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    Your Voice: Refusing Medicare patients a reality

    In response to your article, “Medicare payment advisory board in Congress’ crosshairs” (Sept. 10, 2017), I agree with your premise that Medicare through the Independent Payment Advisory Board (IPAB) should not cut back anymore on the fee schedule. 

    In your article, you worry that physicians may refuse to take Medicare patients. I can tell you that this is already happening. Medicare-only patients amount to 8% of my office visits. 

    In the mid 2000s, through Medicare’s Sustained Growth Rate (SGR) formula, they were paying about 34% of the physician’s usual and customary fee. Today, they pay about 29% of that fee. They cannot cut down any more.

    I am in private practice as an internist in primary care. I employ 1.5 full-time equivalent employees. I see patients in my office who have private insurance, nursing home patients, disability examinations, I contract with LHI to see patients for the Army and Coast Guard and I am medical director of a local hospice.

    In real dollars, I need to bring in about $130 per patient visit to stay open. I track metrics on everything. My average Medicare payment is $61.70 per patient per visit. As a result, I have eliminated Medicare-only patients. Rather, I see Medicare patients who have a supplement plan, or a Medicare replacement plan. This adds an additional $25 per visit. This is still not enough. 

    I have significant overhead: payroll, taxes, internet, telephone bills, electricity, medical supplies, computer technology, malpractice premiums, etc. Income has to exceed expenditures, otherwise, I close my doors and put my employees out of work.

    Kevin P Rosteing, MD MSMI
    Green Bay, Wisconsin



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