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| Texas doctors opting out of Medicare at alarming rate |
| 2010-05-18 |
| Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable. Two years after a survey found nearly half of Texas doctors weren't taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program. Before 2007, the number of doctors opting out averaged less than a handful a year. “This new data shows the Medicare system is beginning to implode,' said Dr. Susan Bailey, president of the Texas Medical Association. “If Congress doesn't fix Medicare soon, there'll be more and more doctors dropping out and Congress' promise to provide medical care to seniors will be broken.' More than 300 doctors have dropped the program in the last two years, including 50 in the first three months of 2010, according to data compiled by the Houston Chronicle. Texas Medical Association officials, who conducted the 2008 survey, said the numbers far exceeded their assumptions. The largest number of doctors opting out comes from primary care, a field already short of practitioners nationally and especially in Texas. Psychiatrists also make up a large share of the pie, causing one Texas leader to say, “God forbid that a senior has dementia.' The opt-outs follow years of declining Medicare reimbursement that culminated in a looming 21 percent cut in 2010. Congress has voted three times to postpone the cut, which was originally to take effect Jan. 1. It is now set to take effect June 1. Not cost-effective The uncertainty proved too much for Dr. Guy Culpepper, a Dallas-area family practice doctor who says he wrestled with his decision for years before opting out in March. It was, he said, the only way “he could stop getting bullied and take control of his practice.' “You do Medicare for God and country because you lose money on it,' said Culpepper, a graduate of the University of Texas Medical School at Houston. “The only way to provide cost-effective care is outside the Medicare system, a system without constant paperwork and headaches and inadequate reimbursement.' Ending Medicare participation is just one consequence of the system's funding problems. In a new Texas Medical Association survey, opting out was one of the least common options doctors have taken or are planning as a result of declining Medicare funding — behind increasing fees, reducing staff wages and benefits, reducing charity care and not accepting new Medicare patients. In 2008, 42 percent of Texas doctors participating in the survey said they were no longer accepting all new Medicare patients. Among primary-care doctors, the percentage was 62 percent. The impact on doctors has not been lost on their patients. Kathy Sweeney, a Houston retiree, twice has been turned away by specialists because they weren't accepting new Medicare patients. She worries her doctors might have to drop her if Medicare cuts go through and they can't afford to continue in the program. “I've talked to them about the possibility,' said Sweeney, who sent her legislators a letter calling on them to fix Medicare. “They're hanging in there as long as there's not a severe cut, but just thinking I couldn't continue doctor-patient relationships I built up over years is disturbing. Seniors should be able to see the doctors they want.' The problem dates back to 1997, when Congress passed a balanced budget law that included a Medicare payment formula aimed at reining in spending. The formula, which assumed low growth rates, called for payment cuts if spending exceeded goals, a scenario that occurred year after year as health care costs grew. The scheduled cuts, expected to be modest, turned out to be large. Congress would overturn the cuts, but their short-term fixes didn't keep up with inflation. The Texas Medical Association says the cumulative effect since 2001 already amounts to an inflation-adjusted cut of 20.9 percent. In 2001, doctors receiving a $1,000 Medicare payment made roughly $410, after taking out operating expenses. In 2010, they'll net $290. If the scheduled 21.2 percent cut goes through, they'd net $72, effectively an 83 percent cut since 2001. The issue caused the Texas Medical Association to break ranks with the American Medical Association and oppose health care reform efforts throughout 2009. Then TMA President Dr. William Fleming said “reform is doomed to failure' without Medicare reform and called Congress' failure to devise a rational payment plan “an insult to seniors, people with disabilities and military families.' No surprise to senator U.S. Sen. John Cornyn, R-Texas, said he isn't surprised by the new opt-out numbers, allowing that Congress' inability to reform Medicare is leaving “seniors without access and breaking the promise we made to them.' “The problem has been how to eliminate the cuts without running