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The claim has become a staple of Republican efforts to undermine the Affordable Care Act and transform Medicare into a system in which future elderly receive vouchers to purchase health insurance in the private market. "We are starting to see physicians turn away from taking patients who are on Medicare," the GOP.gov website warns, with "more and more physicians are choosing to opt out of Medicare altogether." In July, the Wall Street Journal dutifully picked up that cudgel, cheering one "doctor goes off the grid" while fretting "more doctors steer clear of Medicare."

Unfortunately, there's only one problem with the conservative claim that America's doctors are fleeing Medicare—and Medicare patients—in massive numbers. As a new study from the Department from Health and Human Services reveals, it's simply not true.

The New York Times explained why the new analysis should "demolish" the prevailing mythology about vanishing Medicare doctors once and for all:

The analysts looked at seven years of federal survey data and found that doctors are not fleeing Medicare in droves; in fact, the percentage of doctors accepting new Medicare patients actually rose to 90.7 percent in 2012 from 87.9 percent in 2005. They are not shunning Medicare patients for better-paying private patients, either; the percentage of doctors accepting new Medicare patients in recent years was slightly higher than the percentage accepting new privately insured patients.

Medicare patients had comparable or better access to medical services than the access reported by privately insured individuals ages 50 to 64, who are just below the age for Medicare eligibility. Surveys sponsored by the Medicare Payment Advisory Commission, an independent agency that advises Congress, found that 77 percent of the Medicare patients -- compared with only 72 percent of privately insured patients -- said they never had an unreasonably long wait for a routine doctor's appointment last year.

As USA Today detailed, the growing population of Medicare beneficiaries—now some 49 million Americans—has an expanding number of physicians serving them. "In 2007, about 925,000 doctors billed Medicare for their services. In 2011, that number had risen to 1.25 million." As for the tiny fraction of physicians choosing to "opt out," they generally have one thing in common. Continue below the fold to read what it is.

"Overall, the clients we deal with have good access to physicians," said Joe Baker, president of the Medicare Rights Center, a non-profit advocacy group for older Americans and people with disabilities. "We find the physicians who don't take Medicare don't take other insurance, either, but it's not a problem we see regularly."

It's not a problem because, as a 2005 study found, less than one percent of providers eligible to opt out of Medicare did so:

The two specialties with the highest opt out percentages were psychiatrists (with 1.11% opting out) and plastic and reconstructive surgeons (with 1.56% opting out). In contrast, about a third of one percent of primary care physicians (0.35%) opted out of Medicare.
This is not to say there are not serious issues with the compensation system for Medicare providers. On one hand, the current "sustainable growth rate" formula for physician payments has required the annual "doc fix" for years in order to avoid substantial cuts to reimbursements. On the other hand, as the Washington Post and Washington Monthly recently documented in painful detail, the American Medical Association's rate-setting through its Specialty Society Relative Value Scale Update Committee (RUC) often substantially exaggerates the "values to thousands of services doctors provide."

To be sure, the Medicare system, one adding thousands of aging baby boomers each week, faces many challenges. But doctors heading for the hills isn't one of them.

Originally posted to Jon Perr on Wed Sep 04, 2013 at 12:45 PM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Medicare actually pays (8+ / 0-)

    and I dont think Medicare gives bonuses based upon frivolous denials and stalling tactics.
    You just cant say the same for private insurance.

    "Searches with nonspecific warrants were ‘the single immediate cause of the American Revolution.’” Justice Wm. Brennan, referring to the 4th Amendment

    by Nailbanger on Wed Sep 04, 2013 at 12:58:36 PM PDT

  •  Speaking solely for myself, (3+ / 0-)
    Recommended by:
    FloridaSNMOM, Jon Perr, rivercard

    as a patient living in Texas who's only got Medicare for healthcare insurance coverage, I can say firsthand those studies may be accurate, but aren't true - especially so when trying to find a PCP.

    Here is Medicare's provider webpage for anyone/all who'd like to research it for themselves.

    This is closer to my reality.  

    Ancora Imparo. ("I am still learning.") - Michelangelo, Age 87

    by Dreaming of Better Days on Wed Sep 04, 2013 at 01:15:34 PM PDT

    •  Using your webpage (1+ / 0-)
      Recommended by:
      Dreaming of Better Days

      link yields pretty thin results, which has been my experience also.

