As the Pelosi-led congress hurriedly passed Obamacare in a late-night affront to the American people, I thought to myself how odd it was that liberals NEVER seem to learn from the historical record of the massive unintended consequences of their legislation. Specifically, I was reminded of a quote that the best health insurance in the world is worthless if no doctors take it. The passage of Obamacare introduced a new high-level of uncertainty into our clinical practices. Already facing lower reimbursement rates and escalating expenses, this uncertainty has not been welcome. I believe the question now is not so much will doctors be leaving clinical practice, but how many and how rapidly?
Medicare and Medicaid Implosion
Most physicians (which I am considered to be by Medicare) are enrolled in the two major government-run health insurance programs, Medicare and Medicaid. Decreasing reimbursements and onerous regulatory burdens, particularly with Medicare, have inspired many to quit participating in these programs. Many people do not realize that Medicare can audit your office, look at any records they wish, even non-medicare patients, and determine whether you are following their record-keeping, billing, and coding practices to the letter. If they do not like the way you keep records or code for exams, even non-Medicare patients, they can fine your practice enormous sums of money by applying those supposed infractions across your Medicare patient base. Given shrinking reimbursements and risk of participation, it is not difficult to fathom why doctors are declining to participate.
Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before.
More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I’ve had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider — who they liked — abruptly stopped taking Medicare
This is a going trend and has been for several years, even before the passage of Obamacare. In Texas, the situation is becoming alarming.
Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable.
Two years after a survey found nearly half of Texas doctors weren’t taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program. Before 2007, the number of doctors opting out averaged less than a handful a year.
More than 300 doctors have dropped the program in the last two years, including 50 in the first three months of 2010, according to data compiled by the Houston Chronicle.
This is not a small problem. It is severely impacting the ability of seniors to find practitioners who are willing to see them. And this is not just happening in Texas, it is happening all over the nation.
Reimbursements are a major component of this of course.