Shocker: Doctors taking fewer Medicare patients

posted at 2:20 pm on June 21, 2010 by Ed Morrissey

USA Today reports today on the move away from Medicare patients by providers frustrated by the system as if it were a new phenomenon.  The report claims that “a new high” in doctors declining to accept Medicare is linked to the failure of Congress to pass the “doctor fix” bill that would have rescinded a 21% cut in reimbursements.  However, this problem has been building for a long time, and the recent changes to the health-care system won’t make it any better:

The number of doctors refusing new Medicare patients because of low government payment rates is setting a new high, just six months before millions of Baby Boomers begin enrolling in the government health care program.

Recent surveys by national and state medical societies have found more doctors limiting Medicare patients, partly because Congress has failed to stop an automatic 21% cut in payments that doctors already regard as too low. The cut went into effect Friday, even as the Senate approved a six-month reprieve. The House has approved a different bill.

Blame Nancy Pelosi for not getting the doc-fix bill passed in the House.  She’s holding it hostage to more deficit-exploding “stimulus” legislation in the Senate.  However, that’s not the primary reason that doctors are bailing out of Medicare, as USAT’s own stats show:

• The American Academy of Family Physicians says 13% of respondents didn’t participate in Medicare last year, up from 8% in 2008 and 6% in 2004.

• The American Osteopathic Association says 15% of its members don’t participate in Medicare and 19% don’t accept new Medicare patients. If the cut is not reversed, it says, the numbers will double.

• The American Medical Association says 17% of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%.

The reimbursement cuts just occurred, and the Democrats had promised to rescind them as soon as ObamaCare passed.  The trend has been years in the making, though, not just a couple of weeks, as the data above show.  Medicare’s reimbursements have traditionally been significantly lower than private-sector market value for the services rendered.  Thanks to high liability costs and increasing taxes on equipment in ObamaCare, the cost of delivery keeps shooting upward while Medicare attempts to control “costs” by fixing prices.

The end result of that kind of process will always be shortages.  Unless providers can get compensated properly for their time and materials, they will start disappearing from the marketplace.  Top-down price controls create too much pressure on providers, and the only reason we have as many in the market as we do is because enough privately-insured patients remain to spread the losses doctors incur from Medicare patients.  The move to expand governmental price controls over the marketplace makes that a less-than-certain proposition for the future, and so providers have decided to leave the Medicare losses behind them.

What does that mean for Medicare patients?  It means longer wait times, much less choice, and probably a lower quality of care overall as the number of providers narrow to high-volume, low-cost clinics.  Even those providers who continue to accept Medicare patients will get overwhelmed by the demand, and instead of seein doctors, patients will have to make do with triage nurses and physician’s assistants.   The one program that succeeded in ameliorating this process by introducing a private/public partnership, Medicare Advantage, will be emasculated over the next couple of years by massive cuts to the program.

Speaking of which, CQ Politics considers the electoral impact that 11 million angry seniors will have when they realize that their MA plans will get slashed:

During a slow-moving political storm marked by what Harvard pollster Robert Blendon calls “Level Four” anger, the last thing Democratic candidates want to face in September is 11 million angry seniors.

But when seniors in Medicare Advantage — the popular program of private health care plans in Medicare — open their mail this fall and find out how their coverage will change next year, they won’t be happy.

The program has been a big draw because it offers extra benefits, such as dental and vision care. It’s also a much cheaper way than supplemental “Medigap” plans of getting coverage for the out-of-pocket charges not picked up by traditional Medicare.

But chances are seniors soon will be staring art higher premiums, and slimmer benefits, for Medicare Advantage. They’ll no doubt be told the new health care law (PL 111-148, PL 111-152) is to blame.

The reason: As medical costs rise, the overhaul will at first flatten, then cut, federal payments to Medicare Advantage plans as part of an effort to finance coverage of the uninsured and allocate benefit dollars more equitably throughout the program.

