Medicare, the government insurance company for everyone over age 65 (and for the disabled), pays fees to primary care physicians that guarantee bankruptcy.

Additionally, 70 percent of hospitals in the United States lose money on Medicare patients. That’s right, for every patient over age 65, it costs the hospital more to deliver care than the government reimburses. That is why Mayo Clinic has said it will not accept Medicare payments for primary care physician visits. Mayo gets it. Nationwide, physicians are paid 20 percent less by Medicare than from private payers. You can’t make it up in volume if you are not paid a sustainable amount. It just doesn’t pencil out.

Mayo lost $840 million last year on Medicare. Since Mayo is considered a national model for efficient health care, if they are losing money, it doesn’t bode well for the rest of us, who are much less efficient and who have fewer resources for integrated patient care. Instead of Medicare payments for clinic visits, Mayo will start charging patients a $2,000 fee for patients to be seen at their Glendale, Arizona clinic. Much like a “retainer,” this fee will cover an annual physical and three other doctor visits. Each patient will also be assessed a $250 annual administrative fee.

Primary care physicians are on the front line of patient care, and senior patients are the most time-consuming. The average Medicare patient takes 11 different medications. Just refilling and coordinating the medication can take up an entire office visit without addressing other health concerns. I grant all Medicare patients a 1/2 hour visit because I would be chronically behind if I didn’t. After paying office overhead, I am broke with Medicare.

I do not welcome the 65th birthday of my patients, but I continue to see them because I love my senior patients. No kidding, I really love being their doctor. They are grateful and respectful and have interesting health conditions. I am able to see them because I make my income from my administrative position, and I have private pay patients.

Sad but true. Unless we have true payment reform that values primary care and pays for coordination of care, I fear Medicare patients will not find enough willing physicians who will accept Medicare in the future.

Tony Brayer is an internal medicine physician who blogs at EverythingHealth.

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