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Physicians Leaving Medicare

By February 22, 2012Commentary

Doctors have complained for decades that Medicare does not pay them adequately for services they provide to the program’s beneficiaries.  In addition, they feel burdened by the program’s administrative requirements and the constant threat of fraud and abuse and other prosecutions.  Policymakers have expressed concern about whether this might cause physicians, especially specialists, to stop treating beneficiaries and cause access problems, but data and solid research on this topic is missing.  There have been some suggestions that a number of doctors are not taking new Medicare patients, but are continuing to see current ones, but even this is not supported by significant evidence.  A new report from the Health and Human Services Office of Inspector General sought to ascertain how many physicians had opted out of Medicare and whether there was an increasing trend in this regard.  The primary finding of the report was that, contrary to regulatory requirements, the data was not being collected and reported in an adequate enough fashion to do  a good analysis.   (HHS OIG Report)

The most revealing aspect of the report, other than the fact that the government is not collecting data it is supposed to on a pretty important topic, is the ludicrous system set up for physicians to opt out of Medicare.  A doctor who wants to treat older patients outside of Medicare has to jump through numerous hoops and this limits the rights of those older people who have the ability and desire to see these doctors and pay for it themselves.  Doctors have to sign an opt-out agreement every two years and have to tell patients that they aren’t in the program and patients won’t be reimbursed for services received from these doctors, in a complicated way.  That may explain why the OIG noted that although they could not even collect data from all the sources who are supposed to be keeping it, what data was available showed a trend that there was a increase in the number of doctors not participating in Medicare and opting out.  For a significant portion of the population it may be a more palatable option to get their physician services through arrangements made outside the Medicare program.

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