Medicare Cuts

[Rose]

Medicare Cuts May Force Rheumatologists to Close Doors
There is a crisis looming for rheumatologists who treat Medicare patients. The crisis may force more rheumatologists to close their doors to Medicare patients, according to the American College of Rheumatology. Some rheumatologists have already been forced to make that decision. Rheumatologists are facing cuts to physician reimbursement from Medicare. Reimbursements are based on a formula known as The Sustainable Growth Rate — a formula based on the performance of the overall economy. The medical needs of patients do not shrink whenever the economy slows though, so the formula is flawed.

Congress has recognized for years that the formula for physician reimbursement isn't working — but it's still without a permanent fix. With factors that skew the formula, physician reimbursement is dropping while physician costs continue to rise. Cuts to physician reimbursement will affect all doctors who see Medicare patients, not only rheumatologists, but there's already a problem with access to care from rheumatologists. In many areas of the country, patients who need to consult with a rheumatologist are forced to wait several weeks or months. Early diagnosis and appropriate treatment is essential for management of arthritis and other rheumatic diseases. The Medicare reimbursement crisis will only serve to amplify an already existing shortage of rheumatologists in the United States, making access to early treatment more difficult. You can help by urging your members of Congress to repeal the cut

 

[Jennhere]

Well… it's not like I was ever helped by a rheumy, anyway!:D  Oh, they'll all probably end up in private practice, prescribing AP.  I still think rbf should offer t-shirts and bumper stickers…. and tote bags:D… and mousepads…and whatever else for sale.  One, for money to run the site..and two, for some publicity.  Thanks for the info, I kind of think that it signals a turn in our favor.  Honestly- I don't think rheumys do a darn bit for our condition- except kill us sooner!

Jenn

[linda]

Hi Rose,

There is also the problem of once someone gets in to see a rheumy, they are prescribed a biologic that is so expensive that they can't afford the co-pay.

There are Foundations that will provide financial help, but you have to meet their requirements. I don't know if people with medicare qualify, it's worth checking out.T hese Foundations usually require no fees, co-pays or time limits. I'm currently working with a very good Foundation, but I don't think I can post the name here. They also help with insurance premiums.

linda

[Joe M]

Hi Linda,

Last I knew, Medicare covered Remicade, but not the others.  That may have changed.

Joe

[Jennhere]

[user=11]linda[/user] wrote:

Hi Rose,

There is also the problem of once someone gets in to see a rheumy, they are prescribed a biologic that is so expensive that they can't afford the co-pay.

There are Foundations that will provide financial help, but you have to meet their requirements. I don't know if people with medicare qualify, it's worth checking out.T hese Foundations usually require no fees, co-pays or time limits. I'm currently working with a very good Foundation, but I don't think I can post the name here. They also help with insurance premiums.

linda

Linda- buylowdrugs.com!

[linda]

You're right, buylow is great, but you can't purchase biologics on the internet, at least I don't think so; some are given at infusion centers thru an IV, others are prepared, pre-packaged injections that must be kept refrigerated at all times. None are oral or generic at this time.

When I was on Humira a few yrs ago with a good group insurance plan, my copay was 660.00/month.  I'm about to start Remicade, which is app. 5,000.00/infusion, every 6-8 weeks. My copay (after I hit my 2,000.00 deductible) is 1,000.00/ infusion. Did I also mention my monthly insurance premiums are 1,030.00, since I lost my group plan and had to purchase indiv. insurance? Obviously, this is way out of my price range, as it is for patients on Medicare. The Foundation I use paid the entire 660.00 copay a few years ago, and now they are paying the 2,000.00 deductible and the 1,000.00 copay. The website where my Foundation can be found is NeedyMeds.com.

I beleive this is what John is talking about when he refers to the financial implications for pharma's and rheumies if AP were ever to become the conventional treatment. There's a whole lot of money being made off of these drugs. Some rheumies have gotten smart and set up infusion rooms in their offices, which garners them even more of the profits from drugs like remicade.

We're not just fighting tradition, we're fighting big money. I do feel that there is a place for these biologics; for me right now they are going to prevent joint damage and give my tummy a chance to heal so that I can get back on the abx. I'm aware of the controversy, they suppress part of the immune system, which enables the bacteria to grow. But right now, I'm homebound and really struggling with pain and inflammation, but I have to get off off the pred and mobic for my stomach to heal, so until I can get to a place where IV AP is available, this is my only option. It stinks.

I know I've said this a gazillion times, but I really should be the poster child for starting AP early so that the side effects from these dangerous drugs can be avoided.

But I'm hanging, I know the remicade will work, and quickly, too.  And I'll be back in Tx as soon as I can get healthy enough to move, where I can get IV abx. Then we'll see how I roll!!!  😎

[Tiff]

Linda,

Where in TX do you get IV ABX?

[Bill]

Tiff

 I believe there is Dr. M in Palestine. Dr.RK in Lufkin. And possibly Dr P in Houston.  There may be a few more and I am also interested in knowing of any additional ones.

[linda]

Dr. R.K. in Lufkin and Dr. L.M. in Willis, both outside of Houston. Both have articles at rheumatic.org; click on the info for you and your doctor link, they are the bottom 2 doctors in the list of articles. I know there are more, Richie will know more. i think there is someone on the western side of the state as well, but I don't know the name.

you could try emailing members from Tx, there is a list of members and where they are from in the “members” link at the top of this page.

linda

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