Delays a sign of Medicare breakdown

Regarding "Medicare enrollment delays leave doctors out in the cold" (Article, Feb. 23): I believe the Medicare system is breaking down in many ways. In the San Francisco Bay area where I practice, an increasing number of physicians are opting out of Medicare, i.e., not treating Medicare patients at all or putting them at the bottom of the waiting list.

Psychiatrists, in particular, are beginning to refuse to treat Medicare patients because of the low reimbursement and very arbitrary, unpredictable denials.

One of my own patients found her depression severely aggravated by the frustration she encountered trying to find out why her services had been denied. I had submitted extensive documentation for medical necessity on multiple occasions for the disputed period of service. I had mailed it certified with return receipt but Medicare kept saying I had not documented the rationale for treatment.

The patient was told by one of the clerks on the phone, "Oh we just throw that away" because they don't have time to collate the information with the original bill. "Medical necessity" has become a ruse for delay in payment or no payment at all. The paperwork is a nightmare for physicians and patients alike.

As I approach 65, I have serious doubts I can count on Medicare at all. Payment turnaround times are often quite long. Colleagues in other specialties tell me that the reimbursement is often lower than the Medicaid rate, which has become something of a joke in our state.

I hope our leaders and legislators consider these factors that are just as critical to the survival of a reasonable health care system as prescription drug coverage.

Gary S. Nye, MD, Orinda, Calif.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/04/05/edlt0405.htm.