Read the vignette details and answer the Constructed Response…

Question Answered step-by-step Read the vignette details and answer the Constructed Response… Read the vignette details and answer the Constructed Response Questions¬†¬†Vignette: The Case of Benefits DeniedMedicare beneficiary Megyn Kelly (age 70), a retired television reporter, received a disturbing letter.Her gynecologist, who had been managing her ovarian cysts, was opting out of Medicare.Megyn was still welcome as patient, but her gynecologist would not be accepting Medicare reimbursement.Ms. Kelly asked her primary care doctor to recommend another gynecologist who did accept Medicare, but her doctor did not know of any.The primary care doctor asked Ms. Kelly to give her the gynecologist’s name if she were able to locate one who accepted Medicare.Expecting to find another gynecologist quickly near where she lived, Ms. Kelly asked friends and family, but her friends said they too experienced the same problem.One friend’s internist stopped accepting Medicaid because she was unable to cover the costs of indigent care and was consistently losing money as the state decreased Medicaid reimbursement.Physician also stopped taking new Medicare patients because of its low reimbursement rates.Fortunately, the internist had a large group of patients insured by private commercial plans.Ms. Kelly learned of several physicians in the suburbs still participating in Medicare, but these were at a distance.Over the next year, Ms. Kelly was unable to find a gynecologist accepting new Medicare patients.She missed her annual gynecological exam and tests to determine whether any ovarian cysts had returned.Uncertainty weighed heavily; for 30 years, she had never missed an annual gynecological appointment.Her gynecologist had recommended regular monitoring, as she had a family history of ovarian cancer.Motivated by her journalist instinct, Ms. Kelly investigated why physicians were dropping out of Medicare.Physicians are reimbursed at roughly 78 percent of costs under Medicare and 70 percent under Medicaid.Physicians make up the shortfall by shifting costs to the insured, with higher prices. Medicare patients are cared for at a loss.If there are not enough privately insured patients to support the practice, there is an incentive to refuse new Medicare patients.Thirteen percent of physicians do not accept Medicare patients; 17 percent limit the number of Medicare patients they see.Among primary care physicians (e.g., gynecologists), 31 percent limit the number of new Medicare patients.These numbers are even worse for Medicaid, where 20 percent of physicians choose not to participate.Forty percent of doctors are over age 55; they may chose retirement over practice delays from government hassles.Ms. Kelly decided to pay out of pocket and returned to her original gynecologist.Although on a fixed income, during the year she postponed care, she revisited monthly expenses, made some sacrifices, and saved enough to cover the higher costs of care.She even negotiated a payment plan with her provider that allowed her to continue receiving care.She continues to search for a gynecologist accepting new patients who participates in Medicare.Constructed Response QuestionsWhat is an affordable solution for patients who contributed to Medicare all of their working lives but who now face obstacles in obtaining care due to providers leaving the program?Are you willing to pay higher payroll taxes in order to keep the Medicare program solvent and for beneficiaries to receive care?Do you believe the Medicare program will be available to you when you turn 65?Should wealthy Medicare beneficiaries pay a premium for the benefits they receive from the program?¬† Health Science Science Nursing HEALTHCARE 216 Share QuestionEmailCopy link Comments (0)

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