If You’re on Medicare, the Doctor May Not See You Anymore

by Veronique de Rugy

The Wall Street Journal reported yesterday that the regulatory cost of complying with Medicare and its payment rate is driving doctors to steer clear of the program’s elderly patients. Here are the numbers:

CMS said 9,539 physicians who had accepted Medicare opted out of the program in 2012, up from 3,700 in 2009. That compares with 685,000 doctors who were enrolled as participating physicians in Medicare last year, according to CMS, which has never released annual opt-out figures before.

Meanwhile, the proportion of family doctors who accepted new Medicare patients last year, 81%, was down from 83% in 2010, according to a survey by the American Academy of Family Physicians of 800 members. The same study found that 4% of family physicians are now in cash-only or concierge practices, where patients pay a monthly or yearly fee for special access to doctors, up from 3% in 2010.

A study in the journal Health Affairs this month found that 33% of primary-care physicians didn’t accept new Medicaid patients in 2010-2011.

As you can see in the following chart, the trend is clear:

The trend is being driven in part by frustration with the regulatory compliance burden and the fact that “Medicare payment rates that haven’t kept pace with inflation,” and that there is a ”threat of more cuts to come.” This could be made dramatically worse in 2014 because of an automatically scheduled cut to reimbursement rates, though this has always been avoided with legislation that puts it off. Until now, Congress has systematically postponed the cuts, though they’ve also used them as ”savings” to lower the cost of legislation, including Obamacare.

Very few people believe that these cuts will ever be implemented. Allowing these cuts in doctors’ fees to be implemented would reduce Medicare spending, but doctors will be very upset. It shouldn’t surprise anyone that they don’t want to work for less money. As a result, if the cuts were implemented, and once doctors understand that their rates aren’t going back up — no matter how much they lobby and scream about the unfairness of it all —  they will likely stop serving Medicare patients or at least reduce the number of Medicare patients they see, feeding the trend described above. This is the way it works.

Seniors are already upset with the way things are going (they still have to pay a Medicare premium even if they can only find doctors to see by paying out-of-pocket) are unlikely to like the way things will continue to go if the cuts are implemented.

Meanwhile, here is what some doctors are doing in their Medicare after-life:

Doctors who don’t take Medicare say they don’t necessarily raise rates significantly. Some say not having to submit claims and file mandated reports allows them to keep their overhead low. They can also adjust their fees to fit patients’ needs.

“We give discounts to teachers and preachers, and anybody who comes in wearing spurs gets $5 off,” said Juliette Madrigal-Dersch, a pediatrician and internist in Marble Falls, Texas. She says she also treats patients who develop cancer free of charge. “I couldn’t do that if I took Medicare. It’s considered an illegal enticement.” Dr. Madrigal-Dersch is president of the Association of American Physicians and Surgeons, a conservative group that advocates private-pay medicine. “It’s gone from being a fringy, rebellious thing to a business model,” she added.

When the Mayo Clinic’s small family practice office in Glendale, Ariz., stopped taking Medicare in 2009, only about 500 of its 3,500 Medicare patients stayed on. Since then, an additional 250 elderly patients have joined the practice, paying between $200 to $575 a visit. Physicians say dropping out isn’t easy, and some medical specialties are more dependent on Medicare than others.

The whole thing is here.


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