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.
“This new data shows
the Medicare system is beginning to implode,” said Dr. Susan Bailey,
president of the Texas Medical Association. “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.”
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. Texas Medical Association officials, who conducted
the 2008 survey, said the numbers far exceeded their assumptions.
The largest number
of doctors opting out comes from primary care, a field already short of
practitioners nationally and especially in Texas. Psychiatrists also
make up a large share of the pie, causing one Texas leader to say, “God
forbid that a senior has dementia.”
The opt-outs follow
years of declining Medicare reimbursement that culminated in a looming
21 percent cut in 2010. Congress has voted three times to postpone the
cut, which was originally to take effect Jan. 1. It is now set to take
effect June 1.
Not
cost-effective
The uncertainty
proved too much for Dr. Guy Culpepper, a Dallas-area family practice
doctor who says he wrestled with his decision for years before opting
out in March. It was, he said, the only way “he could stop getting
bullied and take control of his practice.”
“You do Medicare for
God and country because you lose money on it,” said Culpepper, a
graduate of the University of Texas Medical School at Houston. “The only
way to provide cost-effective care is outside the Medicare system, a
system without constant paperwork and headaches and inadequate
reimbursement.”
Ending Medicare
participation is just one consequence of the system's funding problems.
In a new Texas Medical Association survey, opting out was one of the
least common options doctors have taken or are planning as a result of
declining Medicare funding — behind increasing fees, reducing staff
wages and benefits, reducing charity care and not accepting new Medicare
patients.
In 2008, 42 percent
of Texas doctors participating in the survey said they were no longer
accepting all new Medicare patients. Among primary-care doctors, the
percentage was 62 percent.
The impact on
doctors has not been lost on their patients. Kathy Sweeney, a Houston
retiree, twice has been turned away by specialists because they weren't
accepting new Medicare patients. She worries her doctors might have to
drop her if Medicare cuts go through and they can't afford to continue
in the program.
“I've talked to them
about the possibility,” said Sweeney, who sent her legislators a letter
calling on them to fix Medicare. “They're hanging in there as long as
there's not a severe cut, but 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.”
The problem dates
back to 1997, when Congress passed a balanced budget law that included a
Medicare payment formula aimed at reining in spending. The formula,
which assumed low growth rates, called for payment cuts if spending
exceeded goals, a scenario that occurred year after year as health care
costs grew. The scheduled cuts, expected to be modest, turned out to be
large.
Congress would
overturn the cuts, but their short-term fixes didn't keep up with
inflation. The Texas Medical Association says the cumulative effect
since 2001 already amounts to an inflation-adjusted cut of 20.9 percent.
In 2001, doctors receiving a $1,000 Medicare payment made roughly $410,
after taking out operating expenses. In 2010, they'll net $290. If the
scheduled 21.2 percent cut goes through, they'd net $72, effectively an
83 percent cut since 2001.
The issue caused the
Texas Medical Association to break ranks with the American Medical
Association and oppose health care reform efforts throughout 2009. Then
TMA President Dr. William Fleming said “reform is doomed to failure”
without Medicare reform and called Congress' failure to devise a
rational payment plan “an insult to seniors, people with disabilities
and military families.”
No
surprise to senator
U.S. Sen. John
Cornyn, R-Texas, said he isn't surprised by the new opt-out numbers,
allowing that Congress' inability to reform Medicare is leaving “seniors
without access and breaking the promise we made to them.”
“The problem has
been how to eliminate the cuts without running up the deficit,” said
Cornyn, responding to blame U.S. Rep. Gene Green, D-Houston, placed on
the Senate for not passing a House bill that would have provided a
longer-term Medicare fix. “There hasn't been the political will, but we
really have no choice but to fix it.”
Cornyn acknowledged
the task is daunting. The Congressional Budget Office recently estimated
that eliminating scheduled Medicare payment cuts through 2020 would
cost $276 billion.
The growth in Texas
Medicare opt-outs began in earnest in 2007, when 70 doctors notified
Trailblazer Health Enterprises, the state's Medicare carrier, they would
no longer participate, up from seven in 2006. The numbers jumped to 151
in 2008, fell back to 135 in 2009 and are on pace for 200 in 2010. From
1998 to 2002, by contrast, no more than three a year opted out.
Now, according to a
Texas Medical Association new poll, more than four in 10 doctors are
considering the move.
“I've been in
practice 24 years, and a lot of my patients got old right along with
me,” Culpepper said. “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.”
SOURCE
Recent Comments