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Date: May 8, 1995 FOR IMMEDIATE RELEASE Contact: HCFA Press Office (202) 690-6145
The overall rate of participation is 72.3 percent this year, up from 64.8 percent in 1994. The actual number of enrollees in the program increased to 620,000 in 1995 from 578,000 last year.
Participation rose in all states except Rhode Island.
"This program is important for Medicare beneficiaries," Secretary Shalala said. "By choosing a participating physician, a beneficiary will not be burdened with charges in excess of Medicare-approved amounts."
Participation has risen every year since the program started in 1984. The overall rate includes medical doctors (MDs), limited license practitioners and nonphysician practitioners:
This was the key factor behind the 1995 increase in the overall participation rate. All these practitioners are now treated as participants. As a result, the participation rate for this group rose from 53.5 percent in 1994 to 100 percent in 1995, accounting for about three-quarters of the total increase in the program.
"Even without this increase, the participation rate would still have gone up by 2.1 percentage points for 1995," said Bruce C. Vladeck, administrator of the Health Care Financing Administration, which manages the Medicare program. "Other reasons for the increase in the enrollment of participating physicians include our continuing efforts both to explain the program's benefits to beneficiaries and to enforce the limit on the charges made by nonparticipating physicians."
The nonphysician practitioners not covered by the Jan. 1 change are audiologists, physical therapists, psychologists and occupational therapists.
A participating physician agrees to accept Medicare fee schedule amounts as full payment for Medicare services.
"Services provided by participating physicians now account for almost 90 percent of Medicare-allowed charges for physician services," Vladeck said.
Medicare pays 80 percent of the fee schedule amount for a physician's service. For a Medicare-covered service provided by a participating physician, the beneficiary is responsible for 20 percent of the fee schedule amount. A nonparticipating physician, however, may charge a beneficiary more, up to a limit defined by law.
Physicians are advised that participating in the program creates the following advantages:
Attached is a table showing the state-by-state rates of participating physicians and other practitioners.
Participation Data by State (Enrollment by percent for MDs and other practitioners) States January 1994 January 1995 Alabama 87.2 90.5 Alaska 66.3 77.1 Arizona 82.6 87.1 Arkansas 64.9 74.8 California 69.0 74.5 Colorado 58.5 65.2 Connecticut 57.8 61.8 Delaware 60.0 68.0 District of Columbia 52.8 63.0 Florida 62.2 68.0 Georgia 82.7 86.3 Hawaii 80.4 82.8 Idaho 49.7 54.7 Illinois 61.8 73.3 Indiana 61.3 72.8 Iowa 63.2 81.1 Kansas 78.7 84.4 Kentucky 69.1 83.4 Louisiana 46.7 57.4 Maine 53.6 68.9 Maryland 77.3 88.1 Massachusetts 48.9 64.7 Michigan 62.1 75.3 Minnesota 51.3 58.6 Mississippi 53.8 59.4 Missouri 81.8 87.6 Montana 58.7 70.1 Nebraska 75.9 82.5 Nevada 87.9 91.2 New Hampshire 48.0 60.4 New Jersey 45.9 54.9 New Mexico 74.2 78.1 New York 46.2 59.2 North Carolina 76.5 77.6 North Dakota 77.4 81.8 Ohio 83.3 90.5 Oklahoma 64.9 72.3 Oregon 66.5 79.7 Pennsylvania 61.1 67.3 Puerto Rico 75.5 70.7 Rhode Island 82.2 80.9 South Carolina 70.2 76.1 South Dakota 41.2 51.7 Tennessee 76.9 80.6 Texas 68.6 76.9 Utah 82.0 85.9 Vermont 58.8 68.8 Virginia 52.9 55.6 Virgin Islands 34.0 32.7 Washington 73.9 76.2 West Virginia 81.9 87.2 Wisconsin 73.7 81.2 Wyoming 63.0 66.1