Physicians Opting Out of Medicare?

Last week the OIG released its long-awaited report evaluating the extent to which doctors are opting out of Medicare and the reasons why they are opting out. Spoiler alert: The report was inconclusive. The OIG reported that CMS and its contractors “do not maintain sufficient data regarding physicians who opt out of Medicare. As a result, we are unable to conduct the proposed evaluation at this time.”

For those of us who are frequently asked by the OIG to review and analyze historical Medicare claims, the temptation to ask why that excuse does not work for us is hard to suppress. However, the OIG’s desire for accuracy and its unwillingness to provide a report based on conjecture is admirable. It is important to understand the factors that will impact access to care for our aging population. A less than thorough analysis would have been a mistake.

The OIG notes in its report that the number of opted-out physicians appears to have increased in each year from 2006 to 2010. The report goes on to predict that more physicians may opt out in the near future due to potential legislated decreases in Medicare reimbursements. A Medical Society of Delaware survey for 2012 validated the OIG’s intuition. More than 50% of the physicians polled said that they were considering changing their Medicare participation status due to the proposed 27.4% proposed reduction to the fee schedule.

This is an issue worth monitoring. A recent Texas study reported that 37% of its primary care practices limit the number of new Medicare patients in the practice and another 13% do not accept any Medicare patients. If the OIG is correct and the national trend is that more physicians are opting out of Medicare each year, we may be closer to a crisis of access of care for seniors than anyone realizes.

The OIG has pledged to conduct a full evaluation when CMS and its contractors are in a position to provide more accurate information.

Bill Authorizing Medical Practice Inspections Up for Consideration by Delaware’s General Assembly

The 146th General Assembly reconvened this week and one of the bills it may consider is SB51, which authorizes the Division of Professional Regulation to investigate complaints of unsafe or unsanitary conditions at any location where “medical or health-related treatment” is rendered, excluding hospitals, freestanding birthing centers, freestanding surgical centers or freestanding emergency centers. The bill also provides that a Delaware-licensed physician may be disciplined for maintaining an unsanitary or unsafe condition in his/her office. Complaints must be in writing, may not be anonymous, must be filed within 5 days of observing the complained-of condition, and can only be filed by a person over the age of 18 who has observed the condition and reported it to the staff at the location where the condition was observed. So while the proposed legislation does not give the Division free reign to conduct inspections of physicians’ offices, it authorizes discipline against Delaware physicians who operate their practices in an “unsafe” or “unsanitary” manner, leaving open to interpretation just what constitutes an “unsafe” or “unsanitary” condition.