The view many doctors have on Medicare funding has certainly been noted by politicians, and there have been attempts to find payment solutions satisfactory to both doctors and politicians. However, in situations where politicians had to scramble in order to resolve funding issues, Forbes reports that, since the balanced budget law was passed in 1997, “only short-term fixes—14 of them since 2002—have been passed as a stopgap measure.”
As Robert Wah, an endocrinologist at the National Institutes of Health and the Walter Reed Army Medical Center, declared at NPR.org, “In 2010, Congress did this to us five times. There were five patches put in place” to stop scheduled Medicare cuts, “and a couple of times they actually waited until after the deadline”—meaning, payment to doctors was delayed.
Uncertainty of this sort explains why many doctors are opting out of Medicare. Even when payments are not in jeopardy, many doctors nationwide simply seem convinced that the Medicare payment formula is not allowing them fair compensation for their services.
According to Dr. C.L. Gray’s January 2010 guest article at FoxNews.com, during the first decade of the 2000s Medicare paid physicians 20% less than traditional insurance companies for the same service. And, remember, many doctors were already dissatisfied with what those traditional insurance companies were paying them.
The most recent cuts in Medicare payment to doctors took effect on April 1 of this year as a result of sequestration cuts. With many doctors arguing that their practices are small businesses and their fixed costs are not reduced in proportion to reductions in what Medicare pays them, an ever-increasing number of providers and practices seem to be washing their hands of dealing with Medicare. Gray reports that even the world-renowned Mayo Clinic’s facility in Arizona stopped accepting Medicare in 2010, two years after posting an $840 million loss in caring for Medicare patients.
Reporting on a survey of about 700 doctors, Townhall.com says two-thirds of those doctors indicated they were either in debt or just getting by financially. While acknowledging that they generally make healthy incomes compared to the majority of Americans, many doctors are quick to point out that they also face a barrage of costs most other people don’t have to worry about—from medical school expenses to the costs of setting up and maintaining practices. Some argue that, given their large expenses, they simply cannot afford to accept Medicare patients, or even patients who belong to many private insurance plans.
Some doctors also argue that participating in Medicare places them under unfair scrutiny. Gray, who is also President of Physicians for Reform, makes the case that, with increasing pressure on politicians to reduce Medicare spending, “one way to do this is to intimidate physicians into under-billing.” How is this done? According to Gray, Washington is able to intimidate doctors through “physician audits using Recovery Audit Contractors (RAC audits) to randomly investigate private physicians’ Medicare billing.”
Describing the experience of some of his colleagues who had been audited, Gray says, “For a year Medicare auditors made their practice a living hell, making them question if it was worth caring for Medicare patients at all.” According to Gray, as a result of the audit his colleagues were wrongly charged with fraudulently billing Medicare before being vindicated—and stuck with legal defense bills totaling over $100,000. The auditors, according to Gray, were “bounty hunters” who were “clearly after money, not justice,” and given legal immunity in the event they were countersued.
While other parties may not share Gray’s view, clearly there are doctors across the country who do. To a growing number, when it comes to taking on Medicare patients under current conditions, the drawbacks outweigh the benefits. This is likely to remain the case until Washington introduces incentives attractive enough to draw doctors who’ve opted out of Medicare back into the system. With the number of Medicare recipients expected to grow substantially in coming years, nearly everyone agrees that the sooner responsible incentives are introduced, the better. As things stand now, far too many Medicare recipients are being deprived of the opportunity to take full advantage of the Medicare benefits they were promised—and millions of Americans are tired of waiting for Washington to figure out a long-term solution, and not just one more quick fix, to the Medicare payment formula problem that is contributing to the departure of so many doctors from Medicare.
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Why Are So Many Doctors Leaving Medicare?© 2013 MedicareMall.com
The number of persons without health insurance coverage in the United States is one of the primary concerns raised by advocates of health care reform . A person without health insurance is commonly termed uninsured (regardless of insurance of objects unrelated to health), and this article uses the term in this sense as well. According to the United States Census Bureau , in 2009 there were 50.7 million people in the US (16.7% of the population) who were without health insurance.
It determined that the proportion of Americans who were underinsured, uninsured, or whose health insurance had gaps had been growing steadily from the year 2003 through 2010. During that time, the number of people who were underinsured exploded to a point that it almost doubled. In 2003, there were 16 million underinsured people in the United States, but that figure rose considerably to 29 million by 2010.
The ACA addresses barriers to acquiring insurance coverage through expanded access to Medicaid, subsidies for private insurance, and health insurance market reforms. The majority of the coverage expansions in the ACA will take effect in 2014, at which point, there will be a requirement that individuals have health insurance coverage. The law will also prevent insurers from rejecting individuals or charging higher premiums based on health status. By 2016, the ACA is estimated to decrease the number of uninsured by nearly half, leaving far fewer individuals facing the health and financial risks that come with being uninsured.
This information comes from a new survey, conducted on behalf of InsuranceQuotes.com by Princeton Survey Research Associates International. The survey reveals that 64 percent of the uninsured say they haven’t decided whether they will buy health insurance by Jan. 1, 2014, as required by the Affordable Care Act (ACA), which is also known as Obamacare .
Having no health insurance also often means that people will postpone necessary care and forego preventive care – such as childhood immunizations and routine check-ups-completely. Because the uninsured usually have no regular doctor and limited access to prescription medications, they are more likely to be hospitalized for health conditions that could have been avoided.