Inspector: Medicare Can't Count Its Doctors

President Lyndon B. Johnson completes the signing of the Medicare bill into law in 1965. (AP Photo) President Lyndon B. Johnson completes the signing of the Medicare bill into law in 1965. (AP Photo)

Officials at the Office of Inspector General for the U.S. Department of Health and Human Services (HHS) say the Centers for Medicare & Medicaid Services (CMS) has no good way to track how many physicians are opting out of Medicare, let alone why departing physicians opt out.

Stuart Wright, a deputy inspector general, writes about problems with counting Medicare providers in a memorandum on physician decisions to opt out of Medicare that was sent earlier this week to Marilyn Tavenner, the acting CMS administrator.

Many physicians and physician groups have argued that uncertainty about Medicare physician reimbursement rates is chasing physicians away from the program and has the potential to limit Medicare enrollees' access to physicians in some parts of the country.

The HHS inspector general's office started to look into the matter in April 2011, to find out which physicians were opting out and why, but investigators discovered there was no way to get good data on opted-out providers, Wright says.

One challenge, Wright says, is that physician decisions to opt out expire after 2 years, and the 16 Medicare administrators and claims payment contractors are not doing a good job of keep track of whether opt-out decisions have expired, or whether some physicians have resumed participating in Medicare.

CMS had a list of just 7,900 opted-out providers who opted out from 1998 to March 2011, and it suggested that the Medicare administrators and contractors should have better lists.

Only 11 of the 16 administrators and contractors ended up providing data, and only 2 of the organizations provided complete data, Wright says.

All 11 organizations that responded gave the investigators physician names, but only 5 could supply National Provider Identifier numbers, and just 3 could identify whether opted-out providers had been reinstated.

Without data from all the current and past Medicare services providers, "we cannot create a complete universe of opted-out physicians for the purposes of conducting interviews with them," Wright says.

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