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Tuesday, February 9th 2010

Physicians Refusing Medicare Is Hoopla

Medicare is the payee for healthcare services for more than 40 million Americans. It accounts for more than 30% of practice revenue by Center for Studying Health System Change measures.

And it’s fee schedule sucks and the proposal to freeze it, as in 2007, sucks; especially for primary care physicians. But even as MedPAC surveys find better than a quarter of Medicare recipients complain they have trouble finding physicians who accept Medicare, I continue to assert that a catastrophic access problem for those >65 is hard to imagine.

The possibility of a 5-year Medicare pay freeze is the latest twist in recent congressional efforts to fix the SGR problem. The current battle over healthcare reform legislation — and how to get federal spending under control — has made that job complicated.

[I]nternists…depend on Medicare for 44% of their revenue. In some ophthalmology practices, 80% of the patients are Medicare recipients, said Kristen Hedstrom, assistant director of legislative affairs for the American College of Surgeons.

Physicians who derive most of their revenue from Medicare can hardly afford to back out of the program, noted Ms. Hedstrom. For all practical purposes, they would not have a patient base anymore.

A single payer insuring 40 million; generating nearly half of all revenue for primary care. Unless primary care physicians are actively losing money, and I admit some of them are, where are the plurality of them going to go to create an access crisis?

As long as the vast majority of primary care physicians are at least breaking even on medicare where is this exodus going to come from?

And yet organized medicine and average docs continue to pretend they have a stick in the coming fight over the proposed freeze or in the fight to fix the SGR. We hear it from groups like The Heritage Foundation or in op/eds or even in New York Times pieces. Yeah, physicians will leave Medicare and we’ll hear the anecdote about the grandmother who can’t find a medicare physician in the middle of midtown Manhattan. But physicians fleeing on a scale large enough to cause outrage? To cause panic at the AARP? To force restitution and continued cost of living increases in the fee schedule?


If organized medicine staves off the freeze and, God willing, the SGR mandated cuts it’ll be because they greased the wheels appropriately and sold the above story. And truly I’m with them in trying to do that. But you don’t have to buy the hoopla yourself to try to sell it.