Cutting Federal Healthcare Spending Requires Physician Input

April 28, 2014

If we hope to reduce Medicare spending, how about we ask physicians for important strategies vs. just ensuring expensive equipment is used properly.

"What is an endocrinologist for?" A new patient asked me this recently. I went on to explain that an endocrinologist is a doctor that specializes in hormones and sees patients with diabetes and other hormonal disorders. "I know that," he said. "I mean, why do I have to see you so often?"

Well, the short answer is: "You don’t." You don’t have to see me often. You don’t have to see me at all. I do not have patients come against their will. As a matter of fact, I am trying to dissuade patients from seeing me if I feel their primary-care doctors can manage them. Some patients welcome having one fewer doctor to see, others feels they "need" a specialist, even if it’s only once a year to check their thyroid hormone levels.

For this particular patient, Medicare requires that he be seen by a physician who will monitor and manage his diabetes and see him every three months because he is on an insulin pump. Why? I suppose because it is an expensive piece of equipment and they want to make sure it is being used correctly and that its use is being monitored. Is there a reason it has to be every three months, as opposed to four months or even six months for someone who is well-controlled? I don’t know. All I know is that if he fails to be seen, Medicare won’t cover his pump supplies. He asked me what the point was of seeing a doctor so often. I said to make pump setting adjustments as needed and to monitor for complications of diabetes and manage them early so they don’t get worse. He kept saying how he doesn’t like doctors, doesn’t want tests done, etc, etc. I told him to call his senator; I don’t make Medicare’s rules, I just try to abide by them. Trust me, I am not thrilled about seeing him often either. OK, I didn’t say that; at least, not out loud.

He does have a point though. Medicare (and other plans for that matter) won’t cover some things physicians feel are important. Like diabetes education for the pre-diabetic. Oh sure, once things have gotten worse and they have diabetes, then (usually) they will pay for it. You can’t get testing supplies covered for more than three times a day if you are on insulin unless forms are filled out and submitted. But every three months, patients with insulin pumps must see their physician or their supplies aren’t covered. Regardless of how well they are doing.

This is your tax dollars at work.