USA Today may only have just noticed it, but it’s a predictable process with an equally predictable end game.


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Really…??

PatriotRider on June 21, 2010 at 2:22 PM

“If you like your doctor, you can keep your doctor”

forest on June 21, 2010 at 2:22 PM

But I like my doctor. I was told I could keep my doctor.

Chuck Schick on June 21, 2010 at 2:23 PM

No one saw this coming……thanks Obama voters!

search4truth on June 21, 2010 at 2:24 PM

“It continues?”

Soon it will be, “It accelerates.”

trapeze on June 21, 2010 at 2:24 PM

It’s all part of the plan.

Mike Honcho on June 21, 2010 at 2:24 PM

Unintended Death Panels.

portlandon on June 21, 2010 at 2:24 PM

duh

txag92 on June 21, 2010 at 2:25 PM

I don’t get it. They only cut half a trillion from Medicare? Does it make that big a difference?

Doughboy on June 21, 2010 at 2:25 PM

Another trend that is getting stronger: Doctors dropping all insurance and only accepting cash payments.

If you’re stuck with the ObamaCare plan and can’t afford cash payments, your healthcare is going to suck.

Norwegian on June 21, 2010 at 2:25 PM

But we had to pass the bill to see what’s in it!

/Pelosi

Steve Z on June 21, 2010 at 2:26 PM

“If you like your doctor, you can keep your doctor”

“Si te gusta su médico, usted puede conservar a su médico”

portlandon on June 21, 2010 at 2:26 PM

My father is a close-to-retirement PCP, so naturally he has a lot of older patients. A couple of years ago, he had to cap the number of Medicare patients he could accept because he was actually losing money as a result of treating so many. Liberals who hate the big bad insurance companies should shift some of the vitriol to Medicare – it’s 100x worse.

krispy on June 21, 2010 at 2:26 PM

Remember the famous slight hike in Medicare charges in the late 80′s- where seniors were bouncing Rostenkowski’s car?

This is going to be much, much worse.

Chuck Schick on June 21, 2010 at 2:26 PM

It’s all part of the plan.

Mike Honcho on June 21, 2010 at 2:24 PM

Yup, this is where the seizure of all student loans comes into the equation. The State will force young doctors to take loss-leading patients as a condition of getting their money to finish school.

forest on June 21, 2010 at 2:27 PM

“If you like your doctor, you can keep him.”

…alas, your doctor may not keep you…….

circles, squared.

ted c on June 21, 2010 at 2:28 PM

If you like your doctor, we’d love to take the money you pay for your healtcare and use it to buy a pair of boobies for a transgendered dude named Frank.
/bho

ted c on June 21, 2010 at 2:29 PM

Obama: Those old fogies are a pain in the @$$ at their Town Halls and Tea Parties. Let’s cut Medicare, let ‘em get sick and die, so that young, healthy people will re-elect My Audacity of Hope.

Steve Z on June 21, 2010 at 2:30 PM

krispy on June 21, 2010 at 2:26 PM

Yep, payor mix is the difference between prospering & closing the doors.

cs89 on June 21, 2010 at 2:30 PM

The problem is that no matter how much this may be ‘part of the plan’, once doctors start to realize they can lower their costs, primarily overhead for paperwork, by removing insurance and going cash only, the greatest health plan in the world won’t attract them back. Once the economic reality sets in, it will set in hard and fast.

Cutting payments just means losing doctors to the plan. That rush to the door has begun, and even repeal of Obamacare won’t stop it. Physicians talk to each other and when the bottom line cost differential is understood, even private plans will have to start facing the music as it is cheaper and easier to take NO plans than to take SOME plans.

ajacksonian on June 21, 2010 at 2:33 PM

WOW, this was unexpected ….

tarpon on June 21, 2010 at 2:34 PM

It’s almost as if the people who were advocating against Obama’s health care takeover expressed the correct concerns about government screwing up health care not only for the young and able-bodied, but also for those who need that care the most (the elderly and infirm).

