Share of Physicians Seeing New Medicare Patients Has Risen

August 23, 2013

Organized medicine sometimes gives the impression its members are itching to quit Medicare. The reimbursement is too low, it says. The regulatory burden is too high.

Furthermore, physicians will leave the program in droves if Congress does not avert a 24.4% Medicare pay cut set for 2014, organized medicine has warned. Just the threat of a massive cut — triggered by the program's sustainable growth rate formula — is enough to make physicians jump ship, especially when Congress dilly-dallies about Medicare reimbursement year after year, the argument goes.

An article in the Wall Street Journal on July 29 appeared to confirm that Medicare was leaking more and more physicians. Citing figures from the Centers for Medicare & Medicaid Services, the newspaper reported that the number of physicians who opted out of Medicare rose from 3700 in 2009 to 9539 in 2012. Physicians who opt out collect their full fee from the patient, who is not reimbursed in turn by Medicare. No bills arrive on Medicare's desk in this private arrangement.

Nearly a month after that article was published, however, the Department of Health and Human Services (HHS) has come out with a study that paints a rosier picture about physician allegiance to Medicare. The study, released yesterday, states that the percentage of physicians accepting new Medicare patients increased, going from 87.9% in 2005 to 90.7% in 2012. The trend for new privately insured patients was the exact opposite: almost 90% of physician accepted new privately insured patients in 2005 compared with between 86% and 87% in 2012.

"To the extent that that there may have been a very small increase in the number of providers 'opting out,' that increase has been mitigated by an increase in the share of other physicians who accept new Medicare patients," write the authors, who work in the Office of the Assistant Secretary for Planning and Evaluation in HHS.

In addition, the number of physicians, nurse practitioners, physician assistants, and other clinicians who participate in Medicare or bill the program as "nonparticipants" steadily rose from 2007 to 2011. Although participating providers accept the Medicare rate for a particular service as payment in full, nonparticipants can balance bill beneficiaries beyond a discounted Medicare rate, within specified limits.

The authors write that all these findings "allay concern that the number of physicians 'opting out' of Medicare has increased in recent years."

What is more, overall access to care for Medicare beneficiaries from 2008 to 2012 was not only stable but was also close to, and sometimes slightly better than, that for the privately insured, according to the HHS report. It cites survey data from the independent Medicare Payment Advisory Committee showing that the percentage of Medicare beneficiaries who said they never experienced a delay in getting an appointment for an illness or injury rose from 76% in 2008 to 77% in 2012. Those same percentages among the privately insured were 69% in 2008 and 72% in 2012. Medicare beneficiaries were slightly less likely than the privately insured to have only a small problem finding a new primary care physician in 2012 (72% vs 75%, respectively) but were slightly more likely to have only a small problem finding a new specialist (87% vs 86%).

The report also cited an HHS survey showing that the percentage of Medicare beneficiaries who were rejected as a new patient in 2011 and 2012 was only a shade over that among privately insured (3.7% vs 2.5%, respectively).

"Overall, Medicare beneficiary access to care has been consistently high over the last decade," the authors write, "and continues to be high today."

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