Docs increasingly abandon Medicare

June 21, 2010 by MassDevice staff

More and more physicians are cutting Medicare patients from their rosters after Congress fails to stay a 21 percent reimbursement rate cut.

Healthcare reform

As Congress allowed a 21 percent reduction in reimbursement rates for doctors to come into effect, the number of physicians pulling out of Medicare was already on an upward trend.

The number of individuals enrolling in the program is increasing as Baby Boomers reach age 65 and qualify for Medicare.

Nearly 40 million seniors will have enrolled in Medicare by 2015 and 57.5 million by 2020, compared to 41.4 million in 2008, according to USA Today and the 2009 Medicare Trustees report (PDF).

The Centers for Medicare and Medicaid Services says that 97 percent of physicians accept Medicare patients, but the agency doesn't know how many have refused to take new Medicare patients, deputy administrator Jonathan Blum told the newspaper.

The American Academy of Family Physicians said 13 percent of doctors did not participate in Medicare last year, according to the paper, up 8 percent from 2008 and 6 percent from 2004. The American Osteopathic Assn. said 15 percent of its members don't participate in Medicare and 19 percent don't accept new Medicare patients. If the 21 percent cut becomes permanent, the AOA estimated that those numbers would double, USA Today reported. The American Medical Assn. cited a survey of 9,000 members that found that 17 percent restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31 percent.

In states such as Florida, where doctors rely on Medicare payments for the majority of their income because most of their patients are elderly, physicians will see a drastic cut in their pay. In other states with smaller elderly populations, however, doctors can opt out of the program altogether. Eighteen percent of Illinois doctors restrict the number of Medicare patients in their practices, according to the newspaper; in North Carolina, 117 doctors have opted out of Medicare since January.

Doctors drop out or refuse to enroll in the Medicare program because its payments are already substantially lower than what private insurers pay. In 2008, Medicare paid doctors an average of 78 percent less than private insurers' rates.