A Medicare exodus? Depends on who’s talking

Different figures show different trends

Increasingly frustrated with red tape and reimbursement hassles, more physicians — especially those in urban areas — are deciding to opt out of the Medicare program, recent studies show. The Association of American Physicians and Surgeons, for instance, estimates 23% of physicians nationwide do not accept new Medicare patients. A survey in Colorado showed that as many as 40% of family physicians are refusing new Medicare patients.

"Many doctors have closed their practices to new Medicare patients," says Marilyn Rissmiller, program manager of the health care financing department at the Colorado Medical Society in Denver. In fact, in Denver, only about 15% of doctors take new Medicare patients.

Arcane, absurd, and inconsistent’ rules

When Medicare was first introduced, "everybody was willing to accept the concept of providing for the health care needs of the elderly," says Richard Corlin, MD, a gastroenterologist in Santa Monica, CA. "But we didn’t realize that the rules would be so arcane, absurd, and inconsistent that any technical violation is considered fraud."

In fact, fear of being hit with warrantless fraud-and-abuse audits and corresponding legal costs is a primary reason why many of Colorado’s family physicians are limiting their Medicare practices, says Rissmiller. Medicare officials, however, dispute the idea that fewer physicians are participating in the program. In fact, physician participation in Medicare is actually increasing, according to the agency. Based on Medicare’s figures, 86.3% of doctors accepted Medicare patients in 2000, up from 74.8% in 1996.

"Naturally, we have heard anecdotal reports about doctors leaving the program, but we have no analytic reason to think there’s a problem," says Murray Ross, executive director of the Medicare Payment Advisory Commission (MedPAC).

According to a 1999 physician survey by MedPAC, while doctors had serious concerns about the program, most still took new Medicare patients. The survey found:

• 95.7% of physicians surveyed accept some or all new Medicare patients.

• 64.7% were very concerned about reimbursement levels.

• 45.4% were very concerned about external review and oversight of clinical decisions.

• 69.7% were very concerned about time spent on billing-related paperwork.

• 47.8% were very concerned about malpractice issues and liability insurance.