up the deficit,' said Cornyn, responding to blame U.S. Rep. Gene Green, D-Houston, placed on the Senate for not passing a House bill that would have provided a longer-term Medicare fix. “There hasn't been the political will, but we really have no choice but to fix it.' Cornyn acknowledged the task is daunting. The Congressional Budget Office recently estimated that eliminating scheduled Medicare payment cuts through 2020 would cost $276 billion. The growth in Texas Medicare opt-outs began in earnest in 2007, when 70 doctors notified Trailblazer Health Enterprises, the state's Medicare carrier, they would no longer participate, up from seven in 2006. The numbers jumped to 151 in 2008, fell back to 135 in 2009 and are on pace for 200 in 2010. From 1998 to 2002, by contrast, no more than three a year opted out. Now, according to a Texas Medical Association new poll, more than four in 10 doctors are considering the move. “I've been in practice 24 years, and a lot of my patients got old right along with me,' Culpepper said. “It's stressful to tell them you're leaving Medicare and they're responsible for payments if they want to stay with you. You feel like you're abandoning them.' |
| Posted by:Beavis |
| #11 In Canada Doctors are contracting with individuals directly. I believe this could happen here but government bulling will squash that I believe. Exit plans are being reviewed now. In truth Doctors are a good bit sharper than the average person. The frog in the hot water is cooked but a toe dip first in the water makes his next move clearer. |
| Posted by: Dale 2010-05-18 18:47 |
| #10 tw: The standard cost savings to doctors is so great, if they refuse Medicare/Medicaid/Insurance, that typically they can charge patients 50% less, and still make more money. At that point, their biggest expense is their own malpractice insurance. If they could ditch most of that, medical care would be downright cheap. |
| Posted by: Anonymoose 2010-05-18 18:13 |
| #9 I'm sure the elderly will be able to get all the care they want from their doctors... but by paying cash out of pocket instead of just Medicare copayments. The thing is -- and I hope someone in the medical field will be able to confirm or refute what I've read -- in enough cases it's actually cheaper for the doctor to provide care if he doesn't have to support the Medicare/Medicaid/insurance system (waiting for months to find out how much the partial payment will be, paying the salaries of support staff to deal with Medicare/Medicaid/insurance companies, etc.). If that's the case, all except the very poorest will find themselves ahead in terms of the care they get, although patients will have less discretionary income because they're paying the full freight for their treatment. |
| Posted by: trailing wife 2010-05-18 17:01 |
| #8 Merck Pharmaceutical I understand is cutting help at this time. This is sad as they for years have been the backbone of our medical needs. Cuts in Medicare were to show savings under new program. So other medical insurers will do just as Medicare. Reasonable and customary charges and patient 20%. |
| Posted by: Dale 2010-05-18 16:41 |
| #7 This was predicted prior to Obamacare, which is making things even worse with 580 BILLION in Medicare cuts. |
| Posted by: OldSpook 2010-05-18 16:28 |
| #6 Doctors can't serve patients if said doctors are forced to provide services to patients below their own cost. |
| Posted by: AzCat 2010-05-18 16:27 |
| #5 That's true. Many doctors' practices have a high number of elders. Oncology doctors, gerontologists, and many other specialties rely on senior patients. |
| Posted by: JohnQC 2010-05-18 16:11 |
| #4 Oh, it can be done on a large scale basis, one doctor at a time. Nothing says they have to do business on a money losing basis. And medicare payments are too close to that. Look for more and more doctors to go out of system all together. The good ones have been for 10 years, fed up with the interference of insurance companies in their practice of medicine. |
| Posted by: Nimble Spemble 2010-05-18 16:08 |
| #3 Medicare patients make up such a large fraction of all patients that this really can't be done on widespread basis. Doctors need patients, too. |
| Posted by: Anguper Hupomosing9418 2010-05-18 16:01 |
| #2 The issue caused the Texas Medical Association to break ranks with the American Medical Association and oppose health care reform efforts throughout 2009. Good for Texas. AMA has only about 20% of the countries physicians. AMA represents physicians about like the AARP represents seniors. |
| Posted by: JohnQC 2010-05-18 15:50 |
| #1 I hold the AMA's poor negotiating strategy responsible for this. I predict their "support" for Obamacare will more grievously wound the AMA than the Sunbeam debacle. |
| Posted by: Glomock Tojo6610 2010-05-18 15:27 |