Physicians Dropping Medicare -- What Do They Know?

For the first time the Centers for Medicare and Medicaid Services published the number of doctors who last year opted out from Medicare.

As Melinda Beck reported last week in “HealthJournal,” a section in the Wall Street Journal, the number of doctors opting out is escalating. According to the CMS, 9,539 physicians opted out of Medicare in 2012, up from 3,700 in 2009.

While the increase is dramatic, the total number opting out is a relatively small percentage of the 685,000 physicians who participated in Medicare last year. However, even though the number is small, it looms large because Medicare enrollment is projected to grow by as much as 3 percent per year over the next several years.

Why are physicians leaving Medicare? Martin Merritt, writing in Physician’s Practice, last year presented a pungent laundry list of the six major reasons physicians opt-out:

• Reimbursement cuts
• Bureaucracy
• Recovery Audit Contractors
• Stark law
• Whistleblowers
• Criminal Prosecution.

You can read his explanations and opinion on each here. When Merritt wrote his 2012 post, CMS did not publish statistics on how many physicians opt out in a given year.

At the end of the Wall Street Journal story, Beck quotes several physicians who opted out for yet another reason: flexibility. By eliminating Medicare bureaucracy, some physicians reported that they can reduce overhead and keep patient fees close to Medicare rates. It also provided physicians the ability to adjust their fees to match a patients’ need. Beck found one doctor who treats cancer patients for free.  ”I couldn’t do that if I took Medicare,” the physician told her. “It’s considered an illegal enticement.”