Medicare Provider or a Concierge Doc

Finding a doctor that accepts medicare and finding out more!

After listening to a friend complain that her physician had retired and she was having trouble finding a physician that accepted Medicare, I decided to explore.  What I did find was a resource on the Medicare.gov site called "Physician Compare".  This is a useful tool and one can search for specialists or general practitioners.  I do think one may have to drive to the next town to find the specialist needed that accepts Medicare.  Sometimes the drive may be up to an hour.  This is similar to health care access a half century ago.  I grew up in a small town.  If a specialist was needed, one took a two and half hour trip to where a larger medical center was located.  That was in the late 1950's and 1960's.
I am hearing about physicians setting up boutique  or concierge practices after they leave practices where insurance and/or Medicare is accepted. An individual would pay a set fee and care would be provided through that practice.  I have heard  $2000-$3000 per year mentioned for these boutique services.  Most family physicians do not see their patients in the hospital now.  Patients are seen in hospital by physicians termed  "hospitalist".  The individual would need catastrophic or major medical insurance to cover hospital admissions.  This would mean if you have the money you may choose your care. 

If you are interested in reading more about the boutique or concierge medical practices, I found an article from late 2013 in the Wall Street Journal by Jen Wieczner that weighs the pros and cons.  The link is below. 

Wieczner, J. (2013).  "Pros and Cons of Concierge Medicine"  retrieved from http://online.wsj.com/news/articles/SB10001424052702303471004579165470633112630

 

Telemedicine

Hi Blog Followers,
This is one of the many faces of health care's future.  I am familiar with the rural areas being serviced by telemedicine for Mental Health Services in my state.  Watch the above video and I will add more about this trend tomorrow.

Making Retirement Last

I have been absent from this blog for almost a month.  I apologize.  I do so enjoy this audience and subject.

I have held information from an article of almost a month ago.  In the May 7 edition of USA Today, Rodney Brooks presented several points you should keep in mind when planning for retirement to last. In "7 Tips to make retirement savings last", he outlines  actions such as not waiting  until you are 701/2 to withdraw from one's retirement plan, consider taxes in everything you do, consider downsizing, consider an annuity, etc. (Brooks, 2014).  The action that stood out to me was making a Health Savings Account (HSA) a big part of the  the planning.  If you have access to a HSA consider not withdrawing until it is absolutely needed.  I have one and am trying to resist pulling funds from it for co-pays and health items I can afford out of pocket.  These funds are "triple tax free" .  It is deposited before tax, grows tax free, and is tax free upon withdrawal if used for healthcare. (Brooks, 2014).  Healthcare can become a major cost in retirement and it is difficult to predict if we are currently healthy.  HSA plans can even be used to pay for the supplemental health insurance premiums in retirement that compliment Medicare.  If your employer offers a HSA, look into the advantages.  Do access Rodney Brook's article.  It raises some good points and gives ideas to further explore with your financial planner such as why not wait until 701/2 to withdraw funds from a retirement account.  He explains that it is better to withdraw now and pay the tax.  Then one can put in a Roth IRA which is not taxed on the growth and there is far less required minimum distribution at 70.  Follow the link below for more good ideas.

Brooks, R. (2014, May 7). 7 Tips to make retirement savings last. USA Today, p. 6B. 

Retrieved from

http://www.usatoday.com/story/money/columnist/brooks/2014/05/06/retirement-401k-pension-savings/8695897/

There goes the family doctor!

In researching healthcare for retirement, I have heard over and over from neighbors that their physician is retiring or their doctor's practice was bought out by the local healthcare conglomerate.
My own family physician is my age and is also considering retirement.  His practice was bought out two years ago by the local hospital corporation.  We no longer are visited in an inpatient hospital situation by our family doctor after being processed by admissions.  We are treated by a "hospitalist".  This is a physician employed by the healthcare institution.  They work shifts just like the nurses and in some instances will cover the entire institution in off hours.  I do miss the warm smile of the physician I have know since I was thirty-five.  What has changed this climate?  Most of it comes to regulations and finances resulting from the regulations.  I began to search the media for information on this trend.

