According to the Centers for Medicare and Medicaid (CMS), fewer doctors are treating patients enrolled in the Medicare health program for seniors and the Medicaid (known as MediCal in California) for low income individuals; they cite frustration with payment rates and pushback against mounting rules, according. At present, only a small proportion of physicians have opted out of the programs; however, the number is increasing significantly. In 2012, it nearly tripled from three years earlier, In addition, some healthcare providers are limiting the number of Medicare and Medicaid patients they treat.
The number of doctors that will accept new Medicaid patients is even less than the number who have opted out of caring for Medicare patients. Another increasing problem is the number of physicians who do not participate in private insurance contracts. This trend is increasing just as millions of Americans are poised to gain access to insurance coverage under the provisions of the Affordable Care Act, which will be implemented next year. At present, healthcare analysts do not feel the physicians opting out of the aforementioned programs is not enough to throw a monkey wrench into the Affordable Care Act; however, some are of the opinion that some individuals may have difficulty finding doctors who will take their new benefits or face long waits for appointments with those who do.
The CMS reported that 9,539 physicians who had accepted Medicare opted out of the program in 2012, marking an increase from 3,700 in 2009. That compares with 685,000 doctors who were enrolled as participating physicians in Medicare last year. According to a survey by the 800-member American Academy of Family Physicians, another trend is that the proportion of family doctors who accepted new Medicare patients last year was 81%, marking a decrease from 83% in 2010,. The same study found that 4% of family physicians are now in cash-only or concierge practices, where patients pay a monthly or yearly fee for special access to doctors; participation in this type of practice is up from 3% in 2010. In addition, a study released this month in the journal Health Affairs found that 33% of primary care physicians (PCPs) did not accept new Medicaid patients in 2010-2011.
Some healthcare analysts blame the situation on Medicare reimbursement to physicians, which has not kept pace with inflation as well as the threat of more cuts to come. Under a budgetary formula enacted by Congress in 1997, Medicare reimbursements to physicians could be slashed by 25% in 2014 unless Congress intervenes to delay the cuts. This may occur, because Congress has intervened on Medicare payments several times in the past.
Another factor in the increasing Medicare and Medicaid dropout rate is that the federal government is becoming increasingly involved in physician practices. 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. Physicians who accept Medicare patients and do not adhere to the policy will face penalties starting in 2015.
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. Currently, nonparticipating physicians can still file Medicare reimbursement claims but can charge as much as 10% over Medicare’s rates for some services; in addition, they must bill patients for the difference. Those who opt out can charge patients whatever they want; however, they must forego filing Medicare claims for two years, and their Medicare-eligible patients must pay out of pocket to see them.