    •  Thanks for the Personal Experience and Links (2+ / 0-)

      This is really helpful.  Much appreciated!

    •  Finding a PCP is difficult regardless of insurance (3+ / 0-)
      Recommended by:
      ER Doc, Larsstephens, FogCityJohn

      Whether you have Medicare, private insurance, or anything else, in many places there are too few PCPs and very few who are accepting new patients.

      That is not a commentary on Medicare, which is what these stats have been used for. You would have just as much trouble finding a PCP no matter what your insurance coverage was.

      It is the result of decades of rewarding specialists far more than primary care/family practice/geriatrics.

      •  Based on my experience and (0+ / 0-)

        it is of course only my experience, I can't agree completely with this

        "You would have just as much trouble finding a PCP no matter what your insurance coverage was"

        I do agree it can be challenging to find PCP and that they are woefully compensated.

        I do wonder if the issue might be worse in urban areas such as where I live.

        Unless there is some issue with the stats that I am unaware of,  I am surely not trying to quibble with them. Only relaying my experience.

        Good diary and interesting links (especially Post and Monthly articles)

      •  True. (0+ / 0-)

        I'm too young for Medicare, and have pretty good private insurance, but finding a good doctor is a hassle.

      •  True.... I have stuck with my doctor (0+ / 0-)

        For years even though I hate him because it would be hard to impossible to find another primary care physician even at the same office (all of them have full loads).

    •  Not on Medicare (8+ / 0-)

      But I must say that, having moved recently, I had a terrible time finding a doctor who was taking new patients.  When I did find one, he tells me that it's not about insurance but about being understaffed and overcommitted.

      •  I am glad you found a physician, tarkangi. (3+ / 0-)
        Recommended by:
        PinHole, FindingMyVoice, tarkangi

        I hope he serves you well and infrequently!

        Welcome from the DK Partners & Mentors Team. If you have any questions about how to participate here, you can learn more at the Knowledge Base or from the New Diarists Resources Diaries. Diaries labeled "Open Thread" are also great places to ask. We look forward to your contributions.

        "The opposite of war isn't peace, it's CREATION." _ Jonathan Larson, RENT -9.62, -9.13

        by BeninSC on Sat Sep 07, 2013 at 09:40:53 PM PDT

        [ Parent ]

        •  Good for a Larf (1+ / 0-)
          Recommended by:
          BeninSC

          A few years back my car needed some work after a fender bender.  When picking it up I was all "great work, hope I never see you again" which I thought was the height of cleverness.

          The mechanic, he begged to differ.  And I can kind of see his point, that was his bread and butter I was joking about.

          But getting back to the point, I would gladly pay double my insurance premiums in exchange for never seeing the inside of a doctor's office again.

    •  planned scarcity (0+ / 0-)

      I was listening to some students coming back from their first week of medical school.  We were all on the bus.  Their banter was not at the level you would expect from the best of the best, they were all white, and none looked like inner city kids.

      This problem with the apparent shortage of doctors, and the apparent refusal to economize like every other sector of the US, is totally created by a medical school system and the AMA.  Recall that the AMA did no even accept black members until the late 60's.  That black doctors only make up less than 5% of MDs.  That medical schools are increasing students, arguably at a slower rate than population growth, but residencies are expected to be scarce.

      All these create a fake scarcity created by greedy people. These scarcity allows MDs to pick and choose clients in a way that, say, engineers, do not. At least we should expect to see the medical profession more closely resemble the general population, unless we believe that white males are intently better doctors than others.

      One can say this is necessary because doctors go to school for so long, but all doctorate program(PhD) are around 10 years, and all require several postodocs which typically mean you are not on your own for often 15 years.

      One can say that with a doctor lives are on the line, but if that were true one would do exactly opposite of what is done now.  One would accept many more into medical school than residencies are available, accept only the best of these into residencies, and then have no expectation that they will complete it.  Right now med students appear to be surprised that they do not get residencies, which means that when everyone did, it might have meant that some unqualified persons got through.

      If medical school were a more competitive environment like engineering, perhaps doctors would see their job as a privileged rather than a favor they are doing for society.

