By Taylor Hemness - email
EAST TEXAS (KLTV) - Dr. Barbara Allen is the chief of primary care at Trinity Clinic in Tyler. She says that roughly 50% of the forms that come across her desk everyday, have to do with Medicare.
"It has a huge impact on not only our present state in primary care, but also our future," Allen said. "With our population aging, rapidly, we know that more and more people are going to be on Medicare. So it's something we talk about, we live, we breathe, and we plan for on a daily basis."
Dr. Scott Lieberman at Cardiovascular Associates of East Texas said that a good number of his patients are also on Medicare, and the challenge for his office is often keeping up with changing policies.
"Every six months to a year, Medicare will publish a new set of rules," Lieberman said. "They don't necessarily announce them, they don't necessarily highlight them."
Lieberman told KLTV that his office is sometimes forced to take out lines of credit to pay salaries and other expenses, when Medicare reimbursement funds unexpectedly dry up.
So why does that happen? When we asked for a response from Medicare, we got no comment. But we were able to speak with Congressman Louie Gohmert, who told us he's heard of that happening quite a bit, and it's because Medicare funds have been managed poorly.
"All of a sudden without warning, they ran out of money, and they said, 'Gee Whiz, we're out of money, what are we gonna do now?'" Gohmert said. "And they had to tell doctors they didn't have any money for reimbursements."
Another concern that Dr. Allen has with Medicare--the "donut hole" that comes with Medicare Part D.
We took her questions to Medicare, again--no comment. But Congressman Gohmert says it was passed in 20003 to make low income, and high income patients happy.
"It was done purely politically, by putting the payments for the lower amount," Gohmert said. "And then leaving the gap between the lower payments and the catastrophic care, and they said for those it costs a lot of money, you'll be covered for the higher amounts."
So now it's time for the red ink. If A is excellent, C is average, and F is failing, how did the people we spoke with grade Medicare?
"My gut feeling is to say C, it's an average coverage," Allen said. "We can do better, we have to better as a health care industry."
"I think I would have to at least give them a B," Lieberman said. "It's not a perfect system, but the vast majority of time when I've needed to take care of somebody, they have not stood in the way."
A big part of the coverage Medicare provides is for patients going through rehabilitation after hospital stays. And people in that industry had good things to say about the program.
"I think a B+," said Providence Park administrator Heather Moore. "I think it's effective, we see about 60% success that we're able to get them back at home."
"I would give Medicare, as far as my business, an A today," said Greg Ortiz, owner of Med-Team Home Health Care in Tyler.
And maybe the best person to ask is Arlyn Vierkant, who's 98-year-old mother is Medicare patient. He called Medicare a "lifesaver."
"I would give A, and again because it's user-friendly," Vierkant said. "It covers a need, and it's not something where family or the elderly have to figure out all sorts of paperwork, and get involved in a bureaucratic process that confuses them."
The public affairs specialist at the Centers for Medicare and Medicaid Services in Dallas, told KLTV that the issues we were asking about were mandated by law or statutes, and because there's current health reform legislation on the table, no one would comment on this story.
As for the final grade from all our responses on KLTV.com, Medicare gets a C. And Congressman Gohmert said that's the same opinion he's getting from people all over East Texas.