More American doctors than ever are opting to not treat patients enrolled in Medicare, citing frustrations with its payment methods and pushback against strict rules.
Although the number of American doctors who have opted out of the Medicare program last year is small, it has nearly tripled over the last three years according to the Centers for Medicare and Medicaid Services, or CMS. Other doctors are limiting the number of Medicare patients they treat even if they aren’t officially opting out of the system. Fewer doctors claim that they aren’t accepting new Medicaid patients, and the number of medical professionals who don’t participate in private insurance contracts is growing as well.
Health experts are quick to point out that the number of doctors who are going “off-grid” isn’t enough to undermine the Affordable Care Act that will allow millions of Americans to gain access to health insurance next year. However, it may mean that some Americans may have difficulty finding doctors who will accept their new benefits.
According to the CMS, 9,539 physicians who previously accepted Medicare opted out of the program in 2012 as opposed to the approximately 3,700 who opted out in 2009. Meanwhile, 81 percent of family physicians accepted new Medicare patients last year according to a survey of 800 members of the American Academy of Family Physicians. This sounds like a high percentage, but it is down from 83 percent in 2010. The study also found that four percent of family physicians are now either cash only or concierge practices in which patients pay monthly or yearly fees. This is up from three percent in 2010.
This pullback from Medicare has caused some problems in certain quarters. According to president Joe Baker of the Medicare Rights Center, more and more seniors are complaining that they are unable to find doctors willing to treat them. These complaints are coming from affluent neighborhoods where many patients are able to pay out of pocket if their doctors won’t accept Medicare.
One reason why so many physicians are turning their backs on Medicare is because payment rates haven’t kept up with inflation. With the threat of more cuts to come, physicians are expecting to receive even smaller payments unless Congress steps in and delays the cuts, something that they have done in the past. Other doctors say that Medicare’s reimbursement rates – which are sometimes as low as $58 for a 15-minute visit – require them to see as many as 30 patients a day just to make ends meet. These doctors are opting out of Medicare so that they can spend more time with fewer patients and give them the treatment that they need.
New rules and regulations are other reasons why so many doctors are choosing to leave Medicare behind. For example, Medicare is currently paying doctors incentives for switching to electronic medical records and sending data on quality measures to the government. Medicare doctors who do not do this may face penalties beginning in 2015. While some larger practices see the benefits of such regulations, other doctors would rather do things the way they’ve always done them. They are also concerned with patient confidentiality. The sharing of information amongst other medical professionals is intended to help patients, but many doctors claim that it will do so at the expense of their privacy.
Doctors currently have three options when dealing with Medicare. They may participate in the program, which means that they bill Medicare directly and accept its reimbursement rates for all services that are covered. Non-participating doctors still have to file Medicare reimbursement claims, but they can charge as much as 10 percent over Medicare’s regular rates for certain services and bill patients for the difference. The third option is to opt out of Medicare altogether. Those that take this option must forgo filing Medicare claims for two years, and Medicare-eligible patients have to pay out of pocket for services.
The fact that more physicians than ever are taking this third option has upset many older patients who are afraid of being charged more than what they should be. Although the physicians opting out of Medicare swear that they don’t raise rates significantly, the fear remains, as does the stigma of being unwilling to accept Medicare. The number of physicians who do accept Medicare still greatly outnumbers those who don’t, and even other doctors are hesitant to refer patients to those who have opted out of the program. In the end, few doctors can compete with what is essentially free health care no matter who they are.
It’s difficult to tell if this trend of doctors refusing to accept Medicare will continue. It is a small trend to be sure, but it is one that is slowly growing. The big test will occur next year when the Affordable Care Act takes effect. Although Medicare is most likely too big to disappear completely, the fact that so many doctors have turned their backs on it is indeed alarming i.
First, if you are a Medicare recipient, check with your doctors to see whether he/she will accept your coverage. Don’t be caught unprepared when you need medical care. Find out what resources are, and will continue to be, available to your family members with special needs. While the elderly are the primary beneficiaries of Medicare, many individuals under 65 who are permanently disabled may also qualify. Then, talk with your elected representatives: get informed and understand how changes to our health care delivery system with impact you and your family. Get the facts, know the law. Join one of the many groups that advocate for special populations.
Copyright 2013 James Stanfield Company. All Rights Reserved.
i: This article was inspired by the following: http://online.wsj.com/article/SB10001424127887323971204578626151017241898.html
The child who is ‘left behind’ most is the one who leaves school without transition readiness.
Dr. James Stanfield, Ed.D.