This letter is in response to the poignant letter sent in by Eric Newcombe ["Health Care Needs to Serve the Poor and Disabled," June 9 Xpress].
I am a family physician who opened a private office out of residency training in 2003. Initially, my partner and I accepted patients with any type of insurance, as well as some self-pay patients. This included disabled patients with Medicare and Medicaid. Over the next few years, we began to realize the specific challenges in taking care of patients on disability. These challenges are often invisible to patients but make the day-to-day reality of providing quality medical care nearly impossible for providers.
I would argue that it is not physicians but the public insurance programs and policy-makers discriminating against the poor and those on disability. Practices would gladly treat patients on Medicare disability and Medicaid, were it not for the fact that these payors will not cover for necessary services needed to take care of these patients.
In order to provide comprehensive care for those on disability, a practice needs a social worker, nutritionist, psychotherapist, physical therapist and nurse educator onsite. The practice also needs to coordinate transportation, home health and medical equipment. In addition, the practice needs to complete an abundance of complex paperwork, obtain pre-authorizations and spend hours of time on the phone trying to justify to payors the medical necessity of various treatments. The only services that are reimbursed by payors from the long list of services above are actual patient visits, and the reimbursement is far below actual cost. To make matters worse, physicians (and thus by extension, their patients) are imminently facing steep cuts in Medicare, and now Medicaid is on the chopping block at the state and national levels.
The reform bill passed this year is a start for what will hopefully be a more comprehensive solution to the problem for millions of under-served Americans, but clearly it is not enough. I invite Eric and other people in our community to join physicians in advocating for expansion of Medicare and Medicaid reimbursements to cover all key services needed by patients and reduce the administrative/bureaucratic burden. If you would like more information on how to get politically involved, contact the Buncombe County Medical Society at 274-2267.
— Robert W. Fields
Vista Family Health