Medicare opt-outs tripled in 3 years

The number of doctors who opted out of Medicare last year--while estimated to be less than 1 percent of physicians, according to the Centers for Medicare & Medicaid Services--nearly tripled from three years earlier, the Wall Street Journal reported.

According to the newspaper, CMS said 9,539 physicians who previously accepted Medicare opted out 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.

Eighty-one percent of family doctors, who will be busier than ever once the Affordable Care Act is implemented, accepted new Medicare patients last year, down from 83 percent in 2010.

One reason physicians are formally and informally leaving the Medicare program is the constant threat of pay cuts posed by the sustainable growth rate (SGR), noted Paul Ginsburg, president of the nonpartisan Center for Studying Health System Change. Although a proposal to do away with the SGR was approved by a Congressional subcommittee last week, physicians face a nearly 25 percent cut in Medicare payments in January if an agreement is not reached.

For other doctors, working without government reimbursement gives them more freedom to practice as they desire. Those who opt out can charge patients whatever they want, WSJ noted, but they must forgo filing Medicare claims for two years, and their Medicare-eligible patients must pay out of pocket to see them.

"We give discounts to teachers and preachers, and anybody who comes in wearing spurs gets $5 off," Juliette Madrigal-Dersch, a pediatrician and internist in Marble Falls, Texas, told the newspaper, adding that she doesn't charge patients who develop cancer. "I couldn't do that if I took Medicare. It's considered an illegal enticement."

According to Madrigal-Dersch,president of the Association of American Physicians and Surgeons, "It's [private-pay medicine has] gone from being a fringy, rebellious thing to a business model."

To learn more:
- read the article from the Wall Street Journal

Suggested Articles

A collaboration between California payers and providers yielded millions in savings and prevented thousands of unneeded ER visits and admissions. 

Physicians certified by the American Board of Internal Medicine will soon have a new option that takes some of the pain out of MOC.

Payers and providers have made significant investments in digitizing the healthcare system but have yet to see a return on that investment.