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1991.06.26 :  Medicare Participating Physicians

Contact:  Bob Hardy (202) 245-6145
June 26, 1991

         Nearly 48 percent of physicians are enrolled as Medicare
participating physicians in 1991, up from 44 percent in 1990, HHS
Secretary Louis W. Sullivan, M.D., announced today.
        The out-of-pocket costs of Medicare beneficiaries can be
limited by the use of participating physicians, who agree to accept
Medicare rates as full payment for their services.
        "The rate of participation has increased by 71 percent in five
years," Secretary Sullivan said.  "Only 28 percent were enrolled as
participating physicians in 1986."
        The number of participating physicians has reached 360,765
in 1991, an increase of 31,757 from 1990.  The term "physicians" also
includes limited license practitioners such as optometrists,
podiatrists and chiropractors.   
        Medicare pays 80 percent of approved charges for medical
services.  The beneficiary's financial liability is limited to the
remaining 20 percent when the doctor is a participating physician. A
non-participating physician may charge more to the beneficiary.
        Medicare offers incentives to encourage participation.
Medicare payments are higher for participating physicians, their
claims are processed faster than those of non-participating
physicians, and their names are included in directories which are
distributed widely and are available to senior citizens in every part
of the country.
        Gail R. Wilensky, Ph.D., administrator of the Health Care
Financing Administration, said that "at a time when all of us are
concerned about the growing burden of health care costs, we want
Medicare beneficiaries to have the information they need to make sound
choices as consumers." 
        She explained that directories listing local participating
physicians and suppliers are available in local Social Security
offices and senior citizens organizations. 
        Services provided by participating physicians account for more
than 70 percent of physicians' charges paid by Medicare.  In the first
three months of this year, more than 85 percent of physicians' bills
were paid under assignment, which means the Medicare rates were
accepted as full payment.  Nonparticipating physicians may accept
assignment for some Medicare patients. 
        Tables of state-by-state rates and participation by medical
specialty may be obtained from the Health Care Financing
Administration's Press Office, 202/245-6145.


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       MEDICARE PARTICIPATING PHYSICIAN AND SUPPLIER PROGRAM

                           National Data


Participation Status --  January 1, 1991


     47.6%  Physicians*       360,765  Participating
                              758,363  Billing Medicare

     22.6%  Suppliers          28,667  Participating
                              126,982  Billing Medicare


     44.0%  Total             389,432  Participating
                              885,345  Billing Medicare

     
Comparison to Previous Enrollment


                              January 1991    April 1990

                    Number          %              %

     Physicians*    360,765        47.6           44.1
     Suppliers       28,667        22.6           21.8
     Total          389,432        44.0           40.9



* 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.