August 31, 2013
New York Times

Doctors and Their Medicare Patients By THE EDITORIAL BOARD

Critics who want radical changes in Medicare, the public insurance program for the elderly and disabled, often allege that the program is heading for disaster because stingy payments from the government are causing a rising number of doctors to refuse to serve Medicare patients. In the critics’ most dire scenarios, baby boomers nearing retirement age could find that their current doctors are no longer willing to treat them under Medicare and that other doctors are turning them down as well. Those concerns have always been greatly exaggerated. Now a new analysis by experts at the Department of Health and Human Services should demolish that mythology for good. 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. The findings from this survey and others can be sliced and diced in many ways. But the overall picture is clear: nationwide there is no shortage of doctors for Medicare patients. It is likely to stay that way, because Medicare is a big insurer that few medical practices can afford to ignore. Still, a small number of doctors have dropped out of the Medicare program. Roughly 9,500 practicing doctors have currently opted out of Medicare, according to the Centers for Medicare and Medicaid Services. If patients want to stay with these doctors, they have to pay the bills themselves; neither the doctor nor the patient can receive any payment from Medicare. The number of doctors opting out is tiny compared with the number of doctors, 735,000, who remain in Medicare. In addition, they are augmented by hundreds of thousands of nurse practitioners and other non-doctor providers. Some experts worry that, when health care reform kicks in next year and provides insurance for millions of uninsured people, the increased demand for medical services could make it harder for all patients, including Medicare beneficiaries, to schedule doctors’ appointments. If that were to happen — by no means a certainty — federal and state officials and leaders of the medical profession would need to find ways to increase the supply of health care providers.