      •  As a physician, all I can say here is, "huh"? (5+ / 0-)

        The AMA is NOTHING.  It is a voluntary association that over half of physicians aren't members of.  They have no authority or power to regulate or oversee physicians.  Why the public still gives the AMA the mantle of being the voice of all physicians is a mystery to me and most other physicians.

        And what's with your theory that that medical school and residency should be a pyramid scheme to get rid of "unqualified persons"?  I went to a state medical school and took out expensive loans (the interest rate was 9% then) to get through.  Medical education is expensive.  In your proposed pyramid, many M.D.s would be left with out prospects for employment in medicine.  That would be a huge waste of taxpayer money, since taxpayers fund medical schools and guarantee student loans.  Also, how is this supposed to solve the shortage of primary care physicians?

        As for your last paragraph, medical school IS harder to get into than engineering school.  More than half who try, don't ever get in, and that's after earning a bachelor's degree in a course of study that is math and science heavy, while maintaining excellent grades.

      •  Having worked in the admissions (1+ / 0-)
        Recommended by:
        tb mare

        office of a mid-sized, highly regarded med school, I can tell you your post is full of holes, lowt.

        This was the situation when I left the job 14 yrs ago:  Many thousands of applications, then 600+ or so interviewed, and only 100 or so spots in an incoming class.  The goal for each class was 10 - 20 minority applicants.  The admissions committee worked very hard to see that each class was balanced not only by race, but by background, by sex, by outside interests & talents, by age, by......almost any characteristic one could think up.  

        They wanted hockey players, they wanted a basketball team, they wanted a piano player for the class play; they wanted Catholics, atheists, Jews, Muslims, Mormons, Humanists, Episcopalians, Eastern Orthodox, Buddhists, Baptists, they wanted students from a variety of states, regions, countries (if they had a green card), and undergraduate schools (public & private).

        They wanted people for international medicine, people who had an interest in research (MD/PhD program), people who wanted to go into Family Medicine, people who would work in clinics, people who would work for drug companies, people who would teach in med schools, people with an interest in medical informatics, people who wanted to be surgeons, people interested in psych, etc etc.  

        I agree 110% with blugrinrdst.

    •  links (0+ / 0-)

      I went to the medicare providers webpage you recommend and found nothing there that concerns physician opt-outs.  Also, the link to your reality page is a letter from a patient from N. Carolina.  That state has not accepted federal medicaid funds.  Might that be responsible for the patient's problem?
        I just don't know what you're trying to say here.  Is TX another state that won't participate?  What?

  •  most private carriers base their fee schedules (3+ / 0-)
    Recommended by:
    FloridaSNMOM, freerad, icemilkcoffee

    based on Medicare instead of relying upon the previous "prevailing area rate" criteria.  If MC is so bad, why do private carriers rely on MC for its rates?

    In 1984, locally, only about 60% of docs took MC and MCD; today it is more like 95%.  What most people commenting ignore is that not so many docs are in private practice as were in 1984 and so the decision to accept or not to accept is a corporate decision and not one reached by the doc himself

  •  This goes against my experience (1+ / 0-)
    Recommended by:
    Jon Perr

    but I will surely read the information provided.

    When trying to help my mother find a Doctor,I went through over 30 GP before finding one that was excepting  new Medicare patients and excepting Medicare payment.

    I found many that would accept new Medicare patients and would file Medicare, but they did not accept medicare payment rates. Patient owed difference.

    Be interested to see if this was accounted for in studies.

    •  Great Question (2+ / 0-)
      Recommended by:
      Larsstephens, rivercard

      I'll have to see what I can find out.

      Thanks!

      •  Maybe it's the difference between... (2+ / 0-)
        Recommended by:
        rivercard, PinHole

        ...doctors' currently treating Medicare patients and doctors' accepting new Medicare patients.

        In any case, I'm glad that PPACA raises Medicaid reimbursement rates to those of Medicare providers for at least one year, and hope that that provision is extended.

    •  Can they really do this? (0+ / 0-)

      My understanding has been that if they accept Medicare, they can't then surcharge the patient extra on top of what Medicare considers the reasonable fee. They can only bill the 20% or whatever co-pay.

