So here is an article about how poor doctors are, yet not a single doctor is quoted telling us how much money he makes (and how much his wages have allegedly declined) . 95% of American workers have seen declines in real wages (i.e. factoring in inflation) since the 1970's. Have doctor's fared better or worse than the rest of us?

If this Dabney guy is going to claim that the system is hurting him and he can't make a living, he should be obliged to offer evidence vis a vis a tax return or two. Extremist right winger and anti-government advocate Rand Paul is estimated to make $260,000 a year treating Medicare patients (source: ). Is Dabney's idea of not making enough money $260,000 a year? If it is, why should we feel bad for him?

Posted: Monday, June 21, 2010
Article comment by: She's Back!

Looks like she copied and pasted her ignorant comment from the first article about patients.

Posted: Monday, June 21, 2010
Article comment by: Preskitt Joe

Now Jenna Kirsky has become Lowe Faber. Read the post and you will see.

Posted: Monday, June 21, 2010
Article comment by: Knot A. Fan

Yes, we are faced with Obama's mistakes and a congress led by progressive socialist Democrats. There ARE problems with medicare, and ambulance chasing lawyers don't help. People will be more restricted with Obama Care and being controlled by 159 new boards and commissions created with this legislation. Mr. Faber, I hope you continue to hide your support for BHO.

Posted: Monday, June 21, 2010
Article comment by: Really Now

If you are going to copy and paste the same message at least do it in proper English

Posted: Monday, June 21, 2010
Article comment by: anon anon

The average American worker's wages are falling, we should begin to correct the high fees paid to medical professionals to bring fees paid to doctors more in line with what the average American worker can afford. Doctors will complain, but as we have seen, Doctors interested in their bottom line will just drop the patients that they cannot make a profit on. those that care more for their patients welfare than money will continue to see them.

Posted: Monday, June 21, 2010
Article comment by: RE: lowe faber

Buy a dictionary. Nothing you said came across as intelligent, because it was all lost in grammatical and spelling errors. People shouldn't comment unless they can write coherent sentences.

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