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Steer Clear of Medicare

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. Other doctors are limiting the number of Medicare patients they treat even if they don't formally opt out of the system. 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. Joe Baker, president of the Medicare Rights Center, said his patient-advocacy group has had an increase in calls from seniors who can't find doctors willing to treat them—mainly from affluent urban and suburban areas where many patients can pay out of pocket if their doctor doesn't accept Medicare. "Medicare has really been pushing its luck with physicians," said economist Paul Ginsburg, president of the nonpartisan Center for Studying Health System Change. 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. 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. Some doctors are particularly concerned about patient privacy. Doctors have three options for dealing with Medicare. Those who participate bill Medicare directly and must agree to accept its reimbursement rates for all covered services. So-called nonparticipating doctors still file Medicare reimbursement claims but can charge as much as 10% over Medicare's rates for some services, and they must bill patients for the difference. Those who opt out can charge patients whatever they want, but they must forgo filing Medicare claims for two years, and their Medicare-eligible patients must pay out of pocket to see them. "I couldn't do that if I took Medicare. Dr. Madrigal-Dersch is president of the Association of American Physicians and Surgeons, a conservative group that advocates private-pay medicine. 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. Physicians say dropping out isn't easy, and some medical specialties are more dependent on Medicare than others.

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