HIGH-QUALITY MEDICAL CARE FOR OLDER PEOPLE: SELECTING A NEW DOCTOR

Changing doctors is an unpleasant task that many older people face, not just the few who awaken to the fact that their trusted family physicians are less than competent. You may have moved after retirement. Or you and your doctor may have grown old together. One year he decides to retire. It is hard to start again from scratch after losing a relationship that may have spanned much of your adult life. You may feel no one will know your body in the same way. Never again will you get the same special attention or care.

These fears are natural. Anyone we have such an intimate relationship with for so long is bound to seem irreplaceable. The truth is that transference is transferable. Provided you make a determined search, you can find a doctor you will eventually feel just as enthusiastic about. But you must choose wisely. Make selecting a replacement a special project. What other investment of time is more important? (Once again, it may be helpful to enlist another person in following the next suggestions, a competent “buddy” who can work with you – or even take over the job – in making this project succeed.)

Develop a list of names. Question friends and relatives, but give most weight to recommendations by doctors or other health-care professionals. They will be better able to evaluate candidates’ skills. You can feel more confident that someone they suggest is competent, not just affable.

Check the credentials of each person on your list. What training and education does the doctor have? Does he or she have an academic appointment at a medical school? What hospital is the physician affiliated with, and what is its reputation? To get these facts, either call the doctor’s office directly or ask your county medical society.

Expense. Find out the doctor’s fees and when payments are due. If your financial situation is tight, would it be possible to arrange a special payment schedule to fit your budget? Find out if the doctor accepts Medicare (or if you are eligible, Medicaid), and if so, for what services. Will the office bill Medicare and your insurance carrier directly?

Medicare will pay only for the services of licensed physicians. Your doctor may bill Medicare directly, or you may pay and then be reimbursed by Medicare. Whatever arrangement you have with your doctor, after you pay the yearly deductible, Medicare pays 80 percent of what it deems the “reasonable charge,” and you pay the other 20 percent. If your doctor charges more than the “reasonable charge,” you are responsible for the additional amount.

If feasible, choose a doctor who takes what is called “Medicare assignment.” This means that even if his normal fee is higher, he agrees not to charge you more than Medicare will cover. Those who accept Medicare assignment also submit claim forms directly to Medicare, which will save you time. Unfortunately, however, it is increasingly hard to find a doctor who does accept assignment. Because of Medicare’s stingy reimbursement rates, nationwide 72 percent do not.

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