      Is that wrong? Can they really take Medicare payment and then charge the patient whatever they want to on top of that????

      •  No (0+ / 0-)

        I'm almost certain that they cannot. With my mother in long-term nursing care, I'm seeing a lot of "This is not a bill", Medicare-benefits-summary mailings. There is a column clearly labeled "Maximum you may be billed". It is mailed from Marion, IL; I doubt very much that it is Massachusetts-specific.

      •  It was explained to me as (0+ / 0-)

        Non par - assigned or non assigned. One pays the Doctor direct and the other pays the patient who owes the Doctor. There is an upper limit % over Medicare to what they can charge, but as my Mothers GAP plan is so bad and money tight it wouldn't work for her.

        I haven't had a chance to read the studies , but wonder if this isn't more of a problem in large Urban areas.

        The new thing here is concierge. I have had three Doctors I use go to that in the last couple of years. Forced me to switch my Endocrinologist recently because of this. Of the two recommended to me - one has an 8 month wait to see new patients and the other 6 months.

        Isn't that the nightmare of socialist medicine the cons keep screaming about?

        •  Shortage isn't socialist (0+ / 0-)

          The shortage is due to lack of doctors, as explained in some of the above postings and answers.  If it takes 11-15 years of schooling to turn out a doctor, this problem has its roots long before Obama even thought of running for president.

      •  So I think I may have (0+ / 0-)

        been misleading/incorrect in saying they don't accept the Medicare payment rates. Should have said that the Non Par Doctors can charge a rate that is slightly higher than the standard Medicare rate , but is still limited by Medicare.

        At least that is the way I understand it. So confusing.

        Can't we just have a single payer?

    •  Patient owed the difference? (0+ / 0-)

      I don't think that's legal.  If a doctor accepts Medicare, he has to accept Medicare reimbursement rates.  It's like agreeing to a PPO contract with an insurance company.

    •  This isn't just a problem with Medicare (0+ / 0-)

      Until recently I had "junk insurance"--paying through the nose essentially for catastrophic-illness coverage. One of the few decent things about it was that visits to the GP and routine screening services were covered after a small copay.

      Or so I thought.

      What happens is that doctors & hospitals place the narrowest possible definition on these covered services--& if they do anything, no matter how trivial, beyond that definition, they tack on an exorbitant bill that the insurer refuses to cover, so the patient is liable.

      My PCP got ~$125 from me & the insurer for an office visit--but whenever I said anything other than "everything is fine" so they could hustle me out the door 5 minutes later, the flag on the taxi meter went down, "routinely" to the tune of another $100 or so.

      Last month I was scheduled for a "routine" colonoscopy, which the insurance was supposed to cover in full. Well, surprise surprise--the doc told me afterwards "we found a couple of tiny, tiny polyps so we took them out"--& here is your bill for $700, which the insurer classifies as "surgery" & refuses to cover.

      It seems pretty obvious to me that there is at least tacit collusion between providers & insurers to transfer as much of the charge for "covered" procedures to the patient via this sort of borderline-illegal-&-clearly-unethical sleight of hand.

      Bastards.

      BALTIMORE RAVENS--SUPER BOWL XLVII CHAMPIONS! WOOO-HOOO!

      by Uncle Cosmo on Sun Sep 08, 2013 at 05:59:10 AM PDT

      [ Parent ]

      •  And I bet your insurance didn't cost... (1+ / 0-)
        Recommended by:
        Uncle Cosmo

        ...didn't cost the $1100/month our COBRA coverage is costing us either.  

        However I did find out that the insurance company's definition of "maximum out of pocket expense" isn't a literal interpretation.  There were a number of things I had to pay for that didn't fit into the definition. Plus the drug bills go to a different company, so they don't come under the max out of pocket either.

        My mom had a tertiary policy that cost her about $200 twice/year.  When it came time to try to collect something on it, well, she got what she paid for, which was almost nothing.  By then my sister and I were in charge of her finances.  We managed to get all of $500 from the company, and only after writing letters of complaint and cc-ing them to everybody under the sun.  Then we stopped paying for that insurance.

