NCPA - National Center for Policy Analysis

More Doctors Steer Clear of Medicare

August 5, 2013

Fewer American doctors are treating patients enrolled in the Medicare health program for seniors, reflecting frustration with its payment rates and pushback against mounting rules, according to health experts. The number of doctors who opted out of Medicare last year, while a small proportion of the nation's health professionals, nearly tripled from three years earlier, says the Wall Street Journal.

Other doctors are limiting the number of Medicare patients they treat even if they don't formally opt out of the system. All told, health experts say the number of doctors going "off-grid" isn't enough to undermine the Affordable Care Act, but they say some Americans may have difficulty finding doctors who will take their new benefits or face long waits for appointments with those who do.

  • The Centers for Medicare and Medicaid Services (CMS) says 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 was 81 percent, down from 83 percent in 2010, according to a survey by the American Academy of Family Physicians of 800 members.
  • The same study found that 4 percent 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 percent in 2010.
  • A study in the journal Health Affairs this month found that 33 percent of primary care physicians didn't accept new Medicaid patients in 2010-2011.

Some experts attribute the rise in defections to Medicare payment rates that haven't kept pace with inflation and the threat of more cuts to come. Under a budgetary formula enacted by Congress in 1997, physicians could see Medicare reimbursements slashed by 25 percent in 2014 unless Congress intervenes to delay the cuts, which it has done several times.

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.

Source: Melinda Beck, "More Doctors Steer Clear of Medicare," Wall Street Journal, July 29, 2013.


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