Good Lt on June 21, 2010 at 2:35 PM

But these doctors are all just greedy and want to rip out your tonsils and send you the bill or something.

Good Lt on June 21, 2010 at 2:36 PM

It’s almost as if the people who were advocating against Obama’s health care takeover expressed the correct concerns about government screwing up health care not only for the young and able-bodied, but also for those who need that care the most (the elderly and infirm).

Good Lt on June 21, 2010 at 2:35 PM

Nope, that was just racism – straight up!

forest on June 21, 2010 at 2:37 PM

Whose a@@ are you going kick now, dear leader?

cmsinaz on June 21, 2010 at 2:37 PM

WOW, this was unexpected ….

tarpon on June 21, 2010 at 2:34 PM

And unprecedented too!

Johnnyreb on June 21, 2010 at 2:38 PM

forest,

Yup, this is where the seizure of all student loans comes into the equation. The State will force young doctors to take loss-leading patients as a condition of getting their money to finish school.

I hadn’t thought about that specifically but it makes sense.

The plan I was referring to is underfunding Medicare to such an extent that doctors no longer accept it.
Couple that with creating millions of uninsured via “penalties” which incentivize private companies to dump their health care plans and watch millions of uninsured and underinsured demand a single payer health care “solution”.

Mike Honcho on June 21, 2010 at 2:39 PM

Isn’t this what the Republican’s said during the passage of this pile o’crap? And if I remember, Obama’s response was, “liar, liar, pants on fire”.

ramrants on June 21, 2010 at 2:40 PM

It’s headline news in the papers where I live.

There’s no surprise. Bam said to just “take a pill”, right?

We all know that the ugly truth is that they don’t want seniors around. It’s called ‘culling’ the population.

Meanwhile, millions of illegals are here, receive treatment – including Barry’s aunt – and the rest of us can simply rot.

Cody1991 on June 21, 2010 at 2:40 PM

If the ‘rats force doctors to accept patients then this problem will go away.

Bishop on June 21, 2010 at 2:44 PM

Obama: Those old fogies are a pain in the @$$ at their Town Halls and Tea Parties. Let’s cut Medicare, let ‘em get sick and die, so that young, healthy people will re-elect My Audacity of Hope.

Steve Z on June 21, 2010 at 2:30 PM

He could probably care less what comes next electorally. As we have seen in his strategy to incrementally cause a wholesale collapse in the health care delivery system in this country – to deliberately create the incipient massive crisis which will require the complete government takeover of the entire health care delivery infrastructure – he doesn’t even care if his own party collapses next fall when voters get wind of the real long-term agenda behind that bogus ‘health care’ bill of his.

He’s here to “bring Amerika to it’s knees” and achieving the incapacitation of this nation in penance for our alleged sins against the third world requires that the Democratic party is also destroyed in the process. Nothing personal, Nancy & Harry.

leilani on June 21, 2010 at 2:44 PM

Kinda takes away from the death panels found in Ocare.

Kissmygrits on June 21, 2010 at 2:51 PM

So they notice the phenomenon only when they have a proper scapegoat for it? The number of doctors refusing Medicare patients has been growing for a while, but it only becomes a story when it can be blamed on Republicans not passing the latest “doctor fix” bill?

Yep, that’s the media we’ve all come to know for the last generation or so….

tom on June 21, 2010 at 2:52 PM

Doctor, Doctor
Give me the news.
I got a bad case of Obamacare blues.

TN Mom on June 21, 2010 at 2:53 PM

Now Obama is hot on controlling health care
He’s made it his personal affair
National Socialist the country will be
As he goose-stepped all over the Constitution, said he
‘Cause you see, if it means more power for me, then the misery it brings is just something you must all grin and bare

Cheshire Cat on June 21, 2010 at 2:54 PM

It is bad enough now but when all the new insured people start trying to get in to see a doctor the situation will only get worse.