I found that the implementation of the electronic medical record, extra personnel to service the claims for payment, and slow payment from government healthcare such as Medicare facilitate a  few of the changes in this landscape.  Practices that do not switch to the new electronic medical records required by the government are docked 2% in payments.  "The cost for purchasing, implementing, and training staff for the new federal software can run $40,000 with additional yearly maintenance costs thereafter. The new software is not designed to integrate with other systems used by medical practices.(Breitbart-California, 2014)."  "Doctors report that electronic systems have cut productivity by about 25 percent. (McSwain, 2014)."  Many of my friends report their physicians now spend as much time in front of the screen as focused on them.  There is still ICD-10 to implement.  It is a coding system required for payment.  It is to  be implemented late this year.  That will require more training and personnel.  Many physicians are hiring "scribes".  That is a person that follows them around with the laptop to facilitate much of this information into the system. That is  another person that must be added to the payroll.  More details are available on the links below.

What I did decided is that physicians financially have little choice but join large practices or be bought by conglomerates to spread the costs around for the implementation of our cumbersome regulations.

There is a trend for concierge services.  That is where one pays upfront and does not file on insurance or medicare.  The costs are often posted in the waiting room and are considerably less than filing insurance.  I recently was in Florida and experienced some irritation in my eye.  I stopped by a concierge practice.  It was a walk-in situation with the costs for all procedures posted in the lobby.  My care was good.  It was quick.  The physician made eye  contact with me.  I even received a follow-up call the next day to check on my progress.  It seems that was what it was like in the 1950's when my mother would take me to the doctor.  No one had insurance other than for hospital stays.

The doctor's office was a one-stop shop.  He even dispensed the medications under most instances.  You did have to have the money to pay. 

Obamacare Killing Off Small Doctor Practices.  (2014) retrieved from

http://www.breitbart.com/Breitbart-California/2014/05/02/Obamacare-Killing-Off-Small-Practice-Docs

Swain, D. (2014).  Obamacare Deals Blow to One Doctor Medicine.  retrieved from

http://www.utsandiego.com/news/2014/Apr/26/obamacare-deals-blow-to-one-doctor-medicine/3/?#article-copy

 

Is it Alaska, Florida or somewhere in between?

I have been thinking about taxes in retirement recently.  I even had a conversation with a friend that is also exploring retirement.  I had even explored my own state of Virginia which offers seniors no tax on the social security benefits and $12.000 cap on benefits beyond the social security before state tax is imposed.  My friend had reported to me that the state she and her husband plan to retire to offers a $41000 cap on social security income, IRA’s and pensions per person.  We had both always felt our only break for state taxes would be to maintain a residence in Florida.  I was somewhat relieved to know that I could maintain my home in Virginia with a somewhat lowered tax rate.  I put this on the table for another day’s exploration.    An article in USA TODAY mobile app caught my eye yesterday, “10 worst states for retirement” (Brody, 2014).  The link is at the bottom of the page if you want to explore this list.  Much has to do with high estate taxes but there are other issues as well. Most appear to be taxes or financial issues.  I thought I might as well explore what is the best state from a tax or financial standpoint to consider for retirement.  I found the list!  In  Kiplinger online,  there is a list published in August, 2013 (“10 Most Tax Friendly States”, 2013.) This link too is available at the end of this blog article.  It does appear from a tax standpoint that Alaska has no state income tax, no sales tax, or no estate tax.  I figured I must check for Florida on the list.  It does have a sales tax but no income or estate tax.  The others listed have many of the mentioned taxes but at a lower rate than others.  I suppose it is not all about the tax but it can  enhance one’s lifestyle with a little more funding available.  Family presence and especially locality of one’s children and grandchildren is important in the consideration of where to settle.  If one is going to be a part- time resident in a particular state to maintain lower tax rates, it would nice if that state had things to offer that were appealing to a preferred lifestyle.  For some that might be weather and for others it might be friends or family.  I hope you explore the links below.  There is some interesting information about the 10 on each list.  Comments are welcome.  I love to know what readers are thinking and considering especially if you follow the links.

“10 Most Tax Friendly States”.( 2013).  Retrieved from http://www.kiplinger.com/slideshow/retirement/T006-S001-10-most-tax-friendly-states-for-retirees/

Brody, J. (2014).  “10  Worst States for Retirement”.  Retrieved from  http://www.usatoday.com/story/money/personalfinance/2014/04/19/retirement-states-taxes/7788891/