My primary care physician has three employees to handle phone calls, set appointments, and check in patients. Those are the front desk duties of the office staff, but there is much more:  Checking a person’s insurance coverage to determine the patient’s  co-pay;  Contacting insurance companies to get prior approval for tests and referrals;  Resubmitting documentation to insurance companies that won’t pay  a bill until they get one more piece of paper.  The list goes on and on.

I always figured the way the American health care system works, with dozens of insurance companies requiring different paperwork and paying different fees for services rendered, was inefficient.  But now there is a study that shows just how inefficient and expensive our convoluted system is.

A study published in the Health Affairs Journal says that American doctors pay out more than four times as much as Canadian doctors because American doctors must deal with dozens of insurance companies (and Medicare).

The study surveyed physicians and administrators in Ontario, Canada about time spent interacting with payers, and compared the results with a national companion survey in the United States.

The findings: Physician practices in Ontario spent $22,205 per physician per year interacting with Canada’s single-payer agency—just 27 percent of the $82,975 per physician per year spent in the United States.

More findings: US nursing staff, including medical assistants, spent 20.6 hours per physician per week interacting with health plans—nearly ten times that of their Ontario counterparts.

Billions could be saved:

The study found that if US physicians had administrative costs similar to those of doctors in Ontario, the total savings would be approximately $27.6 billion per year.

Americans are told they have to pay more for their care, but I haven’t heard any talk about fixing the payment system for health care that is clearly inefficient and expensive. Why hasn’t this issue been addressed? Have the hundreds of insurance companies, each negotiating prices with doctors, kept health care costs from rising each year? The answer is clearly “no”, and the current system is clearly broken. So, before our government pushes more cost onto seniors and working people, why not fix the system?

Have you heard that more and more doctors are dropping out of Medicare because they don’t get paid enough?  Is this fact or fiction?  It turns out that studies have been done to provide an answer to this question.

The Medicare Payment Advisory Commission (MedPAC) is an independent congressional agency established by the Balanced Budget Act of 1997  to advise the U.S. Congress on issues affecting the Medicare program.  The March 2011 MedPAC report addressed the question of Medicare beneficiaires’ access to doctors, especially primary care doctors.

MedPAC found that over 90% of doctors who accept Medicare are taking new patients. Another independent study found that 92.9% of doctors accept Medicare patients. This was reported in a New York Times article in July.

Here are the findings of the March 2011 MedPAC report:

Overall, beneficiary access to physician services is good or better than that reported by privately insured patients age 50 to 64. For example, in 2010, 75 percent of beneficiaries reported that they had no problem scheduling timely routine-care physician appointments.

Multiple surveys show that most physicians are accepting Medicare patients. For example, the 2008 National Ambulatory Medical Care Survey found that 90 percent of physicians with at least 10 percent of their practice revenue coming from Medicare accepted at least some new Medicare patients.

Medicare’s payment for physician fee-schedule services in 2009 averaged 80 percent of private insurer payments for preferred provider organizations, a figure unchanged from the preceding year.

A recent study found that in 2007, hourly compensation rates for some specialties were more than double the rate for primary care. The Commission has recommended enhancements to primary care, such as increasing Medicare payments for primary care services provided by primary care practitioners. (Note:  The 2010 Affordable Care Act increased payments to primary care doctors by 10%.)

In 2009, the Medicare margin for the median efficient hospital was 3.0 percent. (We define efficient hospitals as those that consistently perform relatively well on cost, mortality, and readmission measures.) While most of these relatively efficient hospitals generate profits on Medicare patients, about one-third do not.

I’m in Connecticut visiting friends and family and enjoying the cool rain. A friend who is on Medicare was bemoaning her high drug costs and going into the donut hole, so I did a little research to see if she could qualify for help from the state of Connecticut. I was shocked by what I found.

While most states use standard income levels (up to 135% of the federal poverty level) to determine if a person should get help with their Medicare costs, Connecticut will help people who have nearly twice the standard limit.

Income of $1,246 per month for an individual and $1,675 for a couple is generally the cut-off for getting your state to pay your Part B premium ($96 – $115.40 per month). The income limit in Connecticut is $2,091 for an individual and $2,816 for a couple. And Connecticut does not consider assets a person has such as bank accounts, investments, or retirement accounts. They only look at  a person’s income, so people who live on their Social Security check would likely qualify for help from the state of Connecticut.

If my friend qualifies for help from the state of Connecticut, the state will inform Social Security that she also qualifies for help with her Part D costs.  When this goes into her Medicare record, she will pay $6.30 for her brand drugs and $2.50 for generics, which is the help she really needs.  And she will have no donut hole in her Part D coverage, saving her thousands of dollars each year.

Now, before you decide to move to Connecticut, I must warn you that my home state is an expensive place to live.  My friend had mail from a Medicare supplement company and I was shocked to see that the cost of a Medigap Plan F  is $220 per month for a person turning 65 in Connecticut. That is $100 more than the cost in Arizona for the same coverage with the same company.

Medicare Advantage plans are also more expensive in Connecticut. My friend is enrolled in an Advantage plan for which she pays $110 per month – though it offers much better coverage than $0 premium plans in Arizona.  And we won’t even talk about property taxes, which are three to five times higher than in Arizona.

Maybe, when I’m 65, I’ll buy a Medicare supplement in Arizona and spend my summers in Connecticut – though I can probably only afford a single-wide trailer at Connecticut prices.

For more info on getting help with Medicare and Part D costs, check out a previous post: Help with Medicare Costs

Folks in Connecticut should contact an Agency on Aging for more info and an application.  Here is a link to a web site that provides phone numbers for offices across the state.  http://www.ctagenciesonaging.org/pages/home.php

I came across a website for Connecticut elder services and found an application there – but the application was four pages and asked for lots of info. Turns out that is an old, out-of-date application.  The new application is just two pages.  I used the link above and talked to a very nice lady in Norwich who sent my friend the correct application for the Medicare Savings Program.