Add 30% to the patient load and keep the numbers of doctors constant and you see the problem.

CommentGuy on June 21, 2010 at 2:58 PM

Massachusetts has a bill for that!

Doctors may be forced to accept Medicare rates to stay licensed

…effectively make these physicians employees of the state

The power to license is the power to control.

(But I repeat myself.)

Rae on June 21, 2010 at 3:13 PM

Unexpectedly?

angryed on June 21, 2010 at 3:15 PM

This is nothing new. Doctors have been slowly but surely dropping Medicare patients for a couple of years now. It does not pay their expenses. The fastest growing expenses are their liability and malpractice insurance.

Kermit on June 21, 2010 at 3:18 PM

“If you like your doctor, we’ll shoot your doctor,” -Hussein.

Akzed on June 21, 2010 at 3:19 PM

“The point of Democrats cutting Medicare is to let older people die quicker because they vote for Republicans.”

That’s Democrat propaganda thrown right back in their faces. Two can play this horrid game they love so much.

scotash on June 21, 2010 at 3:23 PM

I’m starting to wonder if there will be 100 Dems left in the House after the midterm tsunami hits.

Yes, that’s an overstatement. Still, the midterms are going to be epic.

Grace_is_sufficient on June 21, 2010 at 3:44 PM

Unless providers can get compensated properly for their time and materials, they will start disappearing from the marketplace.

Axiomatic. Very nice, Ed
(that I feeled compelled to highlight this speaks volumes of the lack of understanding of much of the electorate)

phineas on June 21, 2010 at 3:53 PM

ajacksonian on June 21, 2010 at 2:33 PM

This may true for primary care, but you are forgetting that for surgeons who need an operating room in a hospital or surgical center, the hospital may make the choice or deny privileges to the doctor.

txmomof6 on June 21, 2010 at 3:53 PM

Don’t forget, military voters:

TRICARE reimbursement rates are TIED to Medicare’s.

So all us retirees and active duty TriCare Prime types can just as easily LOSE OUR DOCTORS when they pull out of the system. Many already have in Pensacola.

tree hugging sister on June 21, 2010 at 3:54 PM

If the ‘rats force doctors to accept patients then this problem will go away.

Bishop on June 21, 2010 at 2:44 PM

Hmm, that sounds a lot like slavery to me.

orbitalair on June 21, 2010 at 3:56 PM

TRICARE reimbursement rates are TIED to Medicare’s.
tree hugging sister on June 21, 2010 at 3:54 PM

Most insurance plan payments are also tied to Medicare rates, so when those go down, so do the payments allowed by the plans.

txmomof6 on June 21, 2010 at 3:57 PM

forest,

Yup, this is where the seizure of all student loans comes into the equation. The State will force young doctors to take loss-leading patients as a condition of getting their money to finish school.
I hadn’t thought about that specifically but it makes sense.

The plan I was referring to is underfunding Medicare to such an extent that doctors no longer accept it.
Couple that with creating millions of uninsured via “penalties” which incentivize private companies to dump their health care plans and watch millions of uninsured and underinsured demand a single payer health care “solution”.

Mike Honcho on June 21, 2010 at 2:39 PM

See also that in the stim bill for funds for universities to train health professionals goes ONLY to those who meet minority qoutas. Those quotas by the by, do not have ANY relation to actual demographics and are weighted disporportinately to AA’s. I have nothing against AA’s acheiving in healthcare feilds, I care not one whit the color of those that treat me, but it is unnerving to think that those doing so are not in their position due to merit, but only in the cause of social engineering.

Archimedes on June 21, 2010 at 4:12 PM

WOW, this was unexpected ….

tarpon on June 21, 2010 at 2:34 PM

Yeah, it’ amazing (and depressing) on how virtually everything we warned the country would happen with Obama that the Left just scoffed at and called us racist for suggesting such are all happening.

