*This is an archive page. The links are no longer being updated. 1993.07.27 : 1993 Medicare Participating Physicians Enrollment Contact: Anne Verano (202) 690-6145 July 27, 1993 A record 59.8 percent of the nation's physicians and other practitioners have enrolled in the Medicare participating physicians program for 1993, compared with 52.2 percent in 1992, HHS Secretary Donna E. Shalala announced today. "Doctors in this program accept Medicare fees as full payment for all services, and that's a better financial deal for beneficiaries," Secretary Shalala said. The advantages of enrolling as a participating physician include a 5 percent higher payment and being listed in a Medicare participating physician directory, which is furnished to senior citizen groups and beneficiaries. "It also is significant that participating physicians provided services accounting for almost 75 percent of Medicare allowed charges during 1992, compared with 70 percent during 1991," said Bruce C. Vladeck, administrator of the Health Care Financing Administration, which manages the Medicare program. "Beneficiaries can avoid having to pay more than the Medicareapproved charges by selecting physicians who have signed up for the Medicare participating physicians program," Vladeck added. Participating physician enrollment has risen every year since the program started in 1984. The data for participating physicians also include other practitioners such as optometrists, podiatrists, chiropractors and certified registered nurse anesthetists. "The dramatic increase in participating physicians -- to almost 60 percent of the nation's physicians -- provides more financial protection for Medicare beneficiaries," Vladeck said. Attached is additional information, including tables that show the national participating rates for physicians and suppliers, the state-by-state rates and participation by medical specialties. EDITOR'S NOTE: The Health Care Financing Administration, an agency of the U.S. Department of Health and Human Services, administers the Medicare and Medicaid programs, which help pay the medical bills of 67 million Americans. HCFA's estimated fiscal year 1993 expenditures are almost $230 billion. ADDITIONAL FACTS MEDICARE PARTICIPATING PHYSICIAN PROGRAM Medicare pays 80 percent of the fee schedule amount for physician services, while beneficiaries are responsible for 20 percent of the fee. o The fee schedule for nonparticipating physicians is set at 95 percent of the Medicare fee schedule for participating physicians. Medicare pays 80 percent of this amount, with beneficiaries paying the remaining 20 percent. However, nonparticipating physicians can legally charge 15 percent more than their fee schedule. o Nonparticipating physicians can accept assignment on a claimby-claim basis. Accepting assignment means the physician agrees to accept the Medicare fee as full payment, except for the cost sharing of coinsurance or a deductible. o The assignment rate for covered services increased in the first three months of 1993 to an all-time high