Why Medical Providers No Longer Want to Serve Medicare Patients

A Special Medicare Payments Study by Barbara Brabec


Want an eye-opener? Download this PDF document of Barbara's special study of all the expenses for the various medical visits and procedures related to the recurrence of her breast cancer in 2013.

These figures illustrate how little money medical providers are now receiving from Medicare and supplemental insurance providers for their services, and explains why many doctors are now refusing to take new Medicare patients.


Articles of Interest 

An article on Cancer.org indicates that, as of January 1, 2012, there were more than 2.9 million women living in the US with a history of invasive breast cancer, and it was expected that an additional 226,870 women would be diagnosed that year. For more information, download this PDF article, "Cancer Treatment & Survivalship Facts and Figures."

"Survival and Risk of Having Cancer Return after Treatment (Recurrence, Relapse)"

Excerpt: "With current treatment, women who have lumpectomy plus radiation therapy have a 0.5 percent chance (that is, 5 in 1,000 or 1 in 200) of a local recurrence each year after diagnosis. The best predictor of local recurrence is whether the tumor margins contain cancer cells. Positive (also called “involved”) margins contain cancer cells. Negative (also called "not involved," "clear" or "clean") margins do not contain cancer cells. The chance of local recurrence is lower when the tumor margins are negative.

"Second Time Around"

Excerpt: "One thing we do know for sure: breast cancer is unpredictable. It may disappear after initial treatment, but there is no guarantee that it won’t return, even after mastectomy."

"Checking for Breast Cancer Return"

Excerpt: "Breast cancer can recur at any time, but most recurrences occur in the first three to five years after initial treatment."



See page 2 of this article for more breast cancer articles and research findings.









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Copyright © 2000-2013 by Barbara Brabec. All rights reserved.


<=== To share the special report at left with links to all of Barbara's breast cancer articles and research, download this PDF NEWS RELEASE, which you can send as an email attachment or post to your website, blog, or social networking pages. Thanks!


Breast Cancer Returns
After Twenty Years

A Special Report by Barbara Brabec

An update to Barbara's Original 1993 Report, "What You Need to Know About Breast Cancer."

~ August 2013 ~

Knowing how helpful my original breast cancer article has been to readers through the years, I wanted to share the story of the recurrence of my breast cancer after twenty years, long after I felt I was "home free." This report reflects what I learned this time around from my doctors, my research, and from communicating with breast cancer survivors in my network.

Note: This report, whose message is certainly serious, also includes some humor here and there, proving that even when the overall situation isn't the least bit funny, humorous moments often present themselves.


A FEW DAYS AFTER having my regular annual mammogram in April of this year, I got a call saying the X-rays had revealed a suspicious nodule that needed closer examination, and that another set of X-rays, an ultra sound, and a needle biopsy needed to be done. This nodule was near the center of the same breast where cancer had previously been discovered. I was told that whatever it was might or might not be cancerous, but if it was, it wouldn’t be related to the original cancer in that breast but something new that had to be dealt with. Even though the nodule was tiny—just 2 millimeters in size, about the size of a pencil dot—the doctor at the Breast Center gave me the impression that if the growth turned out to be cancerous, it was quite likely that I might need to have the whole breast removed this time.

Twenty years earlier I’d had a lumpectomy followed by six weeks of radiation and tamoxifen medication for three years. At this stage of my life, now widowed for eight years, I figured I could deal with a breast being removed because I was the only one who’d ever see it. Even so, I knew it would still be upsetting to look at, no matter how much self-talk I gave myself. More important than the disfigurement, however—which millions of women have bravely had to deal with—I was concerned with what surgery would do to my energy and the grand writing and eBook publishing plans I had for this year. That’s simply because I have always been a workaholic, and now that I have all my time to myself, my writing and work on the Web has become my primary interest in life.

Second X-rays and Needle Biopsy

The follow-up appointment for the biopsy was no big deal. Sweet women taking care of me, no pain—not even discomfort during the procedure or upon returning home. Beforehand, the doctor explained that a needle would be inserted into the breast and a tiny piece of the nodule would be removed for biopsy. "Then I’ll insert a miniature metal clip to indicate the exact spot where the nodule is located," she said. "That will show up on any future X-rays so a radiologist will know that this area has been investigated."

Later, after a nurse had numbed my breast for the procedure, I asked her what she thought my chances were for this thing being benign, and her delayed response also suggested that I should brace myself for surgery.

"Prayer helps," she said. "I know," I said, "I’m a born-again Christian," to which she said, "Me, too! And so is Dr. Zimmerman who will be doing the biopsy today."

"I’m not surprised," I said, "because God has always surrounded me with Christians."

Suspicious Biopsy Results

A few days later, Dr. Zimmerman called to say the lab had returned a diagnosis of no cancer, but that she was stunned by that report because her experience in this field suggested that the diagnosis couldn’t be right. For that reason, she recommended that I get a second opinion from a surgeon, and I said I knew exactly who I wanted: Dr. David Piazza, the son of the doctor who’d done my initial breast surgery in 1993.

Turned out that she and Dr. Piazza know one another very well, and after looking at the X-rays and talking to her, he said that he not only trusted her experience and gut feeling but also felt uncomfortable about the radiologist’s report.