        •  Not quite, but $550/month for one person (0+ / 0-)

          whose only hospitalization came in 1975 ain't zackly a bargain either. Tack on the $1200 deductible & copays & I'm out of pocket $8K per year. I'm fortunate enough to be able to afford that for the (fairly short) time till Medicare, but it chaps my arse severely that I'm fattening the bank accounts of "health insurance" bureaucrats & "health care professionals" & getting next to nothing in the way of services for it.

          BALTIMORE RAVENS--SUPER BOWL XLVII CHAMPIONS! WOOO-HOOO!

          by Uncle Cosmo on Sun Sep 08, 2013 at 04:23:09 PM PDT

          [ Parent ]

  •  facts have a liberal bias (0+ / 0-)

    unfortunately,  conservatives control the media bias.

  •  Why would doctors flee Medicare? (0+ / 0-)

    when its so easy to game it?

    Happy just to be alive

    by exlrrp on Wed Sep 04, 2013 at 06:46:08 PM PDT

  •  The federal survey they are referring to (0+ / 0-)

    is a CDC survey.  It's ongoing and has been conducted for some 30 years.  It is a well-respected study.  It is probably true that some doctors in some areas are not accepting new Medicare patients, but it is not true that this is a widespread problem.  

  •  If you go into the listings of physicians in the (0+ / 0-)

    Medicare site, which I did for the first time a couple of years go, and start calling around to get an appointment, what you find out very quickly is that most of the mds in that list don't take medicare patients.

    Sometimes there is no physician for the speciality, like allergies, you are looking for, or dermatologist to name two.

    Now I live in the NW corner of Fairfax Va.  There's gazillions of mds around here.  I finally found a dental surgeon in Bethesda Md., and he was the only one who would take me.

    When you live in a population dense area and there are few to no mds within a reasonable driving distance, or God Forbid bus ride, who will take you, that's a problem.

    •  to be fair (0+ / 0-)

      Doctors not taking new medicare/medicaid patients can be due to issues with how states handle their reimbursement programs.

      Which, to me, shows an obvious flaw in our for-profit government-subsidized healthcare system.

  •  Here in Oregon especially rural areas, getting a (7+ / 0-)

    doctor to accept a new Medicare patient, is next to impossible.

    What is good, is hospitalization esp ER admits. With classic Medicare and a good gap policy, they seem happy.

    I was told by my SHIBA rep they cannot come back for more money if Medicare and Medigap have paid. I keep being told, you will see no bill.

    I haven't tested that statement yet, but I surely hope it is true.

    I am still going through spreadsheets of providers from last year's private insurance coverage. 14 ER admits, physician visits, labs, and they all wanted the part their discounted rates didn't cover from me. Was sent to collections for $2.38, no kidding.

    I want to shout out to Senator Jeff Merkley's staff, they got me into Medicare, which I was qualified for, but my private carrier like those $1000/month payments too much to send a certificate of continuos coverage to SSA. So we fought for two years and I gave up.

    Then when they saw this year was going to be like last year they dropped me around April 15 with two weeks notice.

    Merkley's people made sure I was moved over to Medicare as was appropriate anyway, with no gap in coverage.

    Senator Merkley, a true progressive.

    Science is hell bent on consensus. Dr. Michael Crichton said “Let’s be clear: The work of science has nothing to do with consensus... which is the business of politics. Science, on the contrary, requires only one investigator who happens to be right,”

    by Regina in a Sears Kit House on Sat Sep 07, 2013 at 07:24:40 PM PDT

  •  Free market fetishism has no cure (0+ / 0-)

    Facts will not phase the infected.

  •  If you tell a lie long enough you become... (1+ / 0-)
    Recommended by:
    Woody

    a Republican. If they keep repeating a lie and ignore the truth long enough an unegermicated cornserative base will swallow it hook line and stinker.

    Our money system is not what we have been led to believe. The creation of money has been "privatized," or taken over by private money lenders. Thomas Jefferson called them “bold and bankrupt adventurers just pretending to have money.” webofdebt

    by arealniceguy on Sat Sep 07, 2013 at 08:42:15 PM PDT

  •  There simply aren't enough "better-paying"... (0+ / 0-)

    ...private patients out there for most doctors to make that cruel calculation. But I suppose some practioners will learn that the hard way.

