To Sum Up:
Perhaps you can see why we see "private" patients quickly, as we reserve time for them each week. Without cash pay patients we would be unable to see any Medicare patients, as the private work subsidizes our Medicare work. The crisis in mental health geriatric service delivery is a combination of three facts:
  1. Most elders are covered by Medicare and need to use it, and;
  2. Medicare has always devalued mental health services, actually calling the reduced fees to social workers, psychologists and psychiatrists the "psychiatric reduction" as compared to any other speciality from nutrition to podiatry to dermatology to whatever.
  3. Medicare hires outsider companies to do audits which get paid a percentage of what they collect. Since it's cheaper to settle then defend yourself, they almost always "claw back" some fees. The risk of fraud accusation is just too much for most people to risk their financial well-being to order serve Medicare patients.

The result is very few mental health providers willing or able to accept Medicare. An internet search of the Boston area found one neuropsychologist in the Brookline area interested in dementia. However, looking him up revealed he specialized in motivational psychology. That didn't help.

Some Final Positive Thoughts
Medicare is revenue neutral, that means they can get no more money from anywhere, unless the Congress votes to allow them to raise the Medicare tax. Look at your paycheck and you'll see a FICA deduction. You give up 7.65% of your earnings which goes to fund Medicare. And, your employer matches that by paying another 7.65% into the system on your behalf. If you are self-employed (like Dr. Elovitz) you pay both, or 15.3% of your gross income into the Medicare system. You get quite a lot down the road from this investment, and Medicare is solvent for many years to come. Did you know that only 2–4% of Medicare's budget goes to pay for administration costs? Private Advantage (Medicare replacement products) plans get 20% for administration, and then you hear the government can't do anything right compared to the private sector!

Private insurers say they need that 20% to pay for administration (CEO salaries, business costs like jets and offices with views, etc). And, they need to earn a profit for their shareholders of at least 5%. Medicare is extremely frugal and economical. And it is also better managed and run than the private insurers we deal with.

Medicare is not run poorly, it is poorly financed because the system encourages after-the-fact disease care, rather than preventive care which is emphasized in all other 1st world countries healthcare systems. And, we die earlier and have the worst outcomes among all countries while paying around 30% more then they do.

Well, Medicare is overall well administered–they use local agencies to dole out payments, and each covers several states. When we have a billing problem we could call someone in Hingham, MA who often directly answered the phone speaking standard English and could fix problems in minutes. Try that with your private insurance company! Medicare, if properly funded by the government (not by high taxes to both employees' and their employer’s) would be the ideal model to insure all Americans of all ages as it would save enormous amounts of money to both workers and their companies. You could even afford to open your own business without being trapped by having to work for a company offering insurance for your family. And then we could start encouraging good habits and preventive care (much of which comes through mental health services), and then we might have a real
health-care program rather then the most expensive disease-care system with the poorest health outcomes in the developed world.

Some good news for you Medicare consumers is, despite complaints about reimbursement, more than 96% of all providers still accept Medicare. The bad news is that of those who have dropped out of Medicare (i.e., refuse to accept it at all) the majority are mental health providers. In 2013
Forbes reported over 87% of family doctors and 99% of general surgeons accepted Medicare, as compared to around 60% of psychiatrists. Presently, we know of no psychiatrists in private practice accepting new Medicare patients in most, if not all, of Massachusetts. The situation is complex, but without adequate compensation it is very difficult to provide time-intensive services (like neuropsychological testing) to patients–and there is no brief medical test that can replace this–so the result is long waits for appointments.

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