Physicians are Tired of Medicare Patchwork

Medicare payments to physicians don't come close to the actual cost of patient care.  Physicians are beyond exasperation as Congress continues to patch Medicare rates for short periods at a time.  There needs to be a permanent fix to the system.  With low reimbursement rates, excessive paperwork and fees, many physicians around the country are beginning to opt out of Medicare completely or changing their Medicare status to non-participating. 

Juliette Madrigal-Dersch, MD, opted out of Medicare four years ago and has rarely looked back.  Now, she sees Medicare patients on a private-contracting basis, which means that she nor her patients can claim Medicare payments.  However, she can charge the actual cost for services and can choose not to charge anything such as her services to patients 90 years of age or older.

Although many physicians dream of being able to cut all ties to Medicare, realistically that choice could cost them their practice.  Many physicians have 20% to 70% of their patients as Medicare beneficiaries.  Robert Mingea, MD, a cardiologist in Austin falls under this catagory.  He would love to opt out of Medicare but ~70% of his patients have Medicare which would mean the end of his practice.  He is seriously contemplating moving his practice to another country or retiring early.  Other physicians are beginning to change their Medicare status to non-participating and not accepting new Medicare patients.  By having non-participating status, physicians can see Medicare patients on a case-by case- basis.  A few physicians are willing to see self-paying patients and charge a concierge fee.   

The American Medical Association is aware of physicians' loss of patience with the system. 'Starting last year, the AMA said it no longer would support temporary measures to forestall doctor pay cuts under the sustainable growth rate system, insisting that Congress enact a permanent SGR repeal that would align rates more closely with physician costs.'

If more and more physicians follow this route, these choices will unquestionably affect Medicare patients access to care.  Congress needs to find a long-term solution to the Medicare situation as it is not fair to physicians and patients alike.

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