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How Medicare Is Failing Diabetic Americans
Author : Dr Christopher Segler
Martin has three kids and eight grandkids. As a recently retired engineer, he though he would we sitting on the beach sipping drinks with little umbrellas in them. But instead his is sitting in a wheelchair after a diabetic foot infection ended with an amputation of his left foot. It all happened because his primary care doc couldn't get him to see the podiatrist right when the problem started. The real problem, is that Martin has Medicare.
Retired Americans often view HealthCare paid for by Medicare as one of the few perks of retiring. After a lifetime of working hard, raising children, and paying into the System, Medicare is one of the few reliable ways to get a return. But unfortunately for those who are diabetic, Medicare can be bad for your health. It’s just math; not enough money equals not enough high quality medical care.
The recent attempted resurrection of President Obama’s Health Care reform efforts speak to the broken system. The fact is that Medicare is an expensive program. Since 2002, Medicare has been short of money. There isn't enough money in the Medicare system to pay for everything Americans need. All of the federal mandates that have been written into law to save money are simply killing diabetics. As long as you understand why, you'll be able to get quality care even if you do have Medicare.
1. Difficult to Find a Medicare Doctor.
Since 1986 Medicare has set all doctor fees. Medicare decides how much physicians get pain, doctor's don't. Adjusted for inflation, over the last eight years, Medicare Has reduced fees about 20% every year. On March 1, 2010 doctors took another hit when Congress let another 21.2% reduction in doctor pay take effect. Imagine if at your job every year you get 20% less pay instead of a raise. I'll bet you would start searching the want ads for a better position right away? Obviously your doctor can’t just switch careers, but he can stop taking Medicare.
In some places this means less doctors are available to accept new patients. If you live in San Francisco, the cost of living may be twice that in rural Ohio. But incredibly, doctors seeing patients in San Francisco get paid comparable fees by Medicare. So your doctor has to either learn to live poor or see twice as many patients.
2. Doctors Who Accept Medicare are Swamped.
In 2008, the president of the American Medical Association (AMA) was testifying in front of Congress about declining care for Medicare patients and the problem of Medicare cuts. The AMA's leader explained to lawmakers that most physicians were threatening to quit seeing Americans with Medicare insurance. Senator Stark replied that since Medicare started reducing payments to doctors many years ago, doctor’s have simply seen more and more patients each year to make up for the lost revenue.
But it is now clear that doctor’s can’t keep seeing more and more patients. Sixty patients in a day is just plain bad medicine. Seven minutes of time in a room with a patient is not enough time to understand blood sugar readings, sugar pills, insulin shots, hypertension, peripheral vascular disease and explain diabetic foot care. It just isn’t enough time to practice good medicine. When docs see more patients than they can handle, diabetics can wind up in a terrible situation.
3. Less Pay for Medicare Diabetes Doctors.
Many people don’t think pay should have anything to do with the quality of the care. But the reality is, it just comes down to math. If your doctor accepts Medicare, but has to see 60 patients a day, you won’t get much time. I actually have a doctor friend who says, “I just tell Medicare patients they get two problems to talk about during a visit. ONLY two," she said scowling as she waved two fingers high in the air.
But what if you have high blood pressure, diabetes, and you also have a little sore on your foot? If you can only talk about two problems, you'll ignore the diabetic foot ulcer. And if that diabetic foot sore turns in to a diabetic foot infection, you just might wind up with an amputation.
Healthcare shouldn't be rationed; you have to make sure that you get to talk about ALL of your health problems with the doctor. This of course is the way medicine used to be. What many people don't realize is that the doctor is ethically and legally required to listen to all of your health problems that concern you, even if they don't get paid well for doing so. So if you doctor says, “We’ll have to discuss that next time,” just insist that he hear you out.
4. Medicare is Paying for Fewer Medical Perks.
If you have diabetes you will be sent to a lot of different specialists. Studies have shown that having diabetes make you four times more likely to have a heart attack. You are also way more likely to develop kidney trouble, blindness, or diabetic foot infections that lead to amputation. To make sure everything is working right, your primary care doctor will likely send you for “consultations” with other diabetes specialists like podiatrists, cardiologists, opthalmologists and nephrologists.
A consult is a visit to a specialist requested specifically by your primary care doctor. Medicare decided to just stop allowing specialists like podiatrists and endocrinologists to bill for consultations ordered by your primary care doctor. So don’t expect a specialist to take any extra time explaining your health problems to you or your primary care doctor. And don’t be surprised if these specialists don’t work you into their schedules very quickly. They just aren’t getting paid like they use to.
Once upon a time, house calls were common, but now very few doctors who accept Medicare can afford to make house calls. There is just no way they can take the time to drive from house to house with the low rates medicare pays. This is obviously a big problem for an elderly diabetic who may have poor eyesight or an open wound on the foot. If you have a diabetic sore on your foot and can't walk, your doctor can't really expect you to get to the office for an appointment?
5. No Diabetes Prevention.
It is simply a fact that the problems related to poorly managed diabetes are preventable. Loss of eyesight, renal failure, and diabetes foot sores can be avoided. Doctors fully understand how elevated blood sugar levels damage the eyes, kidneys and feet. Doctors also fully understand how preventative care can prevent this damage. But Medicare won’t pay for intensive diabetic foot monitoring programs. It has been shown that close monitoring of diabetic foot skin temperatures can prevent diabetic foot sores. But this sort of close monitoring by a diabetic foot expert isn’t a service that Medicare will pay for. As a result, it is a service that isn’t offered to you by your doctor.
So now that you know the Top 5 Reasons Medicare is bad for your diabetes, what can you do about it? It is important to remember that you doctor is on your team and really just wants to provide you with the very best medical care. You have to keep in mind that your physician is your ally. But feel free to remind him or her that you need help, even if it might take a little extra time. Usually the physician will hear you.
You've got to ask tons of questions. Take a list of questions so that you can stay on track and get all of your concerns dealt with in a short doctor visit. Ask your doctor about performs house calls. If not, find one that does. Even if you have to pay for it, having a doctor come to your home is an amazing convenience. Make sure you ask your doctor about any new treatments that are available, but not covered by Medicare. If you don’t ask, many docs will simply not take the time to offer all available treatments if they aren’t covered.
Diabetes is a serious disease. Many patients with diabetes will die from health complications directly attributable to poorly controlled blood sugar. Given that most of these problems can be managed and prevented, you owe it to yourself to insist on the very best care from your doctor.
Author's Resource Box
Dr. Christopher Segler is a podiatrist in the San Francisco Bay Area. His podiatry practice provides house calls to treat diabetic foot wounds, and ingrown or thick painful toenails. He also offers medical pedicures at home. You can get more tips for finding the right housecall doc for you at San Francisco Podiatrist housecalls or visit the best website in San Francisco for Podiatry Information.
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Tags: medicare, podiatrist, diabetes, health, care, amputation, foot, doctor, diabetic, sore
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Submitted : 2010-03-16 Word Count : 1 Popularity: 102 Times Viewed: 23