of 93.2 percent of Medicare dollars, compared with 89.2 percent a year ago. o Suppliers, such as ambulance providers and durable medical equipment dealers, also enter participation agreements with Medicare. The participation rate of suppliers is 29.5 percent in 1993, up from 23.7 percent in 1992. MEDICARE PARTICIPATING PHYSICIAN AND SUPPLIER PROGRAM National Data Participation Status January 1, 1993 January 1, 1992 Physicians* 59.8% = 496,341 52.2% =407,495 Participating 829,438 780,131 Billing Medicare Suppliers 29.5% = 40,302 23.7% = 29,791 Participating 136,818 125,870 Billing Medicare Total 55.5% = 536,643 48.3% =437,286 Participating 966,256 906,001 Billing Medicare Comparison to Previous Enrollment January 1993 January 1992 Number % % Physicians* 496,341 59.8 52.2 Suppliers 40,302 29.5 23.7 Total 536,643 55.5 48.3 Includes M.D.s, D.O.s, and limited license practitioners. Participation counts reflect physicians who are participating in at least one practice setting. For example, a physician who is participating in his private practice but not in his group is counted as participating. PARTICIPATION DATA BY STATE JANUARY 1992 JANUARY 1993 STATES PERCENT PERCENT ALABAMA 72.4 74.6 PHYSICIANS/LLP'S 83.4 85.1 SUPPLIERS 34.2 37.2 ALASKA 52.8 58.4 PHYSICIANS/LLP'S 55.1 60.4 SUPPLIERS 26.4 33.0 ARIZONA 61.6 73.6 PHYSICIANS/LLP'S 64.5 76.2 SUPPLIERS 26.0 51.6 ARKANSAS 53.1 58.6 PffYSICIANS/LLP'S 57.8 62.1 SUPPLIERS 30.3 30.5 CALIFORNIA 58.9 59.6 PHYSICIANS/LLP'S 62.6 65.9 SUPPLIERS 32.9 26.2 COLORADO 44.0 53.1 PHYSICIANS/LLP'S 48.0 55.7 SUPPLIERS 20.2 24.1 CONNECTICUT 46.3 52.9 PHYSICIANS/LLP'S 48.1 55.4 SUPPLIERS 30.8 37.0 DELAWARE 47.5 52.9 PHYSICIANS/LLP'S 51.9 57.4 SUPPLIERS 23.8 37.0 DISTRICT OF COLUMBIA 43.5 47.9 PHYSICIANS/LLP'S 45.9 50.6 SUPPLIERS 16.3 31.0 FLORIDA 34.6 50.2 PHYSICIANS/LLP'S 41.5 55.6 SUPPLIERS 14.0 26.7 GEORGIA 50.4 71.3 PHYSICIANS/LLP'S 57.2 74.9 SUPPLIERS 16.5 41.7 HAWAII 60.4 71.1 PHYSICIANS/LLP'S 64.1 75.9 SUPPLIERS 17.9 19.4 IDAHO 20.7 32.6 PHYSICIANS/LLP'S 22.9 37.1 SUPPLIERS 12.5 14.9 ILLINOIS 46.0 52.6 PHYSICIANS/LLP'S 50.8 57.1 SUPPLIERS 21.6 25.2 INDIANA 43.5 49.6 PHYSICIANS/LLP'S 49.3 55.8 SUPPLIERS 18.5 31.5 IOWA 56.4 58.6 PHYSICIANS/LLP'S 58.8 61.8 SUPPLIERS 43.3 40.4 KANSAS 62.3 65.4 PHYSICIANS/LLP'S 70.3 73.2 SUPPLIERS 30.8 32.3 KENTUCKY 55.7 64.0 PHYSICIANS/LLP'S 64.0 73.6 SUPPLIERS 20.0 22.0 LOUISIANA 43.0 42.8 PHYSICIANS/LLP'S 44.6 44.0 SUPPLIERS 32.3 36.5 MAINE 47.4 47.5 PHYSICIANS/LLP'S 51.6 52.0 SUPPLIERS 33.0 34.9 MARYLAND 56.4 69.7 PHYSICIANS/LLP'S 58.7 72.5 SUPPLIERS 33.0 34.9 MASSACHUSETTS 47.0 47.1 PHYSICIANS/LLP'S 50.0 50.2 SUPPLIERS 26.1 26.9 MICHIGAN 50.7 57.2 PHYSICIANS/LLP'S 51.7 58.1 SUPPLIERS 40.8 49.4 PARTICIPATION DATA BY STATE JANUARY 1992 JANUARY 1993 STATES PERCENT PERCENT MINNESOTA 32.1 40.5 PHYSICIANS/LLP'S 34.4 44.4 SUPPLIERS 19.3 18.8 MISSISSIPPI 44.2 48.5 PHYSICIANS/LLP'S 47.9 53.4 SUPPLIERS 30.4 30.8 MISSOURI 47.9 63.1 PHYSICIANS/LLP'S 51.8 67.5 SUPPLIERS 21.5 21.8 MONTANA 21.6 48.1 PHYSICIANS/LLP'S 23.7 54.7 SUPPLIERS 15.1 16.0 NEBRASKA 54.1 