"What I see here is quite unusual," he explained. "None of the literature on breast cancer has ever suggested that a breast that had been partially removed and radiated twenty years earlier could ever become cancerous again."

When I asked if that fact made me a case for the books, he said yes and chuckled when I added, "I always knew I was special."

"This isn’t life-threatening," he said, "but we do need to remove that growth, so let’s get you scheduled for surgery. We’ll then do a biopsy of it and see what we’re dealing with here."

An Interesting Day in the Hospital

Surgery was scheduled a couple of weeks later, with an EKG scheduled for the day before. Surgery day proved to be quite interesting, to say the least. It began with the usual disrobing and getting into a gown, only this time there was something new that had been added since my last surgical procedure at that hospital when I’d had my second knee joint replaced in 2006. Once gowned and slippered and tucked into bed, the nurse drew a machine close to the bed, searched my rather crinkly gown for a hole, and stuck a hose into it. Soon I felt warm air blowing through the gown’s inner lining and I was given a control button so I could adjust the temperature as desired. Of course I found this amusing, since I also got the usual blanket as well. I reasoned that this kind of heated gown meant that microwaves no longer had to be kept in the hall for the purpose of warming blankets, but I wondered how much these fancy disposable gowns cost. (This wasn’t an itemized expense on my hospital bill, so it’s anyone’s guess.)

Soon afterwards I was wheeled to a room where another X-ray of my breast was taken, this time for purposes of seeing where to guide a long needle into the breast in perfect alignment with the metal clip that had been inserted during the needle biopsy to mark the growth’s exact location. I was told that this needle would enable my surgeon to go directly to that tiny 2mm nodule and determine how much of the area around it needed to be removed.

A Coffee-Cup-of-a-Breast

Now this needle procedure proved to be both interesting and amusing. After the mammogram, my breast was numbed and than a skilled nurse named Shannon explained everything step-by-step as it was happening. Picture this. I’m sitting there with my breast on a little shelf, and Shannon is looking at the X-ray image and targeting the miniature wire marker. I couldn’t make myself look as she stuck the needle in my breast, but after she said the needle was in, I looked and saw a couple inches of it sticking out.

"Careful," Shannon said as she cradled my breast with one hand and began to wrap a wad of cotton around the needle with the other one. "Don’t move till I get this covered."

What she did next cracked me up. Someone handed her a Styrofoam cup—the kind normally used for hot coffee—and she proceeded to stick it over the needle and cotton wad surrounding it.

"I don’t believe what I’m seeing here," I said, barely able to suppress a giggle. "With all the modern medical supplies today, whoever figured out that an ordinary coffee cup was the simplest and best way to keep a patient from being stuck by a needle was some kind of genius." She obviously agreed with me as she began to securely tape everything together so it wouldn’t move. When I was all done and ready to go, I was very amused by my new coffee-cup-of-a-breast sticking out from under my gown.

Unexpected Emotional Support

Shannon and I found ourselves talking nonstop as she wheeled me back to my room, and once there, she held my hand as we exchanged some personal information about ourselves. I really appreciated this feminine hand-holding because I had no one with me at the hospital that day; no one in the waiting room to speak with the surgeon afterwards. I have no family or close women friends in my neighborhood, so I’d taken a cab there and arranged for a friend from church to be called when I was ready for release since the hospital wouldn’t release me to go home in a cab.

The only times I’ve ever felt lonely since losing my husband have been when I’ve had to go through medical procedures by myself. I hate to bother acquaintances at church, and although I have a couple of close younger male friends who have helped me with personal issues a few times as a son or brother might do, I don’t like to bother them unless I have no other options for help.

SO THERE I WAS THAT DAY in the hospital, talking to Shannon about what I did for a living and her telling me she’d been thinking about writing a book about her life because she’d had breast cancer at 17 and almost died. Said her faith and positive attitude had gotten her through the ordeal and two bad marriages, one of which had given her a wonderful daughter. I wasn’t surprised to learn during our conversation that she was a born-again Christian—making her the third one I’d met since my breast cancer experience had begun. No "coincidences" here, I thought, now believing that God had put her in my life that day to give me just the emotional boost I needed at that time.

The surgery went without a hitch, but I didn’t know that for more than a week because when the surgeon found no one waiting for me in the waiting room, he simply went on to his next surgery. When I called his nurse the next day to see how the surgery had gone, she said she couldn’t give me any information on the phone and the doctor wouldn’t speak to me about it on the phone, either. "Good news or bad," she said, "it will have to come directly from the doctor when you see him for a follow-up visit." Because I hadn’t been told to schedule this follow-up appointment prior to the surgery, I almost had to wait two weeks instead of one to learn what I felt I should have been told the day of the surgery.

Once home, I had so little discomfort that a Tylenol took care of it, but it took me several days to feel normal again because of the anesthesia, I assumed. Something really knocked me for a loop, and I lazed in and out of bed for three days before I felt able to go back to my work.

GO TO PART II of this report

Surgeon Follow-Up * Gloomy Prognosis from the Oncologist * The Breast MRI Procedure * MRI Results Come Back Clean! * A Reader Shares Her Recurrent Cancer Story * Anti-Hormone Pills and Oral Chemo * More Reader Mail * Closing Thoughts

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