Reports of Doctor Denial for Medicare Beneficiaries on the Rise
Doctors in Denver, Atlanta, Austin and other urban areas, "frustrated with what they say are low Medicare payments and onerous rules," are limiting the number of Medicare patients they take, refusing to take new Medicare patients or dropping Medicare patients altogether, USA Today reports. Although the "vast majority" of doctors nationwide still participate in Medicare, two recent surveys in Colorado showed that fewer are accepting new patients, with one study showing that only 15% of doctors in the state were accepting new Medicare patients. According to USA Today, these "pockets of insurgency" demonstrate doctors' overall frustration with insurance in general and "highlight Medicare's main problem: how to provide more benefits to more people, pay enough to keep health care providers interested -- yet keep spending in check." Doctors in some cities "complain" that Medicare is "downright frustrating" because of low reimbursements, "burdensome rules" and the "threat of being audited."
However, the Health Care Financing Administration, which oversees Medicare, says reports of patient denial are "not widespread" and has asked a regional office to look into the situation in Colorado, where reimbursement rates are "among the lowest in the nation." Government figures show that 91% of doctors accept Medicare patients, but USA Today reports that this figure does not show what percentage have stopped taking new patients. A 1998 study by the Medicare Payment Advisory Committee found that 95% of doctors said they would accept new Medicare patients, the same percentage as in the previous year. The study was not able to determine regional trends, however. According to data prepared for USA Today by the Medstat Group, Medicare pays 5% to 45% more than private insurers for a "typical" office visit in a sample of nine cities or regions, including Colorado, where the Medicare reimbursement rate is "often about 20% less than the highest-paid areas." Reimbursement rates for specialists, however, are 5% to 50% less than private insurers in most regions. The regional "uprising against Medicare" may express doctors' frustration with all insurance, not just the government program, and may "simply reflect their drive to increase the amounts private insurers pay," according to USA Today. But the situation must be "watched carefully," according to economist Paul Ginsburg of the Center for Studying Health System Change, because "[i]f this becomes a widespread problem, that will be the signal that payments have to be increased" (Appleby, USA Today, 2/19).