Medicare Now Covers Alzheimers

[phoenixx]

http://www.nytimes.com/2002/03/31/politics/31MEDI.html

[MrsNormanMaine[$]]

Being in the business, so to speak, I remain skeptical that this will really make a major difference in the way the system operates. Medicare is still predicated on the treatment of acute disease and has no interest in chronic disease and Alzheimer's remains solely a chronic disease.

Dr. MNM

[magenta321]

Agreed. Medicare is a joke. If they do come through in one area, they'll let their patients down in another, I promise you that. There is only so much money to divvy up, and they leave a lot of areas uncovered.

Need an MRI of your shoulder. Medicare will pay that. Need an MRA of your head (generally not ordered without very good reason) and Medicare won't pay in almost all cases.

It's sad. I wish I could send you all to www.medicalnecessity.com -- that's the site where you can find out if any given medical proceedure will be covered by Medicare, based on the dx given by the doctor. But without a username and a password you guys can't have any fun. For ha-has, I logged in today to see if my username and password work. I'd give it out, but it's a hospital wide username and hospital-wide password.

I wonder if there are any other sites where one could figure out what Medicare will pay for, before the bills start arriving at the patient's homes.

[frazzledspice]

Andy, one of the scariest things I read about Medicare is that if a procedure isn't covered and a patient wants to pay for it with his own money, doctors affiliated with Medicare aren't allowed to do it!

If they accept private money for a procedure Medicare doesn't cover, Medicare puts them on their no comp list and refuses to let them participate in the program.

Then, not only is Medicare bad, but there's no alternative.

Of course, my parents and in-laws, cumulatively, had a number of operations: pacemaker, bladder cancer surgery, prostate cancer treatments, number of skin cancer removals, colostomy, gall bladder, back surgery, etc.

Many medical visits. They never complained that something wasn't covered, although they had Medicare supplements and prescription insurance.

[MrsNormanMaine[$]]

This is true to a point. If a physician wishes to participate in Medicare, they agree to accept Medicare assignment as a fee for the service. They are not allowed to charge patients in addition nor are they allowed to sell their services for Medicare covered procedures to patients on private contract. They are allowed to sell non-Medicare covered services to patients for any fees they wish to charge (e.g. Plastic Surgery).

This is the major reason why there are no geriatricians in private practice. All the services I provide, as they are basic primary care services are Medicare covered. The University must accept the $45 Medicare allows for an office visit for my services. Medicare does not distinguish the healthy 65 year old on no medications from the chronically ill 90 year old with 15 problems. A geriatrician like myself, who specializes in the latter, cannot begin to meet overhead on Medicare assignment for outpatient care. My clinic loses hundreds of thousands of dollars annually for this reason. I can get away with it as the University needs my skill set for other things and because I can save them even more money by preventing unnecessary hospitalizations and ER visits. In the real world however, every cost center must pull its own weight and until Medicare is rethought, there will be no good comprehensive health care for the frail elderly in this country.

MNM