If Mayo Clinic loses money on Medicare , what will the "average" internist do?

While the AMA and the ACP seemingly see better things ahead ( I assume they do because of their support for a bill whose particulars still remain a secret) after passage of the final health insurance deconstruction-reconstruction bill, the prestigious Mayo Clinic has seen fit to restrict Medicare patients because they loose money on their care.

Mayo's primary care physicians will only see Medicare patients at its Arizona facility if they agree to pay a $ 1500 annual fee. The Rochester mother ship facility has announced it will see Medicaid patients only from certain states.

Dr. Toni Brayer, author of the blog Everythinghealth, in her Jan 6,2010 on line issue of the ACP Internist tells her readers she has the same problem.Because of other sources of income she plans to continues to care for her Medicare patients but how many other internists will continue to choose to eat that economic loss. How many can afford to?

According to Dr. Brayer, Mayo clinic looses $ 840 million on Medicare patients' care and that about 70% of hospitals loose money on Medicare patients.

The issue is much bigger than Mayo's decision. Many physicians are not accepting new Medicare patients. The Texas Medical Association has reported that their survey of primary care physician indicates only 38% of Texas primary care docs are accepting new Medicare patients.

The incredibly arrogant purposeful secrecy and what has been described as "cash for caucus" of what the legislative process has descended to, makes it impossible to know what is planned to alleviate the problem of primary care docs not being financially able to treat Medicare patients. I share Dr. Wes's indignation at the failure of the leadership of major medical organizations when he states:

We see this as our professional membership leaders failed to ask about the details of the health bills ( my bolding) before them nor inquired about the potential flaws inherent to comparative effectiveness research promulgated on large, unfiltered populations. Rather, our representatives capitulated and mollified themselves with platitudes.

Here is what a recent commentary in the Boston Globe said in regard to the growing disconnect between primary care physician and Medicare-Medicaid patients and the Senate health bill;

The Centers for Medicare and Medicaid Services, a branch of the US Department of Health and Human Services, estimated last month that the Senate bill would squeeze $493 billion out of Medicare over the next 10 years. As a result, it cautioned, “providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and . . . might end their participation in the program (possibly jeopardizing access to care for beneficiaries).’’ In short, the Democratic understanding of health care reform - more government power to set prices, combined with reduced freedom for individuals - will make medical care harder to come by: an Economics 101 lesson in the pitfalls of price controls.

With many millions ( no, Virginia there will not be "universal coverage, still about 23 million will not be insured) more added to the medically insured population, with no meaningful relief in the wage-price controls on physician's fees from CMS and numerous hints in the bills of a heavier and more obtuse administration thumb on medical care details it seems inevitable that more and more physicians, unlike Dr. Brayer, will just shrug.