May 23, 2012

Key Take-Aways

• Texas doctors are opting out of Medicare in record numbers.
• Doctors opting out of Medicare can cause real hardships for Medicare beneficiaries.
• The President’s government takeover of healthcare law does nothing to address this critical access issue nationally.

Last week, Medicare on Main Street highlighted a recent article by Todd Ackerman in the Houston Chronicle about the growing number of doctors in Texas opting out of Medicare.  Dr. Bruce Malone, President of the Texas Medical Association, says in the article, ‘“It’s like we’re standing on a cliff and the ground below is being eroded by incoming waves…When it goes, it’s really going to go.’”  A rather vivid description.

So you might assume that the urgency conveyed suggests the exodus of Texas doctors from Medicare is a recent phenomenon.  But as noted in the article, actually, it’s been happening for several years.  And the very same Houston Chronicle reporter, Todd Ackerman, already sounded the alarm in 2010 with his story “Texas Doctors Fleeing Medicare in Droves.”  Could there be a more eye-opening title?  Were President Obama and his Democrat allies in Congress paying any attention?

Former Texas Medical Association President Dr. Susan Bailey warned “‘Texas doctors are opting out of Medicare at alarming rates…New data shows the Medicare system is beginning to implode…If Congress doesn’t fix Medicare soon, there’ll be more and more doctors dropping out and Congress’ promise to provide medical care to seniors will be broken.”’ 

Medicare beneficiary Kathy Sweeney summed up patients’ concerns:  “‘Just thinking I couldn’t continue doctor-patient relationships I built up over years is disturbing.  Seniors should be able to see the doctors they want.”’

And sentiments run both ways between patient and doctor.  Dr. Guy Culpepper, a Dallas-area family practice doctor laments in the 2010 article, “‘I’ve been in practice 24 years, and a lot of my patients got old right with me.  It’s stressful to tell them you’re leaving Medicare and they’re responsible for payments if they want to stay with you.  You feel like you’re abandoning them.”’ 

Doctors who opt out of Medicare can no longer bill Medicare for anything or anyone with very limited exceptions.  So opting out is not a decision to take lightly especially for physicians who see a significant number of Medicare beneficiaries.  Moreover, again with very limited exceptions, a doctor who opts out cannot resume as a Medicare provider for a period of two years.

A Medicare beneficiary can try to obtain alternative primary coverage, pay out-of-pocket through private agreement, or find a new doctor who accepts Medicare.  As described in previous editions of Medicare on Main Street (e.g., here and here), finding a new doctor for a Medicare beneficiary can be an unpleasant experience: 

For example, “Kay Haneline, 67, said she and her husband were both dumped by their clinic they had been going to when they hit 65.  They could have stayed and paid cash at their old clinic but then couldn’t have used their Medicare or secondary insurance.  ‘The whole experience was distasteful,’ she said.  ‘I called over 30 different doctors and none of them would take us.’” 

Or you may recall the story of Robert Took who was “stunned when he received a letter from his endocrinologist of 15 years informing him that he and other patients on Medicare were being dropped from further coverage.  Took, who is 60 and disabled, immediately began looking for another doctor.  By the time he was done, he had contacted 31 physicians.  ‘One.  One called back,’” Took said in a subsequent interview.

Doctors opting out of Medicare in Texas and elsewhere is still the exception but the rule is showing signs of great stress.  More and more doctors are now considering opting out of Medicare; something they could not have imagined only a few years ago. President Obama could have addressed the underlying payment issues in his 2,700 page government takeover of health care law but failed to do so.  Now, some of those doctors are following through—possibly to their own detriment but certainly to the detriment of America’s seniors.

Spotlight

Dr. Bruce Malone, President of the Texas Medical Association, commenting on the fourth year in a row that the number of doctors opting out of Medicare in Texas has been in the hundreds.

“I’m not surprised – that’s just the tip of the iceberg…things are going to get worse before they get better.”