HHS Attempts To Counter Reports That Doctors Are Opting Out of Medicare

In what appears to be an endeavor to defend against a recent Wall St. Journal report that indicated a rise in the number of physicians opting out of Medicare, the Department of Health and Human Services (HHS) states that its data now shows the number of physicians accepting new Medicare patients is now higher than the number of physicians accepting new private insurance patients.

At the end of July, a WSJ article indicated “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.” In addition, the WSJ piece said “other doctors are limiting the number of Medicare patients they treat even if they don’t formally opt out of the system.”

The source of the information for the WSJ article was the Centers for Medicare and Medicaid Services (CMMS).

USA Today reported Thursday, however, that a new HHS study states in 2007 about 925,000 doctors billed Medicare for their services. In 2011, that number had risen to 1.25 million.

“I think the report comes at a time when people are asking questions about Medicare,” said Jonathan Blum, principal deputy administrator of the Center for Medicare Services. “It provides a more complete picture of how physicians choose to participate in the Medicare system.”

According to USA Today, the new report was commissioned because of the WSJ article that reported the number of physicians who opt out of Medicare increased from 3,700 in 2009 to about 9,500 in 2012. HHS officials said the hike is not a problem because there are more new primary care physicians entering the health care system than older physicians dropping out.

“These findings allay concern that the number of physicians ‘opting out’ of Medicare has increased in recent years,” the HHS report states.

Blum said that departments that monitor Medicare, such as the Medicare Payment Advisory Commission (Medpac) have not seen any “alarming trends,” and, consequently, would not have issued a formal report if it had not been for the WSJ article.

“It confirms the picture we had,” Blum said. “It just adds one more data point to a story we’ve felt quite confident about.”

The researchers say they found that 90% of office-based physicians accept new Medicare patients, a rate similar to those who take privately insured patients. In addition, they say the rates of Medicare patients who can find a new doctor in a timely manner and those who are privately insured are similar.

Health care policy expert Avik Roy, writing at Forbes, however, wrote Monday that, in coming years, the United States could very well see growing shortages in the availability of primary care physicians (PCP’s):

With the number of individuals seeking care increasing and the current medical system continuing to incentivize physicians to specialize, the number of available PCPs will decline proportional to the population.

According to the WSJ report, an American Academy of Family Physicians survey found that the proportion of family doctors who accepted new Medicare patients last year, 81%, was down from 83% in 2010.

In the WSJ report, Joe Baker, president of the Medicare Rights Center, said his advocacy group has had an increase in phone calls from seniors who can’t find doctors willing to treat them.

In the report in USA Today, however, Baker said, “Overall, the clients we deal with have good access to physicians. We find the physicians who don’t take Medicare don’t take other insurance, either, but it’s not a problem we see regularly.”

The WSJ explored some of the reasons why doctors are opting out of Medicare:

Some doctors say Medicare's reimbursement rates—as low as $58 for a 15-minute office visit—force them to see 30 or more patients a day to make ends meet. "Family physicians have been fed up for a long time and it's getting worse," said Jeffrey Cain, president of the American Academy of Family Physicians. By disengaging with Medicare and other third-party payers, he says doctors can practice based on what patients need, not what insurers will pay.

Other doctors are dropping out of Medicare to avoid deeper government involvement in medicine, much of which is occurring in Medicare. For example, Medicare is now paying incentives to doctors who switch to electronic medical records and who send data on quality measures to the federal government. Doctors who are part of the Medicare program who don't do so will face penalties starting in 2015.

Dr. Juliette Madrigal-Dersch, a Marble Fall, Texas physician who is also the president of the American Association of Physicians and Surgeons, does not accept private insurance or Medicare, and says, as a result, her regular patients get better care.

“The service is a lot better because all the decisions about health care are made just between the doctor and the patient,” Madrigal-Dersch said in a Newmax TV interview. “There’s no outside entity that tries to influence what we’re doing as a team.”

While she is happy to put aside private health insurance as a third-party payer, she thinks even less of ObamaCare which, according to her, will turn patients into a number code and place doctors at risk of becoming criminals.

Madrigal-Dersch describes the new ObamaCare coding system rules as “arbitrary and capricious.”

“These codes are ridiculous and they’re just another way that the government or insurance companies can say that doctors are committing fraud,” she said.

Madrigal-Dersch predicts that the bureaucratic red tape involved in health care will only grow worse with ObamaCare.

“The doctor-patient relationship is the most important thing,” she said. “Keeping government and government money out of the doctor-patient relationship is the way to actually take really good care of people.”


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