Yakko77 on June 21, 2010 at 4:27 PM

You can almost hear the talking point lies already: “See, we told you the free market wouldn’t work! We need single payer now!”

Blacklake on June 21, 2010 at 4:45 PM

Eventually, all the doctors will opt out of Medicare, all employers will stop providing insurance, and the health care industry can get back into balance. It’ll be a painful transition, but a great thing in the end. It’s funny how the market tends to move toward freedom and away from organization whenever Uncle Sam isn’t maintaining his deathgrip.

Unfortunately, before the transition can be completed, the unions need to retire. And they’re busy gathering more money and power to themselves.

hawksruleva on June 21, 2010 at 4:46 PM

See also that in the stim bill for funds for universities to train health professionals goes ONLY to those who meet minority qoutas. Those quotas by the by, do not have ANY relation to actual demographics and are weighted disporportinately to AA’s.

Archimedes on June 21, 2010 at 4:12 PM

Here’s an unintended consequence for ya. As a result of Obamacare, doctors will get paid less, and be required to see more patients, and the quality of care will be necessarily lessened. The result of those changes will be a lowering of the status associated with being a doctor. At the same time, a rush of black health care professionals will enter the system. Once again, Uncle Sam’s plan ends up giving AAs the short end of the stick.

hawksruleva on June 21, 2010 at 4:50 PM

Not 10 minutes ago a family member told me his doctor just refused to treat him any longer. Yeah, he’s medicare and the excuse was a change in policy at the clinic that prevents them from engaging in the type of treatment he needs.

csdeven on June 21, 2010 at 5:11 PM

But I like my doctor. I was told I could keep my doctor.

Chuck Schick on June 21, 2010 at 2:23 PM

When Obamacare kicks in full time, no one will have a doctor of their choice. It will be pure medical lottery to see who gets to see THE doctor today.

docdave on June 21, 2010 at 5:14 PM

Did the insurance industry and or any of the large physician organizations make a good faith effort to fix the problems of healthcare like pre-existing conditions?

CWforFreedom on June 21, 2010 at 6:19 PM

Odumbo is a communist

ultracon on June 21, 2010 at 6:34 PM

Hey! CWforFreedom…. you wanna take a 21% pay cut?

ultracon on June 21, 2010 at 6:35 PM

“If you like your doctor, you can keep your doctor”

forest on June 21, 2010 at 2:22 PM

But he never promised the doctor would keep you…

right2bright on June 21, 2010 at 6:43 PM

So by creating ObamaCare, the Democrats slit their own throats.

GarandFan on June 21, 2010 at 7:41 PM

The problem is that no matter how much this may be ‘part of the plan’, once doctors start to realize they can lower their costs, primarily overhead for paperwork, by removing insurance and going cash only, the greatest health plan in the world won’t attract them back. Once the economic reality sets in, it will set in hard and fast.

Cutting payments just means losing doctors to the plan. That rush to the door has begun, and even repeal of Obamacare won’t stop it. Physicians talk to each other and when the bottom line cost differential is understood, even private plans will have to start facing the music as it is cheaper and easier to take NO plans than to take SOME plans.

The days of insurance paying for everything are ending. Medicare is only currently accepted by about 58% of PCPs. Obviously this number will continue to fall. If Mass type legislation passes (tying licensing to accepting Medicare rates), Mass just won’t have any doctors as they will move to states were there are fewer stupid people in the govt. That will help reduce the populations of allegedly educated people on the coasts as no one will deliver babies or treat pnemonia or any of those things that used to have a pretty high incidence of death until the marvels of modern medicine.

Someone mentioned surgeons being stuck – nope, they have their own speciality surgi centers and hospitals. They will continue to provide services for private insurance and private payers.