    When you are right you cannot be too radical; when you are wrong, you cannot be too conservative. --Martin Luther King Jr.

    by Egalitare on Sat Sep 07, 2013 at 09:18:40 PM PDT

  •  eg of success of years of repetition on RW radio (2+ / 0-)
    Recommended by:
    PinHole, Woody

    ignored by the left.

    works great.

    This is a list of 76 universities for Rush Limbaugh that endorse global warming denial, racism, sexism, and GOP lies by broadcasting sports on over 170 Limbaugh radio stations.

    by certainot on Sat Sep 07, 2013 at 10:59:49 PM PDT

  •  Good news if its true. (0+ / 0-)

    Wish I had time to go look at the study in depth.

    One little problem I can see with the private insurance vs Medicare comparison as reported here.

    As somebody in that 50-64 group, I know that many of us have trouble getting decent insurance.  The best I've been able to do has a $5,000 deductible.  Deductibles like that expose doctors to significant risk:  the insurance company will do everything it can to beat their charges down to $5,000 or less, leaving the balance to us.  If we don't have the money, we are left to make payments or file for bankruptcy.  

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Sun Sep 08, 2013 at 01:20:21 AM PDT

  •  It doesn't matter if it's not true, (1+ / 0-)
    Recommended by:
    Bluefin

    Republicans will keep saying it is, anyway. And the media will give them "equal time" with their deliberate lies. Social Security is bankrupting America. The 47% is on welfare. Climate change is bad science and a liberal plot. America has the best health care system in the world. The markets need to be even more deregulated. None of these things are even close to being true or even sensible — but what difference does the truth make? The MSM shrugs and a hundred million loonies scream in approval.

    I thought I was poor because I owned no shoes; then I met a CEO who owned no Congressman.

    by Mike732 on Sun Sep 08, 2013 at 08:14:40 PM PDT

  •  Getting Primary Care Physician - Anecdotal (0+ / 0-)

    This is purely anecdotal -- but enough anecdotes can perhaps suggest a pattern. Or maybe I'm just wasting people's time.

    Relocating to Boston, I needed a new primary care physician. Unfortunately, it seems that neither Mass. General Hospital nor Tufts New England Med Center have physicians accepting new primary care patients -- and that was before any question of insurance came up.  (I was able to find one (I think - I don't get to see him for an intake appointment until mid-November) at a community health center.

    On the other hand, I was able to get an appointment (via a cancellation) with a dermatologist at MGH within 2 days but with respect to an endocrinologist, they need to see my records before they'll even consider me.  Go figure!

    Again, the question of insurance never had the chance to come up. So, to put it mildly, at least with respect to two major teaching hospitals, the validity of the Republiscum claim ranks with the residue of a stool sample.

    About the only thing one can say with certainty is that any connection between what the Republiscum and the truth is purely coincidental.

    •  what you may be experiencing (0+ / 0-)

      is another trend that health policy folks have had on their radar for a while now: a lack of primary care providers, which will only become more acute.

      It doesn't surprise me that major teaching facilities in a place like Boston might actually be demonstrating that trend earlier than other places.

      But then again, you did say it was anecdotal, so we don't want to generalize too heavily from that.

      ;-)

      Welcome from the DK Partners & Mentors Team. If you have any questions about how to participate here, you can learn more at the Knowledge Base or from the New Diarists Resources Diaries. Diaries labeled "Open Thread" are also great places to ask. We look forward to your contributions.

      Words can sometimes, in moments of grace, attain the quality of deeds. --Elie Wiesel

      by a gilas girl on Tue Sep 10, 2013 at 07:30:15 PM PDT

      [ Parent ]

  •  Medicare (0+ / 0-)

    Here on Maui, in Hawaii, my long-time psychiatrist is retiring and has been trying to get me a replacement.  So far, the news is no other psychiatrist here takes Medicare!
    I guess I can move  - after 38 years of residency - or learn to live without medication.  Their compassion overwhelms me.

  •  Time Magazine's "Bitter Pill" story (0+ / 0-)

    Did anyone read that article?  It pertains more to the thread of comments that blossomed off the diary.  

    I only read some of the summery of the story.  It made me too depressed to finish it.

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