Ask any Medicaid patient how difficult it is to schedule a doctor’s appointment, and you’re likely to get an earful.
Health-care providers long have complained that Medicaid, the state/federal health program for the poor, doesn’t pay enough. Many providers consider it a moral obligation to treat the poor and indigent, but they often do so grudgingly.
Now, some doctors and patient advocates are wondering whether Medicare patients might soon be in the same boat. More and more physicians, in Rhode Island and nationally, say they have stopped seeing new Medicare patients or are considering it, because the federal government continues to chip away at Medicare reimbursement to doctors.
Seifert Systems Invests in Energy Efficiency to Strengthen Operations
For manufacturers, energy is more than just another operating expense. It plays a critical role…
Learn More
“I’d hate to see the Medicare card go in the same direction as the Medicaid card, but unfortunately that’s what’s happening,” said Dr. Scott Hanson, a primary care physician at South County Walk In & Primary Care in Narragansett. The practice recently decided to stop taking new Medicare patients, Hanson said, because more reimbursement cuts are on the way in 2003.
Congress cut Medicare payments to doctors by 5.5 percent in 2002. Although the American Medical Association has fervently lobbied Congress against a planned cut next year, another 4.4 percent reduction now is scheduled for early in 2003.
If the schedule for Medicare cuts is left unchecked by Congress, reimbursement rates by 2005 will be pushed below 1991 levels, according to the AMA, which has warned of an “access meltdown.” The association says 24 percent of U.S. doctors already are pulling back on the number of Medicare patients they see.
What makes the situation all the more egregious, the AMA says, is that lawmakers have admitted that the system used to determine physician reimbursements is flawed. This month it has embarked on a media and advertising blitz in an effort to thwart next year’s planned cut.
Steven R. DeToy, director of public and government affairs for the Rhode Island Medical Society, said he’s been getting weekly calls from doctors looking for advice on how to opt out of Medicare.
“A doctor’s office is a small business; they don’t have large endowments like hospitals,” DeToy said. “If they take on too many patients who don’t pay enough to cover the cost of providing care, ultimately the practice will go out of business. Physicians have to be very careful about their patient mix.”
South County Walk In, for example, has a patient mix that tilts toward the elderly, because of the area’s relatively old population. The practice sees hundreds of Medicare recipients, Hanson said, who account for 15 to 20 percent of its revenues. Medicare reimbursement often does not cover the costs of treating those patients, he said.
The prolonged slashing of Medicare payments would be more palatable, Hanson said, if expenses were kept in check. But his practice saw its malpractice premiums climb 45 percent for 2003; health-insurance premiums for the practice’s 10 employees jumped 20 percent.
State regulators are starting to catch wind that some doctors want to leave Medicare because of their growing disenchantment with Medicare cuts. But they say the trend is not widespread – yet.
“It is disruptive for patient care, but at this point I don’t think we’ve reached a crisis juncture,” said Bruce McIntyre, the attorney for the state Board of Medical Licensure and Discipline. But, he added: “Once the medical society begins openly discussing that option with its members, it’s fair to say that a number of them will be opting out.”
Dr. Kathleen Fitzgerald, a Providence gynecologist, said she stopped taking new Medicare patients this year because of the 5.5 percent drop in reimbursement. But the 4.4 percent rate cut planned for next year has her mulling a more drastic measure.
“I’m seriously contemplating becoming a non-participating physician for Medicare,” Fitzgerald said.
That would mean Fitzgerald’s Medicare patients would pay out-of-pocket for their services, and then get reimbursed either directly from the Medicare system or from a third-party administrator.
“It throws the onus of dealing with the federal government onto the patient, rather than the provider,” Fitzgerald said.
Physicians are not obligated to accept Medicare or Medicaid patients. But McIntyre was quick to point out that once a doctor has started seeing a patient, he or she must continue seeing that patient, according to Rhode Island law.
And, if a doctor chooses to be “non-participating physician,” state law says doctors can’t “balance bill” Medicare patients. In other words, a physician is not allowed to charge Medicare patients more than the amount that doctor normally would receive from Medicare. So Medicare patients in Rhode Island wouldn’t pay more if their doctor switches to non-participating status – they’ll just have to deal with the hassle of getting reimbursed.
Doctors who opt out of Medicare in essence are tweaking their patient mix so that they see fewer Medicare patients – and see a greater percentage of patients covered by higher-paying commercial insurers.
Fitzgerald said that in past years, those private-insurance patients have helped offset losses from Medicaid and Medicare patients. But that strategy might be outdated.
Commercial insurers have kept their payment rates to doctors stagnant for years, according to the Rhode Island Medical Society. In recent weeks, Blue Cross & Blue Shield of Rhode Island has hosted a series of meetings with physicians. The topic: lower reimbursement payments in 2003.
For the complete current issue, visit our subscription Web site, or call (401) 273-2201, ext. 227 or 234.
