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doctors declining to accept Medicare is linked to the failure of Congress to pass the “doctor fix” bill that would have rescinded a 21% cut in reimbursements.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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