Medicare patients battle tight rules while doctors express frustrations about payment issues

Jul 7 2010

The Philadelphia Inquirer reports on how high costs and rigorous rules affect Medicare patients and examines the case of Fran Bogom, 86, a widow with mild dementia who broke her arm after falling from a bed. "If Bogom were covered by Aetna, Blue Cross, or another private insurer, she would have been approved right away for a move to a nursing home, to help her get better. But Bogom had Medicare. And because of a regulation dating to 1966, Medicare would not pay for her rehabilitation in a nursing home unless she first stayed in the hospital for three days. If Bogom stayed only one day at Abington, or two, she would have to pay the rehab bill herself. Her family feared it might be $5,000, even $10,000." The hospitals are under intense pressure from Medicare to not keep patients too long and run up costs. And patients and families are often caught in the middle (Vitez, 7/4).

The San Bernardino (Calif.) Sun: Earlier this month, Congress agreed to delay for six months a 21 percent cut in Medicare reimbursements to doctors. The temporary fix came after much Capitol Hill wrangling and after the pay cut had gone into effect for several weeks. Now doctors' are expressing their unhappiness with the process and the law that calls for the automatic cuts. "'Physicians are frustrated,' said Dr. Thawat Eosakul, who opened his practice in Fontana 20 years ago. 'It's not easy. Some doctors see only Medicare patients. Imagine your employer cuts 21 percent of your income. That's going to be devastating.'" Also quoted in the story is Harvey Cohen, a geriatrician whose patients overwhelmingly rely on Medicare for their health coverage. H has not been paid yet for any of the care he provided in June, which is the third time such delays have happened this year. "'It's been quite a disaster,' Cohen said. 'I had to use my personal funds, my life insurance. My credit cards are maxed out. I can't bill secondary insurance until Medicare pays. And if a patient owes any amount I can't collect that until secondary (insurance) pays. I can't pay my bills. They are trying to run us out of business'" (DiMartino, 7/5).