As Medicare rules get stricter and the government gets stingier with reimbursements, a growing number of physicians are walking away from the program, but is it the crisis some have made it out to be?
The latest statistics from the Centers for Medicare & Medicaid Services (CMS), as reported by the Wall Street Journal, show the number of physicians pulling out of the program nearly tripled in 2012, when compared to the dropout rate in 2009. In absolute numbers, 9,539 doctors opted out of the program in 2012, compared to 3,700 in 2009.
[See also: Lack of data regarding doctors leaving Medicare]
While losing some 9,500 clinicians will only make a small dent in the program’s effectiveness – 685,000 physicians continue to accept Medicare – the question on many stakeholders’ minds is: How disruptive will these changes prove to be?
Answering that question requires some background on why clinicians are walking away from the program. Part of the problem, say physician leaders, is the sustainable growth rate (SGR), which the government has been using since the late 1990s to set the Medicare reimbursement rate. Currently, the SGR is set to reduce payments by 24.4 percent on January 1, 2014.
"… if Congress fails to avert this disastrous pay cut before 2014, family physicians once again will be forced to choose between caring for Medicare beneficiaries at a significant financial loss or ending their participation in Medicare," Jeff Cain, MD, president of the American Academy of Family Physicians, has warned. The AAFP estimates that the average family physician would lose nearly $90,000 in revenue in 2014 if that reimbursement cut goes through.
Given that bleak prospect, it’s no surprise that some physicians are leaving the program. Other Medicare regulations may also be contributing to the exodus. CMS has been urging hospitals and practices to implement electronic health records and threatening financial penalties for those who don’t. That has prompted some clinicians to stop seeing Medicare patients, or simply absorb the cost of the penalties.
[See also: Doctors leave private practice in droves]
“I get calls everyday saying ‘What do I do? What are my options? I’m getting such little reimbursement,’” said Jodi B. Laurence, JD, a founding partner of the Florida Health Law Center. “I had about three physicians call me in the last month or two who are opting out of the Medicare program to build concierge medical practices.”
The combination of the health reform law and changes in Medicare policies also seem to be contributing to doctors selling their practices to become hospital employees, or they are joining accountable care organizations, noted Laurence.
Despite these anecdotal reports, Medicare expert Diane J. Omdahl, RN suggests the statistics cited in the Wall Street Journal may not be as worrisome as they first appear.
According to Omdahl, author of The Beacon Guide to Medicare Service Delivery, the article’s statistics only tell part of the story. “If 9,500 doctors dropped out, how many new ones came into the program? … If you’re losing 9,500 but gaining let’s say 5,000 or 6,000, then how significant is the problem?” Similarly, the report didn’t mention how many patients were affected by those 9,500 physicians leaving the program, she said. It’s possible the physicians who opted out did so because fewer older patients were coming into their practices.