Zomcon JEM on June 21, 2010 at 8:10 PM

I just saw my doctor, one my family has had for over 30 years, and he informed me of a change in his practice. He is concerned about the 25 million that will soon be dumped on the health care providers. So, he is joining an organization called MD VIP. Starting in Sept. he will accept on a first come first serve basis, 600 clients. (He now has over 3000) For a membership fee of $1500 per year, I will receive a top rated physical exam every year and premium access to him and first rate clinics and hospitals. Office fees and lab fees still apply and must be paid by cash or insurance coverage. If I cannot afford the new plan, I will be referred to another doctor. He is a great doctor and good friend. He has seen my family for no charge for the past two years as we have been under employed and uninsured since the economy tanked. We are so screwed domestically and internationally.

jbinnout on June 21, 2010 at 8:30 PM

txmomof6 on June 21, 2010 at 3:53 PM

Not forgotten at all. Hospitals are squarely in the targets of Obamacare… they have this problem in spades.

Hospitals have to have physicians, surgeons and technicians to run their medical side and when Medicare can’t support that then they, too, will leave the system, remove overhead staff used for paperwork and reduce operating expenses. The costliest part of running any business is the people to run it, not the equipment or facilities space. It is that overhead that has been adding into the cost of medicine as insurance expands, because of the paperwork and tracking involved with it. This is non-trivial.

Before we subsidized insurance hospitals used to do charity work, and doctors donate time to care for the sick. Charities helped to support the poor in America, and those were supported by citizens who weren’t over taxed. The cost of the subsidy has caused over-use, defensive medical testing, and has tried to isolate Americans from making hard decisions about their long term health options by cushioning monthly and annual decisions. That has been extremely short-sighted and we are now paying for that… Medicare and Medicaid are but the worst symptoms of this disease. If we remove the middle-men, and put patients in charge of their own care and allow doctors to get back to practicing medicine and not become the document input portion of an insurance system, then defensive tests drop, overhead drops as paperwork disappears and doctors can spend more time per patient as patients seriously consider their health care options at its true cost and think about what happens if they do need catastrophic care. That system actually worked in up to WWII…it would be a shock to the Nation to have to return to it quickly, but that is just where we are headed and have been for decades.

I have two chronic conditions that will be with me the rest of my life, plus a host of other side illnesses that comes with them. When one of the top specialists for one of my conditions dropped my insurance, I applauded him… in his declining years he needs less hassle in his life and more time with his patients. And I realized that the amount I had learned from him was enough to make sure I knew which tests had to be run, how often and what the results meant and my PCP could do those. But then I never had good health in my life, so I didn’t think I was immortal and planned for the consequences of my health conditions. Thus I can now get less care, better quality care and understand my problems better than my PCP and most specialists. But then I’m not depending on doctors for everything, and taking up my share of the load in caring for myself. I expect that once this economic contraption implodes doing that will be necessary, not optional.

ajacksonian on June 21, 2010 at 8:41 PM

I just saw my doctor, one my family has had for over 30 years, and he informed me of a change in his practice. He is concerned about the 25 million that will soon be dumped on the health care providers. So, he is joining an organization called MD VIP. Starting in Sept. he will accept on a first come first serve basis, 600 clients. (He now has over 3000) For a membership fee of $1500 per year, I will receive a top rated physical exam every year and premium access to him and first rate clinics and hospitals. Office fees and lab fees still apply and must be paid by cash or insurance coverage. If I cannot afford the new plan, I will be referred to another doctor. He is a great doctor and good friend. He has seen my family for no charge for the past two years as we have been under employed and uninsured since the economy tanked. We are so screwed domestically and internationally.

jbinnout on June 21, 2010 at 8:30 PM

It’s here to stay folks- MD concierge practices are sprouting up like dandelions in springtime – my family practice docs are going to an informational meeting on forming one this summer in preparation for the true advent of Obamacare consequences…….and yes, anyone who cannot afford these service fees will get the long lines like Canada and the UK – Will they hear us in November – YOU BETCHA!!!!!!!

huskerdiva on June 21, 2010 at 8:48 PM

Did I just hear the word “unexpectedly”?

new2wnc on June 22, 2010 at 10:47 AM