62.4 PHYSICIANS/LLP'S 61.1 70.6 SUPPLIERS 28.0 29.8 NEVADA 71.7 82.6 PHYSICIANS/LLP'S 75.4 84.9 SUPPLIERS 34.0 66.5 NEW HAMPSHIRE 36.7 40.3 PHYSICIANS/LLP'S 38.5 43.0 SUPPLIERS 24.8 23.8 NEW JERSEY 34.7 40.2 PHYSICIANS/LLP'S 36.5 42.8 SUPPLIERS 20.9 28.2 NEW MEXICO 49.5 61.4 PHYSICIANS/LLP'S 53.6 66.8 SUPPLIERS 18.5 14.3 NEW YORK 36.0 39.7 PHYSICIANS/LLP'S 36.9 40.7 SUPPLIERS 22.3 24.9 NORTH CAROLINA 61.3 65.4 PHYSICIANS/LLP'S 68.2 72.8 SUPPLIERS 14.1 26.2 NORTH DAKOTA 37.3 44.5 PHYSICIANS/LLP'S 45.8 55.0 SUPPLIERS 15.5 19.9 OHIO 51.7 70.1 PHYSICIANS/LLP'S 57.3 76.6 SUPPLIERS 19.8 22.0 OKLAHOMA 40.3 48.5 PHYSICIANS/LLP'S 44.4 53.9 SUPPLIERS 19.5 19.5 OREGON 48.8 56.3 PHYSICIANS/LLP'S 51.7 59.2 SUPPLIERS 19.2 28.1 PARTICIPATION DATA BY STATE JANUARY 1992 JANUARY 1993 STATES PERCENT PERCENT PENNSYLVANIA 49.2 55.2 PHYSICIANS/LLP'S 53.0 59.7 SUPPLIERS 25.2 36.1 RHODE ISLAND 64.8 76.8 PHYSICIANS/LLP'S 70.3 80.9 SUPPLIERS 24.4 27.2 SOUTH CAROLINA 58.5 62.4 PHYSICIANS/LLP'S 63.0 67.3 SUPPLIERS 22.6 25.5 SOUTH DAKOTA 23.4 25.6 PHYSICIANS/LLP'S 23.7 31.6 SUPPLIERS 20.8 13.7 TENNESSER 61.5 64.5 PHYSICIANS/LLP'S 67.6 70.5 SUPPLIERS 24.2 27.7 TEXAS 49.5 57.0 PHYSICIANS/LLP'S 52.9 61.3 SUPPLIERS 25.3 27.7 UTAH 62.3 74.6 PHYSICIANS/LLP'S 69.5 80.3 SUPPLIERS 21.5 31.9 VERMONT 51.4 53.1 PHYSICIANS/LLP'S 54.2 56.5 SUPPLIERS 29.5 28.2 VIRGINIA 46.5 48.8 PHYSICIANS/LLP'S 49.7 52.2 SUPPLIERS 20.2 21.0 WASHINGTON 49.6 60.5 PHYSICIANS/LLP'S 53.1 64.7 SUPPLIERS 23.9 28.5 WEST VIRGINIA 61.1 70.5 PHYSICIANS/LLP'S 68.4 75.9 SUPPLIERS 27.3 33.8 WISCONSIN 49.7 61.7 PHYSICIANS/LLP'S 55.5 68.8 SUPPLIERS 26.4 38.2 WYOMING 47.3 45.6 PHYSICIANS/LLP'S 50.2 53.3 SUPPLIERS 13.2 18.8 PERCENTAGE BY SPECIALTY JANUARY 1992 JANUARY 1993 Participation Participation Specialty Percentage Percentage Physicians (M.D.s and D.O.s) ---------------------------- General Practice 48.0 55.1 General Surgery 66.3 73.8 Otology, Laryngology, Rhinology 57.0 66.2 Anesthesiology 49-3 64.6 Cardiovascular Disease 72-0 78-7 Dermatology 61.6 69.8 Family Practice 57.7 66.1 Internal Medicine 57.8 66-2 Neurology 63.8 71.8 Obstetrics - Gynecology 58.0 65.7 Ophthalmology 66.1 73.2 Orthopedic Surgery 65.5 74.9 Pathology 65.8 73.3 Psychiatry 48.8 53.5 Radiology 68.2 74.7 Urology 61.7 71.8 Nephrology 76.3 82.4 Clinic or Other Group Practice-Not GPPP 77.0 75.5 Other Physicians 35.9 50.5 Total Physicians 55.3 63.5 Limited License Practitioners (LLP) Chiropractor 31.4 35.8 Podiatry - Surgical Chiropody 64.2 70.9 Certified Registered Midwife 40.7 61.0 Certified Registered Nurse Anesthetist 31.3 43.8 Optometrist 59-0 62.7 Other Limited License Practitioners 35.8 43.9 (Audiologist, psychologist, physicial therapist, occupational therapist, clinical psychologist, clinical social worker, nurse practitioner, certified clinical nurse specialist, and physician assistant) Total Limited License Practitioners 41.0 47.4 Suppliers Independent Laboratory 52.4 55.4 Durable Medical Equipment 24.2 30.8 Suppliers Ambulance Service Suppliers 34.4 36.4 Other Suppliers 18.2 25.7 Total Suppliers 23.7 29.5