Bill was 67-year old real estate agent. He was semi-retired. He like showing houses because he had lived in the same small town his whole life. People trusted him. But one day he got a diabetic foot infection. He called his primary care doctor and was referred to a podiatrist. But the podiatrist didn't have any more "Medicare appointment slots" available until the end of the month. While waiting for the appointment, the infection got worse. So instead of high quality care, Bill got an amputation. Now he sits in a wheelchair, wishing he could sell houses. Medicare is seen by Baby Boomers as a benefit of retirement. Given that there are no more real pension, Medicare is one of the few retirement benefits today. But unfortunately for those who are diabetic, Medicare can be bad for your health. It's just math; not enough money equals not enough high quality medical care. The recent attempted resurrection of President Obama's Health Care reform efforts speak to the broken system. The fact is that Medicare is an expensive program. Since 2002, Medicare has been short of money. There isn't enough money in the Medicare system to pay for everything Americans need. All of the federal mandates that have been written into law to save money are simply killing diabetics. If you know why, you can make sure you get good care in spite of Medicare's limitations. 1. Difficult to Find a Medicare Doctor. Since 1986 Medicare has set all doctor fees. Doctors don't decide how much they get paid, Medicare decides. Adjusted for inflation, over the last eight years, Medicare Has reduced fees about 20% every year. On March 1, 2010 doctors took another hit when Congress let another 21.2% decrease in Medicare physcian reimbursement take over. Imagine if at your job every year you get 20% less pay instead of a raise. I'll bet you would start searching the want ads for a better position right away? Obviously your doctor can't just switch careers, but he can stop taking Medicare. In some places this means less doctors are available to accept new patients. If you live in San Francisco, the cost of living may be twice that in rural Ohio. But incredibly, doctors seeing patients in San Francisco get paid comparable fees by Medicare. So your doctor has to either learn to live poor or see twice as many patients. 2. Medicare Doctors are Simply Too Busy. In 2008, the president of the American Medical Association (AMA) was testifying in front of Congress about declining care for Medicare patients and the problem of Medicare cuts. The AMA President informed congress that the vast majority of doctors in the United States would simply opt-out of Medicare and stop providing care for Medicare patients. Senator Stark replied that since Medicare started reducing payments to doctors many years ago, doctor's have simply seen more and more patients each year to make up for the lost revenue. But it is now clear that doctor's can't keep seeing more and more patients. Sixty patients in a day is just plain bad medicine. Seven minutes of time in a room with a patient is not enough time to understand blood sugar readings, sugar pills, insulin shots, hypertension, peripheral vascular disease and explain diabetic foot care. It just isn't enough time to practice good medicine. When docs see more patients than they can handle, diabetics can wind up in a terrible situation. 3. Less Pay for Medicare Diabetes Doctors. Many people don't think pay should have anything to do with the quality of the care. But the reality is, it just comes down to math. If your doctor accepts Medicare, but has to see 60 patients a day, you won't get much time. I actually have a doctor friend who says, I just tell Medicare patients they get two problems to talk about during a visit. ONLY two," she said scowling as she waved two fingers high in the air. Let's imagine you've got hypertension, high blood sugar and an open sore on your big toe? If you can only talk about two problems, you'll ignore the diabetic foot ulcer. And if that diabetic foot sore turns in to a diabetic foot infection, you just might wind up with an amputation. Healthcare shouldn't be rationed; you have to make sure that you get to talk about ALL of your health problems with the doctor. This of course is the way medicine used to be. What many people don't realize is that the doctor is ethically and legally required to listen to all of your health problems that concern you, even if they don't get paid well for doing so. So if you doctor says, We'll have to discuss that next time," just insist that he hear you out. 4. Medicare is Paying for Fewer Medical Perks. If you have diabetes you will be sent to a lot of different specialists. Studies have shown that having diabetes make you four times more likely to have a heart attack. You are also way more likely to develop kidney trouble, blindness, or diabetic foot infections that lead to amputation. To make sure everything is working right, your primary care doctor will likely send you for consultations" with other diabetes specialists like podiatrists, cardiologists, opthalmologists and nephrologists. "consultations" are specialist visits that involve more work because the primary care physician wants the specialist to explain what is going on. The problem is that Medicare simply stopped paying consult codes" this year. So don't expect a specialist to take any extra time explaining your health problems to you or your primary care doctor. And don't be surprised if these specialists don't work you into their schedules very quickly. They simply are making money like the once were. Once upon a time, house calls were common, but now very few doctors who accept Medicare can afford to make house calls. There is just no way they can take the time to drive from house to house with the low rates medicare pays. This is obviously a big problem for an elderly diabetic who may have poor eyesight or an open wound on the foot. If you have a diabetic sore on your foot and can't walk, your doctor can't really expect you to get to the office for an appointment? 5. No Diabetes Prevention. It is simply a fact that the problems related to poorly managed diabetes are preventable. Blindness, kidney failure, and diabetic leg amputations are all preventable. Doctors fully understand how elevated blood sugar levels damage the eyes, kidneys and feet. Doctors also fully understand how preventative care can prevent this damage. But Medicare won't pay for intensive diabetic foot monitoring programs. It has been shown that close monitoring of diabetic foot skin temperatures can prevent diabetic foot sores. But this sort of close monitoring by a diabetic foot expert isn't a service that Medicare will pay for. As a result, it is a service that isn't offered to you by your doctor. So now that you know the Top 5 Reasons Medicare is bad for your diabetes, what can you do about it? First keep in mind that most doctors decided to become doctors because they really and truly want to help people stay healthy and happy. You have to keep in mind that your physician is your ally. But feel free to remind him or her that you need help, even if it might take a little extra time. Usually the physician will hear you. You should also ask lots of questions. Take a list of questions so that you can stay on track and get all of your concerns dealt with in a short doctor visit. Ask your doctor about performs house calls. If not, find one that does. Even if you have to pay for it, having a doctor come to your home is an amazing convenience. Make sure you ask your doctor about any new treatments that are available, but not covered by Medicare. If you don't ask, many docs will simply not take the time to offer all available treatments if they aren't covered. Diabetes is a serious disease. Many patients with diabetes will die from health complications directly attributable to poorly controlled blood sugar. Given that most of these problems can be managed and prevented, you owe it to yourself to insist on the very best care from your doctor.
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